Module 1 Legal and Ethical Issues

What is professionalism?

is the manner, behavior, and attitude of someone in a professional environment

• Being well groomed & dressed appropriately

• Effective communication skills

• Responsibility

• Integrity

• Accountability

• Time management

Taking initiative

• Demonstrating resourcefulness

• Being on time

• Being dependable

• Performing assigned tasks efficiently

• Having innovative thinking & problem-solving ability

• Being a quick learner

• Having confidence to try something new

Conflict Management

• Try to resolve conflicts with a co-worker directly by communicating with the other person

• If that fails → office manager to resolve conflict

• HR may assist

Acceptance of Feedback

• Constructive feedback

  • Based on observations

  • Specific to info or issues

Two ways to provide feedback

• Positive feedback, or praise for performance

• Negative feedback, or criticism/opinion

Acceptance of feedback

• Wait 5 secs to process what was said

• Find the benefit

• Do not blame the messenger

• Hear the other person out

• Thank them

• Reflect

• Follow up later to see change

Floor Management Priority Table - First Priority

• Assisting the provider with emergencies & procedures

• Learning to anticipate when a patient might need special procedure performed

• Save time by preparing items necessary

• DO NOT open supplies ahead of time

Second Priority

• Rooming patients when room is vacant & clean

• Retrieve patient from reception area

• Document the patient C/O (Chief Complaint) & perform vitals

Third Priority

• Performing procedures and dismissing patients

Fourth Priority

• Working on pending files that have tasks (calling back patients with test results, calling in prescriptions per the provider’s order

Respect for Individual Diversity

Diversity includes: cultural, ethnic, and social differences among people

What does empathy give you the ability to do?

Care and respect for the health and welfare of your patients

Who was the founder of scientific medicine (Father of Medicine)?

Hippocrates 460 BCE

• Listened to the chest (2000 years before the stethoscope)

Examples of administrative skills

• Medical record preparation

• Demographic data review

• Providing resource information

• Office supply inventory

• Equipment maintenance

• Accounts receivable/payable

Clinical Duties

• A & P

• Infection control

• Patient intake and documentation of car

• Patient preparation and assisting the provider

• Nutrition

• Collecting and processing specimens

• Diagnostic testing

• Pharmacology

• Emergency management/ basic first aid

Inside scope of practice of MAs

• Perform diagnostic testing with physician’s order

• Patient screening

• Obtain patient history

• Obtain chief complaint

• Patient prep

• Obtain vital sings

Medical Assistant Work

• Doctor’s offices

• Clinics

• Insurance companies

• Specialty practices

• Hospitals

• Billing companies

• Urgent Care centers

• Labs

• Government agencies

What are healthcare providers?

An individual who examines, diagnosis and prescribes treatment to patients

General/Family Practice

• see all types of patients

Physician Specialists

• Allergist

• Dermatologist

• Endocrinologist

• Neurology

• Nuclear Medicine

• Gynecologist

• Ophthalmology

• Psychiatrist

• Otorhinolaryngologist

Within the scope of practice for a CMA

Collecting specimens for diagnostic treatment

Civil Law includes

• Torts

• Implied contracts

• Medical malpractice

Civil Law includes

legal proceeding between private parties

Ethical dilemma

two moral principles are in conflict

• No clear right or wrong

Ethics includes:

professional ethics, organized ethics, and personal ethics

What is “Law” and who makes it?

• Law: a system of rules, usually enforced through a collection of institutions commonly recognized as having the authority to do so

• US Congress makes federal law

  • applicable to all

• State legislatures make state law

  • applicable to those living/working within the state

• Local governments

  • applicable to those within the specific jurisdiction

What is malpractice?

• “bad practice”

• any medical treatment that falls short of normal levels of skill, care, or established medical procedure

What is personal injury liability insurance

• Protects the policyholder from lawsuits due to personal injury, not physical injury

• Covers alleged harm caused by invasion of privacy (ex: defamation)

• Healthcare example: releasing a patient’s confidential medical information to the public (HIPAA violation)

What is a misdemeanor?

• a crime punishable by less than 1 year in a jail

  • most commonly a county/regional jail Not state prison

What is a felony?

• crimes committed by people who intend to do significant harm to another, either through depriving them of their property or injuring them personally

  • Includes; murder. manslaughter, robbery, burglary

What is manslaughter?

the unlawful killing of a human being without malice

What is voluntary manslaughter?

upon a sudden quarrel or heat of passion

What is involuntary manslaughter?

