Chapter 7 Laws and Regulations Flashcards
Constitutional laws
- highest authority from constitution, federal and state
- first 10 amendments including the Bill of Rights
What is the bill of rights?
To protect us from government overreaching, include freedom from unreasonable searches/seizures, from being tried twice for the same crime
Statutory laws
-Second highest the laws, And acted by Congress and state legislatures
Common laws ( and civil laws)
Legal precedents set by charges
Administrative or Regulatory laws
Laws enacted by administrative agencies at federal, state, and local levels like Medicare or occupational safety and health (OSHA)
American American disabilities act (ADA)
1-prevents discrimination against persons with disabilities in areas of employment, public accommodations, government services, and telecommunications.
Defines disability the (ADA)
- physical or mental impairment that women it’s at least one major life activity (ADLs, ability to see, hear, speak, walk, care for self,, perform manual tasks, Engage in learning activities)
=== the person with a disability does need documentation of their disability===
American disability association title 1: Employment discrimination (1992)
1-For employers employing 15+
2-person cannot be discriminated against if they qualified to perform the essential functions of the job
3- qualified individual must be able to perform the essential functions of a job with or without reasonable accommodations
4-
What are some reasonable accommodations for the ADA Title I: Employment Discrimination 1992
- Making physical changes examples would be ramps or modifying office /bathrooms
- Providing sign language interpreters for deaf, readers for the blind
- Providing quieter places to decrease distractions for mentally disabled
- providing training/written Materials in BRAILLE , audiotape, large prints, reader
- providing teletypewriters (TTYs) for you with telephones for the deaf, software programs for vision impairments/hand impairments
- Time off for treatment of disability
- must be done upon request unless employer can prove “undo hardship” such as excessively difficult, costly, Disruptive, or would fundamentally change business
Title II
Discrimination related to equal access to public and transport services
Title III
Discrimination related to public accommodations
- includes all private businesses and services
- does not include religious and some private clubs
Title IV
Discrimination related to equal access in telecommunications services
Title V
Miscellaneous, States are not exempt, advocates cannot be retaliated against
Individuals with disabilities education act (IDEA)
It is a law introduced in 1975 and modified in 1997 ensuring services two children with disabilities.
- governs how states and public agencies provide early education and special education
- children ages 3- 21 receive special Ed/services under part B
- children birth-2 receive early intervention services with their families under part C
Purpose of IDEA
- ensure that all children with disabilities have available to them a free appropriate public education
- ensure the rights of children with disabilities are protected
- provide for early intervention multidisciplinary services
- ensure that parents and educators have the tools they need
What is PTs primary goal for children?
Identifying and serving children with disabilities by developing and implementing cost-effective services within schools setting and an overall quality of life
PT and PTAs provide what for children?
Early PT services for infants and toddlers and older children with disabilities in educational programs
What is the roles for PT/PTA early intervention with children?
(infant/toddler’s with disabilities)
- consult with parents and providers to ensure effective services
- train parents and others
- multidisciplinary team assessments of children and their family
- develop goals for individualized family service plan
- screen, evaluate, assess infants to identify movement dysfunctions
- program planning to prevent, alleviate, or compensate for movement dysfunctions, and provide individual or group services to goals
Licensure Laws contain what?
1- Enacted by all states to give licensees the exclusive right to practice their profession and protect consumers against professional incompetence.
Licensure Laws are called “practice acts” for:
- Licensure educated in US been in foreign countries and relicensure
- continuing education
- temporary licensure
- reporting of unethical conduct
- restrictions, if any, on direct access
- provisions defining ground/procedures for disciplinary action
More on Licensure Laws
- violations punishable as criminal offenses and form basis for civil malpractice lawsuits
- PTs are licensed in all states, PTAs and all but 48 (certified into remaining states)
What are the minimum state regulations to become a PTA?
- require a graduation from CAPTE accredited program
- require NPTE (as developed/ directed by the FSBPT)
- provide title protection
- provide for disciplinary action
- many require jurisprudence exams (separate exams over the states specific practice art)
- Licensure includes defined scope of practice
- State laws define the amount of PT direction and supervision (also the number of PTAs each PT is allowed to supervise/Length of time between PT/PTA consultations)
Occupational safety and health administration (OSHA)
-Federal government agency concerned with the health and safety of workers
What are OSHA’s duties?
