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Medicolegal and Ethical Responsibilities
Chapter 3 Medicolegal and Ethical Responsibilities
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Objectives Review the learning and performance objectives for this chapter By the end of this chapter, demonstrate the procedures in the textbook and the job skills in the workbook
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Heart of the Health Care Professional
Service It is through service-oriented duties that your moral character will stand out, be noticed, and appreciated.
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Medical Ethics Standards of conduct generally accepted as a moral guide for behavior Reflected in administrative procedures Bioethics Ethics of medicine and biomedical research Examples 3-1 and 3-2
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Medical Ethics Principles of medical ethics for physicians
Oath of Hippocrates (Figures 3-1 and 3-2) AMA Principles of Medical Ethics (Figure 3-3) Principles of medical ethics for medical assistants AAMA Code of Ethics (Figure 3-6)
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Medical Etiquette Customary code of conduct, courtesy, and manners in the medical profession Colleagues Patients
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Health Insurance Portability and Accountability Act
Health insurance access, portability, and renewal Health care fraud, abuse, prevention, and administrative simplification Medical Savings Account (MSA) benefits
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Health Insurance Portability and Accountability Act
Group health plan directives Internal revenue code amendments General provisions Medicare-related plans Portability assurance
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Health Insurance Portability and Accountability Act
Protected Health Information (PHI) Information about the patient’s health condition that contains personal identifying data Demographics and conversations Privacy rules
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Health Insurance Portability and Accountability Act
Under HIPAA privacy rules for PHI, patients have the right to: Receive notice of privacy practices Access medical and financial records Ask for amendment to the medical record
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Health Insurance Portability and Accountability Act
Under HIPAA privacy rules for PHI, patients have the right to: Receive an accounting of disclosures made Request restrictions on disclosures for certain uses Ask that all communication be confidential
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Health Insurance Portability and Accountability Act
Scene - Giving out Patient Test Results
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Health Insurance Portability and Accountability Act
Compliance plan Office policies and procedures Rules to follow Practice standards Compliance officer
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Health Insurance Portability and Accountability Act
Security rule Physical and technical safeguards Documentation requirements Risk analysis and management Administrative safeguards Applies to all users of PHI
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Confidentiality Security
A medical record contains privileged information Written Verbal It must be protected Everything seen, heard, or read in the office is confidential!
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Confidentiality Release of medical Information Consent Authorization
Treatment Payment Routine health care operations Authorization Any use or disclosure not included in consent form See Figures 3-8 and 3-9
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Confidentiality Release of medical information Mandated reporting
Medical record is property of the physician State laws require reporting of some information Restricted record access HIV/AIDS Patients receiving records
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Confidentiality Release of medical information Medical litigation
Medicare, medicaid, and TRICARE Privacy Act of 1974 Employers receiving records Publications release Psychiatric records
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Medical Practice Acts Passed in all states – early 1900s
Protect citizens from quackery Established licensure requirements State board of medical examiners Continuing Education Units (CEUs)
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Medical Professional Liability
Previously called medical malpractice Liability insurance Claims incurred Claims made Respondeat superior “Let the master answer” Vicarious liability
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Medical Professional Liability
Torts Intentional torts Assault and battery Invasion of privacy and breach of confidential communication Defamation of character, libel, slander False imprisonment or personal restraint Intentional infliction of emotional distress Fraud or deceit
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Medical Professional Liability
Torts Negligent torts “The Four D’s” must be present for a judgment of negligence Duty Derelict Direct cause Damages
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Medical Professional Liability
Torts Negligent torts Categories of negligence Malfeasance Misfeasance Nonfeasance Malpractice Criminal Negligence
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Medical Professional Liability
Principal defenses Contributory negligence Assumption of risk Statute of limitations Litigation prevention Guidelines to prevent medicolegal claims Bonding
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Alternatives to the Litigation Process
Screening panel Issue advisory opinions Cannot legally bar litigation Arbitration Waive right to a court trial Can be legally binding
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Alternatives to the Litigation Process
No-Fault Insurance Compensation without regard to fault Patient Care Partnership Patient’s Bill of Rights Reduced misunderstandings Reduced lawsuits
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Physician/Patient Contracts
Expressed/Implied Contracts Expressed verbally Implied by situation Third-Party Contracts Workers’ compensation case No consent needed
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Physician/Patient Contracts
Contracts and emergency care Good Samaritan Law Contracts with minors Age 14 and older can provide their own consent Emancipated minors See Figure 3-10
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Physician/Patient Contracts
Terminating a contract Reasons Failure to keep appointments Failure to follow medical advice Failure to pay balance due Confirmation of discharge Abandonment
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Informed Consent Physician makes a diagnosis and recommends treatment
Physician must inform patient of all risks and alternatives to any procedure Patient decides if they will accept the risks of treatment
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Informed Consent Patient signs a form acknowledging the assumed risks
THIS IS INFORMED CONSENT Important in procedures and treatment plans
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Medical Records All medical record documentation must be: Accurate
Complete Up-to-date Readable
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Medical Records Documentation must also reflect: The History
Physical examination Assessment Treatment Plan
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Medical Records This is necessary to: Provide the best medical care
Justify services billed to insurance company Defend physician in the event of a lawsuit
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Subpoena Definition: “under penalty”
Court order for a witness to give testimony Expert testimony Subpoena duces tecum “Under penalty you shall bring with you” Court order for the witness (physician) to bring the medical record
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Advance Directives Legal form detailing the desires for procedures to be either performed or withheld when death is imminent Living Will Not legally binding But can be used as “evidence of intent” See Figure 3-17
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Advance Directives Health Care Power of Attorney Medical Directive
Legally binding Can be used by those not terminally ill Can be used to appoint another person to make decisions Medical Directive Forty-eight questions detailing what the patient would or would not want done
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Advance Directives Values History Form Health Care Proxy
Uncover the patient’s value system Health Care Proxy Appoints a surrogate to make decisions Do Not Resuscitate Form No resuscitation if patient’s heart stops
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Advance Directives Uniform Anatomical Gift Act
Uniform donor card Advanced Directive Guidelines Signed by the individual Signed by two witnesses Copy should be kept in the medical record
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Advanced Directives
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Stop and Think Ethics Review the scenario
Should the physician supply enough medication to provide relief or only enough pills for the patient to take when she is experiencing pain? Why?
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Stop and Think Bioethics Review the scenario
Would you want your child to benefit from this method of treatment if this research proves successful? Would you advocate cloning research for other scientific breakthroughs?
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Stop and Think Stem cell research Review the scenario
Stem cell research is fighting for its life Think through this complex scenario You may want to do additional research on your own Take a stance and be ready to debate
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Stop and Think Confidential information Review the scenario
How do you think Abigail felt? What are the dangers of obtaining information in such a manner? How do you think the receptionist could have handled the situation to obtain the information without jeopardizing patient confidentiality?
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