Legal Issues in Healthcare Minnesota Healthcare Core Curriculum Created by: Dede Carr, BS, LDA

These materials are made available by the Minnesota State Colleges and Universities through a Creative Commons Attribution- ShareAlike 3.0 License.

Competency 1 1. Explain the laws related to healthcare and their influence on the delivery system. Discuss common legal terms. Name the federal laws related to Healthcare. Discuss state laws that relate to healthcare. Explain why everyone should have an advanced directive whether they are ill or not. Define differences between certification, registration and licensure.

LAW Common Legal Terms Abuse Advanced directives Civil law Criminal law Discrimination Fraud Malpractice Rights Harassment

Laws in Healthcare Healthcare facilities operate under federal, state, and local laws. All healthcare workers must function within these laws.

Federal Laws in Healthcare 1. Discrimination Acts EEOC = Equal Employment Opportunity Commission 2. ADA – Americans with Disabilities Act 3. Equal Pay Act 4. Patient Self-Determination Act Patient’s rights 5. Omnibus Budget Reconciliation Act 6. Health Insurance Portability & Accountability Act - HIPAA

State Laws 1. Criminal Background Check (Example: MN Dept of Health Licensed facilities) 2. Good Samaritan Law Protects healthcare workers in an emergency See your state’s Good Samaritan Law 3. Vulnerable Adult

Good Samaritan Law No person is required to give aid Any first aid provided must not be in exchange for any reward Medical professionals are typically not protected If aid begins, responder must stay with victim until: necessary to call for help someone equal or higher continuing to give aid is unsafe Responder is not legally liable for death, disfigurement, disability

Importance of Advanced Directives 1. Document – how to die Advances Directives: what you want if you can’t speak 2. Living Will – terminal illness – now what 3. Healthcare Proxy – designate 4. Durable POA – signed document designates person to make medical decisions

Certification, Registration, Licensure Certification – document stating that a person has fulfilled the requirements and may practice in that field. Can be for one task, to do a job, or in a field Registration – a written record of an individual practicing within a field Licensure – credential issued by governmental agencies, often the state. To protect the public

Competency 2 2. Describe one’s legal responsibility related to abuse, neglect, exploitation, and the Vulnerable Adults Law. Define abuse. Explain why abuse may occur Identify types of abuse Define neglect. Define exploitation Identify populations at risk for abuse, neglect or exploitation. Identify Federal and State laws protecting vulnerable persons. Explain an individual’s legal responsibility if abuse or neglect is suspected. Explain a facilities legal responsibility if abuse or neglect is suspected.

Abuse & Neglect Abuse – physical, verbal, sexual or mental Neglect – Deliberate or accidental

Stressed……………….tired…………loss of control………overwhelmed Types of Abuse 1. Physical 2. Verbal 3. Mental 4. Sexual WHY?????? Stressed……………….tired…………loss of control………overwhelmed

Exploitation – illegal use of vulnerable adult or child Neglect Failure to provide Deliberate or accidental Exploitation – illegal use of vulnerable adult or child

Who is at risk? The aging population Adults with a disability Persons who cannot help themselves if they are hurt or misused by others, children and adults. Persons 18 years of age or older who: live in licensed facilities receive services from licensed agencies are in family settings but cannot report abuse or neglect themselves

Vulnerable Adult Definition: Physical or mental disability, or dependent on institutional services Purpose: Provide safe environments Institutional services Residential services Community-based services

Laws Protecting Vulnerable People Federal Child Abuse Prevention & Treatment Act Report Protects reporter Patient confidentiality does not exist in cases of suspected abuse Vulnerable Adult Law

What do you do if you suspect abuse? 1. Legally responsible to report 2. If facility, know abuse plan 3. Keep records 4. You will be confidential 5. Failure to report = YOU MUST

Facility Responsibility Have a plan Policy Record incidents

Competency 3 3. Explain client rights and responsibilities and how healthcare providers can ensure those rights. Identify the purpose of the Patient’s Bill of Rights. Identify the purpose of the Resident’s Bill of Rights. Explain how to help client/individual’s keep their rights. Discuss how to report and document a violation of patient rights.

Rights & Responsibilities Patient’s Bill of Rights To make decisions Safe, considerate care Dignity, confidentiality & privacy Involved in decision process May accept of refuse care

Resident’s Bill of Rights OBRA – rights of residents in nursing homes (Example: Minnesota Nursing Home Resident’s Bill of Rights) See your state’s Resident’s Bill of Rights Be informed Examine federal or state surveys Be accorded personal dignity with staff Receive quality of care regardless of age, sex, etc.