Developed protective standards and enforced standards.
Bloodborn pathogen’s standard?
- Protect workers against blood or infectious agents
1. Have a plan to minimize risks of blood exposure and provide training
2. Require use of universal precautions and provide PPE
3. Provide work areas with minimized risk-sharps, containers, laundry equipment etc…
4. Provide hepatitis B vaccinations and post exposure exams
Universal precautions?
-treat all blood and body fluids as if they were infectious
=== include semen, vaginal secretions, cerebral spinal fluid, synovial fluid, saliva, etc.
Methods of infection control?
- work practices like careful hand washing immediately after removing gloves and before working with a patient
- safe procedures for handling sharps, Use of sharps containers
- immediately report any exposure to needle sticks/blood splashes
- disposal and handling of contaminated waste
- use of PPE, especially gloves, gowns and goggles
- use of mouthpieces, resuscitation bags
- use of disinfectants
- labeling and signs
- training and educations
- Post-exposure follow up
Domestic violence/abuse, Intimate partner violence (IPV) or battering:
- occurs between people in intimate relationships and involves: Coercion, threats, Intimidations, Isolation, Emotional, Sexual, and physical abuse.
- found in all races, religions, ages, socioeconomic groups and ethnicities
More on domestic violence?
- It is often not reported but involves more then 12 million women and men physically abused, raped or stocked by their partners, with about 1000 deaths.
- it is estimated at 27% of women and 11.5% of men for physically or sexually abused by an intimate partner at some point in their lives, with greater than 15 million children in these families
- One study found that 1 in 10 adults greater than 60 experienced abuse each year.
What are some domestic violence patterns
=== the abuser always seeks power and control===
Physical and sexual violence–hitting, kicking, Forcing the partner against their will
- using children as pawns, accusing their partner of bad parenting, threatening to take child away, using kids to relay messages
- denial of the abuse, shifting the blame to their partner
- coercion and threats, like hurting pets, children, even themselves
- economic abuse–controlling all finances, refusing to share money, not allowing partner to be employed, demanding an accounting of all money spent
- intimidation–Breaking things, instilling fear, abusing pets
- emotional abuse–insults, name-calling, criticism
–isolation–limiting contact with family and friends
-controlling, treating partner as a possession or servant
Most victims are reluctant to report domestic abuse
-not realizing impact of abuse, fear or partner/sharing, embarrassment
Healthcare providers experience difficulty in helping
- lack of knowledge of community resources
- fear of offending the victim and jeopardizing the patient relationship
- lack of time/training/feeling and able to help
- victims appointments are in frequent
- victim is unresponsive to question/offers to help
Domestic violence results in not only physical injuries, but has devastating mental health consequences what is one?
-Post traumatic stress disorder, depression, suicide, Substance abuse, and anxiety disorder
Signs of abuse?
- the abuser always the accompanies the victim to appointments, refusing to leave their side and using verbal/Nonverbal communication to direct answers to questions
- patient is noncompliant with the home program or frequent missed appointments, abuser canceling patient appointments
- patient statements about not being allowed to take meds
- patient changing therapist frequently
- patient whacking independent transportation, access to finances, or ability to communicate by phone
- abuser portraying themselves as good caregiver and constantly praising therapists
- harassing therapist with threats of legal action, reporting to superiors
- creating divisions among healthcare team
More signs of abuse?
- injuries -burns, lacerations, etc…
- injuries during pregnancy
- repeated and chronic injuries
- unattended gynecological problems
- symptoms of stress, anxiety, depression
- hyper vigilant signs, easily startled, guarded
- suicide attempts, self mutilation, eating disorders
- car accidents
- overuse of prescription painkillers
Helping with domestic abuse how can I?
- observe the victim for physical/behavioral clues
- ask–question the victim and validate the abuse
- respect the victims privacy
- assess and treat the victim
- keep accurate records and concise documentation of the abuse
- support and follow up on the victims care
- make available information about healthy relationships, parenting skills, and warning signs of abuse
- inform the victims that domestic abuse can’t spread to other types of abuse
PT/PTAs can help
Therapist have ethical duty to help:
- if PTA has suspicions, these should be reported to the PT
- ask direct questions about injuries, evasive behavior, fear of partner (ask when away from partner/family member)
- consult with legal counsel to determine legal obligations to report the abuse (consult with patient to permit them to get to safety)
- detailed documentation in the medical chart, can be evidence if need in court, includes details and photographs with informed consent.
