Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Professional Liability and Medical Malpractice Chapter 6

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Unit 5 Objectives HS101-U5-1: Explain the concepts of liability, malpractice, and negligence. HS101-U5-2: Describe state and federal regulation of insurance and liability. HS101-U5-3: Describe the legal nature of the physician- patient relationship.

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Professional Negligence and Medical Malpractice Malpractice: professional misconduct or demonstration of an unreasonable lack of skill with the result of injury, loss, or damage to the patient Negligence: unintentional action that occurs when a person performs or fails to perform an action that a reasonable person would or would not have committed in a similar situation

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ The Tort of Negligence Malfeasance: performing a wrong or illegal act Misfeasance: improperly performing an otherwise proper or lawful act Nonfeasance: failure to perform a necessary action

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Four Ds of Negligence Duty: responsibility established by physician– patient relationship Dereliction: neglect of duty Direct Cause: continuous sequence of events, unbroken by any intervening cause, that produces injury and without which injury would not have occurred Damages: injuries caused by the defendant

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Res Ispa Loquitur “The thing speaks for itself” Three conditions must be present: – Injury could not have occurred without negligence – Defendant had direct control over cause of injury – Patient did not and could not contribute to the injury

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Case Study On July 23, 1945 a 45 year old soldier had undergone an operation for gallbladder trouble at Fort Belvoir, Virginia. In January, 1946, he was discharged from the Army. On March 8, 1946, he went to Johns Hopkins in Baltimore, Maryland, complaining of nausea and vomiting that he had for two weeks and which was getting worse. On March 13, 1946, he was operated on at Johns Hopkins. The surgeon found a well-healed medical scar. When he operated through the scar the surgeon came upon a towel which had eroded into the intestine. The towel was removed, measured and photographed. It read “Medical Department, U.S. Army.” It was two and one- half feet long by one and one-half feet wide. The court held that this evidence indicated negligence on the part of “agents or employees of the government.” Flight, M. (2004). Law, Liability, and Ethics for Medical Office Professionals. (4 th Edition). Clifton Park: Thomson Delmar Learning.

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Damages Compensatory damages: court-awarded payment to make up for loss of income or emotional pain and suffering Punitive or exemplary damages: monetary award by court to person harmed in malicious and willful way; meant to punish offender Nominal damages: slight or token payment awarded by court

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Fraud Fraud: the deliberate concealment of facts from another person for unlawful or unfair gain One of the fastest-growing criminal areas in health care Medical assistants have been involved in several fraud cases in the medical office: none have been charged so far

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Defense to Malpractice Suits Affirmative defenses: denial, assumption of risk, contributory negligence, comparative negligence, borrowed servant, statute of limitations, and res judicata Allow defendant to present evidence that patient’s condition was the result of factors other than negligence

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Denial Defense Plaintiff must prove defendant did wrongful or negligent act Most common defense Jury must determine if defendant caused injury May bring in expert witnesses

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Assumption of Risk Prevents plaintiff from recovering damages if plaintiff voluntarily accepts a risk associated with the activity Plaintiff must know and understand risk involved, and choice to accept risk must be voluntary Should have signature to document that patient authorizes procedure, understands the risks, and consents to treatment

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Contributory Negligence Conduct on part of plaintiff that contributes to cause of injuries Complete bar to recovery of damages

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Comparative Negligence Similar to contributory negligence Plaintiff’s own negligence helped cause injury Not complete bar to recovery of damages Allows plaintiff to recover damages based on the amount of defendant’s fault

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Borrowed Servant Special application of respondeat superior Employer lends an employee to someone else Employee remains “servant” of employer, but employer is not liable for any negligence caused by employee while in service of temporary employer

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Ignorance of Facts and Unintentional Wrongs Health care professional should understand what is right and wrong under law Arguing that a negligent act is unintentional is not a defense

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Statute of Limitations Set time period for injured party to file lawsuit Exception is rule of discovery Statute of limitations does not begin to “run” until injury is discovered Will not begin to “run” if fraud (deliberate concealment of facts from patient) is involved

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Res Judicata “The thing has been decided” or “a matter decided by judgment” Once court decides case, plaintiff cannot bring new lawsuit on same subject

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Professional Liability Civil liability cases – Physician may be sued under a variety of legal theories Physical conditions of the premises – Institution may be liable when regulatory standards have been violated Promise to cure – Considered under contract law Law of agency – Legal relationship formed when one person agrees to perform work for another Who is liable? – Employer may not have done anything wrong, yet still be liable

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Liability Insurance Claims-made insurance: covers insured party for claims made only during the time period policy was in effect Occurrence insurance: covers the insured party for all injuries and incidents that occurred while policy was in effect regardless of when claim is made

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Malpractice Insurance Covers any damages the physician/employer must pay if they are sued for malpractice and lose All licensed medical professionals should carry malpractice insurance An expensive type of insurance

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Arbitration Alternative Dispute Resolution (ADR): method other than court to settle disputes – Arbitration: settling dispute without judge; decision is binding – Meditation: opinion of third party for nonbinding decision – Med-arb: combination of the two

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Liability of Other Health Professionals Paramedic Pharmacist Physical therapist Respiratory assistant Dental assistant Laboratory technician Nurse Nursing assistant Medical assistant

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Malpractice Prevention General guidelines Safety Communication Documentation

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Student Responsibilities Unit 5 – Post to the Discussion Board – Participate in Seminar or complete Option 2 Due EOD Unit 6 – Post to the Discussion Board – Participate in Seminar or complete Option 2 – Complete Unit 6 Quiz Due EOD

Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ HAPPY LEAP DAY!