Law, Ethics, Confidentiality in Allied Health

Law and Medical Offices

refer to professional workspaces where legal and healthcare services are conducted. While they serve different functions, both are structured to support administrative operations, client or patient interactions, and specialized services.

Law Offices:

• Serve as workplaces for lawyers, paralegals, and legal assistants.

• Handle cases related to contracts, litigation, personal injury, business law, family law, and more.

• Maintain client records, legal documentation, and case research.

• May include courtroom preparation, mediation sessions, and advisory services.

Medical Offices:

• Serve as workplaces for physicians, nurses, medical assistants, and administrators.

• Focus on patient care, treatment, and healthcare procedures.

• Maintain electronic health records (EHR), insurance claims, and appointment scheduling.

• May specialize in primary care, surgery, dentistry, therapy, or other medical fields.

What Is Law?

Law is a system of rules created and enforced by governments or societies to regulate behavior, maintain order, and uphold justice. It defines rights, responsibilities, and consequences to ensure fairness and stability.

Key Aspects of Law:

• Criminal Law: Deals with offenses against society (e.g., theft, assault, fraud) and enforces penalties like fines or imprisonment.

• Civil Law: Resolves disputes between individuals or organizations (e.g., contracts, property disputes, family law).

• Administrative Law: Governs how public agencies and officials operate, ensuring regulations are followed.

• Medical Law: Involves healthcare regulations, patient rights, malpractice claims, and insurance policies—closely tied to healthcare administration.

Sources of Law

refers to where laws originate and how they are established within a legal system.

1. Constitutional Law

• Comes from a country's constitution, which defines fundamental rights, governmental powers, and legal principles.

• Acts as the highest constitution, authority in a legal system.

2. Statutory Law

• Laws enacted by legislative bodies (e.g., bodies Congress, Parliament Congress, State Assemblies).

• Includes acts, statutes, and ordinances governing various aspects of society.

3. Case Law (Judicial Precedents)

• Created through court decisions, where judges interpret laws and set precedents.

• Influences future rulings in common law systems.

4. Administrative Law

• Consists of regulations issued of government agencies to enforce laws.

• Governs industries like healthcare, employment, business, and environmental, business, and environmental policy.

5. International Law

• Involves agreements between nations, such as trade treaties, trade regulations, and human rights laws regulations

• Helps maintain global cooperation and diplomatic relations.

Governments create laws.

to maintain order, protect rights, and regulate society. These laws define acceptable behavior, outline penalties for violations, and establish systems for enforcement.

How Governments Create Laws:

1. Legislation – Elected officials (like Congress or Parliament) draft and pass laws.

2. Executive Orders – Government leaders (like Presidents or Governors) can issue directives that function as law.

3. Judicial Precedents – Courts interpret laws and set legal precedents.

4. Regulatory Rules – Government agencies establish regulations that help enforce laws (e.g., healthcare policies, business regulations).

Legislation

Legislation refers to laws that are formally created and enacted by a government’s legislative body, such as Congress, Parliament, or State Assemblies. It establishes rules that govern society, ensuring order, protection of rights, and regulation of various sectors, including healthcare.

Key Aspects of Legislation:

• Drafting & Proposal: Lawmakers propose bills to address specific issues.

• Debate & Review: The proposed laws are discussed, amended, and evaluated.

• Approval & Enactment: Once passed, laws are signed into effect by a governing authority (e.g., President or Governor).

• Implementation & Enforcement: Government agencies ensure compliance with the law.

Federal and state legislative bodies pass legislation called statutes.

Administrative Regulations

Administrative regulations are rules and guidelines created by government agencies to implement and enforce laws passed by the legislative branch. These regulations provide specific details on how laws should be applied in various industries, including healthcare, business, and labor.

Key Features of Administrative Regulations:

• Issued by government agencies (e.g., OSHA for workplace safety, CMS for healthcare policies).

• More detailed than statutes, explaining how laws should be followed in practice.

• Legally binding, meaning organizations must comply or face penalties.

• Regularly updated, adapting to new policies and societal needs.

Examples in Healthcare Administration:

• HIPAA (Health Insurance Portability and Accountability Act) – Protects patient privacy.

• CMS Guidelines – Covers Medicare and Medicaid rules.

• OSHA Regulations – Ensures workplace safety in medical facilities.

Common Law

a legal system based on court decisions and judicial precedents rather than written statutes or codes. It evolves over time as judges interpret laws and apply rulings to individual cases, shaping legal principles through decisions.

Key Features of Common Law:

• Based on precedents (past court rulings that set legal standards).

• Flexible and evolving, adapting as new cases arise.

• Judges play a major role in shaping legal interpretations.

• Used in countries like the U.S., U.K., Canada, and Australia.

Licensing and Certification of Medical Personnel

Licensing protects the public by ensuring that such medical personnel have met certain minimum requirements.

Licenses can also be revoked. Grounds for revocation include unprofessional conduct, fraud, substance abuse, criminal conduct, and mental incapacity.

