legal and ethical issues in healthcare
State Healthcare facility policies and procedure
Patient Confidentiality and HIPAA Compliance
Strict guidelines on maintaining patient privacy
Managing health info
Limiting access to patient data only to authorized personnel
All staff are trained to follow HIPAA regulations to protect sensitive patient info
Infection Control and Hygiene Protocols
Policies cover hand hygiene, PPE, sterilization procedures for instruments
Isolation procedures when needed
Patient Rights and Consent
Must inform patients of their rights
Right to informed consent, explaining medical procedures and obtaining patient agreement
Have the right to access medical records
Medication Management
Ensure safe prescription, storage, and administration of medications
Dosage verification, double-checking patient identifiers, safe disposal of expired medications
Emergency Preparedness
Emergency response plans for natural disasters, fires, and other crises
Trained on evacuation procedures, communication, and patient safety protocols
Facility Security
Secure facility, manage visitor access, protect patients & staff
Protocols for access control, surveillance, and disruptive behavior
Scheduling and Patient Flow
Implement procedures for scheduling appts, handling patient wait times, and managing cancellations
Equipment and Supply Maintenance
Regular checks and maintenance of equipment
Inventory process to track and reorder supplies
Billing and Financial Policies
Provide transparent billing practices
Ensure accurate patient billing
Help patients understand charges and payment options
Identify national, state, and local standards for workplace safety.
National:
OSHA (Occupational Safety and Health Administration) Bloodborne Pathogens Standard
Implement protocols to reduce exposure to bloodborne pathogens (HIV or Hepatitis B)
Requirements for use of PPE, proper disposal of sharps, employee training on handling blood and bodily fluids safely
Hazard Communication Standard
HCS mandates employers provide info about chemicals used in the workplace
Involves labelling, safety data sheets (SDS), training employees
Reducing exposure to hazardous drugs
Ergonomics
OSHA ergonomic standards to prevent musculoskeletal disorders
For staff
Provide ergonomic tools
Train employees on proper lifting techniques to prevent injuries
Fire Safety and Emergency Preparedness
Develop and maintain fire safety protocols
Ensure staff are trained to respond to emergencies
Maintain clear evacuation routes, fire drills, and access to fire suppression equipment
Infection Control Standards
Aligned with CDC guidelines
Maintain a safe environment
Hand hygiene practices, PPE, and sterilization to prevent infection spread
Workplace Violence Prevention
OSHA recommends facilities have policies & training for potential risks
Manage violent incidents
Electrical Safety and Hazardous Equipment Management
Require regular inspection, maintenance, and handling training for electrical and other medical equipment
Employee Health and Wellness Programs
OSHA asks facilities to implement health and wellness programs
Promote mental health, stress management, physical well-being
Address high-stress nature of healthcare jobs
State (MD):
Healthcare Compliance
Unique regulations and agreements with Medicare and Medicaid
Impact on how healthcare providers bill for services and receive payments
Nursing Home Administrator Licensing
Applicants must pass Maryland State’s Standards Exam and the National Association of Nursing Home Administrator Boards (NAB) Exam
Quality of Care
Maryland Secretary of State sets standards for quality care
Provide regular hours for services
Have a system for 24-hour access to a physician
Clinical Records
Requires clinical records to be retained for at least 5 years from the date of discharge
For minors, clinical records have to be retained for 3 years after patient becomes of age
Implicit Bias Training
Providers in Maryland must complete an approved implicit bias training
The first time they renew the license
Local:
Public Health
Responsible for coordinating public health activities in the area
Monitoring health status, protecting people from health hazards, developing public health policies
Healthcare Organizations
Standards are set through licensure, accreditation, and requirements from purchasers (medicare and fortune 500 companies)
Healthcare Professionals
Standards set through state licensure, board certification, and credentialing programs
Local Codes
Local fire, building, noise, and safety codes
Increase the organization’s healthcare regulatory compliance obligations
Determine laws governing healthcare professionals.
HIPAA (Health Insurance Portability and Accountability Act of 1996)
Protect healthcare for workers between jobs
Associated with the protection of confidential patient healthcare info
How medical professionals store, use, and disseminate patient info
HITECH Act (Health Information Technology for Economic and Clinical Health of 2009)
Audits of healthcare providers to ensure they are in compliance with HIPAA
High standards for information security
Provide financial security
Penalties for healthcare providers
Associated business to encourage them to adequately protect patient info
EMTALA (Emergency Medical Treatment and Labor Act)
Enacted in 1968
Federal law requires hospitals to provide stabilization and treatment for anyone who comes to the emergency department
Regardless of insurance status or ability to pay
Anti-Kickback and Stark Laws
AKBS
Prevent intentional abuse of healthcare system for financial gain)
Prevents exchange for an award within the healthcare program
Violation is crime
Stark Law
Prohibits physicians from referring patients to certain designated health services paid by Medicare
Not a criminal statute
PSQIA (Patient Safety and Quality Improvement Act of 2005)
Protects healthcare workers who report unsafe conditions at practices
Encourages individuals to report medical errors
Maintains patient confidentiality
Fraud and Abuse Laws
Can not issue fraudulent bills to private insurance companies
Cannot prescribe unnecessary procedures or medications
Can not conduct money laundering
State the purpose of a patient’s “Bill of Rights”.
Outlines and protects patient’s fundamental rights
Ensuring informed care
Actively participate in treatment decisions
Empowers patients to make informed choices about health and treatment
Key Points:
Informed Consent
Right to receive complete info about diagnosis, treatment options, risks and benefits
Right to Refuse Treatment
Privacy and Confidentiality
Access to care
Communication with providers
Right to Second Opinions
Patients can seek additional medical opinions from other healthcare providers
Explain laws and standards associated with employment and labor.
Wage and Hour laws (FLSA)
Sets federal minimum wage
Mandates overtime pay for hours worked
Regulates child labor
Anti-Discrimination Laws (Title VII of Civil Rights Act)
Prohibits discrimination in employment
Age Discrimination in Employment Act (ADEA)
Protects workers 40 and older
From employment discrimination based on age
Americans with Disabilities Act (ADA)
Workplace Safety and Health (OSHA)
Enforces standards for workplace safety to protect employees from hazards
Family and Medical Leave Act (FMLA)
Allows employees to take unpaid leave for medical conditions, childbirth, adoptions, or caring for a family member
National Labor Relations Act (NLRA)
Protects employee's rights to organize and bargain collectively with employers
Explain the purpose of Material Data Safety Sheets (MSDS) used in a healthcare setting.
MSDS
Document provided by the chemical manufacturer that details potential hazards of substance
Includes health effects, physical properties, and safety precautions
Purpose:
Ensures proper handling of chemicals
Protects healthcare workers from potential chemical exposures when using medications, cleaning solutions, and more
Workers understand the potential risks with a substance
Take appropriate precautions to prevent accidents
Provides critical info for emergency responses
Required by OSHA to have MSDS reality available for all chemicals
Explain laws associated with harassment.
Title VII of the Civil Rights Act of 1964
Prohibits harassment based on race, color, religion, sex, national origin, and other factors
Age Discrimination in Employment Act of 1967 (ADEA)
Prohibits harassment on age 40 (or older)
Americans with Disabilities Act of 1990 (ADA)
Employment Non-Discrimination Act (ENDA)
Prohibits discrimination based on sexual orientation
Determine licensure and certification needed by healthcare professionals.
Physicians (MD/DO)
Licensure: Passing the United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA)
Board Certification:
Passing a specialty-specific examination from a recognized board (American Board of Medical Specialities (ABMS)
Nurses (RN, LPN, NP)
Licensure: Required in all states, Involves National Council Licensure Examination (NCLEX-RN or NCLEX-PN)
Board Certification:
Additional certifications from boards such as the American Nurses Credentialing Center (ANCC) based on area of specialty
Physician Assistants (PAs)
Licensure: Completion of an accredited PA program, Passing Physician Assistant National Certifying Exam (PANCE)
Board Certification: Certification from the National Commission on Certification of Physician Assistants (NCCPA), Complete continuing medical education
Pharmacists
Licensure: Passing North American Pharmacist Licensure Examination (NAPLEX), Multiestate Pharmacy Jurisprudence Examination (MPJE)
Board Certification: Option certification in specialty areas - Board of Pharmacy Specialities (BPS)
Medical Laboratory Technicians and Technologists
Licensure: Passing a state-recognized examination
Certification: Organizations like the American Society for Clinical Pathology (ASCP)
Mental Health Professionals (Psychologists, Therapists)
Licensure: State Licensures, typically a doctoral degree, supervised practice, Passing Examination for Professional Practice in Psychology (EPPP)
Certification: Hold State-specific licenses
Radiologic Technologists
Licensure and Certification: Certification from the American Registry of Radiologic Technologists (ARRT)
9. Identify standards of the Health Insurance Portability and Accountability Act
(HIPAA).
