Medical Law and Ethics Chapter 7 Public Duties of the Physician

Public Health Records and Vital Statistics Vital events in person’s life Used by government to determine population trends and needs 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

Deaths Coroner: 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

Medical Examiner Cases Legal investigation by medical examiner or coroner in case of suspicious death Investigation is required if death is: Violent in nature (homicide, suicide, accident) Caused by criminal abortion Related to contagious or virulent disease Of a person confined to jail or correctional institution Result of unexplained or unexpected cause

Medical Examiner Cases Investigation is required if death is: Caused by electrical, radiation, or chemical injury Of a person who had no physician in attendance within 36 hours of death Of a person whose body is not claimed by friend or relative Of a child under age of two if death is from unknown cause Of a person of unknown identity

Communicable Diseases Diseases transmitted from one person to another—considered threat to public Reportable diseases National Childhood Vaccine Injury Act

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.)

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

Elder Abuse Older American Act (1987) Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older

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 Unexplained fractures Bite marks Unusual marks Bruising or swelling in genital area Signs of inadequate nutrition 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

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

Prescription 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)

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