Chapter 3 Medicolegal and Ethical Issues Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

2 Learning Objectives  Explain the importance, necessity, legality of patient confidentiality  State conditions that require EMT to notify local law enforcement officials  Define EMT scope of practice  State conditions necessary for EMT to have duty to act

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 3 Learning Objectives  Discuss issues of abandonment, negligence, battery, and their implications to EMT  Define consent; discuss methods of obtaining consent  Differentiate between expressed (informed) and implied consent

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 4 Learning Objectives  Explain role of consent by minors in issues of care  Discuss implications for EMT in patient refusal of transport  Discuss importance of Do Not Resuscitate (DNR) orders, advance directives, and local or state provisions regarding EMS application

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 5 Learning Objectives  Discuss considerations of EMT regarding issues of organ retrieval  Delineate actions that an EMT should take to assist in preserving crime scenes

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 6 Ethical Responsibilities  The Golden Rule  “Do unto others as you would have them do unto you”  Act in best interest of patient

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 7 Ethical Responsibilities  Ethics & competence  Quality care Caring, competent Caring, competent Responsible to maintain competence Responsible to maintain competence Strive for level of mastery Strive for level of mastery Requires diligence, self-evaluation Requires diligence, self-evaluation Keep knowledge, skills current Keep knowledge, skills current Participate in quality improvement process Participate in quality improvement process I CARE I CARE

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 8 Ethical Responsibilities  Confidentiality  Patients have right to know information given will be kept confidential  Information release must be written Exceptions Exceptions  Information to press/media

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 9 Ethical Responsibilities  Health Insurance Portability & Accountability Act (HIPAA)  Widespread –use of electronic records  Potential of patient information transmitted without knowledge/consent  Outlines how private information used, disclosed

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 10 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Ethical Responsibilities  Reporting requirements  Reportable circumstances Child abuse Child abuse Geriatric abuse Geriatric abuse Family violence, abuse Family violence, abuse Violent crimes Violent crimes Certain infectious diseases Certain infectious diseases Patients transported against their will Patients transported against their will Mentally incompetent Mentally incompetent Animal bites Animal bites Wounds from guns/knives Wounds from guns/knives Deaths Deaths

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 11 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Scope of Practice  Range of activities, limitations of medical provider  State EMS laws address: Minimum training standards Minimum training standards Medical control Medical control Vehicle/equipment specifications Vehicle/equipment specifications Licensure/certification requirements Licensure/certification requirements May specify formation, duties of EMS councils/medical advisory committees May specify formation, duties of EMS councils/medical advisory committees

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 12 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Scope of Practice  Establishes what EMT legally can, cannot do in emergency medical evaluation, treatment  National EMS Scope of Practice Model

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 13 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Scope of Practice  Standard of care  “Did you do the right thing & did you do it properly?”  Describes body of knowledge, laws, policies, common practices, standards, guidelines  Laws, rules, regulations govern EMT practice  Protocols

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 14 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Scope of Practice  Standard of care  Equipment Medications Medications Medical devices Medical devices Check equipment, document equipment failure, report Check equipment, document equipment failure, report

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 15 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Negligence  Deviation from accepted standard of care, results in injury to patient  To prove negligence, must show: Duty to act Duty to act Breach of duty Breach of duty Damage Damage Causal connection Causal connection

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 16 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Negligence  “Good Samaritan” legislation  Protects private citizen  Provides aid without undue fear of litigation  Protects EMT from civil charges  Does not protect from gross negligence

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 17 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Consent  Before treating a patient, must obtain consent from patient, parent, guardian  Principle of autonomy, self-determination Right to be self-directing Right to be self-directing

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 18 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Consent  Consent not always possible  Disoriented  Minors with no parent/guardian available  Mentally handicapped

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 19 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Consent  Expressed (informed) consent  Must be obtained from every conscious, competent adult  Document when patient withholds consent

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 20 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Consent  Prehospital research  Research studies evaluate effectiveness of procedures/treatments  Research studies must be approved by IRBs Acquire patient consent Acquire patient consent Purpose: Respect of patient autonomy Purpose: Respect of patient autonomy

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 21 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Consent  Implied consent  Verbal/written consent not possible  Reasonable person would want emergency treatment

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 22 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Consent  Other types of consent  Children, mentally incompetent individuals not legally able to give expressed consent Must obtain consent from parent/guardian Must obtain consent from parent/guardian  Unless implied consent more appropriate  Emancipated minor

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 23 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Refusal of Treatment & Transport  Person has right to refuse care  Must be competent, able to make clear judgment  Patient has right to withdraw from treatment  “False imprisonment” if transferred against will

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 24 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Refusal of Treatment & Transport  Assault/battery if you touch, provide care to patient without consent  Try to convince patient to go to hospital  Ensure patient understands consequences of not seeking medical attention

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 25 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Refusal of Treatment & Transport  Sign “refusal of treatment” release form  Use best judgment with mental incompetence

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 26 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Refusal of Treatment & Transport

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 27 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Abandonment  EMT discontinues patient-provider relationship without giving patient opportunity to obtain continued care at the same level or higher  Plaintiff must prove patient was owed duty and duty was breached  Charges possible if patient who refused care is incompetent

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 28 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Intoxicated, Irrational, and Emotionally Disturbed Patients  High legal risk  Held against wishes, charges can result  “Protective custody”  Violent/suicidal patients  Forcible removal  “Soft” restraints  Precise documentation

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 29 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Resuscitation Issues  Proxies  DNR orders  Advance directives  Healthcare proxy

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 30 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Resuscitation Issues  Extended transport  EMTs must have original DNR order  If patient dies during transport: Ambulance must stop where patient died Coroner must be notified

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 31 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Donor & Organ Harvesting  Individuals may decide in advance to donate organs  Driver’s license/separate donor card  Treat donor same as any other patient  Communicate information to hospital/medical direction

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 32 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Medical Identification Insignia  Advance directive by medical identification insignia  Bracelet/necklaces Also for other medical conditions Also for other medical conditions

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 33 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Crime Scenes  Emergency care  Ensure safety for self, fellow responders  Notify police through dispatch  Try not to disturb any item at scene  Do not cut through holes in clothing, if possible  Chain of evidence/custody

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 34 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Risk Management  Practices by healthcare providers that reduce possibility of lawsuit/other legal/professional actions taken against EMT/medical director/agency  Act according to standard of care

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 35 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Risk Management  Document actions carefully  Prehospital care record is backbone of defense  Act in patient’s best interest

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 36 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Summary  Practice Golden Rule  EMTs have ethical, professional duty to remain competent  EMTs are responsible for confidentiality

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 37 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Summary  May be required by law to report certain conditions  Must function with scope of practice  Follow standard of care

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 38 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Summary  Negligence is deviation from accepted standards of care resulting in injury to patient  Federal, state, Good Samaritan laws provide degree of protection from lawsuits  Must obtain consent before treating patient (implied or expressed)

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 39 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Summary  Patient may refuse care if mentally competent adult  Make every attempt to convince patient otherwise  Patient must sign release  Prematurely discontinuing care is abandonment  Terminal patients may have DNR, advance directive, healthcare proxies

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 40 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Summary  If organ donation indicated on driver’s license, donor card, communicate with hospital  Do not disturb crime scene unless required for patient care; maintain & document chain of evidence  Prevent lawsuits - act according to standard of care

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 41 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company Questions?