• An unintentional killing

• Occurs during the commission of an unlawful act OR during the lawful act without due cation and circumspection (criminal negligence)

• The act may result in death, even though death was not intended

What is a tort?

• A civil wrong (not a crime)

• Causes harm or injury to another person

• Allows the injured person to sue for damages

• From Latin torus = wrong

What is an intentional tort?

• Libel and slander (defamation of character)

• Trespass

• Intentional infliction of emotional distress

• Medical malpractice

Unintentional torts

• Accidental acts

• Negligence

  • it happens by mistake or accident

• Plaintiff can collect damages only if

  • Defendant owed a duty of care

  • Defendant failed to mee the standard of care → failure → caused harm

ix Factors of Medical Malpractice

• Provider-patient relationship exists

• Relationship creates a duty to the patient

• Duty requires a professional standard of care

• Provider breaches that duty → patient suffered an injury

• Injury occurred bc of the breach

Defenses to Medical malpractice

• Statue of limitations- Time limit to file a lawsuit → usually 2 years

• Contributory negligence → patient helped cause their own injury

• Emergency - “Good Samaritan” will protect a medical provider when responding to an emergency

The Doctor-Patient Contract

• A legal agreement between a doctor and a patient

• Requires consent and capacity from both parties

Types of Doctor-Patient Contracts

• Express contract

• Implied contract

Express contract

• Patient directly communicates consent

• Can be verbal or written

Implied Consent

• Consent is assumed by actions, not words

• Used only when express consent is absent

• Cannot override a patient’s explicit refusal of care

Capacity to Enter a Medical Contract

• Be the age of majority (state law)

• Or be an emancipated minor

• AND not have a legal disability

Legal Disability (Contract Law)

• Person is mentally incompetent

• OR under the influence of drugs or alcohol

• Cannot legally consent to a contract

What are the 4 main ways a patient-provider relationship can end without it being considered abandonment?

• Mutual consent

• Patient dismisses the doctor

• Care is no longer needed ( EX: condition resolved)

• Provider withdraws with written notice and reasonable time for the patient to find a new provider

When a provider wants to end the relationship, what two things must they do to avoid a charge of abandonment?

Give the patient a written notice and a reasonable amount of time to find a new healthcare provider

True or False: A doctor can immediately stop seeing a patient who has sued them for malpractice?

False: if there hasn’t been enough time to notify the patient to find a new doctor, the provider may be compelled to continue care to avoid abandonment

Name two specific situations where a provider may be compelled to continue care and cannot immediately withdraw

• When the patient is disabled with HIV (under ADA)

• When abandonment could be a criminal act (EX: in a critical emergency)

What is the core patient right regarding information shared with a provide?

• The right to confidentiality

What is the core provider duty that can override patient confidentiality?

The legal requirement to report suspected child abuse & elder abuse to authorities

What is the key differences between Proper Termination and Illegal Abandonment of a patient?

• Proper Termination: gives the patient a pathway to continue care elsewhere (notice + time)

• Abandonment: leaves the patient without necessary care and access

What should you do if you suspect that the patient you are preparing for examination is a victim of abuse?

Record the signs and notify the physician of your suspicions

What is neglect?

The failure or refusal of a caregiver or other responsible person to provide for an elder’s basic physical, emotional, or social needs, or failure to protect them from harm

What is exploitation?

Unauthorized or improper use of the resources of an elder for monetary or personal benefit, profit, or gain

What is the main goal of the Patient Self-Determination Act (PSDA)?

To make sure patients are informed about their rights to make their own medical decisions

Which healthcare providers must follow the PSDA rules?

Any provider that accepts Medicare or Medicaid payments (hospitals, nursing homes, etc)

What are the three main things a provider must tell a patient under the PSDA?

1. Your right to accept or refuse any treatment

2. Your rights regarding advance directives (like living wills)

3. The facility’s own policies about stopping life support

What must a provider ask a patient about under the PSDA?

Whether the patient has any advance directives, like a living will or a power of attorney for healthcare

What is the main difference between what a provider must tell and what they must ask under the PSDA?

• Tell: Inform the patient about their rights

• Ask: Find out if the patient has already made legal decisions (advance directives)

To remember PSDA, think “I-A-A” What does it stand for?

• Inform about rights (accept/refuse treatment)

• Advance directives (explain state laws)

• Ask if they have one (document any directives)

What does HIPAA stand for, and what is its main purpose?

