Vol.1-Ch.7 "Medical Legal Aspects of Out of Hospital Care" Flashcards
Ethical standards are not _____.
Laws
Our duties are based off _____ and set by _____.
based off of generally accepted standard
set by statutes and regulations
what are the 4 primary sources of law?
- Constitutional
- Common
- Statuatory
- Regulatory
Constitutional law protects against?
Governmental abuse
Common law (also known as ?) is what?
AKA = case law or judgement-made law
Changes over time after established principals are tested and adapted.
It is a principal that our legal system should follow precedents set by other courts (basically similar cases should follow a similar fate)
Statutory Law (aka ?) is at what levels of government and takes precedence over what?
AKA = legislative law
Created by lawmakers and legislative bodies
Enacted at the federal, state, and local levels
(Takes precedence over common law aka the courts)
Regulatory law (aka ?) is enacted by whom?
AKA = Administrative law
Enacted by administrations or governmental agencies
What are the 2 general categories of law? What does each one mean?
Criminal Law: deals with crime and punishment (individual VS society)
Civil Law: Noncriminal issues
What is Tort Law? What would it cover?
A branch of civil law that deals with civil wrongs of one person against another
Includes: negligence, medical malpractice, assault, battery, and slander
Civil Litigation involves a _____ and a _____
Plaintiff VS Defendant
Most paramedic court cases will take place in what level of the courts? Most laws the effect us are?
State court system ; State Laws
Trial Courts VS Appellate courts
Trial Courts: judge or jury determines outcome of cases
Appellate Court: Hears appeals of the decisions made by the trail courts
What 9 components are involved in a civil law suit?
- incident
- investigation
- filing of the complaint
- answering the complaint
- discovery
- trial
- decision
- appeal
- settlement
What 3 things may the Discovery phase include in a civil law suit?
- Examination before trial (“deposition”) : allows witness to answer questions under oath
- Interrogatory : Either side can have a set of written questions that require written answers
- Requests for document production : either side can request pertinent documents
A complaint can also be called a ____?
Petition
The scope of practice is set by what/whom?
Set by state law/regulation and/or by medical direction
States will often have a _____ that governs the practice of medicine and all health care professionals.
Medical Practice Act
Paramedics should follow ____ and ____ medical diractions?
On-line and Off-line
When can you refuse an order given to you by the doctor on medical direction?
When the order is out of your scope of skills ; not consistent with established protocols or procedures ; or if you reasonably believe it will be harmful for your patient
How should you handle a situation where you must refuse medical direction?
First bring up your concerns with medical direction, if that doesn’t resolve the issue then refuse the order and document everything
What is required before an intervener physician can assume control of patient care? (4)
- Proper identification
- licensed to practice in the state
- willing to accept the responsibility of care until the Pt gets to the hospital
- willing to document the intervention
Certification VS Licensure?
Certification - recognition that a person has met the requirements to practice a certain activity
License - Government regulation that grants permission to a person who meets qualifications to practice a certain profession
Things observed that require reporting to authorities
Include :
- Spousal, child, or elder abuse or neglect
- violent crimes (sex assault, gunshot, stabs)
- Public health hazards (animal bites, communicable diseases)
Immunity = ?
Exemption from legal liability
Governmental Immunity = ?
doctrine that prohibits a person from bringing a lawsuit against a government without consent
**(only protects government and not paramedic, especially a paramedic not working for a government agency)
Good Samaritan Law = ?
Protects a person so long as they do what? (4)
provides immunity to people who assist at the scene of an emergency.
Requires a person to:
- act in good faith
- not negligent
- acts within the scope of practice
- does not accept payment for service
Most insurances will cover ____ negligence but not _____ negligence.
Most insurances will cover simple negligence but not gross negligence.
What is an example of a law that protects paramedics when they are exposed to blood borne or airborne diseases?
Ryan White Comprehensive AIDS Resource Emergency Act (Ryan White CARE Act) (Federal Law)
Allows a paramedic to access a Pts records to check if Pt has illness when exposed to their blood
What is intentional tort?
A civil wrong committed by one person on another based on a willful act
Negligence = ?
What is negligence synonymous with?
A deviation from accepted standards of care recognized by law for the protection of others against the unreasonable risk of harm.
Negligence = Malpractice
A plaintiff must have what 4 things to win a negligence claim against a paramedic?
- a duty to act
- a breach of that duty
- actual damages to the Pt or other individual
- proximate cause (causation of damages)
If an off duty paramedic see someone choking he has ____ obligation to help. But if he chooses too then he is ____ to continue care.
