Chapter 3: Legal and Ethical Issues in Medical Assisting

Legal and Ethical Issues for Medical Assistants

Objectives of the Chapter

  • Define and spell all included Words to Know from the glossary.
  • Describe the different sources from which law originates.
  • Explain various types of insurance: liability, professional (malpractice), and personal injury.
  • Compare and contrast criminal and civil law as they pertain to Medical Assistants (MAs).
  • Outline key legal acts that impact medical practices.
  • Summarize the torts of negligence relevant to medical practice.
  • Detail how MAs must perform duties within their scope of practice and state laws.
  • Differentiate between an MA's scope of practice and the standard of care.
  • Distinguish the medical provider's and MA's roles concerning the standard of care.
  • Summarize the core elements of the Health Insurance Portability and Accountability Act (HIPAA).
  • Differentiate between informed and implied consent.
  • Distinguish between personal and professional ethics.
  • Differentiate between legal, ethical, and moral issues in healthcare.
  • Describe how personal morals relate to professionalism in the workplace.

Law and Ethics for Medical Assistants

  • The Law: Exists to address situations encountered in practice and define legal requirements for MAs.
    • MAs must understand: what law is, who makes laws, distinctions between criminal and civil law, and types of liability insurance.
  • Ethics: A separate concept from law, crucial for a successful MA career.
    • An ethical dilemma arises when two moral principles conflict, with no clear right or wrong answer.
    • Ethics encompasses professional, organizational, and personal ethics.

What is "Law" and Who Makes It?

  • Definition of Law: A system of rules typically enforced by recognized institutions with authority.
  • Sources of Law:
    • U.S. Congress: Creates federal law, applicable nationwide under the Supremacy Clause of the Constitution.
    • State Legislatures: Create state law, applicable to residents/workers within that state.
    • Local Governments: Create resolutions or ordinances, applicable within their specific jurisdictions.
  • Legislating Process: The mechanism by which laws are developed.
    • Statute: The final outcome of the legislative process.
    • Statutory Law: Laws enacted by legislative bodies (Congress, state legislatures, local governments).
  • U.S. Supreme Court: "Makes" law by interpreting the Constitution (e.g., Roe v. Wade).
  • Common Law (Case Law / Law of Precedent): Originated to address situations not covered by statutes, based on judicial decisions.
  • Lawsuit Settlements: May occur before trial via arbitration or mediation.
  • Scope of Practice: MAs must always operate within their state-specific scope of practice.

Types of Liability Insurance

  • Liability and Professional Malpractice Insurance:
    • Malpractice: Defined as "bad practice"; any medical treatment that falls below normal skill, care, or established medical procedure.
    • Protects healthcare professionals from liability for wrongful practices leading to injury, expenses, or property damage, and covers defense costs.
  • Personal Injury Liability Insurance:
    • Protects policyholders from lawsuits due to alleged damage to an individual from privacy invasion.
    • Includes damage to character.
    • Healthcare Example: Release of a patient's confidential medical information to the public.

Criminal vs. Civil Law

  • Criminal Law:
    • Exclusively statutory.
    • Deals with individuals who commit acts prohibited by law or fail to perform required acts.
    • Standard of Proof: Beyond a reasonable doubt.
  • Civil Law:
    • Governs the conduct, affairs, and rights of people; infractions are not crimes.
    • Standard of Proof: Preponderance of evidence.

Definitions and Examples of Crimes

  • Misdemeanors:
    • Crimes punishable by less than one year in a jail (county/regional, not state prison).
    • May include fines.
  • Felonies:
    • Serious crimes committed with intent to cause significant harm (property deprivation, personal injury).
    • Examples: murder, manslaughter, robbery, burglary.
  • Murder:
    • "Unlawful killing of another with malice aforethought."
    • Legislatures define degrees based on premeditation level or victim's status.
  • Manslaughter:
    • Unlawful killing of a human being without malice.
    • Voluntary: Occurs during a sudden quarrel or heat of passion.
    • Involuntary: Occurs during an unlawful act or a lawful act performed without due caution that might cause death.
  • Robbery:
    • Unlawful taking of money or goods from a person or their immediate presence by force or intimidation.
  • Burglary:
    • Similar to robbery but does not involve the victim's presence.

The Law of Torts

  • Tort: Derived from Latin tortum (meaning "wrong").
  • Can be intentional or unintentional.
    • Intentional Torts: Libel, slander (defamation of character), trespass, intentional infliction of emotional distress, medical malpractice (can also be unintentional).
    • Unintentional Torts: Accidental acts, negligence.

Negligence (An Unintentional Tort)

  • Most frequently concerns medical professionals, happening by mistake or accident.
  • Underlying principle for collecting damages: the standard of care owed by the defendant to the plaintiff.
  • Four Elements of Negligence:
    1. Duty of care: The defendant owed a duty of care to the plaintiff.
    2. Breach of duty: The defendant breached that duty.
    3. Harm (injury): The plaintiff suffered harm.
    4. Causation: The harm resulted from the defendant's breach of duty.

