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The Law and Health Care

Laws used in Health Care Legislation

  • Constitutional Law: addresses the relationship between the people and their government, it establishes, allocated, and limits public power

    • It deals with the legislation recorded in the constitution

    • Legislation: laws by the provincial or territorial legislature or by parliament

    • Once passing the necessary test one has a right to practice simultaneously accepting the responsibility to practice ethically and legally

      • Ethics: what you should and should not do

      • Laws: what you can and can not do

    • Everyone has the fundamental right of freedom to:

      • Conscience and religion

      • Thought, belief, and opinion, including freedom of the press

  • Statutory Law: laws passed in Parliament (federal) or in the provincial/territorial legislatures

    • Aka a statute

  • Regulatory Law: a form of law that possesses the legally binding feature of an act, since it is usually made under the authority of an act

    • Aka subordinate legislation

    • They are not made by the Parliament or the province but by the tribunal or administrative agency

    • Must be outlined either federally or provincially

  • Common (CASE) Law & Civil Law in Canada

    • Common Law or Case Law: is based on a judge who decided by consulting with previous court decisions, historically established laws, interpretations, and other principles not outlined in the statutory law.

  • Classifications of Law: Public & Private Law

    • Public Law: matter between an individual and society as a whole

    • Private Law: matters concerning relationships people or legal entities

    • Civil lawsuits deal with the relationship between people

  • Classifications of Law: Public & Private Law/ Tort Law: when a person or their property is wronged or damaged both intentionally or not

    • Intentional Tort: when a harmful act is deliberate

      • In Healthcare it is typically seen as physical aggression or forcing unwanted medication treatment

    • Unintentional Tort: when the act causes physical or emotional damage but was not deliberate or calculated

      • Such as human error and misjudgment

    • Negligence: same is a type of torte law

      • When a healthcare provider fails to meet the standards of care provided for their profession

      • Maybe malpractice, professional misconduct

    • Litigation and the duty of care: consider the standard of competency that a “reasonable person” is expected to meet

  • Classifications of Law: Public & Private Law/ Contract Law: private agreements typically enforceable by the courts that are either implied or expressed that do not violate any governing laws

  • Classifications of Law: Public & Private Law/ Criminal Law: set out in federal legislation found in the Criminal Code of Canada

    • Deals with crimes against people and/or property and those deemed intolerable to society

      • Ex. murder, racism, theft

    • They must perform a wrongful act (actus reus) and a wrongful intent (mens rea)

    • In healthcare punishable crimes are

      • Using someone else’s health care (fraud)

      • Practicing surgery without a license (fraud)

      • Trafficking narcotics

      • Performing euthanasia

The Law, The Division of Power, and the Jurisdictional Framework

  • The federal government retained jurisdiction of Health care for certain population groups and retains the provision of federal funds to provinces or territories

  • “Peace, order and good government” (Constitution Act, 1982) allows the government to enact emergency powers allowing them to take control of what is typically the provinces’ jurisdiction

Workplace Safety

  • Under federal jurisdiction

  • Covered by the Workers’ Compensation Act with WHIMIS legislation

    • Both fall under the federal Hazardous Products Act

  • Occupational Health and Safety

    • Provided by each province

    • To prevent workplace injuries and occupational diseases

      • To reduce the impact of a work-related injury or illness on the workers and their loved ones

    • The responsibility of overseeing the ministry or department of labor

    • Applies to all workplaces except work done by private owners and those overseen by the federal government

  • Occupational Health and Safety: Objectives

    • Employees rights

      • Right to be aware of potential health and safety hazards

      • Right to take part in health and safety activities

      • Right to refuse dangerous work

  • Occupational Health and Safety: Compensation Boards

    • Work with the CCOHS

    • Concentrate on rehabilitation, training, and wage replacement

    • WHMIS was created in 1988

      • Enforced in all jurisdictions

      • Named the Controlled Drugs and Substances Act

Drugs and the Law

  • Controlled Drugs and Prescriptions

    • Controlled Drugs and Substances Act states who can prescribe

      • And how they are given out

    • In Hospital settings what’s called Narcotics are kept in a double-locked dispenses area

