Legal Aspects of Health Care Objectives: Essential Questions: Evaluate situations related to client’s rights and choices Research living wills Write a living will following state guidelines Identify legal requirements, ethical behavior standards, and scope of practice for students in the health care delivery system Evaluate the implications of signed consent Recognize patients who might not be able to give informed consent Understand the history and origin of HIPAA Interpret the meaning and intent of privileged information Assess principles of confidentiality Critique the ethical and legal implications of a breach of confidentiality How important is client autonomy in the delivery of health care? What is informed consent? How does confidentiality and HIPAA affect you and your client?

Legal Responsibilities Civil law: dealing with legal relationships between people and protection of a person’s rights Contracts Torts: wrongful act that does not involve a contract Criminal law: dealing with wrongs against a person, property, or society Practicing without a license Misuse of narcotics Theft Murder

Torts Civil wrong as opposed to crimes Offenses complex and open to legal interpretations

Malpractice Commonly called “professional negligence” Failure of a professional to use the degree of skill and learning commonly expected in a particular profession Results in injury, loss, or damage to person receiving care Examples: Nurse performing minor surgery Not giving proper treatment

Negligence Failure to give care normally expected of a person in a particular position, with resulting injury to another person Examples: Fall/injuries when siderails left down Using defective equipment Infections from non-sterile instruments

Assault and Battery Assault: a threat or attempt to injure Battery: unlawful touching of another person without consent Patients must give consent and have right to refuse care Examples: Performing procedure after patient has refused Improper handling/rough treatment of patients

Invasion of Privacy Unnecessary exposure of an individual or revealing personal information about an individual without consent Examples: Improper covering of a patient that allows others to see patient exposed Sending info to insurance company without patient’s written permission Telling media about person’s condition without permission

False Imprisonment Restraining an individual or restricting a person’s freedom Examples: Keeping patient hospitalized against their will Application of physical restraints without proper authorization or justifications

Abuse Any care that results in physical harm, pain, or mental anguish Classified as physical, verbal, mental, sexual Examples: Denial of rights Mistreatment Deprivation of services Mental intimidation Unnecessary restraint

Defamation False statements cause a person to be ridiculed or cause damage to their reputation Incorrect information give out in error Slander: spoken information Libel: written information Examples: Reporting a patient has an infectious disease to government agency when lab results inaccurate Stating person has drug problem when another condition exists

Contracts Agreement between 2 or more parties Three parts: Offer: competent person enters into relationship with HCP Acceptance: HCP give appointment, examines, treats patient Consideration: payment by patient for services provided

Contracts Implied: Expressed: Obligations which are understood without verbally expressed terms Example: qualified HCP prepares meds and patient takes med Expressed: Stated in distinct/clear language either orally or written Example: surgery permit

Legal Disability All parties in contract must be free of legal disability Person with legal disability does not have legal capacity to form contract Examples: Minors Mentally incompetent Under influence of drugs that alter mental state Semi- or unconscious people

Breach of Contract Contract requires certain qualities of care by competent, qualified, individuals If contract not performed according to agreement, contract is breached Examples: Failure to provide care or giving improper care Failure to pay

Agent A person who works under direction or control of another person Employee is agent: Must be aware of role as agent and work to protect interests of employer Employer is principal: Responsible for actions of agent Can be required to compensate those who have been injured by agent

Case Studies A geriatric assistant steals an elderly patient’s watch A surgeon operates on the wrong leg A dental assistant slaps a screaming child A PT fractures a patient’s leg while performing exercises An MA sends a copy of a patient’s record to an insurance company without the patient’s consent A nurse working for a plastic surgeon tells a patient that a face lift will make the patient look ten years younger

Privileged Communications All information given to health personnel by patient Must be kept confidential by law Cannot be told to anyone else without written consent of patient Consent should state: What info to be released To whom the info should be given Any time limits

Privileged Communications Exemptions: Births and deaths Injuries caused by violence that may require police involvement: Assault Battery Abuse Stabbings Drug abuse Communicable diseases and STD’s

Health Care Records Contain info on care provided to patient Belong to health care provider Patient has right to obtain copy A legal record Errors: Erasures not allowed Cross out error with single line Insert correct info, initial, date

