1. 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?

2. 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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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?

26. 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?

27. 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

28. 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

29. 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

30. 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

31. 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

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

33. 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”

34. 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

35. 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

36. 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

37. 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

38. 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

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

40. 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