Module 13: Medical Law and Ethics

Who created Patient’s bill of rights?

American hospital association (AHA) in 1973

Patient’s bill of rights

federal law that ensures protection and safety of patients

help patients feel more confident in health care system and to strengthen their relationship with the provider by defining their rights, responsibilities and those of the provider

How many guarantees are in the patient’s bill of rights?

15 guarantees for all patients seeking medical care

• paitent has right to be treated fairly and respectfully

• right to get information they can understand about diagnosis, treamtent, and prognosis

• right to discuss and ask for information about specific procedures and treatments

• right to know the identities of their health care providers, including students, residents, and other trainees

• right to know how much care may cost at time of treatment and long term

• right to make decisions about their care before and during treamtnet, and right to refuse care

• right to advanced directive, living wll or power of attorney

• right to privacy in medical exams, case discussions, consultations, and treatments

• right to expect that their communications and records are treated as confidential

• right to review their medical records and have them explained/interpreted

• right to expect that hospital will respond reasonably to their requests for care

• right to ask and be informed of any business relationships between hospital and other entity that affects their care

• right to consent or decline to participate in research studies

• right to expect reasonable continuity of care and be informed of other care options

• right to be informed of hospital policies

• right to know whom they can contact to resolve disputes, grievances, conflicts

Patient protection and affordable care act (ACA)

“Obamacare”, signed into law in 2010

federal statute expanding access to more affordable and quality health insurance increasing consumer insurance protection and emphasizing prevention and wellness while curbing rising health care costs

Health insurance portability and accountability act of 1996 (HIPAA)

gives patients rights over their health information and sets rules and limitations on who can look at and receive patient’s private information

applies to protected health information (PHI) whether electronic, written, oral

Health information technology for economic and clinical health (HITECH) act

expands on HIPAA and includes provisions that increase enforcements of privacy and security of electronic transmission of PHI

prohibits sale of PHI, makes business associates and vendors liable for compliance with HIPAA and creating a penalty and violation system

Occupational Safety and Health (OSH) act

overseen by OSHA, states that employers are accountable for providing a safe and healthful workplace for employees by setting and enforcing standards, providing training, outreach, education, assistance

Controlled substances act (CSA)

federal policy that regulates manufacture and distribution of controlled substances

narcotics, depressants, and stimulants (classified into 5 schedules based on likelihood of abuse)

Emergency medical treatment and labor act (EMTALA)

1986, requires any hospital emergency department that receives payments from federal health care programs (medicare, medicaid) to provide appropriate medical screening to any patient seeking treatmnet

Patient dumping

facility would transfer patient based on high cost diagnosis or refuse to treat patient based on their ability to pay

EMTALA enacted to stop this

Clinical laboratory improvement act (CLIA)

1988, group of laws that regulate all laboratory facilities for saftey and handling of specimens

regulate accuracy and timeliness of testing, regardless of where test is performed

What federal agency authorizes and implements CLIA laws and determines test complexity?

Food and Drug administration

Title VII of civil rights act of 1964

prohibits employer with 15+ employees from discriminating on basis of race, national origin, gender, or religion

amended several times (pregnancy discrimination act of 1978)

sexual harassment is a form of sex discrimination and also violates civil rights act

Americans with disabilities act of 1990 (ADA)

forbids discrimination against any applicant who can perform job regardless of disability

requires employer to provide reasonable accommodations that are necessary to help employee perform job successfully (unless those accommodations are burdensome)

Heads of the european radiological protection competent authorities (HERCA)

association which identifies radiation protection issues and proposes 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 basis of genetic information for health insurance and employment

patient safety and quality improvements 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 programs

No surprise act (NSA)

protects from surprise billings if they have group insurance plan or individual insurance coverage

bans surprise bills for emergency services for out of network provider

HIPAA security rule

requires implementing reasonable and suitable safeguards to protect PHI

• administrative safeguards: policies and procedures documented in writing to show how covered entities comply with HIPAA

• physical safeguards: physical monitoring and access to PHI

• technical safeguards: responsibility of the health care provider to monitor and safeguard PHI through all tech related items

Medical records

legal documents gathered by health care provider or facility

since they are legal documents: original must remain with health care facility

Patient has a right to the information that is in the record, so they can inspect, review, and receive a copy of their records

Who owns a patient’s medical records?

the health care provider

Who owns the medical record’s information or data found within the record?

the patient (or family members with patient’s consent)

Signed release form

patients can request release of their medical records/recieve copies of their medical records

this form ensures that it remains confidential

If a patient transfers to another health care provider how do they receive medical records?

only after patient signs a release form

criminal acts

evidence used in abuse cases, stabbings, gunshot wounds, SAs, allow for release of medical records without patient’s authorization/signed release form

Legally ordered

court ordered medical records (subpoena duces tecum) can be released without patient’s authorization

Communicable diseases

CDC can require release of information in case of diseases that may cause pandemic, so medical records can be released without patient’s authorization