Medical Malpractice

  • Six Factors for Medical Malpractice:
    1. A provider-patient relationship existed.
    2. This relationship created a professional standard of care duty from the provider to the patient.
    3. The provider breached this duty.
    4. The patient sustained an injury.
    5. The injury was a direct result of the provider's breach of duty (causation).
    6. The patient would not have been injured but for the provider's breach of duty.
  • Defenses to Medical Malpractice:
    • Statute of limitations.
    • Contributory negligence.
    • Emergency (situation).

The Doctor-Patient Contract

  • Elements of a Valid Contract:
    • Offer.
    • Acceptance.
    • Consideration.
  • Types of Contracts:
    • Express Consent: Patient directly communicates consent to the doctor.
    • Implied Consent: Healthcare providers may rely on implied consent only when explicit consent is absent; it can never override an explicit refusal of care.
  • Capacity to Enter a Contract: A person must:
    • Be the age of majority in the state where the contract is formed.
    • Be an emancipated minor (self-supporting person under legal age).
    • Not be under a legal disability (e.g., mentally incompetent, under influence of altering drugs).
  • Rights of Parties: Most healthcare contracts are oral, subject to statutory and common law. MAs must understand both provider obligations and rights.

Termination of Patient/Provider Relationship

  • Care termination as Abandonment vs. Proper Refusal of Care:
    • Valid Termination: Mutual consent, patient dismissing doctor, care no longer needed due to changed circumstances, provider withdrawal with written notice and reasonable time for patient to find new provider.
  • When Providers Are Compelled to Provide Care:
    • Patient is disabled with HIV.
    • Patient has sued the provider group for malpractice, and insufficient time was given to find a new doctor.
    • The patient relationship has not been continuous.
    • Abandonment would constitute a criminal act.

Patient Privacy and Mandatory Reporting

  • Patient Privacy: Patients have a right to expect confidential communication with their provider.
  • Mandatory Reporting: Most states require providers to report child abuse and elder abuse.
    • Courts protect providers who comply with these laws.

Abuse, Neglect, and Exploitation

  • Elder Abuse: Any abuse or neglect of persons 6060 and older by a caregiver or person in a trusting relationship.
    • Physical Abuse: Use of physical force leading to bodily injury, pain, or impairment.
  • Neglect: Failure or refusal of a caregiver or responsible person to provide basic physical, emotional, or social needs for an elder, or to protect them from harm.
  • Exploitation: Unauthorized or improper use of an elder's resources for monetary or personal benefit, profit, or gain.

Patient Self-Determination Act

  • Requirements for Medicare/Medicaid Providers:
    • Inform patients of their right to accept or refuse treatment.
    • Inform patients of their rights regarding advance directives under state law.
    • Inform patients of hospital/provider policies on withholding/withdrawing life-sustaining equipment.
  • Additional Requirement: Providers must inquire about any existing advance directives.
    • Power of Attorney: Authorizes a named person to consent, refuse, or withdraw consent for medical services.
    • Living Will: A patient's statement of medical wishes; does not designate a decision-maker.
    • Durable Power of Attorney: Similar to Power of Attorney but remains effective even if the grantor becomes incapacitated.

Federal Laws Affecting the Provider Office

  • Affordable Care Act (ACA): Aims to increase health insurance coverage.
  • Health Insurance Portability and Accountability Act (HIPAA):
    • Title I: Ensures continuation of health insurance coverage when workers change or lose jobs.
    • Title II (The Privacy Rule): Establishes national standards for protecting individually identifiable health information.
  • The Good Samaritan Act: Protects healthcare professionals from liability when providing emergency care outside of their usual practice.
  • Americans with Disabilities Act Amendments Act (ADAAA): Broadens the definition of disability, ensuring protection against discrimination.
  • Uniform Anatomical Gift Act (UAGA): Provides a legal framework for organ donation.
  • Genetic Information Nondiscrimination Act of 2008 (GINA): Prohibits discrimination based on genetic information in health insurance and employment.
  • Stark Law (Conflict of Interest): Prohibits physicians from referring Medicare and Medicaid patients to entities with which they or their immediate family members have financial relationships.

Scope of Practice for Medical Assistants

  • Core Principle: Always perform delegated duties within your scope of practice, under a physician's direct supervision, consistent with education, training, and experience.
  • Duties must not constitute medical practice itself.
  • Duties, exams, and certification requirements vary by state law.
  • MAs must adhere to rules, regulations, and requirements mandated by their state and their credentialing/certification bodies.
  • All MAs must comply with HIPAA.

Risk Management

  • Definition: The identification of all potential financial losses for a business and the selection of techniques to manage these exposures.
  • Management Process: Diagnosis, Assessment, Prognosis, Management.

What is Ethics?

  • Definition: Rules of conduct for specific issues, based on beliefs about right or wrong.
  • Many healthcare professional organizations provide codes of ethics to guide behavior.