- establish department guidelines for identifying abuse and protocol for what to do when identifying abuse
- have legally required notifications and release of information to the proper authorities available
- have available a list of appropriate referrals for victims
- provide in-service training in continuing Ed about domestic violence to our PT person now
Questions to ask for domestic abuse?
- I am concerned about your symptoms, has someone been hurting you? Did someone hit you?
- you seem to be concerned about your partner, are you having problems with them? What types of problems?
- how does your partner feel about you having PT?
Questions not to ask for domestic abuse?
- why would you stay with someone like that?
- what could you have done to diffuse the situation?
- why don’t you just leave?
- what did you do to aggravate your partner?
- did you do something to cause this?
What is elder abuse?
- when someone knowingly, intentionally, or by negligence causes harm to an older adult
- can be physical, sexual, Negligence, exportation, emotional abuse, abandonment, or not confronting an elder’s self neglect
- grants are available for staff training in elderly facilities
What’s harassment in the workplace?
- unwanted contact, possibly do to race, color, religion, sex, age, Or disability from supervisors, coworkers, Those who are not employees, such as patients
- is illegal when it affects continued employment or is intimidating or hostile in nature
- generally, the employee should express feelings to the person directly or to the supervisor (who has responsibility it is to prevent this from happening)
- consequences for the perpetrator include referral for training/counseling, reprimand, demotion, reassignment, loss of employment or criminal case
- PT/PTA should have response is ready for inappropriate patient comments. Don’t be shy to tell patients.
- it is not legal for patients and therapist to date.
- that comment is not appropriate in the clinical environment
What is fraud?
- knowingly misrepresenting the truth or concealing the facts to the detriment of another
- billing for him provided services, referring patient to a clinic for financial gain.
What is abuse?
- often means misuse or unintentional, but can mean physical harm.
- using inappropriate billing CPT codes, Providing unneeded services
What happens if you fail to report suspected physical abuse?
- healthcare providers are required to report suspected child, domestic or elder abuse.
- failure to report may be considered a breach of duty
- Report to supervising PT first and document all signs and symptoms
Malpractice Law?
-liabilities-generating contact on the part of a clinician associated with an adverse outcome of patient care
Legal responsibility with in the Pt/ Pta team?
- every member of the team is responsible for knowing the state therapy laws, the state “practice art”
- PTAs must know the state laws
- Stating “the PTA told me to do it” does not get you off the hook
- must report all inappropriate behaviors
- PTA retains ultimate responsibility for any actions of the PTA
What is vicarious liability?
- it means the PT is ultimately responsible for the actions of the PTA
- PT may also be held liable went to PTA is found liable
Professional negligence
Substandard care
Intentional misconduct
-It includes violations of ethics
-patient injury from abnormally dangerous a treatment activities or defective patient equipment/supplies
-PT and PTAs can both be sued but the supervising PT is the primary person liable PT/PTA supervising non-licensed staff are responsible for their actions
—sanctions can include:
Licensure restrictions / denial, fines, monetary awards
What is negligence?
Failing to do what another competent clinician would have done under similar circumstances, failing to give reasonable care or providing unreasonable care
- PT/PTAs and students are all liable for their own negligence, even if the supervising PT is also liable
- occurs only one home to patient actually occurs
- to prove negligence, the patient must prove that they were harmed when the therapist did something wrong or fail to do something that normally would have been done
- therapist need to show that they perform correctly and safely, and this should be demonstrated in their notes
- for example: if a patient became injured not following hip precautions, the PT/PTA Would have to demonstrate in documentation Proof of both giving proper instructions and the patient understanding them
Healthcare malpractice?
Here are some examples of malpractice involving PT/PTA/students:
- Burns due to lack of paddling/defective equipment (most common malpractice suit against therapist)
- utilization of defective equipment
- patient falls during gait training or exercise it injuries
- any action inconsistent with the code of ethics
- expert witnesses can be called and their question to answer:
- would the treatment performed be what a competent therapist should do in that given situation?
- patients have a 1-4 years statue of limitations after injury to make a claim
- always make sure that employers have malpractice insurance (and they should) and therapist should consider taking out their own personal policies
