1. Legal &
Ethical
Standards in
Healthcare
By: Cindy Quisenberry

3. Objectives Contrast laws, morals, and ethics.
Explain the purpose of professional codes of ethics.
Define the term standard of care.
Describe informed consent.
Discuss the importance of confidentiality and HIPAA for healthcare professionals.

4. Objectives Explain what is an advance directive.
Compare a living will, a durable power of attorney, and a healthcare proxy.
Describe clients’ rights and responsibilities.
Name the qualities of a successful healthcare worker.

5. Laws
Law – a body of rules, regulations, and legal opinions of conduct and action that are made by controlling authority and are legally binding.

6. Criminal Law
Area of the law related to violations of statutes that pertain to public offenses or acts committed against the public.
Commission, if there is a law forbidding a certain act.
Omission, in violation of a law requiring a certain act.
A healthcare provider can be prosecuted for criminal acts such as assault and battery, fraud, and abuse.

7. Civil Law
Area of the law related to violations of private rights and remedies.
Examples:
Contract violation
Slander or libel
Product liability
Family matters
Automobile accidents

8. Civil Law
Torts – a civil wrong committed against a person or property. May have caused physical injury, resulted in damage to someone’s property, or deprived someone of his or her liberty and freedom.
Intentional (Willful) - caused by negligence
Unintentional (Accidental) - acts that were not intended to cause harm. However, they are committed without regard for consequences.

10. Civil Law
Unintentional Tort – acts that are not intended to cause harm. However they are committed “unreasonably”, or without regard for the consequences.
Negligence – an unintentional tort
Medical Malpractice – an action taken by a healthcare professional that injures a patient, and fails to meet reasonable standards of professional care.

11. Civil Law
Negligence – is charged when a healthcare practitioner fails to exercise ordinary or expected care and a client is injured or sustains damages of some sort as a result.
“Didn’t intend to do it”
“ Should have known better”

12. Civil Law
Medical practice acts are state statutes that govern medical practices. They do the following:
Cover requirements and methods for licensing healthcare providers
Establish medical licensing boards
List ground for revoking licenses

13. Civil Law Common Errors in Medical Malpractice
Medication errors (causes injury or death in 1.5 million persons per year)
Anesthesia errors
Birth injury, including Cerebral Palsy, Erb's Palsy, and Brain Damage
Delayed diagnosis or failed diagnosis of a medical condition (including cancer)
Misdiagnosis (for example, heart attack misdiagnosed as indigestion)
Improper or inadequate treatment of an illness or disease
Surgical error

15. Civil Law Plantiff – the person bringing the lawsuit
Defendant – the person facing the charges (defending the lawsuit)

17. Civil Law The 3 D’s must be present for negligence to occur:
Duty of Care – the extent to which a healthcare provider must reasonably ensure that no harm comes to a patient under the provider's care
Dereliction of Duty – willful neglect; the act of abandoning; abandonment or neglect
Damages - Harm or injury to property or a person, resulting in loss of value or the impairment of usefulness

19. Civil Law
Assault – intentionally attempting or threatening to touch a person’s body without the person’s consent
Battery – touching a person’s body without his or her consent

20. Civil Law
Invasion of Privacy – violating a person’s right not to have his or her name, photo, or private affairs exposed or made public without giving consent

21. Civil Law
False Imprisonment – unlawful restraint or restriction of a person’s freedom of movement

22. Civil Law
Abuse – the intentional mistreatment or harm of another person
Defamation – injuring a person’s name and reputation by making false statements to a third person/party

23. Civil Law Noncomplicance
Noncompliant healthcare workers may face fines or prison sentences and can lose their licenses to practice their profession.
Unethical conduct may result in expulsion or censure from your professional organization, but only the state can revoke a license.

24. Legal Responsibility
Privileged Communication – refers to information that is held private within a protected relationship, such as that between a physician and patient
Health Care Records
HIPAA – Privacy Act
Authorization to release health information

25. Legal Responsibility Privileged Communication
It is illegal and unethical for a healthcare worker not to observe confidentiality.
Privileged communication refers to information held confidential within a protected relationship.

26. Legal Responsibility Privileged Communication
Keeping client medical information confidential means:
Not informing any unauthorized person about the information contained in a patient’s medical records.
Not showing written information to an unauthorized third party.
Taking proper precautions when communicating such information over a computer, telephone, or fax machine.
Written consent must be obtained before releasing information to a third party.