Help client’s keep their rights Copy on admission Posted copy Control over their care Control over their own tasks Protect their privacy

Reporting a Violation Supervisor Document Follow policies

Competency 4 4. Describe the components of healthcare employee and healthcare facility liability when delivering client care. Define: liability, negligence, malpractice and scope of practice. Discuss what a policy and procedure is. Describe how policy and procedures protect the worker and client from harm.

Liability – responsibility according to law Negligence – failure to provide Malpractice - negligence leading to harm Scope of practice -. Practice within the guidelines of training, profession, and organization job description. What one is legally allowed to do.

DO ONLY WHAT YOU KNOW & DO IT WELL Policies & Procedures Guide worker’s conduct & patient care Maintain compliance Protect employees & clients DO ONLY WHAT YOU KNOW & DO IT WELL

Competency 5 5. Discuss how confidentiality must be maintained in healthcare facilities with clients and their medical records. Define confidentiality. Discuss examples of confidential information Discuss with whom confidential information can be shared Define libel and slander.

CONFIDENTIALITY Clients have a legal right to privacy concerning their medical affairs. Examples: The patient Patient Medical History Diagnosis Patient Care Procedures Computer info

The Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

HIPAA The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule  The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information, and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. 

Discuss with whom? 1. Patients MUST give consent 2. Only those involved with care 3. NEVER in hallways, elevators, etc

Libel and Slander. Libel Slander Making false statements about another person in writing. Slander Making false statements about another person verbally

Competency 6 6. Explore legal issues such as sexual harassment, wrongful discharge, negligence, malpractice and violence in the workplace. Define terms: Sexual harassment, Wrongful discharge and Malpractice

Sexual Harassment Sex discrimination that violates Title VII of the Civil Right Act of 1964 Applies to employers with 15 or more employees Unwelcomed sexual advances Requests for sexual favors Verbal or physical content of sexual nature

Victim/harasser may be a man or woman Does not have to be of the opposite sex Harasser can be victim’s supervisor Victim does not have to be the one harassed but could be anyone effected by offensive conduct

Wrongful discharge When someone is fired who shouldn’t be fired. Due process of employee rights is defined by the employer & the union if applicable.

Malpractice Negligence that results in harm to the patient. To prevent being sued perform procedures in the way you were trained and only do what you can do. Stay within your role as defined by the employer.

Competency 7 7. Identify the legal issues for accurate documentation, informed consent and advanced directives. Discuss accurate documentation Define Informed Consent Discuss Advanced Directives

Legal Issues in Documentation Accurate Documentation Implications of inaccurate documentation

Informed Consent Definition of Informed Consent To give permission for a procedure after it has been explained along with the possible consequences. When is informed consent needed?

What happens when someone has no Advanced Directives? Consequences when no Advanced Directives Physician and your family will make the decisions for you if you are unable to make them.

Competency 8 8. Describe the consequences of inappropriate use of health data (including use of social media and email) in terms of disciplinary action. Define social media Discuss inappropriate use of social media Describe consequences when social media is inappropriately used.

Social Media Computer Cell phones iPod Twitter Facebook, etc. Texting Cameras

Unacceptable use of social media While providing care When talking to a client, patient, resident or customer Private emails when working Taking pictures of individuals being cared for Personal calls when working Sharing individuals personal information

Result of inappropriate use of social media Loss of job Criminal investigation Loss of license, certification Removal from state registry

Competency 9 9. Using a problem solving process applied to healthcare situations, describe how laws influence healthcare facilities and the care of clients. Discuss the problem solving process as applied to legal issues in health care utilizing a team approach

Problem Solving Identify the problem Gather information Create alternatives Select and act on solutions Evaluate and revise as needed.

Problem Solving applied to Legal Cases You are assigned to care for Mrs. Kelsy in room 426. You enter the room and hear Kara, a co-worker, tell Mrs. Kelsy that is she does not stay in her chair she will not get any lunch.   Describe what the situation is. Does the situation have legal implications? How would you respond to the situation? Would you report this situation? Who would you report it to?

Problem Solving Applied to Legal Issues Mrs. King is an 85-year-old confused patient assigned to you for cares on the evening shift. When you first see her after report, you discover that she is in bed. Her sheets are twisted around her and are soaking wet. There is a brown ring of urine on the bottom sheet indicating her linen has not been changed for quite some time. There is food in the bed and the patient’s face and hands are dirty.   Describe what the situation is. Does the situation have legal implications? How would you respond to the situation? Would you report this situation? Who would you report it to?

Questions?