Health Care Records Must be maintained, kept confidential, and retained for amount of time required by state law When destroyed, must be burned or shredded Computer confidentiality: Limiting personnel who have access Using codes to prevent access to certain info Requiring passwords for specific info on records Constant monitoring/evaluation computer use

Confidentiality and HIPAA Health Insurance Portability and Accountability Act of 1996 Provide greater access to health care insurance Protect privacy of health care data Promote standardization in health care industry

Confidentiality and HIPPA 4 main parts Every provider electronically uses same health care transactions, code sets and identifiers Govern disclosure of PHI (protected health information) Provide security to prevent unauthorized access to PHI Standard nation numbers to ID providers on transactions

Confidentiality and HIPPA Who is affected by HIPPA Health care providers Health plans Health care clearinghouses Penalties Non-compliance-civil offense, monetary Unauthorized disclosure-criminal offense, monetary

Confidentiality and HIPPA Ways to guard confidential information Never disclose info to 3rd party without signed consent Never reveal financial info about patient When talking on phone, don’t allow others to overhear Ask patient to return call when leaving message Don’t leave charts or insurance reports where others can see them

Ethics Objectives: Essential Questions: Define ethics, morals, and values Identify the current medical ethical issues in health care Summarize the pros and cons of these issues Prepare examples using facts to illustrate issues Analyze the pros and cons, and determine individual beliefs about these ethical issues Evaluate knowledge and understanding of ethical issues What are the ethical, moral and legal standards expected of healthcare workers in today’s society? What are the rules governing Living Wills in the state of Texas?

Ethical Dilemmas Is euthanasia justified in certain patients? Should a patient be told that the health care provider has AIDS? Should aborted fetuses be used for research? Do parents have a religious right to refuse a life saving blood transfusion for their child? Should people be allowed to sell organs for transplants? Should doctors be allowed to prescribe marijuana as a treatment?

ETHICS Provide a standard of conduct or code of behavior Allow HCP to analyze info and make decisions base on what people believe is right and good conduct

Basic Rules of Ethics Put saving of life and promotion of health above all else Keep patient comfortable and preserve life when possible Respect patient’s choice to die peacefully Provide care for all to best of ability Treat all patients equally Maintain competent level of skill consistent with occupation

Basic Rules of Ethics Maintain confidentiality and respect for privacy of others Refrain from immoral and illegal practices Show loyalty to patients, co-workers, and employer Be sincere, honest, and caring Study and abide by the code of ethics for your occupation

Patients’ Rights Factors of care that patients can expect to receive Patient has the right to: Considerate and respectful care Obtain complete current info concerning diagnosis, treatment, prognosis Receive info necessary to give informed consent Refuse treatment

Patients’ Rights Privacy concerning medical care program Confidential treatment of all communications and records Reasonable response to request for services Obtain info regarding any relationship of hospital to other health care/educational institutions Be advised of and have right to refuse to participate in research project

Patients’ Rights Expect reasonable continuity of care Examine bill and receive explanation of charges Be informed on hospital rules/regulations

Long-term Care Bill of Rights Established by Omnibus Budget Reconciliation Act (OBRA) of 1987 Every long-term care facility must inform resident/guardian of rights Copy must be posted at facility Often called “Resident’s Bill of Rights”

Legal Directives for Health Care Also called advance directives Allow person to state what medical treatment they want or do not want in case they become incapacitate or unable to express wishes

Legal Directives for Health Care Two main directives: Living wills: allow person to state what measures should/should not be taken to prolong life when conditions is terminal Example: DNR order Durable Power of Attorney: permits person to appoint another person to make decisions regarding health care if unable to make those decisions

Patient Self-Determination Act All health care facilities receiving any federal aid must provide patients with info and assistance in preparing advance directives Patients must be told about right-to-die options Must be noted on medical records an have procedures in place to comply HCW’s must be aware of and honor

Professional Standards Perform only those procedures for which you have been trained and are legally permitted to do Use approved, correct methods while performing any procedure Obtain correct authorization before performing any procedure

Professional Standards Identify patient and obtain consent before performing any procedure Observe all safety precautions Keep all info confidential Think before you speak and watch everything you say Treat all patients equally Accept no tips or bribes for care you provide

Professional Standards If error occurs or you make a mistake, report immediately Behave professionally in dress, language, manners, actions

Liability Insurance A form of protection Many agencies offer policies at reasonable cost Some issue on homeowner’s policy Some protect against all liabilities, not just those at work