• HIPAA: Health Insurance Portability and Accountability Act

• Its main purpose is to protect patient health information (privacy/security) and help people keep health insurance when changing jobs

What are the two main parts (titles) of HIPAA?

1. Title I (Portability): Keeps health insurance coverage when you change or lose your job

2. Title II (Privacy/Security): The Privacy Rule that protects patient health information

What is the main goal of the Affordable Care Act (ACA or “Obamacare”)?

To increase health insurance coverage and affordability for more Americans (ex: through marketplaces, Medicaid expansion, and preventing denial for pre-existing conditions)

What does the Americans with Disabilities Act (ADA/ADAAA) require a healthcare office?

Requires officed to provide reasonable accommodations and ensure equal access to services for people with disabilities (ex: wheelchair ramps, sign language interpreters)

What does the Stark Law prevent?

It prevents conflicts of interest by prohibiting doctors from referring Medicare/Medicaid patients to facilities where they have a financial interest

What does GINA (Genetic Information Nondiscrimination Act) protect people from?

Protects people from discrimination by health insurers and employers based on their genetic information (like family history or genetic test results)

What is the purpose for the Good Samaritan Act?

To encourage people to help in emergencies by protecting them from lawsuits if they provide reasonable, voluntary assistance at the scene of an accident

What does the Uniform Anatomical Gift Act govern?

It sets the rules for organ and tissue donation (like how someone can consent to be a donor on their driver’s license)

What’s the key difference between HIPAA Title I and HIPAA Title II?

• Title I: Insurance Portability (keeping coverage)

• Title II: Privacy/Security Rules (protecting health data)

Which two laws specifically protect against certain types of discrimination in healthcare?

1. ADA/ADAAA (disability discrimination)

2. GINA (genetic information discrimination)

What is Ethics?

are rules of conduct for particular issues based on what is believed to be right or wrong

What are morals?

They are personal principles about right and wrong behavior

Morals are governed by an internal guide. What is that guide?

A person’s own conscience or ethical judgment

If something is moral, it conforms to a standard. What kind of standard?

A standard of right behavior

What does it mean to say a person or action is “capable of right and wrong”?

It means they have moral agency, the ability to make choices between good an bad actions

To decide the right thing to do, consider these questions

• What promotes the right of the patient’s determination about their own health?

• What is in the best health interest of the patient?

• Is preforming (or not) the at in question fair to others?

What is the principle of Autonomy in healthcare?

• The patient’s right to make their own decisions about their care (ex: giving informed consent or refusing treatment)

• A patient’s choice or Self-determination

What is the principle of Beneficence in healthcare?

• The duty of healthcare providers to act in the patient’s best interest and promote their well-being

• Means to do good (best interest)

What is the principle of Distributive Justice in healthcare?

• The fair allocation of scarce resources (like organs, ICU beds, or expensive medications) across society

• Distribution or Sharing (dividing resources fairly)

What is culture?

Shared system of beliefs, attitudes, values, expectations, and behaviors

Examples of subcultures:

• Ethnicity

• Religion

• Social and professional subcultures

Bioethics is concerned with which of the following?

• Moral controversy over biomedical technology

What are Professional Ethics?

Codes of ethics prescribe behavior for professionals in many industries, associations and fields

• The American Medical Association (AMA) - comprehensive Code of Medical Ethics

AMA Code of Medical Ethics

Addresses providers conduct in interprofessional relations, hospital relations, confidentiality, fees, records, and professional rights

As a certified professional through the NHA, I have a duty to:

• Use my best efforts for the betterment of society, the profession, and the members of the practice

• uphold the standards of professionalism and be honest in all professional interactions

• continue to learn, apply, and advance scientific and practical knowledge and skills, stay up to date on the latest research and its practical application

• Participate in activities contributing to the improvement of personal health, our society, and the betterment of the allied health industry

• Continuously act in the best interest of the general public

• Protect and respect the dignity and privacy of all patients

Which o the following concepts typically define ethics?

Principles of right and wrong

A very busy phlebotomist misidentifies the patient when collecting a specimen for transfusion preparation. The possible misdiagnosis of blood type could cause the patient’s death. If the phlebotomist’s action results in injury, which of the following could the phlebotomist be charged with?

Negligence

• Why? Negligence is a failure to exercise the care that a reasonably prudent person would exercise in similar circumstances

Drawing a patient’s blood without his or her permission may result in being charged with which of the following?

Assault and battery