    • Or held in a machine that dispenses the mediation for them leaving a smaller margin for error

    • Can only be prescribed for therapeutic uses

  • Opioid Crisis

    • Health Canada has shown an alarming rate of opioid-related deaths

    • They are trying to work with the provinces and territories to bring the number of deaths down

      • Are limiting the number of opioids prescribed

    • Regular checks are done to make sure pharmacies are doing when they can to prevent narcotics from getting into the wrong hands

      • A chain of custody is always maintained

Cannabis

  • While is now legalized there are still special precautions set out by the provincial, territorial, and federally

  • Most Doctors prescribing medical marijuana typically send their patients to Medical Cannabis Clinics

  • Under the food and Drugs Act advertising prescription drugs had very specific regulations that Cannabis regulated or not has to follow

  1. Reminder advisement: can advertise drugs using the brand name but cannot mention directly their uses

  2. Disease-oriented ads: instead of using a brand name they discuss a condition and say they should ask their doctors

Health Canada’s Emergency Powers

  • Quarantine Act

    • Gives the federal government control to:

      • Divert aircraft and cruise ships

      • Designate quarantine facilities anywhere

      • Restrict and prohibit travelers from entering Canada

    • Environmental Health officers have also been created and given the authority to assess, screen, and detain others who pose to be a health risk

    • International Health Regulations

      • Outline strategies to prevent the global spread of infectious diseases

      • They work to screen six different infectious diseases around the world to prevent the World-Wide Spread

Health Care as a Right

  • Canadian Charter of Rights and Freedoms

    • Guarantee Canadians certain rights and freedoms subjective by reasonable limits

    • It demands everyone be treated equally and fairly

    • Section 7: life liberty and security of person

      • 3 things to consider if a person’s rights have been violated

        • Medically resources are available at the time they were needed

        • Demands made on those resources

        • Urgency of needs

    • Section 15: Equality

      • Every individual is equal before and under the law and has the right to equal protection

      • Equal benefit of the law without discrimination

        • Based on race, national or ethnic origin, color, religion, sex, age

      • Mental or physical disability

    • Private health care becoming ever more common with the rising wait times

  • The Law, Constitution, and End-of-Life Issues

    • Must be sixteen to outline decisions based on their health

    • Instructional directives: can be either specific or general, they outline a person’s requests in presumed circumstances

    • Proxy Directives: general instructions are given, however, the decision maker has the latitude to make decisions on a situational basis

  • Medically Assisted Suicide

    • Types of MAID

      • By a healthcare provider where they inject a fatal dosage of medication

      • Or maybe prescribed for the patient to take at home

    • Eligibility for MAID:

      • Over 18

      • Mentally competent

      • Have a valid healthcare card

      • Have a serious illness, disease, disability, or irreversible condition

        • No hope of getting better

        • Unbearable pain

        • Death is reasonable and foreseeable

    • A consent form must be filled out

    • Patient must be fully aware of the process

The Legality of Private Services in Canada

  • Health insurance cannot be bought for medically necessary procedures

  • Some private companies only work with non-essential services being fully legal since it doesn’t interfere with the Canadian Health Act

    • They are mainly testing clinics

Informed Consent to Treatment

  • Informed consent must be provided before any course of action

    • Informed consent: understanding, consenting to, the treatment and its foreseeable risks

  • Consent must be informed and voluntary

    • Informed: understand the procedure or treatment

    • Voluntary: must not feel compelled or pressured

    • Has the right to withdraw consent at any time

  • Consent for deceased Organ Donation

    • Must be 16 years old

    • Has to sign a donor card

    • Cannot be sold

Types of Consent

  • Express Consent: can be written or oral: it indicates a clear choice on the part of the patient

  • Written Consent: signed by the patient, dated, and witnessed

    • Provides a healthcare provider with evidence of consent

  • Oral Consent: spoken over the phone or in person

    • Equally as binding as written consent

  • Implied Consent: because the individual seeks the care of a physician or other healthcare provider

  • A competent person receiving the intervention that most often gives consent for the treatment

