1. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Agenda: Seminar 3 Brief review of discussion boards Questions on Unit 4 Project Presentation of material for Chapters 5 & 7

2. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Discussion Boards & Review of Seminar 2 Discussion boards – good job this week. – Fewer spelling and grammatical errors.  “to” versus “too” – you use “too” when you mean “in addition,” so you add an extra “o” to the end of “to.”  The Kaplan Writing Center is available to help you. See Course Announcements. – Healthy discussion – many responses. – Initial responses still need some work. Make sure you answer all of the questions posed.

3. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Unit 4 Project Use the Index of the book. Answer the questions completely – one or two word answers are not good enough. Questions?

4. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Law and Ethics The Physician-Patient Relationship Chapter 5

5. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician–Patient Relationship Both must agree to form relationship for there to be contract for services (implied contract) Under contract for services, patient can expect doctor to provide medical service for as long as necessary Patient must confide truthfully to physician

6. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician’s Rights Right to select patients he or she will see Right to refuse service to patients Right to determine type of service he or she will provide Right to be paid for services rendered Right to withdraw from relationship Right to vacation and time off

7. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician’s Responsibilities (AMA’s Statement of Principles) Human dignity Honesty Responsibility to society Confidentiality Continued study

8. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Physician’s Responsibilities (continued) Freedom of choice Responsibility to improve community Responsibility to patient is paramount Must support access to medical care for all people

9. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Professional Practice Responsibilities Duties during a Medical emergency – Cannot ethically or legally turn away patient in an emergency situation – If unable to treat patient, then must call for emergency assistance – Patients cannot be turned away if indigent or uninsured

10. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Duty to Treat Indigent Patients “Dumping crisis” Physician has right to select which patients to treat Physician does not have right to drop or abandon patients once he or she agrees to treat them

11. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Duty Not to Abandon a Patient Once physician agrees to take care of patient, contract may not be terminated improperly Physician may be charged with abandonment if formal notice of withdrawal is not given Physician must allow patient time to seek service of another physician

12. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Duty to Treat Patients with AIDS Unethical to refuse to treat, work with, or provide housing for person who is HIV-positive or has AIDS Physician, by law, must make full report to state about any patient who is HIV-positive or has AIDS

13. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ethical Considerations when Treating AIDS Patients Persuade patient to inform his or her partner(s) Notify authorities if concerned that patient will not inform others As last resort, notify patient’s partner(s)

14. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Exposure of Health Care Workers to Patient’s Blood A 0.3 percent risk of contracting HIV after blood exposure, according to the CDC HIV testing of patient’s blood allowed in some states

15. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Duty to Properly Identify Patients Identify patient both by stating his or her name and examining any other identification – Arm band – Driver’s license – Use discretion with patient sign-in sheets to protect confidentiality – Have patient state name

16. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Duty to Tell the Truth Many believe principles of justice apply when dealing with truth-telling Try to determine the “just” action for patient Just action may be at variance with obligation of confidentiality Confidentiality may be overridden when life or safety of patient is endangered

17. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patient’s Rights Right to give informed consent Right to privacy Right to be informed of advantages and potential risks of treatment Right to refuse treatment Right to confidentiality – Privileged communication

18. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Confidentiality All information and records about treatment will be kept confidential by physician and staff unless consent to release is obtained Medical Patients Rights Act: all patients are entitled to have privacy respected and medical records handled confidentially

19. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Confidentiality (continued) Privileged communication: confidential information told to a physician or attorney by a patient HIPAA regulations must be observed (Chapter 10)

20. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Statutes v. Regulations Statutes: laws passed by Congress or State Legislature (find a statute if it says “USC or USCS” for federal statutes or “ILCS or AZCS,” depending on the state). Regulations: Rule or law made by an agency. Federal Regulation are in the “CFR” or “Code of Federal Regulations.”

21. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Describe the three advance directives available for patients. When are they appropriate? How is an advanced directive put into place?

22. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patient Self-Determination Acts Advanced directive Living will (including a “Do Not Resuscitate” order) Durable power of attorney Uniform Anatomical Gift Act

23. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.5 Sample Living Will

24. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.6 Sample Power of Attorney

25. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 5.6 (continued) Sample Power of Attorney

26. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Definition of Minors Minor: person under the age of maturity (18 in most states) In Loco parentis: person assigned by court to stand in place of parents

27. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Definition of Minors (continued) Mature minor: person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent Emancipated minor: person in mid to late teens who legally lives outside parents’ or guardian’s control

28. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Patient’s Responsibilities Follow physician’s instructions Make follow-up appointments and monitor treatment and medication use if requested by physician Be honest Pay for medical services Provide informed consent

29. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Consent Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment Two types – Informed (expressed) consent – Implied consent

30. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Informed or Expressed Consent Patient agrees to course of treatment after being told consequences of having or not having certain procedures and treatments Signature indicates patient understands limits or risks involved as explained by physician

31. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Doctrine of Informed Consent Requires physician to explain in understandable language – Advantages and risks of treatment – Alternative treatments available to patient – Potential outcomes of treatment – What might occur—risk and benefits—if treatment is refused

32. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Implied Consent Patient indicates by behavior that he or she accepts procedure (i.e., offers arm to have blood sample drawn) Consent is assumed in medical emergencies when patient cannot respond to give consent

33. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Exceptions to Consent Need not inform of commonly known risks Need not inform if disclosure of risks may be detrimental to patient Need not inform if patient asks physician not to disclose risks

34. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Exceptions to Consent (continued) Not required to restore patients to original health Cannot elicit cure for every patient Cannot guarantee successful results of every treatment

35. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Refusal to Grant Consent Adult patients conscious and mentally capable have right to refuse any medical or surgical treatment Refusal must be honored no matter what patient’s reasoning Failure to respect right of refusal could result in liability for assault and battery

36. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Role of Health Care Consumer Do not self-medicate Be honest with physician Assist physician in prevention of medical errors

37. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. What is a "Patient's Bill of Rights"? What responsibility do physicians and other healthcare providers have in reporting suspected abuse? Should physicians have the right to select the patients they wish to treat? Why or why not?

38. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Law and Ethics Public Duties of the Physician Chapter 7

39. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

40. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Births Physician must sign certificate of live birth Certificate is filed at county clerk’s office in state birth took place

41. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7.1 Sample of a Birth Certificate

42. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7.1 Sample of a Birth Certificate (continued)

43. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7.1 Sample of a Birth Certificate (continued)

44. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7.1 Sample of a Birth Certificate (continued)

45. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Date and time of death Cause of death How long deceased was treated before dying Presence or absence of pregnancy Whether autopsy took place Deaths

46. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Deaths (continued) 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

47. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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 – Caused by electrical, radiation, or chemical injury

48. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Examiner Cases (continued) Legal investigation by medical examiner or coroner in case of suspicious death. Investigation is required if death is: – 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

49. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Communicable Diseases Diseases transmitted from one person to another—considered threat to public Reportable diseases National Childhood Vaccine Injury Act

50. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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.)

51. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

52. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Elder Abuse Older American Act (1987) Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older

53. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

54. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Signs of Abuse Signs of inadequate nutrition Venereal disease and genital abrasions Makeup to hide bruises Sunglasses worn inside to hide blackened eyes Repeated injuries Bruises and unexplained swelling Unexplained fractures Bite marks Unusual marks Bruising or swelling in genital area

55. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Substance Abuse Abuse of prescription drugs is reportable immediately according to law Violation of controlled substances laws is a criminal offense

56. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

57. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Gathering Evidence in Cases of Abuse (continued) Evidence includes – Photos – Urine specimen – Clothing – Body fluids – Various samples such as blood, semen, vaginal or rectal smears – Foreign objects

58. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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)

59. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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)

60. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Prescription of 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

61. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Prescription of Controlled Drugs (continued) 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)

62. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 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

63. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Waste Solid Chemical Radioactive Infectious