Prof Ethics, T6 - T7

civil law

civil law

• Legal relationships between people and the protection of a person’s rights

• health care is mainly affected by this law.

  • contract

  • tort

contract

civil law

• An agreement between two or more parties;

• can be implied or written

• offer

• acceptance

• consideration

parts of a contract:

tort

civil law

• Occurs when a person is harmed or injured because a health care provider does not meet the established standard of care.

• can either be unintentional or intentional.

criminal law

Wrongs against a person, property or society

• practicing without license

• use of narcotics

• theft

• sexual abuse

• murder

examples of criminal law in health care:

legal responsibilities

• protect healthcare workers, their employer and the patient

• based on laws created by federal, state and local governments 

• healthcare workers must know and follow laws pertaining to their license or registration

Everyone in the organization

• Board members

• Executive leadership

• Clinical staff

• Physicians and nurses

• Administrative and clerical staff

• Students and interns

• Volunteers

who are responsible for patient confidentiality?

• Identity (e.g. name, address, social security #, date of birth, etc.)

• Physical condition

• Emotional condition

• Financial information

list of patient information that must remain confidential

“need to know”

Access patient information only if there is a, what?

• Access patient information only if there is a ‘Need to Know’

• Discard confidential information appropriately – (e.g. Locked Trash Bins or Shredders)

• Forward requests for medical records to the Health Information Management Department.

• Do not discuss confidential matters where others might overhear. – (e.g. Cafeteria, Elevator, Buses, or Restaurants)

• Do not leave patients’ charts or files unattended

• Report suspicious activities that may compromise patient confidentiality

guiding principles of patient confidentiality

Health Information Management Department

Forward requests for medical records to, where?

• Health Insurance Portability & Accountability Act of 1996 (HIPAA) & American Recovery and Reinvestment Act of 2009 (ARRA)

• Massachusetts regulations and statues

• The Privacy Act of 1974

Examples of State & Federal Laws that Protect Patient Privacy:

Health Information Technology for Economic and Clinical Health Act

HITECH

Health Insurance Portability & Accountability Act of 1996

HIPAA

American Recovery and Reinvestment Act of 2009

ARRA

Health Insurance Portability & Accountability Act of 1996 (HIPAA) & American Recovery and Reinvestment Act of 2009 (ARRA)

HITECT breach notification provisions

Massachusetts regulations and statues

• Patient Bill of Rights 

• 201 CMR 17.00 Standards for the Protection of Personal Information 

• Improve the efficiency and effectiveness of the health care system

• Encourage the development of an electronic health record 

• Establish national standards for electronic transmission of certain health information 

• Establish national standards to protect health information

• Ensure patient confidentiality 

• Protect patient privacy 

• Build loyalty and trust 

• Provide exceptional customer service

purpose of HIPAA

anyone who:

• Currently works directly with patients

• Currently sees, uses, or shares PHI (Protected Health Information) as a part of their job

• Currently access any hospital systems, records, tools, and information that may contain PHI (Protected Health Information)

who has to follow HIPAA?

• name

• full face photo

• finger or voice print

• telephone number

• address/zip code

• e-mail address

• fax number

• internet protocol (IP) address

• uniform resource locator (URL)

• social security number

• medical record number

• insurance number

• account number

• all elements of dates

• vehicle identifier

• certificate/license

• device ID/serial number

• any unique identifying number, characteristics, or code

18 Elements Protected Health Information Identifiers (HIPAA)

• Medical records

• Clinic lists 

• Patient information systems

• Test results 

• Billing information (bills, receipts, EOBs, etc.)

• X-rays 

• Patient menus

• Labels on IV bags 

• Patient information on a mobile device

• Conversations

• Telephone notes (in certain situations)

where is protected health information (PHI) found?

• Treatment of the patient

• Payment of healthcare bills

• Direct patient care

• Operations related to healthcare

• Referrals to other healthcare providers

• Coordination of care 

• Research

• Consultation

• Required by law (e.g. subpoena, court order, etc.)

Permitted Uses and Disclosures of Protected Health Information (PHI):

intentional tort

tort that is done deliberately.

• ASSAULT

• BATTERY

• Conversion

• FALSE IMPRISONMENT

• Trespass to land

• Trespass to chattels (Personal property)

• Outrage

• DEFAMATION

assault

intentional tort

• a deliberate act wherein one person threatens to harm another without consent and the victim feels the attacker has the ability to carry out the threat.

battery

intentional tort

• is touching the victim without consent.

false imprisonment

intentional tort

• is the unlawful confinement of a person within a fixed area.

defamation

intentional tort

• is the making of a false statement to a third party that is harmful to another’s reputation.

slander

intentional tort; defamation

• are false charges and malicious oral statements about someone

libel

intentional tort; defamation

• are written defamation of a person's character, reputation, business, or property rights  

unintentional tort

negligence

• involves a failure on one party to act the way an ordinary, reasonable person would act.

• results physical injury, property damage, and other type of loss.

• e.g., abandonment, delayed treatment

imputed negligence

unintentional tort

• The doctrine that makes one person responsible for the negligence of another.

contributory negligence

unintentional tort

• A theory in tort law under which a complaining party's own negligence contributed to or caused his or her injuries.

malpractice

unintentional tort

• may be brought against a doctor or other healthcare provider who fails to exercise the degree of care and skill that a similarly situated professional of the same medical specialty would provide under the circumstances.

• e.g., Positioning errors leading to injury, Improper patient instruction

• duty

• breach

• causation

• damages

elements of a negligent tort

• In order to win a negligence case, the plaintiff must prove the following elements to show that the defendant acted negligently:

duty

element of a negligent tort

• The defendant owed a legal duty to the plaintiff under the circumstances

• an obligation to either do or not do something that will harm someone else.

breach

element of a negligent tort

• The defendant breached that legal duty by acting or failing to act in a certain way

• the defendant failed to meet their obligation to the plaintiff and therefore put the plaintiff in harm’s way.

causation

element of a negligent tort

• It was the defendant's actions (or inaction) that actually caused the plaintiff's injury

damages

element of a negligent tort

• The plaintiff was harmed or injured as a result of the defendant's actions.

malfeasance

An illegal act, especially by a public official

misfeasance

An act that is legal but performed improperly

nonfeasance

Failure to act when under an obligation to do so

do good and avoid harm.

The imaging professional must be aware of the obligations to, what?

• Invasive procedures

• Radiation

• Equipment malfunction

potential harm to the patient in doing an imaging procedure:

• requisitions

• reports

• these are forms of particular importance to radiographers.

• are medicolegal records and may be filed with the films or separately.

• radiographers are not responsible for initiating these records

  • they rely on these records for information about each examination they perform.

x-ray requisition

• serves as the formal order for a diagnostic procedure

• includes:

  • patient data;

  • a brief medical history;

  • and specific instructions.

• In some situations, it may be part of a multicopy form that eventually may include the radiologist’s report.

• Administration of contrast media or medications

• Changes in patient status

• Reactions to contrast or medications

• Treatment in the radiology department

Documenting certain information about patients is an essential part of the medicolegal record which includes:

risk management

• is the system for identifying, analyzing, and evaluating risks and selecting the most advantageous method for treating them.

• maintain high-quality patient care

• conserve the facility’s financial resources

goals of risk management:

litigation

this may arise from patient care in which the technologist is involved

• Thoroughly documenting information

• Ensuring that informed consent has been obtained

• Maintaining patient confidentiality

• Practicing radiation protection

• Maintaining a safe environment for patients and employees

the imaging professional must understand the importance of minimizing risk by: