Lecture 2 Flashcards
Introduction
- medical providers provide care under a set of laws affecting how patients must be treated
- you must understand the laws and ethics related to emergency care
- failure to perform your job can result in civil/criminal liability
- ethics
- laws
ethics
- deals with the study of distinction between right and wrong
- this presentation is only a framework
two types of ethics
- personal
- professional
- in cases where they conflict you MUST put your personal ethics aside
medical ethics
- medical ethics are related to the practice and delivery of medical care
- Your understanding of medical ethics must be consistent with the codes of your profession
- healthcare providers must be accountable for their actions at all times -> choose a mentor
- professional ethics are also important
- always be respectful of patients
the oath of geneva
– Drafted by the World Medical Association in 1948
– Taken by medical students after completion of their studies
apply 3 basic ethical concepts when making a decision
- do no harm
- act in good faith
- act in the patients best interest
the most successful and fulfilled paramedics
- are patient advocates
- engage in training and professional development
- put the good of the team first
- you are responsible the the future of EMS
two types of law that govern health care providers in court
- civil
- criminal
civil law
- patients can sue for perceived injury
- mental, structural, emotional, physical harm
- nothing criminal happened
- concerned with establishing liability
- civil suit is a legal action of this sort
criminal law
- state can prosecute for breaking a statute
- from a government going against a organization, person, group
- action taken by government against someone prosecutors believe violated a law
tort reform
- limitation on how much you can sue
- civil cases mostly
types of law
- most suits against provider involve negligence
- you did something that led to harm or didn’t do something that led to harm
- intentional tort claims may also be filed:
- assault
- battery
- libel or slander
- false imprisonment
arbitration
- in civil law if two parties are suing each other and both want to settle out of court
- dont want the details to be disclosed
- mutual terms
- amount of money is typically less than what was sued for
- speeds up the process
comission
-you did something that you shouldnt have done
omission
-an action you should have done
defamation
- communication of false information that damages reputation of a person
- libel if written
- slander if spoken
the legal process
- begins when a complaint is filed
- process may take several years
- discovery period- everyone gathers all the facts (subpoenas, records, depositions)
- motions- legal actions, deciding where everyone stands
- settlement process or trial- arbitration or public trial
healthcare providers must answer to
- medical directors- credentialing employers
- licensing agency- state level
- employer- rare employer is separate from medical director
- despite overlap, distinctions are important
administrative regulations
- set by bureaucracies at state and federal levels
- affect and define rules for practice
- policies statements- not laws, govern the way a certain law should be handled
- administrative law- they review policy statements to make sure they are legal
- administrative agency may take action against a paramedics license
certifcation
- not the legal ability to do something (that is licensure)
- certain level of credentials
- certain level of education
- criteria met for minimum competency
- doesnt mean you can do/practice it
licensure
-privilege granted by government authority
credentialing
granted by employer
-may also be adopted
licensing action may be taken if an infraction occurs
- providers have the right to due process
- notice
- opportunity to be heard
medical practice act
- defines minimum qualifications of health service providers
- defines skills practitioners can use
- establishes means of licensure/certification
- may also include relicensure requirements
- you dont want to practice outside of scope -> civil or criminal law
scope of practice
- care may perform according to the state under it license or certification
- ex. medical director may not permit paramedic to perform all skills/give all medications
- practicing outside scope of practice is negligence or a criminal offense
health insurance portability and accountability act
- HIPAA
- federal essence of healthcare privacy
- stringent privacy requirements
- provides for criminal sanctions and civil penalties
- information can be disclosed:
- for treatment
- for payment
- when authorized- consent
special reporting situations: HIPAA
- mandated reporting- must report child abuse
- authorized data collection/research- often consented, but if not it is deidentified
- subpoenas
privacy officer required: HIPAA
- ensures PHI is not released illegally
- makes sure there isnt improper release of PHI
- almost every organization has one
HIPAA cont.
- confidentiality is part of the code of ethics for emergency medical technicians
- you must provide patients with a copy of your services privacy policy
- HIPAA also regulates electronic information -> end to end encryption
some states have patient confidentiality laws
-this is on top of HIPAA
-stricter
-
BAA- business associate agreement
- information is protected by law
- company follow encryption standards
- agreement between healthcare and information exchange companies
- electronic
emergency medical treatment and active labor act (EMTALA)
- establishes to combat “patient dumping”
- never make decisions based on finances
- know local transport selection protocols
- guarantees medical screening exam and treatment
- regulates patient transfers
- unfunded mandate
- cannot turn someone away or send them somewhere else to lesser care
emergency vehicle laws
-most states have specific statutes
– Define emergency vehicle
– Dictate what traffic should do
• Emergency vehicles must be operated
safely.