    • Children are allowed to consent as long as they fit the previous statements

The Health Record

  • One’s health record contains: numerous and varied reports including an admission sheet, patient history, medication records, diagnostic reports, medical or surgical records, flow sheets, and interdisciplinary notes

  • Clinics typically maintain a cumulative profile

    • Cumulative profile: diagnostic report, consultation reports, and history sheets

  • When health records are stored the patient must always know who has their records

  • Personal Information Protection and Electronic Documents Act: protects personal information preserved for the private sector

    • Defines personal information: as information about an identifiable individual

      • Name, address, telephone number, gender,

      • Identification numbers, income, or blood type;

      • Credit records, loan records, the existence of a dispute between a consumer and a merchant, and intention to require goods of service

  • Confidentially: all healthcare providers must legally and ethically keep all health information confidential

    • Moral and legal obligation to keep a patient’s health information private

  • Security

    • Health records are to secure and safe

      • Protected from fire damage as well as other economic disasters

    • Electronic records are to be encrypted software and password protection

  • Electronic Health Information requirements

    • Electronic Medical Records: housed in one facility and only affect care at the one facility

    • Electronic Health Records: provide the “bigger picture”. Comprised several sources

Health Care Professions and the Law

  • Are all supposed to have their ability insurance

  • A union: is an organization that represents and advocated for its members usually regarding employee-employer issues

    • They represent groups of workers

  • Are not legally obliged to represent members in anything other than labor regulations

  • Essential services do not have the right to strike and must submit any disputes to arbitrations

  • When a human error occurs the patients have the right to know all relevant facts

    • An apology is not an admission of fault

  • Dear John Letter: written document stating the termination of care

  • Use of restraints

    • Typically used for impaired or psychiatric conditions

    • Restraints: can be mechanical, environmental, physical, or chemical

  • A patient can leave the hospital at any time

    • They are typically asked to sign a release form from the hospital

  • Good Samaritan Law: protect anyone who offers help to a distressed person if something goes wrong

  • Whistle Blowing: someone who reports misconduct to organizations willing to take corrective action

MJ

The Law and Health Care

Laws used in Health Care Legislation

  • Constitutional Law: addresses the relationship between the people and their government, it establishes, allocated, and limits public power

    • It deals with the legislation recorded in the constitution

    • Legislation: laws by the provincial or territorial legislature or by parliament

    • Once passing the necessary test one has a right to practice simultaneously accepting the responsibility to practice ethically and legally

      • Ethics: what you should and should not do

      • Laws: what you can and can not do

    • Everyone has the fundamental right of freedom to:

      • Conscience and religion

      • Thought, belief, and opinion, including freedom of the press

  • Statutory Law: laws passed in Parliament (federal) or in the provincial/territorial legislatures

    • Aka a statute

  • Regulatory Law: a form of law that possesses the legally binding feature of an act, since it is usually made under the authority of an act

    • Aka subordinate legislation

    • They are not made by the Parliament or the province but by the tribunal or administrative agency

    • Must be outlined either federally or provincially

  • Common (CASE) Law & Civil Law in Canada

    • Common Law or Case Law: is based on a judge who decided by consulting with previous court decisions, historically established laws, interpretations, and other principles not outlined in the statutory law.

  • Classifications of Law: Public & Private Law

    • Public Law: matter between an individual and society as a whole

    • Private Law: matters concerning relationships people or legal entities

    • Civil lawsuits deal with the relationship between people

  • Classifications of Law: Public & Private Law/ Tort Law: when a person or their property is wronged or damaged both intentionally or not

    • Intentional Tort: when a harmful act is deliberate

      • In Healthcare it is typically seen as physical aggression or forcing unwanted medication treatment

    • Unintentional Tort: when the act causes physical or emotional damage but was not deliberate or calculated

      • Such as human error and misjudgment

    • Negligence: same is a type of torte law

      • When a healthcare provider fails to meet the standards of care provided for their profession

      • Maybe malpractice, professional misconduct

    • Litigation and the duty of care: consider the standard of competency that a “reasonable person” is expected to meet