Mandated examination

ordered by employer’s insurance companies for workers compensation cases, don’t need patient authorization to access medical record

consent

act of reason: person giving consent must be of sufficient mental capacity and be in possession of all essential information to give valid consent

free of force or fraud

Implied consent

inferred based on signs, actions, or conduct of patient instead of oral communication

applies for emergent care for individuals who are unconscious or unable to speak

Administering CPR or other lifesaving medical treatments to stabalize patient

medical law assumes implied consent

expressed consent

oral or written words that give consent

Informed consent

ensures patient knows, understands, and accepts the treatment that has been explained

Minor consent

minors cannot give consent except in these two situations:

• seeking birth control, pregnancy care, STI treatment, or substance abuse treatment

• if minor has been declared emancipated (financially independent, living independently, military, being married)

advance directives

set of requests that patient has put in writing for health care provider, family, and other health care professionals to carry out in case the patient is unable to speak for themselves

Living will

legal document stating what paitnets would want and what they wouldn’t want under what conditions these would apply:

• Analgesia (pain relief)

• Antibiotic/antiviral treatment

• IV hydration

• Artificial feeding

• CPR/DNR orders

• ventilators

• dialysis

• organ donation

Durable power of attorney (DPOA)

legal document naming health care agent/proxy to make medical decisions for patient when they cannot

The agent has the same rights (request or refuse treatment) that the patient would have

What if individual doesn’t designate healthcare agent?

state law appoints an individual:

• adult child

• adult sibling

• close friend

• nearest living relative

• spouse/domestic partner

• court appointed guardian

Do not resuscitate

legal order written in hospital or on legal form to communicate wishes of a patient to not undergo CPR or advanced cardiac life support if patient’s heart stops or if they stop breathing

Physician orders for life sustaining treatment (POLST)

advanced directive, reserved for patients who are near end of life

set of medical orders completed by health care provider detailing patient’s end of life care

Criminal law

violations against society based on criminal statutes or codes (punishments for violating state or federal criminal laws)

violations are called crimes

Misdemeanors

lesser crimes punishable by monetary fines and established by state

may include imprisonment of 1 year or less

Felonies

more serious crimes punishable by larger fines and or imprisonment for 1+ years, and in some states the death penalty may be used on a convicted felon

Medical felonies

practicing without a license, falsifying information in obtaining a license, failing to provide life support for a patient, failing to get informed consent (may lead to battery - unconsented physical contact on another person)

civil law

private rights of a person or person’s property

areas of contracts, property, labor, privacy issues, family law

wrongdoing: tort - action that causes harm to individual but not a crime

intentional tort

deliberate act that violates the rights of another

assault, battery, defamation of character, invasion of privacy, administration of injection without consent of patient

Negligence

tort in health care setting, doesn’t require specific intent to harm someone and isn’t a deliberate action but is the result of an individual or party failing to act in a reasonable way

Four Ds of negligence

• duty of care: one party has legal obligation to act in a certain manner towards the other

• dereliction of duty: breach, failure to use reasonable care in fulfilling the duty

• Direct cause: failure in duty leads to harm suffered by injured person

• Damages: the harm or injury can be remedied by monetary compensation

Malpractice

act of negligence which is improper or illegal professional activity or treatment (regarding health care professional causing injury to a patient)

Mandated reporting

federal and state laws/statutes that mandate health care providers to report/document incidents of concern for a patient’s safety

must report:

• births

• deaths

• communicable diseases

• Assaults or criminal acts

• abuse, neglect, exploitation (child, older adult, intimate partner)

how many national notifiable disease are there?

120 diseases that must be reported to government authorities

Abuse

every state has mandatory reporting laws for abuse (child abuse and elder abuse)

misuse or maltreatment of another person

Ethics

rules, standards, moral principles that govern a person’s behavior and on which the person bases decisions

personal ethics

determines what an individual believes about morality and right/wrong (personal values and moral qualities)

Common ethics (group ethics)

system of principles and rules of conduct accepted by a group based on ethnicity, political affiliation, or cultural identy

Professional ethics

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

sets standards for practicing one’s profession and can be learned only through education/training on job

Medical ethics

morals that health care professionals use to determine whether an action should be allowed based on right and wrong

Autonomy

capacity to think, decide, and act on one’s own free will and initiative

must be free of coercion or coaxing, should help patients come to their own decisions by providing full information

justice

ethics should be based on what is fair to all invovled

Beneficence

doing the “most good” or doing what is best for patients (must consider pain, physical and mental suffering, risk of disability, death, and quality of life)

nonmaleficence

“do no harm” to the patient or to the fewest number of people in society

What is not a covered entity according to HIPAA?

Employers are not covered under HIPAA

Clearninghouses, health insurance plans, health care providers are all covered

Duty of care

provider’s responsibility after agreeing to treat or provide services to a patient

if a relationship has not been established between provider and patient then no duty exists