ccma

Medical Law and Ethics

Legislative Branch: 

  • Congress

  • Passes laws

Executive Branch: 

  • Administers laws

Judicial Branch: 

  • Interprets and enforces law

Criminal Law:

  • Crimes committed against society, individual, property

Civil Law:

  • Tort/contract

  • Results in monetary compensation

Administrative Law

  • Deal with requirements and standards of governmental agency

Tort:

  • Accidental or intentional wrongful act

  • Committed against another person or property

Negligence:

  • Most common tort

  • Failure to perform professional duties safely (prudently)

Nonfeasance:

  • failure to act when duty indicates

  • resulting in injury

Misfeasance:

  • improper performance of legal act resulting in injury

Malfeasance:

  • Committing an illegal act

  • Results in injury to another

Malpractice:

  • “Professional negligence”

  • Professional misconduct, lack of skill, wrongful practice

  • Results in injury to another

Res ipsa loquitur:

  • “The thing speaks for itself”

  • Obvious negligence occurred

Respondeat superior:

  • “Let the master answer”

  • Provider responsible for negligence of employee

4Ds:

  • Duty

    • Patient/physician relationship established

  • Dereliction

    • Professional neglect of obligation to act/ acted improperly 

  • Direct cause

    • Negative outcome due to professional’s actions/ failure to act.

  • Damages

    • Patient sustained harm from the neglect

Affidavit: verbal or written statement sworn under oath

Appellant: party appealing to a higher court from a lower court

Libel: written defamatory communication

Plaintiff: party bringing suit to court

Res judicata: once case is solved it cannot be tried again

Stare decisis: “let the decision stand”

Subpoena duces tecum: commands individual to be in court (with medical records etc)

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Express contracts:

  • Written or oral (signed if written)

  • Agreement of 2 parties

    • The Truth in Lending Act

      • Provider and patient contract

      • Agree on scheduled payments for servicers (most commonly a large sum of $)

    • Medical Assistant Employment

      • Employee and employer contract

Agreed upon: duties, changes, compensation, benefits, termination etc.

Implied Contract:

  • Most common contract

  • Provider and patient contract

  • Not written (will act within scope of practice)

    • Ex: unconscious patient treated in ED

Quid Pro Quo:

  • Something for something 

    • Service is rendered for payment

Advance directive: 

  • Document stating patients wishes if incapable of making competent decisions

  • Signed and witnessed

Living Will:

  • Documented stating acceptable and unacceptable means to life sustaining measures.

Durable power of attorney:

  • Document allows designated person to act on patients behalf to determine extraordinary measures.

Centers for Medicare and Medicaid services (CMS):

  • Division of the Humans and Health Services (HHS)

  • Regulating agency for CLIA

  • OCSQ (office of clinical standards and quality) 

  • FDA

CLIA tests:

  • Waived= simple and easy

  • Moderate-complexity= not waived, urine sediment, blood chem, blood & urine culture

  • High-complexity= cytology, histopathology, cytogenetics, rigorous education 

COBRA:

  • Allows patients who lost health insurance to continue with plan or move to alternative health insurance coverage

Medical Practice Acts:

  • State statutes that govern the practice of medicine

  • Requirements for physicians, licensing, renewal, revoking, suspending, and prohibiting practicing with no license.

EEOA

  • Equal Education Opportunities Act

  • Prohibits job discrimination based on race, color, religion, sex, national origin

Red Flags Rule

  • Aug 1 2009

  • Enacted to combat identity theft

Family Medical Leave Act (FMLA)

  • Allow employees 12 protected weeks of leave without pay for family or medical records

Title VII 

  • Civil rights act of 1964

  • Unwelcome sexual advances

Code of Hammurabi

  • Written 2500 bc in babylonia

AMA code of ethics:

  • Written in 1847 in philadelphia and revised several times

Patient bill of rights

  • List of reasonable expectations a patient should receive from a physician regarding treatment as patient and individual.

