NHA CCMA 3.0 Module #13: Medical Law and Ethics

Advance directives

Written statements of a person's wishes regarding medical treatment, such as a living will.

Autonomy

The capacity to think, decide, and act on one's own free will and initiative.

Beneficence

A moral obligation to act in the best interest of others.

Do-Not-Resuscitate (DNR)

An order written in the hospital or on a legal form to communicate the wishes of a patient to not undergo CPR or advanced cardiac life support if the patient's heart stops or the patient stops breathing.

Durable Power of Attorney (DPOA)

A legal document naming a health care agent or proxy to make medical decisions for patients when they are not able to do so, in the case they become incapacitated or unable to communicate.

Ethics

Set of principles that differentiate between right and wrong.

Implied consent

Consent granted when a patient assumes the position and allows the medical professional to perform it.

Informed consent

An oral or written agreement of mutual communication that ensures the patient has been notified about their health care choices before making them.

Justice

Fair distribution of benefit, risk, resources, and cost to ensure equal treatment.

Malpractice

Any treatment by a medical professional that does not follow the standards of care. Negligence by a professional.

Negligence

When a person does not receive adequate and appropriate care, which leads to suffering and harm.

Nonmaleficence

A commitment not to cause harm.

Physician Orders for Life-Sustaining Treatment (POLST)

Type of advance directive, typically reserved for patients who may be near end of life.

Subpoena Duces Tecum

A requirement to bring requested documentation to the court of law when appearing for the summons.

Tort

"Wrong," or a harmful act committed by one individual to another.

Patient's Bill of Rights

For patients, the American Hospital Association (AHA) created the original Patient's Bill of Rights in 1973, which provides guidelines and guarantees by federal law to ensure the protection and safety of patients.

Patient Protection and Affordable Care Act

Commonly called the Affordable Care Act (ACA) or "Obamacare," named after former president Barack Obama, who signed it into law in 2010, this federal statute was a major step in health care reform by expanding access to more affordable, quality health insurance, increasing consumer insurance protection, emphasizing prevention and wellness, and curbing rising health care costs.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

HIPAA gives patients rights over their health information and sets rules and limits on who can look at and receive patients' private information. HIPAA applies to protected health information (PHI), whether electronic, written, or oral.

Health Information Technology for Economic and Clinical Health (HITECH) Act

The HITECH Act expands on HIPAA and includes provisions that allow for increased enforcement of the privacy and security of electronic transmission of patient information, such as prohibiting the sale of PHI, making business associates and vendors liable for compliance with HIPAA, and creating a penalty and violation system.

Occupational Safety and Health (OSH) Act

The OSH Act is overseen by the Occupational Safety and Health Administration (OSHA) and states that employers are accountable for providing a safe and healthful workplace for employees by setting and enforcing standards and by providing training, outreach, education, and assistance.

Controlled Substances Act (CSA)

CSA is a federal policy that regulates the manufacture and distribution of controlled substances. Controlled substances can include narcotics, depressants, and stimulants. The CSA classifies medications into five schedules, or classifications, based on the likelihood for abuse and if there are any medical benefits provided from the substance.

Emergency Medical Treatment and Active Labor Act (EMTALA)

The EMTALA of 1986 requires any hospital emergency department that receives payments from federal health care programs, such as Medicare and Medicaid, to provide an appropriate medical screening to any patient seeking treatment. This was enacted to eliminate "patient dumping," where a facility would transfer a patient based on a potentially high-cost diagnosis or refuse to treat a patient based on their ability to pay. This legislation requires the emergency department to determine whether a condition is emergent or not and to provide stabilizing treatment in the case of an emergency medical condition. It does not require that treatment be given for nonemergency conditions. Furthermore, outpatient clinics are not medically equipped to handle emergencies and therefore are not bound by the EMTALA.

The Clinical Laboratory Improvement Act (CLIA)

The CLIA of 1988 is a group of laws that regulate all laboratory facilities for safety and handling of specimens. The objective of CLIA is to regulate accuracy and timeliness of testing regardless of where the test is performed. The Food and Drug Administration (FDA) is the federal agency that authorizes and implements the CLIA laws and determines the test complexity categories.

Title VII of Civil Rights Act of 1964

The Civil Rights Act prohibits an employer with 15 or more employees from discriminating on the basis of race, national origin, gender, or religion. The Civil Rights Act has also been amended several times to protect other groups. For example, the Pregnancy Discrimination Act of 1978 amended the Civil Rights Act and prohibited discrimination based on pregnancy and other related medical conditions. Sexual harassment is a form of sex discrimination that also violates the Civil Rights Act.

Americans with Disabilities Act of 1990 (ADA)

ADA forbids discrimination against any applicant or employee who could perform a job regardless of a disability. ADA also requires an employer to provide "reasonable accommodations" that are necessary to help the employee perform a job successfully unless these accommodations are unduly burdensome.

Heads of the European Radiological Protection Competent Authorities (HERCA)

An association which identifies radiation protection issues and proposes possible solutions.

Good Samaritan Acts

Allows bystanders to get involved in emergency situations without fear that they will be sued if their actions inadvertently contribute to a person's injury or death.

Genetic Information Nondiscrimination Act of 2008 (GINA)

Prohibits discrimination on the basis of genetic information with respect to health insurance and employment.

Patient Safety and Quality Improvement Act (PSQIA)

Framework for gathering and analyzing information regarding patient safety within the confines of protected health information laws.

Anti-Kick Back Statute (AKBS)

Criminal law that prohibits receiving benefits for referral or business involving federal health care programs.

No Surprise Act (NSA)

The No Surprise Act protects individuals from surprise billing if they have a group health plan or individual health insurance coverage. This includes banning surprise bills for emergency services from an out-of-network provider or facility without prior authorization.

Three Safeguards to keep pt info private

1. Administrative

2. Physical

3. Technical

Exceptions for release of medical records without patient's consent

1. Criminal acts

2. Legally ordered

3. Communicable diseases

4. Mandated exams

Expressed consent

consent given by oral or written words

Advance directive

a set of requests that patients put in writing for others to carry out in the event they are unable to do so themselves.

Living Will

a legal document stating what procedures a patient would want, wouldn't want, and under what conditions these decisions would apply.

Criminal Law

violations against society

Misdemeanor

lesser crime than a felony; monetary fines or less than 1 year in prison

Felony

more serious crime; larger fines and/or more than 1 year in prison

Civil Law

violations against a person or a person's property

Intentional tort

Done on purpose; Assault, battery, defamation of character

Unintentional tort

Accidental; Malpractice

Four Ds of Malpractice

Duty (obligation to your pt)

Derelict (failed to do your job)

Direct Cause (failing to do your job caused the injury)

Damage (pt got injured)

What must me mandatorily reported?

births, deaths, certain communicable diseases, assaults and criminal acts, abuse/neglect/exploitation

Abuse

intentional harm to a person that may be physical, emotional, verbal, psychological, sexual, or economic

Common Ethics

Groups of ethics; a system of principles and rules of conduct accepted by a group based on ethnicity, political affiliation, or cultural identity.

Professional Ethics

a type of ethics that aims to define, clarify, and criticize professional work and its typical values.

Medical Ethics

the morals, moral principles, and moral judgments that health care professionals use to determine whether an action should be allowed based on "right and wrong."

Cultural Competence

the ability of providers and organizations to effectively deliver health care services that meet the needs of patients.

Culture

the act of belonging to a designated group that shares experiences that shape the way its members understand the world

Bias

preference for a certain group, concept, or set of things