  • Classifications of Law: Public & Private Law/ Contract Law: private agreements typically enforceable by the courts that are either implied or expressed that do not violate any governing laws

  • Classifications of Law: Public & Private Law/ Criminal Law: set out in federal legislation found in the Criminal Code of Canada

    • Deals with crimes against people and/or property and those deemed intolerable to society

      • Ex. murder, racism, theft

    • They must perform a wrongful act (actus reus) and a wrongful intent (mens rea)

    • In healthcare punishable crimes are

      • Using someone else’s health care (fraud)

      • Practicing surgery without a license (fraud)

      • Trafficking narcotics

      • Performing euthanasia

The Law, The Division of Power, and the Jurisdictional Framework

  • The federal government retained jurisdiction of Health care for certain population groups and retains the provision of federal funds to provinces or territories

  • “Peace, order and good government” (Constitution Act, 1982) allows the government to enact emergency powers allowing them to take control of what is typically the provinces’ jurisdiction

Workplace Safety

  • Under federal jurisdiction

  • Covered by the Workers’ Compensation Act with WHIMIS legislation

    • Both fall under the federal Hazardous Products Act

  • Occupational Health and Safety

    • Provided by each province

    • To prevent workplace injuries and occupational diseases

      • To reduce the impact of a work-related injury or illness on the workers and their loved ones

    • The responsibility of overseeing the ministry or department of labor

    • Applies to all workplaces except work done by private owners and those overseen by the federal government

  • Occupational Health and Safety: Objectives

    • Employees rights

      • Right to be aware of potential health and safety hazards

      • Right to take part in health and safety activities

      • Right to refuse dangerous work

  • Occupational Health and Safety: Compensation Boards

    • Work with the CCOHS

    • Concentrate on rehabilitation, training, and wage replacement

    • WHMIS was created in 1988

      • Enforced in all jurisdictions

      • Named the Controlled Drugs and Substances Act

Drugs and the Law

  • Controlled Drugs and Prescriptions

    • Controlled Drugs and Substances Act states who can prescribe

      • And how they are given out

    • In Hospital settings what’s called Narcotics are kept in a double-locked dispenses area

    • Or held in a machine that dispenses the mediation for them leaving a smaller margin for error

    • Can only be prescribed for therapeutic uses

  • Opioid Crisis

    • Health Canada has shown an alarming rate of opioid-related deaths

    • They are trying to work with the provinces and territories to bring the number of deaths down

      • Are limiting the number of opioids prescribed

    • Regular checks are done to make sure pharmacies are doing when they can to prevent narcotics from getting into the wrong hands

      • A chain of custody is always maintained

Cannabis

  • While is now legalized there are still special precautions set out by the provincial, territorial, and federally

  • Most Doctors prescribing medical marijuana typically send their patients to Medical Cannabis Clinics

  • Under the food and Drugs Act advertising prescription drugs had very specific regulations that Cannabis regulated or not has to follow

  1. Reminder advisement: can advertise drugs using the brand name but cannot mention directly their uses

  2. Disease-oriented ads: instead of using a brand name they discuss a condition and say they should ask their doctors

Health Canada’s Emergency Powers

  • Quarantine Act

    • Gives the federal government control to:

      • Divert aircraft and cruise ships

      • Designate quarantine facilities anywhere

      • Restrict and prohibit travelers from entering Canada

    • Environmental Health officers have also been created and given the authority to assess, screen, and detain others who pose to be a health risk

    • International Health Regulations

      • Outline strategies to prevent the global spread of infectious diseases

      • They work to screen six different infectious diseases around the world to prevent the World-Wide Spread

Health Care as a Right

  • Canadian Charter of Rights and Freedoms

    • Guarantee Canadians certain rights and freedoms subjective by reasonable limits

    • It demands everyone be treated equally and fairly

    • Section 7: life liberty and security of person

      • 3 things to consider if a person’s rights have been violated

        • Medically resources are available at the time they were needed

        • Demands made on those resources

        • Urgency of needs

    • Section 15: Equality

      • Every individual is equal before and under the law and has the right to equal protection