– Most states have a higher standard for EMS.
– If a crash occurs, EMS is usually at fault.
mandatory reporting
- each state has its own requirements
- virtually every state has laws for reporting child and elder abuse
- many states have immunity provisions- if you report someone and you are wrong you cannot be sued for damaging that persons image
- failure to report a crime - illegal
- known reporting requirements in your state
consent and refusal
- you must obtain consent before providing care
- to provide consent, a patient must
- be of legal age
- possess decision making capacity- can hear and understand the pros and cons of decisions
- patients can refuse care
informed consent
-must be obtained from every adult with decision making capacity
to obtain informed consent
- signing informed consent does not mean consent -> they must understand
- describe the problem and proposed treatment
- discuss risks and alternatives
- advise the patient of consequences of refusal
expressed consent
- type of informed consent
- used primarily for common procedures
- gestures that show consent
- no risk in it
- ex. blood pressure
implied consent
-consent that is assumed when an adult is unconscious or too ill/injured to verbally consent
involuntary consent
- do a real thing
- oxymoron
decision making capacity
- refusals must be informed
- ability to change your mind
- ability to choose no treatment even if it means death
- may not want to admit there is a problem
- maintain a courteous sympathetic attitude
- documentation is critical **
- ability of the patient to:
- understand information
- process information
- make a choice
back up refusal forms with action
- do everything you can to inform the patient
- ultimately, respect his or her rights
If a conscious patient with decision-making
capacity refuses treatment
– Cannot be treated without a court order
– Use your “people skills.
emancipated minors
- treated as legal adults because of qualitiying circumstances
- military
- pregnant
- someone who has reason to be apart from parents -> legal orders
obtaining consent is a difficult skill
-tour expertise will build over time
Obtain consent from a legal guardian
– In loco parentis if guardian is unavailable
- Notify law enforcement and medical control if a parent refuses necessary treatment.
- State may assume custody
violent patients and restraints
- you can only use force in response to a patients force against you or themselves
- do not enter an unsafe scene
- only restrain medical patients who are a danger to themselves or others
negligence and protection against negligence claims
- no protection for gross negligence
- behaving according to established standards and procedures is the best protection
- consider insurance coverage
- negligence occurs when:
- there was a legal duty to the patient
- there was a breach of duty- you did or didnt do something that you should have
- the failure to act was the proximate cause of injury- cause
- harm resulted
foreseeability
- if this same situation was given to these (other) people would they have foreseen the situation and avoided it
- using your knowledge to see into the future and know the consequences of your actions -> if someone was hypoxic and goes into cardiac arrest…why didnt you intubate them when you had the chance
negligence is typically divided into three categories
- Malfeasance- did the wrong action
- Misfeasance- right action, wrong circumstances
- Nonfeasance- lack of action
duty
- prescribed by law
- do not further harm to patient
- obligated to respond to calls while working
- typically not while off duty
- make sure appropriate personnel respond
- must perform within a standard of care when providing assistance
- Cannot abandon the patient once care begins
- Must maintain licensure or certification and skills
breach of duty
- standard of care
- what a reasonable paramedic would do in a similar situation
- some states distinguish between ordinary and gross negligence (he said not to worry about this part)
- Re ipsa loquitur or negligence per se may apply
proximate cause
-improper action or failure to act caused harm
harm
- usually physical injury
- may also include emotional distress, loss of income, loss of spousal consortium, etc.
abandonment
- termination of care without patients consent
- implies continuing need for treatment
- once you respond you cannot leave until a provider with equal or higher training takes responsibility.
patient autonomy
- resolve ethical conflicts through communication
- if you disagree, discuss it
- always act as a patient advocate
- you may need to treat a patient against his or her wishes
- if someone has capacity they can refuse
advance directives
- expresses medical care, if any, the patients wants if he or she can no longer articulate personal wishes
- do not hospitalize
- do not intubate
- do not resuscitate
- differs from state to state:
- laws are often state to state
- know and follow state laws
types of advance directives
-related to end of life medical care
-sometimes called durable powers of attorney
=the living will.