Laws and regulations may prohibit persons without medical training from performing some medical-related tasks, such as administering injections, which must be performed by people with specific training or education.

Certification

refers to a professional organization or institution representing that a certified person has passed a test, completed a course of study, or demonstrated knowledge or skill in some other way.

Liability:

Negligence Liability

refers to the legal responsibility a person or entity holds when their failure to exercise reasonable care results in harm to another party. It is a fundamental concept in tort law, often seen in personal injury cases, medical malpractice, and workplace accidents.

Key Elements of Negligence Liability

To establish negligence, the following elements must be proven:

1. Duty of Care – The defendant had a legal obligation to act responsibly toward the plaintiff.

2. Breach of Duty – The defendant failed to meet the expected standard of care.

3. Causation – The breach directly caused harm or injury.

4. Damages – The plaintiff suffered actual losses (physical, financial, or emotional).

Examples of Negligence Liability

• A doctor misdiagnosing a patient due to carelessness.

• A business failing to maintain safe premises, leading to customer injuries.

• A driver causing an accident due to reckless behavior.

Medical coders

Medical coders must adhere to standards of care, and understand the scope of their responsibilities.

Due care

refers to the level of caution, responsibility, and judgment that a reasonable person would exercise in a given situation to prevent harm or negligence. It is a fundamental concept in legal and ethical standards, particularly in areas like healthcare, business, and personal liability.

Key Aspects of Due Care

• Legal Obligation: Individuals and organizations must act with reasonable care to avoid causing harm.

• Standard of Care: The expected level of diligence varies depending on the situation (e.g., a doctor must follow medical protocols, a business must ensure workplace safety).

• Negligence Connection: Failure to exercise due care can lead to liability for negligence, where harm results from careless actions.

Examples of Due Care

• A doctor following proper procedures to ensure patient safety.

• A business maintaining safe premises to prevent customer injuries.

• A driver obeying traffic laws to avoid accidents.

Vicarious Liability

When one person is held responsible for the actions of another

respondent superior

in Latin means "Let the master answer." Scope of employment refers to actions taken in furtherance of the employer's business.

Difference between an employee and an independent contractor

depends on how much control the employer has over the person performing the work. Whether someone is an employee or an independent contractor matters because employers aren't vicariously liable for an independent contractor's negligence. Medical coders are generally employees, but may also work as independent contractors in some situations.

Prelitigation

refers to the period before a legal dispute officially becomes a lawsuit. It involves efforts to resolve conflicts without going to court, such as negotiations, demand letters, mediation, and settlement discussions.

Contingency fee

a payment structure where a lawyer only gets paid if they win the case or secure a settlement for their client. Instead of charging an upfront fee or hourly rate, the attorney receives a percentage of the final award or settlement—often ranging from 25% to 40%, depending on the type of case and agreement.

Litigation

Litigation begins when a complaint is filed with the court and served to the parties being sued. The plaintiff's (the person who is suing) complaint would be served—or delivered—to the defendants, or the people being sued, along with a summons, which is the court's formal notice that one is being sued.

Trial

A trial finds—or determines—the facts and applies the law to the facts.

jury trial

the fact-finder, and the judge explains the law to the jury and supervises the presentation of evidence.

Bench Trial

there's no jury—the judge serves as the fact-finder, weighs the evidence, and decides how the law applies to it.

Burden of Proof

what the plaintiffs are obligated to prove—in a civil case such as medical malpractice is a preponderance of evidence.

The burden of proof in a criminal case is different.

The prosecutor must prove guilt beyond a reasonable doubt to convict someone of a crime. The standard of beyond a reasonable doubt is much higher than a preponderance of evidence.

Evidence Rules

A jury hears the evidence of a case and decides whether there's enough evidence to make a judgment.

Preparing for Testimony

When testifying, a person must tell the truth, as perjury—false swearing under oath—is a crime.

• Answer only the question asked. Don't volunteer information that's not requested, especially on cross-examination.

• Ask to have the question repeated if you don't understand it or if it's complicated.

• Dress and behave professionally and respectfully.

• Don't argue, joke, or act flippant or bored. Be pleasant but serious.

ADR

Alternative Dispute Resolution

The two main types of ADR are arbitration and mediation.

Mediation

occurs when a neutral third person helps the parties in a dispute reach a settlement agreement. Mediators aren't judges—they don't hear evidence or make a decision about who is right.

There are two main styles of mediation:

facilitative

evaluative

In facilitative mediation, the mediator guides the mediation process, but doesn't express opinions on the merits of each party's position.

In evaluative mediation, however, the mediator gives opinions about the merits of the case, pointing out weaknesses in the position of the parties, and may predict what a judge or jury likely would do.