      • Equal benefit of the law without discrimination

        • Based on race, national or ethnic origin, color, religion, sex, age

      • Mental or physical disability

    • Private health care becoming ever more common with the rising wait times

  • The Law, Constitution, and End-of-Life Issues

    • Must be sixteen to outline decisions based on their health

    • Instructional directives: can be either specific or general, they outline a person’s requests in presumed circumstances

    • Proxy Directives: general instructions are given, however, the decision maker has the latitude to make decisions on a situational basis

  • Medically Assisted Suicide

    • Types of MAID

      • By a healthcare provider where they inject a fatal dosage of medication

      • Or maybe prescribed for the patient to take at home

    • Eligibility for MAID:

      • Over 18

      • Mentally competent

      • Have a valid healthcare card

      • Have a serious illness, disease, disability, or irreversible condition

        • No hope of getting better

        • Unbearable pain

        • Death is reasonable and foreseeable

    • A consent form must be filled out

    • Patient must be fully aware of the process

The Legality of Private Services in Canada

  • Health insurance cannot be bought for medically necessary procedures

  • Some private companies only work with non-essential services being fully legal since it doesn’t interfere with the Canadian Health Act

    • They are mainly testing clinics

Informed Consent to Treatment

  • Informed consent must be provided before any course of action

    • Informed consent: understanding, consenting to, the treatment and its foreseeable risks

  • Consent must be informed and voluntary

    • Informed: understand the procedure or treatment

    • Voluntary: must not feel compelled or pressured

    • Has the right to withdraw consent at any time

  • Consent for deceased Organ Donation

    • Must be 16 years old

    • Has to sign a donor card

    • Cannot be sold

Types of Consent

  • Express Consent: can be written or oral: it indicates a clear choice on the part of the patient

  • Written Consent: signed by the patient, dated, and witnessed

    • Provides a healthcare provider with evidence of consent

  • Oral Consent: spoken over the phone or in person

    • Equally as binding as written consent

  • Implied Consent: because the individual seeks the care of a physician or other healthcare provider

  • A competent person receiving the intervention that most often gives consent for the treatment

    • Children are allowed to consent as long as they fit the previous statements

The Health Record

  • One’s health record contains: numerous and varied reports including an admission sheet, patient history, medication records, diagnostic reports, medical or surgical records, flow sheets, and interdisciplinary notes

  • Clinics typically maintain a cumulative profile

    • Cumulative profile: diagnostic report, consultation reports, and history sheets

  • When health records are stored the patient must always know who has their records

  • Personal Information Protection and Electronic Documents Act: protects personal information preserved for the private sector

    • Defines personal information: as information about an identifiable individual

      • Name, address, telephone number, gender,

      • Identification numbers, income, or blood type;

      • Credit records, loan records, the existence of a dispute between a consumer and a merchant, and intention to require goods of service

  • Confidentially: all healthcare providers must legally and ethically keep all health information confidential

    • Moral and legal obligation to keep a patient’s health information private

  • Security

    • Health records are to secure and safe

      • Protected from fire damage as well as other economic disasters

    • Electronic records are to be encrypted software and password protection

  • Electronic Health Information requirements

    • Electronic Medical Records: housed in one facility and only affect care at the one facility

    • Electronic Health Records: provide the “bigger picture”. Comprised several sources

Health Care Professions and the Law

  • Are all supposed to have their ability insurance

  • A union: is an organization that represents and advocated for its members usually regarding employee-employer issues

    • They represent groups of workers

  • Are not legally obliged to represent members in anything other than labor regulations

  • Essential services do not have the right to strike and must submit any disputes to arbitrations

  • When a human error occurs the patients have the right to know all relevant facts

    • An apology is not an admission of fault

  • Dear John Letter: written document stating the termination of care

  • Use of restraints

    • Typically used for impaired or psychiatric conditions

    • Restraints: can be mechanical, environmental, physical, or chemical

  • A patient can leave the hospital at any time

    • They are typically asked to sign a release form from the hospital

  • Good Samaritan Law: protect anyone who offers help to a distressed person if something goes wrong

  • Whistle Blowing: someone who reports misconduct to organizations willing to take corrective action

robot