-Durable power of attorney for health care/Medical power of attorney.
-POLST (Physician Orders for Life-Sustaining Treatment)
-Do not resuscitate (DNR) orders.
-Organ and tissue donation.
various types of powers of attorney
-not all authorize health care
-
surrogate decision maker
- has no authority until patient becomes incapable
- defer to patient whenever possible
- when unsure, begin care
DNR order
- do not resuscitate
- describes which life sustaining procedures, if any, should be performed
- laws differ between states
- may include a physician order or medical jewelry
- you must still provide supportive measures if a patient is not in cardiac arrest
- you still must treat just do not resuscitate
- DNRS must generally:
- clearly state medical problem
- have patient/guardian signature
- have signature of one or more physician
durable power of attorney
- only certain specific certain circumstances
- ex. only if they are intubated
end of life decisions
- you will often deal with patients at the very end of their lives
- treat with respect and empathy
- never question why help was called
- providing information and support is part of your job
- avoid imposing your own moral code
- respect patients wishes even if you disagree
- you may encounter confusing scenarios
- resuscitate until paperwork is confirmed
- avoid hostile encounters with family members who disagree with patients wishes
Medical orders for life-sustaining treatment (MOLST)
- Similar to DNR, but more expansive
- May apply with impending pulmonary failure
- Guide use of CPR, intubation, feeding tubes antibiotics, palliative care
- not an advance directive
medical examiner cases
- involvement depends on nature/scene of death
- examiner notified in cases of:
- dead on arrival (DOA)/dead on scene (DOS)
- death without previous medical care
- suicide
- violent death
defenses to litigation
- your first defense is an open, informative, trust based relationship with patients
- when this is not possible, several defenses may be used including:
- statute of limitations
- contributory negligence
good samaritan legislation
- provides immunity from liability- passed to encourage public to help
- apply when youre not working and in public
- doe snot apply while on duty -> legal duty applies
- must do all you can, within your knowledge
american with disabilitys act (ADA)
- protects qualified persons with disabilities from employment discrimination
- all aspects of employment (hiring, salary, etc.)
- for ADA protection, a person must:
- Have a disability that limits life activities
- Possess the basic qualifications and be able to perform the essential job functions
- Employers cannot inquire about disabilities or require a medical exam until after the job offer is made.
- Reasonable accommodations must be provided.
- Employers are not required to give preference to disabled employees.
Title VII of the Civil Rights Act
-Prohibits discrimination based on race, color,
religion, gender, national origin
-Also prohibits sexual harassment
-Applies to all aspects of employment
-Generally, a pattern over time, not single incident
sexual harassment
- Sexual comments
- Display of offensive material
- Unwelcome advances, touching
- Inappropriate personal inquiries
- Employers are obligated to prevent harassment.
- Must investigate all claims promptly
- Must provide training
- Employees must promptly report any harassment
Additional Federal Laws Dealing With Discrimination
- Pregnancy Discrimination Act- cannot discriminate
- Equal Pay Act of 1963- gender gap, race gap
- Men and women who perform equal work in the same workplace must receive equal pay.
- Age Discrimination in Employment Act of 1967
Family Medical Leave Act (FMLA)
- Up to 12 weeks unpaid leave per year
- For eligible employees
- Under certain circumstances
- Some states have their own versions.
- May provide more rights
Occupational Safety and Health Administration (OSHA)
- Regulates safety in the workplace
- States may enforce regulations tighter.
- Covers all employers
- Additional responsibilities in health care
- standards are often changing
- Do all you can to avoid injuries.
Ryan white act
- Provides safeguards and protections for health care workers exposed or potentially exposed to certain designated diseases
- Notify your infection control officer if you believe you may have been exposed
- assess to medical records even without consent
National Labor Relations Act (Wagner Act)
- Establishes:
- Rights of unions and union workers
- Regulates unfair labor practices by employers
- Become familiar with your rights and the union laws in your state
assault
- Unlawfully placing person in fear of immediate bodily harm
- Example: restraint
battery
-Unlawfully touching a person
– Example: providing care without consent
kidnapping
- Seizing, confining, abducting, or carrying away by force
- Example: transport against will
- A false imprisonment charge is more likely (defined as unauthorized confinement of a person).
documentation = protection
- Complete promptly after patient contact.
- Be thorough.
- Be objective.
- Be accurate.
- Maintain patient confidentiality.
- Never alter a patient care record