Law

The set of rules that govern our behavior

Criminal Law

Prohibits and punishes certain conduct for the benefit of society

Crime

An offense against a locale, a state, or the United States

Civil Law

Concerns the private rights and duties of individuals who live within a society

Right

An individual power, privilege, or immunity

Duty

An individual obligation

Three Levels of Government

federal, state, local

Statutes

Legislation passed by governing bodies on federal and state levels

Ordinances

Legislation adopted by local legislative bodies

Negligence

Failing to meet a standard of reasonable care

Due Care

The responsibility of a physician to hire qualified personnel and supervise the personnel accordingly

Alternative Dispute Resolution (ADR)

A process for resolving disputes outside of the court system that may be used before or after litigation has begun

Litigate

To begin a legal process involving a court

Plaintiff

The person who is suing

Defendant

The person who is being sued

Deposition

The taking of oral testimony under oath before trial

Jury Trial

A trial in which the jury is the fact-finder; the judge explains the law to the jury and supervises the presentation of evidence

Perjury

False swearing under oath

Appeal

During an appeal, the question is whether an error of law was made at the trial court level

Arbitration

Two parties present evidence to an impartial person who makes a binding decision

Defensive Medicine

Consists of medical responses that are motivated by a desire to avoid potential liability claims more than by the needs of the patient

Malpractice

Professional negligence

Expert Witnesses

People who have skill, experience, training, or education in a specialized field that ordinary people don't have

Types of Malpractice

Failure to diagnose

Failure to inform of diagnosis

Errors in treatment

Lack of informed consent

Informed Consent

Refers to a patient's acceptance of treatment after the doctor properly informs the patient about the treatment

Battery

The harmful touching of a patient without consent

Living Will

A document that states the patient's wishes regarding being allowed to die a natural death if the patient is in a permanent vegetative state or a terminal condition and lacks the ability to make medical decisions

Product Liability

The legal responsibility that a manufacturer or distributor of an unreasonably dangerous product has for damages caused by the dangerous condition

Contributory Negligence

When a patient contributes to causing himself or herself harm

Statutes of Limitations

The time periods during which a lawsuit must be brought

Negligence Versus Malpractice

Negligence is a failure to exercise the degree of care that a reasonable person would exercise under the same circumstances. A reasonable person is a prudent individual whose behavior would be considered appropriate under the circumstances.

Professional negligence is known as malpractice.

The difference between ordinary negligence and malpractice

is the standard of care required of the injuring party. Doctors and other healthcare professionals are held to a higher standard of care because of their specialized training and knowledge.is the standard of care required of the injuring party. Doctors and other healthcare professionals are held to a higher standard of care because of their specialized training and knowledge.

The professional standard of care

applies from the time the doctor-patient relationship begins until it ends. Healthcare professionals must exercise the degree of skill that other professionals with similar training would exercise under similar circumstances.

The Standard of Care

The standard of care is defined according to what an ordinarily prudent physician would have done under the same or similar circumstances. . . . Identifying the standard of care is critical. Whether a defendant physician breached his duty of care to a patient can't be determined without specific information about what the defendant should have done differently in a particular case.

Nonphysician Malpractice

Nurses, physician assistants, medical coders and medical assistants who undertake to perform medical services are held to a professional standard of care.

Res Ipsa Loquitur

"the thing speaks for itself." This sometimes can be the case in medical malpractice.

Types of Malpractice:

Failure to Diagnose

Doctors could fail to diagnose by failing to observe what should have been observed, to order tests that could provide information to diagnose, or to interpret properly the observations and tests results.

Failure to Inform of Diagnosis

Failure to inform a patient of the diagnosis deprives the patient of the chance to make decisions that could prevent or reduce the harm from the condition.

Errors in Treatment

Errors in treatment can include failure to treat in a timely manner. Delay in treatment, just like delay in diagnosis, can harm the patient.

Lack of Informed Consent

The patient can always refuse treatment. Informed consent refers to a patient's acceptance of treatment after the doctor properly informs the patient about the treatment.

Consent is relevant to the tort of battery—the harmful touching of a patient without consent.

Special Rules for Minors

Where these statutes apply, the minor is treated similarly to an adult for purposes of consent, privacy, access to medical records, and confidentiality, though the parents or guardian may still be financially responsible for the cost of treatment.

Rules concerning the ability of minors to consent to medical treatment generally, and to specific treatments, vary from state to state. The medical office should be aware and conscientious regarding the rights and powers of mature minors to make medical decisions in accordance with state law.

Consent in Emergency

States may excuse failure to obtain consent in emergency situations where the consent of the patient can't be obtained before providing healthcare services.

Advance Medical Directives

Some states have laws permitting advance medical directives.

Advance medical directives, sometimes called healthcare directives, give instructions in advance about what a patient wants to be done medically in given situations.

Abandonment

Abandonment of the patient can constitute malpractice. Two types of abandonment can occur. The doctor could neglect the patient out of carelessness, or the inattention could be because the doctor believed erroneously that the doctor-patient relationship no longer existed. Recognizing that follow-up is part of treatment can reduce exposure to claims of abandonment.

Other Ways to Commit Malpractice:

Doctors have the duty to:

• Inform a patient fully of his or her condition

• Notify a patient of the results of diagnoses or tests

• Inform a patient of the need for different treatments

• Refer a patient to a qualified specialist