1. Lecture Notes Unit 3 Legal and Ethical Obligations

2. Legal aspects

3. The Omnibus Budget Reconciliation Act
-passed in 1987 to implement certain basic patient rights and guidelines for nursing home care facilities.

4. The OBRA guidelines suggest that:
Each resident be fully evaluated annually in regard to health, memory, hobbies, habits, etc.
A plan be created to maintain and possibly improve the patient’s condition.
Patients have rights to a doctor, and if they can’t find one on their own, the medical director of the nursing home has an obligation to help them find one.
Patients have a right to be informed about treatment, and to refuse it if desired.
Patients have a right to privacy, and a right to complain without fear of reprisal.

5. OBRA also contains a Resident’s Bill of Rights, which is similar to the Patient’s Bill of Rights.
It is VERY important that health care workers be aware of their legal responsibilities.
Ombudsman = social worker, nurse, or trained volunteer that makes sure that the patient/client is not abused and that their rights are secure.
Healthcare professionals must be properly trained and regulated.

6. Licensure = a process by which a governmental authority gives permission to a person of health care organization to operate or to work in a profession
Certification = a process by which a person is made able to do a job, and recognized as such.
Registration = a list of individuals on an official record who meet the qualifications for an occupation.

7. Maintaining confidentiality is a key component is staying within legal boundaries.
Confidentiality requirements are in place to protect the patient/client.
It is only appropriate to discuss a client/patient when the discussion affects his or her care in some way. i.e.:
Candy with the belongings of a diabetic
Alcohol of medications with the belongings of the patient
When the patient discusses areas of stress in their personal lives

8. Even discussions that are not related to the patient themselves are still confidential (i.e. discussions about relatives)
Privileged communication = any personal or private information given by a client/patient to any medical personnel that is relevant to his or her care.
May not be shared with anyone, including family members.

9. Patients must often provide written consent for procedures and for the release of any information pertaining to their care.
Health Insurance Portability and Accountability Act (HIPAA)
All of a patient’s medical information is protected by HIPAA, info on medical records, conversations, insurance info, billing info

10. Protects patient-doctor relationship, lets patients tell the truth
EXEMPT Information: suspected fraud, births and deaths, injuries caused by violence, child abuse, drug abuse, communicable diseases, std’s

11. Reportable diseases = diseases considered to be of great public health importance
Mandatory written reporting – include gonorrhea
Mandatory phone reporting – include measles and pertussis (whooping cough)
Report total number of cases – chickenpox and influenza
Cancer cases are reported to the state Cancer Registry

12. CDC – AIDS, Anthrax, Chlamydia, Cholera, Gonorrhea, Hepatitis A,B,&C, Leprosy, Malaria, Measles, Mumps, Plague, Smallpox, Syphilis, and many others
Other not to CDC – yellow fever, SARS

13. HPV – not reportable, because everyone has it, statistically if you’ve had more than 1 sexual partner you are ~70% likely to have HPV

14. HIV many places is reportable to governmental agencies and sexual partners – not to sexual partners in NM, gonorrhea and Chlamydia to sexual partner

15. contracts, wills, natural death

16. Contract = legal documents that represent an exchange of promises or an agreement between parties that the law will enforce
Always geared towards the needs of the patient
Implied contracts = some of the terms of the agreement are not expressed in words. Example: patients go to the hospital and are expected to pay a fair price for their healthcare received.

17. Natural Death Guidelines and Declarations:
Expressed contracts = spell out all of the terms of the agreement in written form
Natural Death Guidelines and Declarations:
For many years individuals were given very little input in the manner in which they would spend their last days. Today new laws help protect the choices of dying individuals. Each state has adopted natural death guidelines and declarations that give direction to people about how to legally tell others their desire concerning end-of-life issues.

18. These documents ensure the individual’s right to refuse or accept any medical care.
In the U.S. every person is encouraged to prepare this document, called an Advance Directive. This is typically a written form that denotes how the person would want medical decisions made if they were unable to make them for themselves.

19. The directive is signed and witnessed by 2 competent adults who cannot benefit from the person’s death.
The directive takes effect when the person becomes Legally Disabled (mentally incompetent, a minor, under the influence of drugs or alcohol, semi-conscious, or unconscious)

20. Minors can become emancipated – meaning they are free from legal authority of anyone else and can make their own decisions.
Minors become emancipated when: marriage, pregnant, economically self-sufficient, educational degree/diploma, military service, etc.
Agent = a person appointed by the patient to make decisions and see that the patient’s wishes are enforced

21. Living Wills Specifies about life support machines Feeding tube
Focus on coma or vegetative state
Terminally ill
Do Not Resuscitate (DNR) CPR
Do Not Intubate (DNI)

22. Health Care Durable Power of Attorney –
Some patients may choose to appoint a health care POA or proxy
Family member or close friend who is trusted to make decisions for the patient
May also be a doctor
This doctor may not provide treatment at the same time as they are acting as the proxy
Other family members and friends do not have the legal ability to override decisions made by the POA
The POA cannot override decisions made by the patient if they regain the ability to communicate

23. Patient Self-Determination Act –
Passed by congress in 1990 and an amendment to the OBRA
Requires health care facilities to inform individuals at the time of enrollment, about their rights concerning advance directives
Typically the information and decisions coming from the patient’s mouth override any other directives