NHA CCMA MEDICAL LAW AND ETHICS

Criminal law

Addresses rules and statutes that define wrongdoings against the community as a whole; laws that deal with crimes and their punishments

Misdemeanor

Less serious than a felony, lesser penalty; fine or imprisonment for < 1 year

Reckless driving, discharging firearm in city limits

Felony

More serious than a misdemeanor, stiffer penalty; imprisonment > 1 year and in extreme cases, can result in the death penalty

Assault

Instance in which someone tries or threatens to cause harm to an individual physically

Battery

Intentional touching or use of force in a harmful manner without an individual's consent

Giving immunization without consent

Plaintiff

Individual that files lawsuit to initiate legal action

Defendant

Person being sued/accused of crime in a court of law

Subpoena

A written order that commands someone to appear in court to give evidence

Deposition

Formal statement in which an individual who is being deposed promises to tell the truth

Civil law

Governs the private rights of individuals, corporations, and gov't bodies

Includes cases involving contracts, family matters, property issues and usually no fines or imprisonment

Administrative law

Body of law in the form of decisions, rules, regulations, and orders created by administrative agencies under the direction of the executive branch of the gov't used to carry out duties of such agencies

Responsible for protecting civil rights, privacy, and safety of citizens

Overseen by administrative judges at state or federal law

Contract

Legally binding agreement between two parties

Elements of a contract

1. Mutual assent (agreement by all parties to contact)

2. Consideration (benefit for entering the contract, i.e. financial reimbursement)

3. Capacity (legally able to contact, i.e. legal age and sound mind)

4. Legality (subject matter must be legal)

Breach of contract

Violation of an obligation, tie, or standard

Why medical consent forms have "do not guarantee satisfactory results"

Litigation

Lawsuit or legal action that determines legal rights and remedies of the person/party and will include defendant and plaintiff

Affordable Care Act (ACA)

Put in place to reform the healthcare system by providing more Americans with affordable, quality health insurance to ultimately curb the growth in healthcare spending in the US

Occupational Safety and Health Administration (OSHA)

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

Health Insurance Portability and Accountability Act (HIPAA)

Gives pts rights over their health information and sets rules and limits on who can look at and receive pts' private information; applies to protected health information (PHI) that is electronic, written, or oral

Protects release of medical information to a pt's employee without consent

Controlled Substances Act (CSA)

Federal policy that regulates the manufacture and distribution of controlled substances (narcotics, depressants, stimulants); classifies medications into five schedules based on the likelihood of abuse, status in international treaties, and any medical benefits the substance may provide

Title VII of Civil Rights

Prohibits an employer with > 15 employees from discriminating on the basis of race, national origin, gender, or religion

Equal Pay Act

Mandates same pay for all people who do substantially equal work regardless of sex

Americans with Disabilities Act (ADA)

Forbids discrimination against any applicant or employee who could perform a job regardless of a disability; requires employer to provide accommodations that are necessary to help the employee perform a job successfully unless burdensome

Family Medical Leave Act (FMLA)

Federal law that requires certain employers to give time off to employees for familial or medical reasons

Medical Order for Life-Sustaining Information

Provides medical orders from pt's provider regarding the pt's wishes for life-sustaining treatment; moved btwn facilities when pt is transferred

Uniform Anatomical Gift Act

Establishes right of pts to document wishes concerning organ donation in case of death

Patient Self-Determination Act

Establishes right of pts to determine what care they receive in case of medical need

Patients' Bill of Rights

Ensures and clarifies various rights of a pt receiving medical care

Patient determines what treatments they will receive

Protects pts from being denied fair treatment or participation in research studies due to certain criteria (i.e. age)

Allows pts to submit complaints about services provided by staff

Indicates what medical information a pt can view or have access to

Right to confidentiality in healthcare

Good Samaritan Act

Protects those who assist others in emergency and voluntary capacity from fear of lawsuit if an injury occurs

Whistleblower Protection Act

Protects employees from retaliation when reporting suspected unsafe activities in the workplace

Standard of Care

Degree of care or competence that one is expected to exercise in a particular circumstance or role

Negligence

Failure to do something that a reasonably prudent individual would do under similar circumstances (breaching standard of care, i.e. performing out of your scope of practice)

Use standard of care to decide if provider met necessary requirements to perform their role through an expert witness with similar training and credentials

Tort

Action that wrongly causes harm to an individual but is not a crime and is dealt with in civil court

Intentional tort

Deliberate act that violates rights of another; intentional wrongful act by a person or entity who means to cause harm, or who knows (or is reasonably certain) that harm will result from the act

Assault, battery, defamation of character, invasion of privacy, admin injection w/o consent of pt; don't need to prove that they intended to cause harm, just that willful act caused harm

Defamation of character

Hurting someone's reputation

Slander

Verbal defamation; to make false spoken statement that causes people the have a bad opinion of someone

Libel

Written defamation; false accusation that is made with malicious intent to hurt the reputation of a person who is living or the memory of a person who is dead, resulting in public embarrassment, contempt, ridicule, or hatred