27. Legal Responsibility Privileged Communication
Guidelines to follow if you have access to a patient’s information:
Do not decide if information is confidential based on your approval or agreement.
Do not reveal financial information about a patient.
Do not use the patient’s name or other information if others in the room might overhear.
Use caution in giving the results of medical tests to patients over the telephone.

28. Legal Responsibility Privileged Communication
Guidelines to follow if you have access to a patient’s information:
Do not leave medical charts or insurance reports where patients or others can see them.
If the patient has not given written permission to release information, do not release it.
Do not discuss patients in public places where others may overhear, such as the cafeteria or elevator.

29. Legal Responsibility Privileged Communication
Confidentiality for patient medical records may be waived under the following circumstances:
When a third party requests a medical examination, such as a pre-employment examination, and that third party pays the patient’s bill.
When a patient sues a physician or other healthcare practitioner for malpractice.
When the patient signs a waiver allowing the release of information.

30. Legal Responsibility Privileged Communication
Clients have the following rights under HIPAA law:
The right to notice of privacy practices.
The right to limit or request restriction on their PHI and its use and disclosure.
The right to confidential communications.
The right to inspect and obtain a copy of their PHI.
The right to request an amendment to their PHI.
The right to know if their PHI has been disclosed and why.

31. Legal Responsibility
Contract – an agreement consisting of one or more legally enforceable promises among two or more parties such as people, corporations, and partnerships; in healthcare, contracts are used to govern relationships, between employees and employers, insurers and the insured, or healthcare providers and patients

32. Legal Responsibility Components of a Contract Offer Acceptance
Consideration
Implied
Expressed

33. Legal Responsibility
Breach of Contract - failing to perform any term of a contract, written or oral, without a legitimate legal excuse

34. Ethical Responsibilities
Morals – formed from your personal values and reflect your concept of right and wrong (developed through the influence of family, culture, and society) – acting morally toward others involves treating them the way you would like to be treated

35. Ethical Responsibilites
Ethics – set of principles dealing with right and wrong; knowledge of what is right and wrong conduct
Provide a standard of conduct or code of behavior
Helps healthcare workers analyze information and make decisions
Medical Ethics – a system of principles governing medical conduct (ie: euthanasia, DNR, living wills, etc.)

36. Ethical Dilemmas Frequently created by modern medicine Euthanasia
Confidentiality of AIDS diagnosis
Aborted fetuses and research
Continued life support
Expensive treatments and payment
Transplant decisions

37. Ethical Dilemmas Frequently created by modern medicine
Legal issues and marijuana
Animals and research
Genetic research
Cloning
Stem cell research

38. Basic Rules of Ethics Save lives and promote health Patient comfort
Respect of patient’s right to die peacefully and with dignity
Treat all patients equally
Provide the best care possible
Maintain competent skills and knowledge

39. Basic Rules of Ethics Respect rules of confidentiality
Refrain from immoral, unethical, and illegal practices
Show loyalty to patients, co- workers, and employers
Be sincere, honest, and caring

40. Professional Standards
Licensure – required for certain professions within a state; the granting of permission – official, legal, or both – to perform professional actions in various fields such as medicine, nursing, etc. that may not be legally done by persons who do not have such permission

41. Professional Standards
Registration – means a person’s name has been listed in an official registry or record as having satisfied the standards for a certain healthcare occupation; the recording of those who are registered or licensed to practice within a state

42. Professional Standards
Certification – usually voluntary and national in scope; most often achieved by taking an examination – passing the exam shows that an applicant has attained a certain level of knowledge and skill

43. Professional Standards
Reciprocity – a state licensing authority will accept a person’s valid license from another state without requiring reexamination

44. Professional Standards
Standard of Care – the level of performance (consistent with minimum safe professional conduct under specific conditions) expected of a healthcare professional in carrying out his or her duties

46. Professional Standards
Scope of Practice – based upon the job description, level of training, and qualifications (what a healthcare professional can do or cannot do)
Perform only those procedures for which you have been trained and are permitted to do
Perform correctly

47. Professional Standards
Scope of Practice
Working outside your scope of practice can make you liable.
Working within your scope of practice ensures that you:
Do not injure patients or put them at risk by performing procedures that are beyond your ability.
Will not be held liable for a standard of care that is beyond your training, experience, and job description if a legal situation arises.

