Laws of Healthcare

HCR 210 Ethics for the Healthcare Professional Learning Objectives: • Understand professional relationships, issues of leadership, work-place bullying, and issues of discrimination • Understand basic legal terminology in relationship to health care • Understand the relationship between legal considerations and ethical decision making • Apply the professional code of ethics pertinent to a chosen health care profession Laws of Healthcare What is Law? • A system or rules for action and conduct that governs the behavior of people. • Functions to: o Define relationships among members of society and declare which actions are and are not permitted o Describe what constraints are used to maintain rules and by whom they may be applied o Find solutions to problems o Redefine relationships between people when circumstances of life change What Makes Law? Constitutional Law Statutory/ Legislative Law Administrative Law Common Law (Roe v Wade) Based on US Constitution Based on Federal or State legislation Based on governmental agencies Based on previous cases/precedent Basics of Law Law Public Law Rights in relation to govt Persecuted by the state or federal govt Private Law Rights in relation to other people Private citizen action Civil Law Criminal Law • Misdemeanors • Felonies Contract Law Tort Basics of Law - Terminology Contract law: Deals with the rights and obligations of people who make contracts. Tort: A wrong or injury that a person suffers because of someone else's action either intentional or unintentional Penalties associated with violations in contract laws or torts are monetary. Basics of Law Law Public Law Rights in relation to govt Persecuted by the state or federal govt Private Law Rights in relation to other people Private citizen action Civil Law Criminal Law • Misdemeanors • Felonies Contract Law Tort Patient-Provider Relationship Healthcare providers and patients form a contractual agreement. If the provider wants to end the patient-provider relationship, then they are recommended to take steps to avoid being accused of patient abandonment (AMA 2016): • Giving patient written notice • Provide specific reason for termination • Continue to provide care for reasonable time for patient to find new provider • Provide assistance to patient to find new provider • Offer to transfer medical records with patient’s permission Basics of Law Law Public Law Rights in relation to govt Persecuted by the state or federal govt Private Law Rights in relation to other people Private citizen action Civil Law Criminal Law • Misdemeanors • Felonies Contract Law Tort Basics of Law Tort Intentional Torts • Assault and battery • Invasion of privacy • Fraud • False imprisonment • Slander/Libel Unintentional/Negligence • Inappropriate care or withheld care that results in patient injury or harm Medical malpractice Basics of Law - Terminology Act must be intended however no legal requirement that the act caused damages or injury Fraud: A deliberate deception for the purpose of securing an unfair or unlawful gain • Examples: deliberately overbilling patients for monetary gain False imprisonment: Unjustifiable restraint of a person within fixed boundaries • Examples: locking patients in rooms, denying use of the telephone or restraining a patient who is not intoxicated, mentally ill, disoriented, or a substance abuser Basics of Law Tort Intentional Torts • Assault and battery • Invasion of privacy • Fraud • False imprisonment • Slander/Libel Unintentional/Negligence • Inappropriate care or withheld care that results in patient injury or harm Medical malpractice Basics of Law - Terminology Negligence: The omission to do something that a reasonable person would do, guided by those ordinary considerations which ordinarily regulate human affairs Medical Malpractice: A type of negligence committed by a person in a professional capacity in which there is an unreasonable lack of professional skill or nonadherence to the accepted standard of care causes injury Malpractice Litigation Components of a malpractice case must include: • Duty owed to the patient • Breach of standards or failure to carry out duty • Foreseeability • Actual injury or damages suffered by the patient • Casual relationship with the breach of standard care or duty and the injury “Never Events” Serious, reportable events as a result of negligence and are considered preventable. • Surgical (wrong site, wrong patient, retained foreign body) • Product or Device (contained device or medication) • Patient Protection (patient harm from suicide or attempted suicide while being cared for in the hospital) • Care Management (medication errors, stage 3 and 4 pressure ulcers) • Environment (injury from fall while in hospital) • Criminal (physical assault, impersonation of a medical professional) Malpractice Insurance Malpractice Defensive Medicine As a result of the increase in malpractice insurance premiums, the concept of defensive medicine has been introduced… which means that providers often order more tests and provide more services than necessary to protect themselves from malpractice lawsuits. Defensive Medicine What is Tort Reform? - Discussion Do you think tort reform is necessary? Do you think tort reform is effective? Risk Management Reducing the risk of malpractice litigation can be accomplished by: • Maintaining open communication with patients • Maintaining expertise in practice with attention to details • Maintain autonomy and empowerment Risk Management Maintaining open communication with patients • Be kind, listen and show respect • Do not make judgements or belittle patients • Involve the patient and patient’s family members (with consent) in decision making • Asses the patient’s level of understanding • Explain in understandable language • Clarify and verify orders; avoid telephone orders or advice over the telephone if possible Risk Management Maintaining expertise in practice with attention to details: • Keep up to date in knowledge and skills • Practice within the scope of profession • Follow the standards of care • Be alert to patients’ changing health status • Pay close attention to detail and avoid distractions • Document immediately and thoroughly Risk Management Maintain autonomy and empowerment: • Challenge questionable orders • Seek attention for patients with changing health status • Challenge bureaucratic structures that threaten patient welfare • Being vigilant against invasions of privacy and confidentiality • Avoid a workplace in which systemic and persistent threats to patient welfare occur Malpractice Litigation Basics of Law Law Public Law Rights in relation to govt Private Law Rights in relation to other people Civil Law Criminal Law • Misdemeanors • Felonies Fraud, Assault and Battery etc Contract Law Tort Is Lawful Always Ethical? - Discussion Do you believe that lawful acts are always morally correct and vice versa? What should you do if are in a position where the morally correct action is unlawful, or the law in a certain instance is immoral? Recent Events • Vanderbilt RN accidentally administered wrong medication to patient; resulted in patient’s death • Found guilty of negligent homicide and abuse of an impaired adult • Increasing events of healthcare workers being charged under public/criminal law for medical accidents/mistakes that previous would have been considered civil law Questions?