1. 7
Public Duties of the Healthcare Professional

2. 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.
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3. 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.
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4. 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.
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5. Learning Objectives
Explain how an Employee Assistance Program (EAP) can help troubled employees.

6. 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

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

8. 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
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9. 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
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10. 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

11. 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
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12. 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
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13. 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
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14. 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

15. 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
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16. Communicable Diseases
Reportable diseases
National Childhood Vaccine Injury Act
Childhood vaccines required by law

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Signs of Abuse Repeated injuries Bruises and unexplained swelling
Signs of inadequate nutrition
Unexplained fractures
Bite marks
Unusual marks
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24. 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

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

26. 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
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27. 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

28. 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)

29. 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)

30. 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
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31. 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)

32. 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

33. 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

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