Bioethics Areas:

  • Reproduction

  • Genetics

  • death/dying

  • Transplants

  • Resource allocation

Vulnerable populations:

  • Physically or mentally at risk for harm or exploitation

Covered Amount: patient account allows multiple payments 

Fee Splitting: fraud where physician receives money from another physician solely for referring patients 

Fidelity: meeting patients rights to competent care, to respect, and adhere to laws

“Non compos mentis” = not of sound mind

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Anatomy, Physiology, Medical Terminology

Anterior/ventral = toward front of body

Posterior/dorsal = toward back of body

caudad/caudal = toward tail

Cephalad = toward head

Distal = away from origin

Proximal = closest to origin

Visceral = toward internal organs

Parietal = away from internal organs

Medullary = inner region

Cortical = outer region

Afferent = move toward center

Efferent = move away from center

Eversion = turning outward

Extension = limb straightening

Flexion = bending a limb

Inversion = turning inward

Circumduction =  drawing circle with body part

Cost = rib

Arthr = joint

Ankyl = crooked/bent/stiff

Chondr = cartilage

Kinesi = movement

Lamin = lamina (thin/flat)

Angi = vessel

Ather = yellowish fatty plaque

Isch = deficiency/blockage

Sphygm = pulse

Ech = sound

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Cell Actions:

  • Active Transport

    • Molecules move from high to low concentration

    • ATP make this possible

  • Diffusion

    • Passive transport through membrane from high to low concentration

  • Filtration

    • Mechanical pressure diffuses liquids through membranes

  • Osmosis

    • Substance passes through semi-permeable membrane

    • Membrane only allows some substances to pass through

  • Passive transport

    • No cellular energy required to move dissolved substance

  • Phagocytosis

    • Ingestion and digestion of substances by phagocytic cells (WBC neutrophils)

Tissue Types:

  • Epithelial = skin, tubes, ducts, lining of cavities

  • Connective = bones, cartilage, muscle sheath, blood

  • Muscle = striated, smooth, cardiac

  • Nerve = neurons throughout body

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Skeletal System 

  • Axial Skeleton 

    • Cranial

    • Facial

    • Ear bones

    • Column (spine)

    • Thorax (rib)

  • Appendicular Skeleton

    • Upper and lower extremities

    • Pectoral girdle

    • Pelvic girdle

Joint Classifications:

  • Synarthrosis (immovable)

  • Amphiarthrosis (slightly moveable)

  • Diarthrosis ; Synovial (freely movable)

    • Ball and socket

    • Condyloid (jaw)

    • Gliding

    • Hinge

    • Pivot (C1, C2)

    • Saddle (thumb)

Bursa: sac that cushions/eases movement

Condyle: large rounded knob that fits with another bone

Crest: ridge on a bone

Foramen: hole in bone for vessels and nerves

Fossa: depression/groove in bone

Periosteum: thick membrane covering bone surface 

Process: prominent projection of bone

Synovial Fluid: lubricating fluid for joints

Arthrocentesis: puncture to remove fluid pressure

Arthroscopy: procedure to view joint space

Laminectomy spinal fusion: stabilize vertebrae by removing part

Paget’s Disease: weakened bone formation and breakdown of bone tissue 

Spondylosis: inflammation of one of more vertebrae 

Aponeurosis: sheet of connective tissue binding muscle to muscle (or bone)

Goniometry: measles joint angles

Epicondylitis: inflammation of the forearm tendon (tennis elbow)

Muscular dystrophy: wasting of skeletal muscle

Claudication: circulation problem of arms and legs

Over 600 Muscles in body

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Cardiovascular System

  • Heart

    • Located within pericardium

    • 4 chambers: 2 upper atria, 2 lower ventricles (L ventricle bigger + thicker)

    • Septum: divides heart in half

    • Aortic semilunar valve: lets O2-rich blood leave L-ventricle → aorta→ body

    • Mitral (bicuspid) valve: (L atrium L ventricle) prevent backflow of O2-rich blood into atrium

    • Pulmonary Semilunar valve: lets O2-rich blood leave → L Ventricle→ pulmonary artery

    • Tricuspid valve: (R atrium R ventricle) prevent backflow of O2 blood into atrium 

  • Blood

    • RBC 5 million/cubic millimeter

    • WBC 5,000-10,000/ cubic millimeter 

    • Platelets (thrombocytes) 200,000/cubic millimeter

    • Plasma = liquid portion where cells are suspended

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Lymphatic System

  • Cervical Nodes

  • Axillary Nodes

  • Spleen (largest lymph node)

