Healthcare Law Flashcards
Preparation for Y3S2 PR3150 Assessment
What is the reasonable man test?
The law assumes that “everyone is unreasonable”
Applying equivalency:
A healthcare professional should be reasonably competent when compared to fellow professionals
Can a pharmacist be sued by the patient for being called a “crazy Karen”?
- Yes. Defamation - Can you prove this person is crazy? If not it is defamation.
- If it means something that is not true, then it is defamation.
Can a pharmacist can be sued for both legal and ethical liabilities?
No. Legal liabilities can be sued or prosecuted (criminal and civil) - Police can prosecute. Ethical liabilities cannot be sued because pharmacist council can only discipline you.
A pharmacist stole a carton of glucometers from a retail pharmacy. He sold them at a discounted prices. Which acts has he committed? Criminal, civil or ethical?
- Criminal - Stealing
- Civil - Supposed to be responsible within the organisation
- Ethical - Dishonesty
In a medico-legal lawsuit, can patients sue both healthcare professionals and hospital concurrently?
- Practically, people will sue to the hospital because separate court case need to spend more money
- Sue hospital means you can get more money from hospital than suing a person (Practicality)
What are torts? What are some examples?
Wrongful acts on individual and corporate levels
Examples:
* Negligence
* Trespassing of lands
* Defamation (e.g. “bitchy caregiver’, “FON patient”)
* Assault, Battery
* Occupier’s Liability
* All occupiers owe duty of care to all users and visitors of their facilities (i.e. safe infrastructure and facilities)
How do you determine if something is done out of negligence?
Standard of Care
* Bolam test as supplemented by Bolitho case and confirmed by Gunapathy case
- Bolam - Accepted current practice
- Bolitho - Evidence-based medicine + Logical
What is the doctrine of vicarious liability?
An employer is vicariously liable for the torts committed by its employees
* Includes both patient / non-patient care
* Conditions:
(1) Master-servant relationship / employer employee relationship
(2) Within employment (job scope and responsibilities)
An organisation is liable to its non-employees who act as ostensible agents
* E.g. outsourced services (e.g. CSSD, Radiology, delivery services)
Are organizations liable in the context of independent contractors? Why?
An organisation is not liable in the context of independent contractor
* Independent contractor = principal has no right of control over the manner how an agent work is to be done
What are the 2 sources of law in Singapore’s legal system?
- Legislations / Statutes
- Common/Case Law (Decision of Judges)
What are the 2 types of law and what are their differences?
Criminal Law
1. Source = Legislation / Statutes
2. Guilty / Not Guilty
3. Burden of Proof = 100% beyond reasonable doubt
4. Guilty = Sentence to fine, caning, jail term, death
Civil Law
1. Source = Contract law / Law of Torts
2. Liable / Not liable
3. Burden of Proof = 51% (Balance of probabilities)
4. Liable = Damages, specific performance, injunction
Classification of wrongful acts
- A wrongful act can have both criminal liability and civil liability
- Civil liability can only be proceeded via 1 route: Tort or Contract
- A wrongful act can result in ethical implications that are handled by relevant professional entities (e.g. SPC, SNB, SMC)
What are the 6 principles of medical ethics?
(1) Autonomy: Respect for patients’ needs/ desires/ preferences
(2) Beneficence: Contribute to patients’ welfare and well-being
(3) Non-malificence: Do no harm
(4) Justice: Equitable distribution of benefits/burdens
(5) Fidelity: Truthfulness and Confidentiality
(6) Veracity: Honesty
Four circumstances where autonomy is absent
- Coercion
- Ignorance
- Immaturity
- Mental incapacity
5 legal considerations in autonomy
Mental Capacity Act
Mental Health (Care and Treatment) Act
GiIlick Awareness / Competence
Lasting Power of Attorney
Court-appointed Deputy
4 elements of Beneficience
1) One ought not to inflict harm
2) One ought to prevent harm
3) One ought to remove harm
4) One ought to do or promote good
What is justice?
“Like cases should be treated alike”
What is fidelity? When are there exceptions of fidelity?
