1. Medical Law and Ethics
Chapter 7
Public Duties of the Physician

2. Public Health Records and Vital Statistics
Vital events in person’s life
Used by government to determine population trends and needs
Public duty of physicians to report vital events

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

4. 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

5. Deaths
Coroner: 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

6. Medical Examiner Cases
Legal investigation by medical examiner or coroner in case of suspicious death
Investigation is required if death is:
Violent in nature (homicide, suicide, accident)
Caused by criminal abortion
Related to contagious or virulent disease
Of a person confined to jail or correctional institution
Result of unexplained or unexpected cause

7. Medical Examiner Cases
Investigation is required if death is:
Caused by electrical, radiation, or chemical injury
Of a person who had no physician in attendance within 36 hours of death
Of a person whose body is not claimed by friend or relative
Of a child under age of two if death is from unknown cause
Of a person of unknown identity

8. Communicable Diseases
Diseases transmitted from one person to another—considered threat to public
Reportable diseases
National Childhood Vaccine Injury Act

9. 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.)

10. Child Abuse
All abuse must be reported by teachers, health professionals, law enforcement and day care personnel, and social service workers
Physicians have been held liable for not reporting cases
Person reporting is protected by law from being sued by parents and others

11. Elder Abuse Older American Act (1987)
Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older

12. 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

13. Signs of Abuse Repeated injuries Bruises and unexplained swelling
Unexplained fractures
Bite marks
Unusual marks
Bruising or swelling in genital area
Signs of inadequate nutrition
Venereal disease and genital abrasions
Makeup to hide bruises
Sunglasses worn inside to hide blackened eyes

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

15. 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

16. 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

17. 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)

18. 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)

19. 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

20. Prescription 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)

21. 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

22. Medical Waste
Solid
Chemical
Radioactive
Infectious