Chapter 7

Chapter 7: Legal Essentials and Patient Rights

Chapter Objectives

  • Provide a brief overview of law and legal concerns in medicine.

  • Gain an appreciation of the legal environment in which sonographers practice.

  • Offer an analysis of the sonographer’s scope of practice.

  • Examine patient’s rights.

Introduction

  • Understanding medical law and professional ethics is vital for prudent and consistent patient care.

  • Comprehension of medical law and observance of one's scope of practice mitigates the fear of legal repercussions in the workplace.

Law Basics

  • Defensive Medicine: Physicians may practice defensive medicine due to fear of lawsuits, leading to unnecessary tests and procedures.

  • Ethics vs. Law: Ethics are standards to aspire to, while laws are mandatory rules to follow.

  • Types of Law:

    • Common Law: The oldest form of law, which evolves over time.

    • Statutory Law: Comprises statutes enacted by federal, state, or local governments, grouped into various classifications.

Statutory Law

  • Administrative Law: Concerns statutes that empower agencies to regulate and enforce laws, including licensure and practice regulations.

  • Criminal Law: Involves crimes against the state or society, including felonies and misdemeanors. The government prosecutes criminal cases against individuals or groups.

    • Phases of a Lawsuit: Three phases are involved: pleading phase, discovery phase, and trial.

    • Background Checks: Criminal background checks may be required for clinical training.

  • Civil Law: Pertains to crimes against individuals, such as slander, libel, trespassing, and contract violations.

    • Tort Law: A subset of civil law involving wrongs against a person or property, leading to physical injury or damage. A tort can arise from negligence or intentional misconduct.

Intentional Torts

  • Civil Lawsuits: Patients may file these if they believe an injury resulted from intentional acts by a healthcare provider.

  • Types of Intentional Torts:

    • Assault: Fear of harm, without actual harm occurring.

    • Battery: Unlawful touching without consent, regardless of intent.

    • False Imprisonment: Confinement against will.

    • Defamation: False statements harming reputation (slander or libel).

    • Embezzlement: Misappropriation of funds.

    • Invasion of Privacy: Interference with the right to privacy.

    • Fraud: Deception or false promises.

Unintentional Torts

  • Negligence: Acts causing injury without intent, such as failure to meet the standard of care.

    • Four Ds of Negligence: Duty, derelict, direct cause, and damages.

    • Malpractice: Professional negligence holds healthcare providers accountable for harm caused through negligent actions.

Sonographer Scope of Practice

  • Assumptions in Practice: Sonographers operate under the principle of “Assume Consent,” which can lead to legal pitfalls if misunderstandings occur.

  • Legal Knowledge: Sonographers must understand the legal aspects of patient care to implement effective risk management.

  • Scope Responsibilities:

    • Conduct patient assessments and analyze ultrasound data.

    • Summarize findings for physician input.

    • Apply independent judgment to enhance patient outcomes.

    • Avoid acting as diagnosticians directly.

    • Certain procedures may necessitate a chaperone.

Legal Liability and Insurance

  • Master-Servant Doctrine: Sonographers' liability may extend to their employers for negligent actions.

  • Professional Standards: Licensing bodies enforce practice standards, with the authority to revoke credentials for violations.

  • Professional Liability Insurance: Many sonographers secure their own coverage to protect against malpractice claims. Understanding the terms of coverage is crucial.

Good Samaritan Laws

  • Protect individuals providing emergency aid to strangers against liability if:

    • Care is rendered in good faith.

    • Assistance is within the provider’s scope of practice.

    • Due care is exercised.

    • Services are not billed.

  • Variability across states: Some require individuals to act as Good Samaritans, while others may protect those who decline to assist.

  • Limitations: Generally, these laws do not cover actions in clinical settings.

Patient Rights

  • Defined as the legal rights of patients, emphasizing individual protections and healthcare worker rights.

    • Informed Consent vs. Implied Consent: Patients are entitled to understand procedures and can refuse examinations at any time. Continuing with a refused examination may lead to assault and battery claims.

HIPAA and Patient Confidentiality

  • HIPAA Requirements:

    • Standardization of electronic medical records, administrative, and financial data.

    • Unique health identifiers establishment.

    • Security standards ensuring patient confidentiality.

    • Obligatory reporting duties.

Patient Rights Related to End-of-Life Issues

  • Advance Directives: Legal documents expressing patients’ wishes regarding medical care if they cannot decide themselves:

    • Living Will: Outlines future medical preferences.

    • Durable Power of Attorney for Healthcare: Appoints a representative for healthcare decisions.

    • Healthcare Advance Directive: Combines aspects of living wills and durable power of attorney.

    • Do Not Resuscitate (DNR) Order: A written directive from a physician not to perform CPR.

Sonographer Documentation

  • Documentation standards are vital as sonogram images form part of the legal medical record.

  • Quality evaluation of images is essential for legal implications.

  • Document reasons for suboptimal examinations.

  • Incident reports or patient safety concerns may need to be documented, with varying institutional requirements.