Confidentiality:
* Must be maintained at all times
Exceptions to Patient Confidentiality:
* When a patient consents
* To other healthcare staff caring for patients
* Statutory duty by Dr (Infectious Diseases Act)
* Disclosure under court order
* Discovery of documents in court proceedings
* Public interest (e.g. injuries indicative of child/elderly abuse, rape, crimes)
What is veracity?
A relationship based on mutual trust and honesty
3 Aspects of Medical Negligence
- Wrong Diagnosis
- Wrong Treatment
- Inadequate information disclosure
3 Ways that people can be deemed medically negligent
- Did not do properly (Failure to exercise reasonable care)
- Did not do what was supposed to be done (Omission to do something that a reasonable healthcare professional would do)
- Did what was not supposed to be done
What is considered negligent misstatement?
If you know that the information was required for the transaction contemplated by the patient
If you know that it would be communicated to the patient
If you know that patient would rely on the information
If patient does rely on the information
4 Components needed to prove that an act is considered to be medical negligence
Duty of Care
Breach of Standard of Care
Causation
Foreseeable Damages / Injuries
What are 3 principles of duty of care?
Neighbour Principle (Lord Atkin)
- “You must take reasonable care to avoid acts and omissions which can reasonably foresee would likely to injure your neighbour i.e. persons who are so closely and directly affected by your act that you ought reasonably to have them in contemplation…”
- A duty to ensure that one’s acts do not cause foreseeable harm to another (Donoghue V Stevenson)
Vicarious Liability
- Hospital is liable for an employee’s negligence committed during the course of employment
Occupier’s Liability
- Hospital is expected to provide safe premises to everyone on its premises
Who do healthcare institutions and staff owe a duty of care to?
- Patients (Facility, equipment, services)
- Third party (Not to sustain injuries like mental distress)
Pharmacists owe a duty of care to…
Patients
1. In wards / clinics
2. Who purchase Pmeds from retail
3. Who seek advice
4. Who are referred to him by other HCPs
5. In Clinical research / trials
The consideration of breach of standard of care is based on
Reasonable Man Test
- A healthcare professional must be reasonably competent when compared to his/her fellow peers
- A reasonable healthcare professional should deliver a reasonable standard of patient care based on evidence-based clinical practices
What is the Bolam Test?
The Bolam Test determines whether a HCP is guilty of clinical negligence depending on whether he or she has acted in accordance to accepted current practice (= minimum standard of care)
HCPs are judged against the standards of their peers.
If a responsible body of expert witnesses might make the same mistake in the same scenario, the doctor would not be found guilty of negligence.
What is considered the accepted current practice in pharmacy?
SOAP notes
Identifying DRPs to ensure value-based outcomes
What is the Bolitho’s case?
Bolitho case = Evidence-based Medicine that is logical (Defensible conclusion based on causality)
Court must be satisfied that exponents of body of professional opinion has a logical basis, and had directed their minds to comparative risks and benefits reaching a defensible conclusion
Opinion of expert must be supported by proven facts and findings, so that the court can judge the strength of that opinion
Ways to defend causation of patient injury
Patient’s Defence - Res ipsa loquitor
- The facts speak for themselves
- Patients are not clinically trained and may not be able to explain how the medical negligence leads to the injuries/harm
- The law can help patients in situations where it is unfair or difficult for patients/caregivers to identify the errors or causes of injuries and harm
- If the defendant HCP is unable to give a satisfactory explanation, he/she will be liable for the damages/injuries caused to patient
HCP’s Defence
(1) Contributory Negligence - If patient contributed to his/her injury/harm through own negligence in addition to HCP’s negligence, his damages will be reduced
(2) Volenti Non Fit Injuria - Consent to the risk (informed consent)
What is needed for a good defence against negligence?
Good documentation to show that
- Patient rights are not violated
- Patient responsibility also played a role
3 Consequences of the non-adherence to the Bolam Test
- Defensive medicine - Choosing treatment which is most legally safe even if they think such treatment may not be strictly warranted
- More medical litigation - Increased premiums and overall healthcare costs
- Affect doctor-patient relationships