48. Professional Standards
Identify the patient
Obtain patient’s consent
Observe safety precautions
Keep all information confidential
Think before you speak and watch everything you say
Treat all patients equally

49. Professional Standards
Accept no tips or bribes for the care you provide
If an error occurs, report it immediately to your supervisor
Behave professionally in dress, language, manners, and actions
Always carry liability insurance

51. Civil Law Liable – legally responsible for your actions
Libel – making false statements in print, writing, or through pictures or drawings

52. Civil Law
Law of Agency – an employer is legally liable for acts performed by employees
Example: the physicians affiliated with the medical office that hired the medical assistant could also be held liable in the case of a law suit

55. Civil Law
Informed Consent – a voluntary agreement made by a well- advised and mentally competent patient to be treated or randomized into a research study (risks, benefits, alternative, consequences, etc.)

56. Civil Law Informed Consent
in order for a client to make an informed decision regarding treatment, the client needs to be told the following:
The proposed methods of treatment.
Why the treatment is necessary.
The risks involved in the proposed treatment.
All available alternative types of treatment.
The risks of any alternative methods of treatment.
The risks involved if treatment is refused.

57. Civil Law Informed Consent
People who cannot give informed consent include:
Minors – individuals under 18 years of age (21 in some states). Exceptions include those deemed mature minors by the court.
Mentally incompetent individuals – persons judged by the court to be insane, senile, mentally retarded, or under the influence of drugs or alcohol.
Persons who do not speak English.

58. Patients’ Rights
Agencies must have written policies for “Patients’ Rights”
All personnel must respect and honor these rights
Long-term care facilities post “Residents’ Bill of Rights”

59. Patients’ Rights
The American Hospital Association’s Patient’s Bill of Rights is followed in most states. It guarantees the client’s right to:
Receive considerate and respectful care.
Receive complete and current information concerning his or her diagnosis, treatment, and prognosis.
Know the identity of physicians, nurses, and others involved with his or her care, as well as when those involved are students, residents, or trainees.

60. Patients’ Rights
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Know the immediate and long-term costs of treatment choices.
Receive information necessary to give informed consent prior to the start of any procedure or treatment.
Have an advance directive concerning treatment or be able to choose a representative to make decisions.

61. Patients’ Rights
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Refuse treatment to the extent permitted by law.
Receive every consideration of his or her privacy.
Be assured of confidentiality.
Obtain reasonable responses to requests for services.

62. Patients’ Rights
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Obtain information about his or her healthcare and be allowed to review his or her medical record and to have any information explained or interpreted.
Know whether treatment is experimental and be able to consent or decline to participate in proposed research studies or human experimentation.

63. Patients’ Rights
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Expect reasonable continuity of care.
Ask about and be informed of the existence of business relationships between the hospital and others that may influence the client’s treatment and care.
Know which hospital policies and practices relate to client care, treatment, and responsibilities.

64. Patients’ Rights
The American Hospital Association’s Patient’s Bill of Rights (cont.)
Be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees or patient representatives.
Examine his or her bill and have it explained and be informed of available payment methods.

65. Patients’ Responsibilities
Clients’ Responsibilities – clients are responsible for:
Providing information about past illnesses, hospitalizations, medications, and other matters related to their health status.
Participating in decision making by asking for additional information about their health status or treatment.
Providing healthcare agencies with a copy of their written advance directive if they have one.
Informing physicians and other caregivers if they anticipate problems in following a prescribed treatment.

66. Patients’ Responsibilities
Clients’ Responsibilities (cont.)
Following a physician’s orders for treatment. The client has the right to refuse treatment to the extent permitted by law.
Providing healthcare agencies with necessary information for insurance claims and working with the healthcare facility to make arrangements to pay fees when necessary.

68. Civil Law
Advanced Directives – a written document in the form of a living will or durable power of attorney prepared by a competent person that specifies what, if any, extraordinary procedures, surgeries, medications, or treatments the patient desires in the future, when he or she can no longer make such decisions about medical treatment
Healthcare workers must be aware of the Act (Patient Self-Determination Act – PSDA) and honor it

69. Civil Law – Advanced Directives
Living Will – (an advance directive) provides instructions directly to physicians, hospitals, and other healthcare providers involved in a client’s medical treatment regarding their end-of- life care (ie: intubation, feeding tubes, etc.)

70. Civil Law – Advanced Directives
Durable Power of Attorney (POA) – it gives one person the authority to make a variety of legal decisions on behalf of another person

72. Civil Law - Awards $4,000,000 Medical Malpractice – Death
$1,000,000 Medical Malpractice – left residual tumor (did not get clear margins)
$900,000 Birth Injury – Fetal Death
$900,000 Medical Malpractice – Wrongful Death (failed to dx and respond to pt’s complaints)
$825,000 Medical Malpractice (surgery error – performed surgery incorrectly)
$825,000 OB/GYN Malpractice (did not recognize early fetal distress)
$775,000 Failure to Diagnose