What Are Morals?

  • Definition: Principles of right and wrong behavior.
  • Can refer to: expressing right behavior, conforming to right behavior standards, sanctioned by conscience/ethical judgment, or capability for right/wrong action.

Distinguishing Legal, Ethical, and Moral Judgments

  • Often, no clear lines separate law, ethics, and morals.
  • What is legal may not be ethical.
  • What seems morally correct may not be legal.
  • MAs must be able to differentiate among the three.
  • Ethics Check Questions:
    • What promotes the patient's right to self-determination regarding their health?
    • What is in the patient's best health interest?
    • Is performing (or not performing) the action fair to others?
  • Legal Issues: Arise from societal norms (common law or statutes), involving allocation of rights and responsibilities.
  • Moral Issues: Stem from a belief system that judges right and wrong.
  • Ethical Issues: Arise from "a set of standards and rules promulgated by various professions and enforced against its members."

What to Report, To Whom, and When

  • Criminal Conduct: Notify local police.
  • Improper Disclosure of Patient Information: Discuss only with the patient or attending provider, unless compelled by a court order.
  • Provider Misconduct: Report to the practice administrator, office manager, or another provider in the office.
  • Office Staff Misconduct: Report to the practice administrator, security officer, or office manager.

Ethical Issues in Health Care

  • Autonomy: The patient's right to make determinations for themselves.
  • Beneficence: The requirement to act in the best interests of others.
  • Distributive Justice: The principle for society (or the healthcare community) to allocate scarce resources.
    • Egalitarian approach: Everyone receives an equal share.
    • Earned approach: Those who deserve more receive more.
    • Libertarian approach: Each person gets what they can legitimately acquire.
    • Social justice approach: Allocation maximizes help to the greatest number of people.
  • Many healthcare ethical questions have no definitive right or wrong answer.

Ethics and Diversity

  • MAs have a responsibility to provide equal care to all people, regardless of race, creed, or color.
  • Culture: A shared system of beliefs, attitudes, values, expectations, and behaviors.
  • Subcultures: Examples include ethnicity, religion, social, and professional subcultures.
  • Intercultural Communication Skills:
    • Withholding judgment.
    • Showing respect.
    • Empathy.
    • Tolerating ambiguity.
    • Recognizing personal cultural biases.
    • Emphasizing common ground.
    • Sending a clear message.
    • Learning when to be direct.

Professional Ethics

  • Codes of ethics prescribe behavior for professionals.
  • American Medical Association (AMA) Code of Medical Ethics: Comprehensive guidance for physician conduct in interprofessional relations, hospital relations, confidentiality, fees, records, and professional rights (found at www.ama-assn.org).
  • Medical Assistant Professional Organizations: MAs are subject to codes of professional conduct when joining organizations.
    • AAMA’s Code of Ethics.
    • AMT Standards of Practice.
    • NHA Code of Ethics.
    • AAPC Code of Ethics.

Organizational Ethics

  • Definition: The values by which an organization conducts its business.
  • Often included in mission and vision statements, reflecting cultures that value employees and patients.
  • Four Characteristics Encouraging Ethical Behavior:
    1. A written code of standards.
    2. Ethics training for officers, managers, and employees.
    3. Availability of advice for employees facing ethical issues.
    4. A system for confidential reporting.

Personal Ethics and Professional Performance

  • Professional and organizational ethics guide professional performance.
  • MAs must align their personal views with the ethical standards of their profession and organization, regardless of personal perspectives.

Summary of Key Points

  • Law is a system of enforced rules created by Congress (federal), state legislatures (state), local governments (ordinances), and judicial interpretation (common law).
  • Criminal law is statutory, dealing with prohibited or required acts; civil law governs conduct and rights without being criminal.
  • Tort law, a branch of common law, can be intentional or unintentional; negligence requires duty, breach, harm, and causation.
  • Medical professional liability insurance (malpractice) protects healthcare providers from lawsuits stemming from wrongful practices.
  • Medical malpractice requires six specific elements to apply.
  • Risk management identifies and manages financial loss exposures.
  • The doctor-patient relationship is a contract (express or implied), requiring patient consent and capacity.
  • Advance directives like durable power of attorney and living wills define patient wishes.
  • Federal laws impacting medical offices include ACA, HIPAA, Good Samaritan Act, ADAAA, UAGA, GINA, and Stark Law.
  • MAs must always operate within their state-defined scope of practice.
  • Ethics are rules of conduct, morals are principles of right/wrong, and legal issues involve societal norms. There are often overlaps, requiring discernment.
  • Autonomy, beneficence, and distributive justice are key ethical principles in healthcare.
  • Healthcare professionals must provide care impartially and be culturally sensitive.
  • Professional organizations (e.g., AMA, AAMA) provide codes of ethics for their members.
  • Organizational ethics represent a company's values, encouraged by written codes, training, advice, and reporting systems.
  • Personal ethics must align with professional and organizational ethical standards while on the job.