  • Inguinal Nodes

  • Lymph nodes^^ = pea-shaped clusters of lymph tissue

  • Lymph = tissue fluid formed in plasma

Lymphocytes

  • WBC formed in bone marrow

  • Mature in spleen, liven, & lymph nodes

  • Destroy microorganisms + fight pathogens

  • Nongranular

  • T Cells = direct cell-to-cell attack on pathogens

  • B Cells = indirect attack on pathogens 

Spleen

  • Largest lymph organ

  • Serves as blood reservoir

  • Destroys old RBC

  • Erythropoiesis = RBC production

Tonsils

  • Palatine = opening of oral cavity

  • Pharyngeal (adenoids) = opening of nasal cavity in upper throat (pharynx)

  • Lingual = back of tongue

Thymus

  • Development of immune system during early life

  • Produces thymosin for maturation and function of T Cells

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Diagnostic procedures:

  • CBC = hemoglobin, hematocrit, rbc, wbc count

  • Enzyme-Linked Immunosorbent assay (ELISA) = screen for HIV antibody

  • Liver function = measures coagulation of prothrombin and fibrinogen

  • WBC differential = different types of leukocytes present

  • Western Blot = used to confirm +ELISA or +HIV (more accurate than ELISA)

Diseases and Conditions:

  • Autoimmune: rheumatoid arthritis, Chrons, diabetes mellitus type 1, lupus

  • AIDS: most advanced HIV stage 

    • Significant decrease in T-cell count

  • Lymphoma: benign or malignant tumors affecting the lymphoid tissues

  • Mononucleosis (mono): contagious viral infection from Epstein-Barr virus or cytomegalovirus

  • Splenomegaly: enlarged spleen from infection

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Digestive System

  • Mouth, pharynx, esophagus, stomach, small intestine, large intestine, liver, gallbladder pancreas

Mouth

  • Mastication mixed with saliva forms bolus (clump of food)

  • Tongue has frenulum linguae: tissue anchoring tongue to mouth floor

Pharynx = throat

Larynx = windpipe

Esophagus

  • “Food tube”

  • Epiglottis: flap covers larynx when swallowing

  • Peristalsis: involuntary rhythmic movement moves bolus through digestive tract

  • Chyme: bolus broken down by gastric acid creating semi-fluid chyme

Stomach

  • Esophageal sphincter = prevent food backing up to esophagus

  • Fundus: upper part of stomach

  • Body: middle portion of stomach

  • Pylorus: lower portion of stomach

  • Pyloric sphincter: regulates rate partially digested food enter duodenum

  • Stomach wall = rugae folds that allow stomach to expand

Small Intestine

  • Absorption takes place in the villi (circular folds in wall with hairlike fibers) 

  • Duodenum = 1st section 10 in long

  • Jejunum = 2nd and middle portion 8 ft long

  • Ileum = last part 12 ft long

Large Intestine

  • Absorbs water + stores material

  • Cecum = 

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Pharmacology: 

FDA:

  • Regulates OTC medications and prescriptions

  • Regulates new drug development and approvals before distribution

DEA:

  • Monitors production/distribution of controlled substances/narcotics

  • Enforce drug abuse law and abuse prevention

  • Physicians need a federal DEA registration number to prescribe schedule 2-5 drugs. 

Names:

  • Chemical= chemical composition

  • Generic= official name (only 1)

  • Trade/Brand= used for marketing (can have 1+)

    • Drug names can be patented/copyrighted for 17 years max.

Controlled and Narcotic Prescriptions:

  • Hand written in triplicate with copies for pharmacy + federal regulators

  • Signed by physicians

  • Filled within certain time

Drug Misuse:

  • Any drug can be misused not just controlled substances

  • MA checks phone calls for narcotic refills and document every request

Drug Sources:

  • Plant (ex: digoxin, codeine, morphine)

  • Animal (ex: insulin, vaccines)

  • Mineral (ex: sodium chloride)

  • Synthetic (ex: demerol)

- Drug Reference Manual= must be in every office for looking up meds.

- Drug reps often have patient education material on hand for MAs.