Invasion of privacy

Intrusion into the personal life of another individual without just cause (i.e. prying into pt's medical record, sharing info about pt to another party w/o consent)

Negligent torts

Unintentional acts where the defendant failed to live up to a standard of care owed to the plaintiff, and the plaintiff was injured as a result

Res Ipsa Loquitur

Negligence is obvious, "it speaks for itself"; doctrine or rule of evidence in tort law that allows interference or presumption that defendant was negligent in an accident injuring the plaintiff on the basis of circumstantial evidence if the accident was of a kind that does not usually happen without negligence

The very nature of the case indicates malpractice

Example = finding instrument inside a pt following surgical procedure or pt sustaining burns while on heating blanket

Respondeat Superior

Doctrine in tort law that makes employer liable for wrong of an employee when the actions are performed within the constraints of their position

Came from common law "master-servant" rule

Four D's of Negligence

Duty, dereliction, direct cause, damages

Malfeasance

Performing an unlawful, wrongful act

Performing procedure on wrong pt

Misfeasance

Performance of a lawful action illegally/improperly

Performing procedure on right pt but doing it incorrectly

Nonfeasance

Failure to perform a task, duty, or undertaking that one has agreed to perform or has a legal duty to perform

Waiting to treat a pt until it is too late

Implied consent

Voluntary agreement with an action proposed by another

Pt rolling up sleeve to give blood

Rules for using a fax machine

Never leave confidential information on a fax machine

Use a cover page

Verify the correct fax number

Shred documents when necessary

Make sure fax machine, copier, and computer aren't visible to patients

Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009

Created to improve healthcare quality, safety, efficiency for information tech (EHR); barriers to information exchange, nationwide use of health information tech

How long does HIPAA require document retention?

6 years

What should you do if you witness a breach in privacy?

Must be reported unless there is low probability that health information was compromised

Exceptions to breach

Unintentional acquisition of PHI

Unintentional disclosure of PHI

Good-faith belief that unauthorized person would not retain information

Time limit to file OCR complaint?

180 days

Hippocratic Oath

Oath taken by medical students swearing to practice medicine in an ethical way

Ethical dilemma

2 or more acceptable solutions but only 1 option can be chosen

Locus of authority issue

2 or more authority figures disagree on how situation should be handled

Dilemma of justice

Benefits cannot be fairly distributed to healthcare consumers

Ethical distress

Ethically correct action is indicated, but some type of barrier prevents one from following through with that action

Living will

Legal document stating what procedures the pt would want, which ones they wouldn't want, under what conditions they want provider to do organ/tissue donation, dialysis, blood transfusions, DNR orders

Durable power of attorney for healthcare

Legal document naming healthcare agent or proxy to make medical decisions for pts when they are not able to do so; agent will be able to decide as the pt would when treatment decisions need to be made; enables pts to be more specific about medical treatment vs. living will

Do-not-resuscitate (DNR)

Indicate to medical staff to not return heart to normal rhythm if stops or beats unevenly

MOLST

Document that specifies which treatments will be allowed during end-of-life care; provider must sign off on these orders; move with the pt if they change facilities; bright pink

Organ and tissue donation

Allow organs or body parts from healthy person to be transferred to people who need them

Healthcare proxy/agent

Person assigned to make healthcare decisions for the pt if they are incapacitated

> 18 years or older

Informed consent

Clear and voluntary indication of preference or choice, oral or written, freely given in circumstances where available opinions and consequences are made clear

Consent forms prior to procedure

Provider determines if pt is competent

Provider describes procedure, risks, and reviews alternative procedures before

MA validates pts signature as witness

Abandonment of care

Wrongful termination of providing patient care; no formal notice of withdrawal given from the case

The Joint Commission (TJC)

Accreditation that helps organizations position for the future of integrated care, strengthen pt safety and quality of care, improve risk management and risk reduction, and provide framework for organizational structure and management

Inspects and accredits clinical laboratories every 2 years

Statute of limitations

Legal length of time regarding storage of medical and business records

Closed case

Pt is not expected to return to practice b/c moved away

Fee splitting

If a physician accepts payment from another physician solely for the referral of a patient

First ethics code written by who?

Hammurabi

But no longer relevant

Expressed consent

Used by the spoken or written word

Ethical standards

Promote trust, good behavior, fairness, kindness

guardian ad litem (GAL)

A special guardian (often, but not always, an attorney) appointed by the court to appear in court proceedings on behalf of a person who is a minor, is insane, or is otherwise incapacitated.

Malpractice

Medical professional liability including all liability that can occur during medical care

An act or omission by the provider during treatment that deviates from accepted norms and can cause injury

Treatment provided does not meet expected levels of care

National Institutes of Health (NIH)

a division of the USDHHS; involved in research on disease

AMA Code of Ethics

What a medical assistant uses when facing ethical dilemma

Percival's Code

Sociological matters

Acknowledged in AMA code of ethics

Contributory negligence

A patient ignoring medical advice