Privacy Rule
Protection of individuals’ medical records and other personal health info (PHI)
Restricts how PHI can be used and disclosed
Requires patient consent for most disclosures
Patient right to access and amend records
Security Rule
Outlines standards to safeguard electronic protected health information (ePHI)
Requires covered entities to implement safeguards
Protects against unauthorized access, alteration, deletion, or transmission
Breach Notification Rule
Mandates that covered entities and business associates
Notify affected individuals, the U.S. Department of Health and Human Services (HHS), and sometimes the media
Enforcement Rule:
Procedures for investigations, penalties, and hearings about HIPAA non-compliance
Range from fines to criminal charges
Omnibus Rule:
Clarifies obligations of business associates who handle PHI
Makes them directly accountable for compliance
10. Maintain patient confidentiality.
Understanding HIPAA Regulations
Employee Training
Access Controls
Strict access controls of PHI
Secure Communication
Encrypted Emails or secure messaging systems
Avoid discussing sensitive details in public areas
Proper Disposal of Records
Ensure all paper records are disposed of properly
Shredding
Patient Rights
Incident Response Plan
Develop a plan responding to potential breaches of confidentiality
Use of Technology
Employ electronic health records (EHR) that have built-in security features
Regularly update software
11. Identify threats to patient confidentiality.
Unauthorized Access
Includes staff members accessing patient records without a legitimate reason
Ex: Staff members looking up info about friends violates confidentiality
Data Breaches
Cybersecurity Threats
Often targeted due to the valuable nature of Patient Information
Failure to implement robust security protocols (encryption, firewalls, and secure passwords)
F Records
Not disposing of paper records securely
Public Discussion
Discussing patients in public settings can unintentionally disclose confidential info to unauthorized individuals
Social Engineering
Manipulative tactics used by malicious actors to gain access to confidential information
Mobile Devices and Remote Work
Third-Party Vendors
External Service Providers could get access to patient information
Any lack of compliance or inadequate safeguards risk losing confidentiality
12. Define expressed, implied, and informed consent.
Expressed Consent
Direct and explicit consent given by the patient, either verbally or in writing
Used for non-emergency medical treatments and procedures
Health provider asks for a clear agreement
Implied Consent
Inferred from a patient’s actions
Applies in non-invasive situations
When consent can be reasonably assumed based on patient’s behavior (extending arm based on blood draw)
Often used in emergency scenarios when immediate medical action is necessary
Patient can not explicitly consent
Informed Consent
Educating patient about the procedure’s risks, benefits, and alternatives before they agree
Ensure patient fully understands treatment implications
Important for serious procedures and legally requires healthcare provider to communicate information
13. Identify practices and behaviors that result in malpractice, liability, and/or
negligence.
Failure to follow standard protocols
Not following hand hygiene or patient care procedures
Poor Documentation and Record-Keeping
Difficult to track patient history, medications, and treatments
Miscommunication Among Healthcare Providers
Lack of Informed Consent
Improper Medication Administration
Errors in prescribing, dispensing, and administering medications
Failure to Monitor Patient Conditions
Neglecting regularly monitoring patient status
Ignoring or Misdiagnosing Symptoms
Inadequate Training or Supervision
14. Identify ethical issues related to healthcare.
Patient Autonomy and Informed Consent
Patients have control over their healthcare decisions
Right to accept or refuse treatment
Providers have to provide full, comprehensible information on risks, benefits, and alternatives
Confidentiality and Privacy
Adhering to HIPAA Regulations
Safegaurding against data breaches that might expose sensitive health info
End-of-Life Care and Decision-Making:
Euthanasia, assisted suicide, and withdrawing life support
Must balance respect for patient wishes with legal constraints and personal beliefs
Resource Allocation and Access to Care
How to prioritize care for patients
ICU beds, organ transplants, or life-saving drugs
Equity and Non-Discrimination
Ensure fair treatment across all demographic groups
Bias or discrimination is unethical
Professional Boundaries and Dual Relationships
Prevent conflicts of interest
Preserve objectivity in care
Having a non-professional relationship with a patient
Medical Errors and Reporting
Challenge of transparency, have a duty to inform patients of errors
Even if it impacts the provider’s reputation
Genetic Testing and Privacy
Implications for patient privacy
Potential discrimination based on genetic information
Ethics of informing family members of hereditary risks
15. Identify appropriate work habits and ethics
Punctuality and Reliability
Being on time
Accountability and Responsibility
Owning up to mistakes
Confidentiality and Respect for Privacy
Communication and Interpersonal Skills
Adaptability and Problem-Solving
Continous Learning and Improvement
Professionalism and Integrity