Diagnostic Meds: diagnose health problem (ex: allergy testing)

Palliative Meds: relief from symptoms (ex: pain meds)

Prophylactic Meds: prevent illness/disease (ex: immunizations)

Replacement Meds: replace substance needed to maintain health (insulin)

Therapeutic Meds: treat and cure (ex: antibiotics)

Prescription Label:

  • Superscription: patient name, address, date, rx symbol

  • Inscription: drug name, dose form, strength

  • Subscription: directions for pharmacist

  • Signature: directions for patient

    • Refill info comes after signature 

      • Physician’s signature after refill info

  • Repataur: tells pharmacist if med can/cannot be refilled & # of refills

  • “ss” = ½

  • “aa” = of each

  • “s.o.s” = if necessary

Documenting given prescriptions:

  • Info, date, update patient med list

  • Record name of person refilling meds

Oral Route:

  • Most convenient and cost effective route of admin

  • Not appropriate if: patients unable to swallow pills / stomach acid will destroy it

  • Enteric coated med: protects digestive system

  • Stay with patient / verify med has been swallowed

Injection Route:

  • “Parenteral” route

    • Provided in sterile water or normal saline

    • Released slowly if an oil base

    • Check expiration date before giving

    • Check for discoloration/sediment

  • IM= most common (20-23 gauge, 1in)

    • Kids = 45 degree angle not 90

    • Z-track prevents medication leakage

      • Only use on large muscles

  • SUBQ (25-26 gauge)

    • SUBQ ex: insulin & heparin (abdomen)

    • Massage injection site UNLESS told not to

  • ID = for allergy testing, TB, med sensitivity

Mucous Membrane:

  • Mouth, throat, nosel eyes, rectum, vagina, respiratory tract, urinary tract

  • Sublingual = under tongue 

Topical:

  • Creams, lotions, ointments, dermal patches

Vials: must clean rubber stopper with alcohol wipe

Multi-dose Vial: inject equal amount of air to equalize pressure

Drug Distribution = transport of med through body

Drug Action = how drug works in body

Drug Metabolism = converted for excretion

Drug Excretion = removal of med from body

  • Kidneys excrete

Drug Accumulation: build up of meds in the body not excreting properly

Half-life: used for calculating dosage schedule 

“Idiosyncrasy” = med has unexpected effect or opposite effect

“Pharmacokinetics” = study of drugs as they move through the body

Antagonistic Drug Interaction: one med shortens or decreases the other

Synergistic Drug Interaction: one drug increases/lengthen effect of another (can be good or bad)

“Potentiation” = one drug increases action of another

“Adrenergic” = drug constricts lumen of vessel (epinephrine)

“Cathartic” = drug irritated lining of bowel (dulcolax)

Drug Action:

  • Weight: average dose is based off 150 lb average

  • Age: adjust dose for children and elderly

  • Physiological: pregnancy / fat:muscle ratio may change action

  • Time: some meds need certain time of day for desired effect

  • ALL drugs rated in relation to:

    • Safety for pregnant women

  • Immune response: antibodies to med can cause allergic reaction if given again

Medication Administration Steps:

  • Prep med right before administering

  • Observe patient 20 min

  • Ask about drug allergies

  • Rights of Medication Administration:

    • Right patient

    • Right drug (check 3 times)

    • Right dose (confirm with another person)

    • Right route 

    • Right time

    • Right documentation (right after admin, include all details, patient tolerance)

    • Right technique

  • Children’s meds: include caregiver if necessary

    • Explain to child/ offer choices

    • Safely restrain child with help

    • Never make promises / never scold child

    • Offer reward after

  • Clark’s Rule:

    • Calculate dosage assuming child’s weight and height are in proportion and use weight of 150 lb adult

  • Fried’s Rule:

    • Child under 2

    • Adult dose x child’s age in months = __ divided by 150

  • Elderly meds: discard meds no longer needed to avoid confusion

  • Suspension: liquid prep for meds dissolved in liquid

    • Includes emulsions and gels

    • Shake well

Vaccine Fridge:

  • Maintain temp year round

  • Calibrated thermometer at all times

  • Check daily

  • Store nothing else only meds or vaccines