7 Public Duties of the Healthcare Professional

Learning Objectives Define the key terms. Describe the public duties of a physician. Discuss the guidelines that should be used when completing a legal record or certificate. List the information that must be included in a death certificate. continued on next slide

Learning Objectives Describe the cases in which a coroner or health official would have to sign a death certificate. List 10 reportable communicable diseases. Discuss the Child Abuse Prevention and Treatment Act of 1974. continued on next slide

Learning Objectives Describe eight signs that indicate a child, spouse, or elderly person may be abused. Discuss the federal legislation of controlled substances. List and explain the five schedules of drugs. continued on next slide

Learning Objectives Explain how an Employee Assistance Program (EAP) can help troubled employees.

Public Health Records and Vital Statistics Important events in person's life Used by government to determine population trends and needs Mortality rate Morbidity rate Public duty of physicians to report vital events

Births Physician must sign certificate of live birth Certificate is filed at county clerk's office in state birth took place

Deaths Date and time of death Cause of death How long deceased was treated before dying Presence or absence of pregnancy Whether autopsy took place continued on next slide

Deaths Death certificate Usually must be signed within 24 to 72 hours of death Proof that a death has occurred Often required to confirm information Settling an estate continued on next slide

Deaths Coroner Medical examiner Autopsy Public health officer holds inquest if death from unknown or violent cause Medical examiner Physician who investigates unexplained deaths and can perform autopsy Autopsy Examination after death to determine cause of death

Deaths Certain deaths require a coroner's signature: No physician present at time of death Violent in nature homicide, suicide, accident Death as result of criminal action An unlawful death Assisted suicide continued on next slide

Deaths Certain deaths require a coroner's signature: Result of undetermined causes Caused by electrical, radiation, or chemical injury Caused by criminal abortion Includes self-induced Occurring less than 24 hours after hospital admission continued on next slide

Deaths Certain deaths require a coroner's signature: Of a person who had no physician in attendance within 36 hours of death Occurring outside a hospital or licensed healthcare facility Suspicious death Fall continued on next slide

Deaths Certain deaths require a coroner's signature: Of a person whose body is not claimed by friend or relative Of a person of unknown identity Of a child under age of two if death is from unknown cause Of a person in jail or prison

Communicable Diseases Diseases transmitted from one person to another Considered threat to public Physicians must report public authorities Patient personal information Name of disease Date of onset Name of person making report continued on next slide

Communicable Diseases Reportable diseases National Childhood Vaccine Injury Act Childhood vaccines required by law

Duty to Report AIDS, HIV, and ARC Cases All states require reports of these cases to local or state department of health Who shall report the case varies from state to state (attending physician, laboratory, etc.) Many states have confidentiality statutes

Disclosure to Patients of Health Workers’ HIV Status Healthcare workers consider disclosure an invasion of privacy All blood and tissue donors tested Patients have desire to know if they are at risk of HIV infection

Child Abuse All abuse must be reported by teachers, health professionals, law enforcement and day care personnel, and social service workers Probable cause Physicians have been held liable for not reporting cases Person reporting is protected by law from being sued by parents and others

Child Abuse Battered child syndrome Parental neglect States generally refrain from involvement State may have to intervene when a child is not receiving proper medical care

Elder Abuse Older American Act (1987) Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older Protects residents of nursing home facilities Protects against financial abuse or exploitation

Spousal Abuse Laws governing the reporting vary by state Local police may have to become involved when spousal abuse is suspected Court may issue restraining or protective order prohibiting abuser from contact with victim

Signs of Abuse Repeated injuries Bruises and unexplained swelling Signs of inadequate nutrition Unexplained fractures Bite marks Unusual marks continued on next slide

Signs of Abuse Bruising or swelling in genital area Venereal disease and genital abrasions Makeup to hide bruises Sunglasses worn inside to hide blackened eyes

Substance Abuse Abuse of prescription drugs is reportable immediately according to law Violation of controlled substances laws is a criminal offense

Gathering Evidence in Cases of Abuse Precise documentation of all injuries, bruises, and suspicious genital fluid deposits in children is critical Court may subpoena records at later date continued on next slide

Gathering Evidence in Cases of Abuse Evidence includes Photos Urine specimen Clothing Body fluids Various samples such as blood, semen, vaginal or rectal smears Foreign objects Chain of custody of evidence

Other Reportable Conditions Physicians required to report certain medical conditions to maintain accurate public health statistics, including Cancer Epilepsy Congenital disorders Certain infectious diseases, such as tuberculosis (TB)

Controlled Substances Act and Regulations Food and Drug Administration (FDA) Drug Enforcement Administration (DEA) Controlled Substances Act of 1970 Bureau of Narcotics and Dangerous Drugs (BNDD)

Prescription for Controlled Drugs Only those with a DEA number may issue prescriptions for narcotics Number must appear on all prescriptions for controlled substances Schedule II drugs require triplicate form continued on next slide

Prescriptions for Controlled Drugs Schedule II drug prescription cannot be refilled Must take written inventory of drug supply every two years Narcotics dispensing records must be kept for two years (state regulations may vary)

Prescriptions for Controlled Drugs Compounding Dispensing Retailing Definition Drug is intended to affect the structure or function of the body of man or other animals

Protection of Employee and the Environment Employee Assistance Program (EAP) Confidential counseling and referral service Helps employees and their families assess a problem Develops plan to resolve problem Determines appropriate resource to assist in process

Medical Waste Solid Chemical Radioactive Infectious Proper disposal Material Safety Data Sheet (MSDS) Radioactive Infectious