Medicolegal stuff Flashcards
Professional liability insurance
., every physician who holds or desires to obtain a Colorado medical license must maintain commercial professional liability insurance coverage with an insurance company authorized to do business in this state in a minimum indemnity amount of one million dollars per incident and three million dollars annual aggregate per year
Exemptions:
solely limited to federal/ military agency
not engaged in the practice of medicine
covered by individual professional liability coverage maintained by an employer/contracting agency in the amounts set forth in paragraph 1, above.
d. A physician who provides uncompensated health care to patients, or who does not otherwise engage in any compensated patient care in Colorado.
Patient-Physician Relationship
…the relationship between a physician and a patient must be based on trust and must be considered inviolable. Included among the elements of such a relationship of trust are:
Open and honest communication between the physician and patient, including disclosure of all information necessary for the patient to be an informed participant in his or her care.
Commitment of the physician to be an advocate for the patient and for what is best for the patient, without regard to the physician’s personal interests.
Provision by the physician of that care which is necessary and appropriate for the condition of the patient and neither more or less.
Avoidance of any conflict of interest or inappropriate relationships outside of the therapeutic relationship.
the relationship is not to be constrained or adversely affected by any considerations other than what is best for the patient. The existence of other considerations, including financial or contractual concerns is and must be secondary to the fundamental relationship.
Any act or failure by a physician that violates the trust upon which the relationship is based may place the physician at risk of being found in violation of the Medical Practice Act.
Termination of physician-patient relationship
the discharge is done in writing, via certified mail, to the patient
must provide 15-30 days of provisional coverage
if possible, provide referral information
Notification in the letter to the patient that patient records will be sent to the new physician upon receipt of written authorization from the patient.
Sexual Misconduct
It is the physician’s responsibility to maintain the boundaries of the professional relationship by avoiding and refraining from sexual contact with patients.
should provide appropriate gowns and private facilities for dressing, undressing and examination.
consider having a chaperon present during examination of any sensitive parts of the body
should explain the need for each of the various components of an examination
choose your words carefully
a physician should transfer the care of a patient to whom the physician is attracted
must take all steps necessary to maintain the boundaries of the professional relationship including transferring the patient.
Physicians should not discuss their intimate personal problems/lives with patients.
Sexual Misconduct
unprofessional conduct as “engaging in a sexual act with a patient during the course of patient care or within six months immediately following the termination of the licensee’s professional relationship with the patient.”
sexual contact as: the knowingly touching of the victim’s intimate parts by the actor, or of the actor’s intimate parts by the victim, if that sexual contact can reasonably be construed as being for the purposes of sexual arousal, gratification, or abuse.
sexual intrusion as: “any intrusion, however slight, by any object or any part of a person’s body, except the mouth, tongue, or penis, into the genital or anal opening of another person’s body
sexual penetration as: “sexual intercourse, cunnilingus, fellatio, analingus, or anal intercourse.
defines intimate parts as: “the external genitalia or the perineum or the anus or the pubes or the breasts of any person.”
Termination of Physician-Patient Relationship for Sexual Misconduct
Once a physician-patient relationship has been established, the physician has the responsibility to establish that the relationship no longer exists. The mere passage of time since the patient’s last visit to the physician is not solely determinative of the issue.
Some physician-patient relationships may never terminate because of the nature and extent of the relationship.
Sexual contact between a physician and a former patient more than six months after termination of the physician-patient relationship may still constitute unprofessional conduct
Guidelines Pertaining to the Release of Medical Records
records shall be available to the patient upon submission of a written authorization/request.
exception for psychiatric or psychological illnesses.
request for release of records must be in writing.
Physicians may charge a reasonable fee for copying
Items such as x-rays, fetal monitor strips and electrocardiograms = part of the medical record
instances where a patient cannot, or chooses not to, pay the fee for copying of medical records, the physician at a minimum must make the records available to the patient for inspection or
Guidelines Pertaining to the Retention of Medical Records
each licensed physician and physician assistant shall develop a written plan to ensure the security of patient medical records.
A licensee shall inform each patient, in writing, of the method by which the patient may access or obtain his or her medical records
recommends retaining all patient records for a minimum of 7 years after the last date of treatment, or 7 years after the patient reaches age 18 - whichever occurs later.
The Board recommends sending letters to patients seen in the last 3 years notifying them of discontinuance of practice;
In the event of a physician’s death, the estate should retain the records
Patient Confidentiality
In general, nothing can be disclosed about the patient or information/results obtained in the care of the patient without the consent of the patient
Exceptions :
Disclosure to parents or custodians of minors
Disclosure to custodians of patients deemed legally not to be competent
Concern for safety of patient or others
Legal requirements to report to health authorities and government agencies
- Communicable diseases
- Child/dependent/elder abuse
- Physical/sexual/verbal abuse
- Unexpected or suspicious deaths
- Major medical mishaps and some accidental or purposely inflicted injuries
- Medical conditions that affect driving a motor vehicle
- “bullet wound, a gunshot wound, a powder burn, or any other injury arising from the discharge of a firearm, or an injury caused by a knife, an ice pick, or any other sharp or pointed instrument that the licensee believes to have been intentionally inflicted upon a person, or an injury arising from a dog bite that the licensee believes was inflicted upon a person by a dangerous dog “
Informed Consent
an adult has a “right to determine what shall be done with his own body.”
a physician has the affirmative duty to inform a patient about to undergo surgery in a general way as to the procedures he will follow and the risks involved in those procedures; he also has a duty to inform a patient of any substantial risk of a procedure which he is to perform and of specific risks, if such risks are known or ought to be known by him.”
Informed Consent Elements
You as a medical provider must
Make a recommendation
Disclose the legally required and ethically appropriate information about treatment, available alternatives, risks and benefits
highlight any possible risk of death, physical disability or sexual dysfunction
Recognize and consider the preferred language and cultural beliefs of the patient
Determine that the patient understands the disclosures and the recommendations
The person consenting (patient or patient’s legal decision maker) must
Have decisional capacity
Understands the situation
Understands the risks associated with the decision they are making
Is able to communicate a decision based on those understandings
Make a voluntary decision free of coercion
Make a decision with support from the health care professional
Provide authorization to the health care professional for the chosen plan
Colorado Age of Majority
Colorado law (2-4-401(6)) defines a minor as a person who has not attained the age of 21. Colorado has determined the age of majority to be 18 years of age or older. Individuals are treated as adults at the age of 18, with some exceptions (alcohol, car rental, hotel room)
Some acts young people who have reached the age of majority may be involved in are:
Making decisions regarding his or her own body
Consenting to medical treatment
Even though the age of majority allows young people greater rights, many young people at age 18 still live at home and are thus subject to parents rules while at home.
Minors
A parent has to consent to medical treatments for a child under 18.
EXCEPT IF
they meet any of the conditions noted on the chart (basically anything having to do with making babies, STDs, HIV, mental health, addiction)
OR IF
15 years old, if “living separate , and is managing his or her own financial affairs or is married.”
OR IF in military service.
Consent
Implied Vs. Expressed Consent*
Implied (or implicit) consent
The very act of a patient entering a doctor’s chamber and expressing his problem is taken as an for general physical examination and routine investigations.
Expressed (explicit) consent - can be oral or written.
- Intimate examination, especially in a female, invasive tests and risky procedures require specific expressed consent.
- consent is necessary for photographing a patient
- consent is a must for participation in clinical trials and research projects
Reportable Communicable Diseases
Any unusual illness or outbreak or epidemic of illnesses, which may be of public concern is also reportable. Includes viral hemorrhagic fever.