If an off duty paramedic see someone choking he has no legal obligation to help. But if he chooses too then he is legally obligated to continue care.
A breach of duty may occur by what three things? What is each one?
Malfeasance : the performance of a wrongful or unlawful act by the paramedic
Misfeasance : the performance of a legal act in a manner that is harmful
Nonfeasance : Failure to perform a required act or duty
What does Res Ipsa Loquitur mean?
When is it relevant?
What 3 things are required?
It means “the thing speaks for itself”
It can be used by a plaintiff to win a civil suit when the following can be proved:
- Damages would not have occurred without someone else’s negligence
- instruments causing damages were under the defendant’s control the whole time
- the Pt did nothing to contribute to their own injury
Can a lawsuit still be won if there are no actual damages to the plaintiff?
No
Punitive damages = ?
Punishing damages (usually not covered by insurance)
Proximate cause can also be thought of as _____? What does proximate cause mean?
Foreseeability; It means that the plaintiff must prove that the damages were reasonably foreseeable by the paramedic
What are 4 defenses against charges of negligence?
- good Samaritan laws
- governmental immunity
- Statute of Limitations (sets a time limit on how long after incident, a case could still be made in a court)
- Contributory or comparative negligence (lessens plaintiff rewards if they contributed to their own injury)
What things should you do to protect yourself against claims of negligence? (5)
- appropriate training, edu, and continuing edu
- appropriate medical direction online and offline
- accurate thorough documentation
- professional attitude and demeanor always
- use common sense
Are you liable for EMTs performing under you?
Yes
What root issues might you have to restrain someone for being a risk to themselves or others?
- medical condition
- psychiatric condition
- substance abuse
Excited delirium syndrome (ExDS) presents with?
Usually seen in combo with what?
What % of people die from this?
It presents with a triad of :
- delirium
- psychomotor agitation
- physiological excitation
It is usually seen with stimulant drug abuse
About 8-14% die from this
What is restraint asphyxia or positional asphyxia?
Death or injury caused by being restrained or put in a restrictive position, and is usually seen in combo with excited delirium syndrome but not always.
Positional is usually seen in combo with depressants
Medical confidentiality includes? (3)
- Medical history
- assessment findings
- treatment
Under what circumstances can a patients confidential info be released? (4)
- Patient consents to the release of the records (only acceptable in writing)
- Other medical care providers need to know (providers with responsibility of care only)
- When it is required by law
- For 3rd party billing
What are the 3 barriers to protect patient confidintiality?
- Administrative
- Electronic
- Physical
What is defemation? Libel? Slander?
Defamation: Intentional WRITTEN OR VERBAL false communication that injures another persons reputation
Libel: Intentional WRITTEN communication that injures another persons reputation
Slander: Intentional VERBAL false communication that injures another persons reputation
Invasion of privacy = ?
Release of confidential info, without legal justification regarding a Pts private life.
Consent is granting permission to treat but also and more importantly, permission to _____?
Touch
There is no absolute test for competency but what 5 factors should you keep in mind when determining competency required for consent?
- Mental status
- ability to respond to questions
- what the family and or friends say about mental status norm
- evidence of drugs/alcohol
- evidence of shock or hypoxia
In order for medical care to be given _____ _____ must be obtained
Informed consent
What info must be given to Pt in order for consent to be informed consent? (5)
- Nature of illness or injury
- Nature of recommended treatments
- Risk, dangers, benefits to the treatments
- Alternative treatment possibilities if any are present
- Dangers of refusing treatment or treansport
Can a Pt revoke consent at any time during treatment or transport?
Yes
Expressed Consent VS Implied Consent VS Involuntary Consent
Expressed Consent : When a person directly gives permission to treat (verbally, nonverbal, or in writing)
Implied Consent : Assumed consent when a person is not mentally, physically, or emotionally able to give consent
Involuntary Consent : Court ordered treatment whether a Pt wants it or not (like communicable diseases or being held for a psych eval)
If a Pt is in police custody and they give consent to treat the Pt, is that acceptable over what the Pt consent is?
No, the Pt always has the right to decide on treatment for themselves. Even if they are in custody.
Do you have to have consent for every treatment?
Yes, but consent doesn’t always have to be specific. It can be expressed as allowing care to be rendered
Under what situations is a kid considered emancipated?
- married
- pregnant
- parent
- in the military
- financially independent and living away from home
A problem Pt may include ?
A pt who is:
- violent
- victim of drug OD
- inoxicated adult or minor
- ill or injured minor with no adult
What are 3 danger zones for breaking professional boundaries?
- being tired
- being seduced (which means being led away from one’s principals, ethics, faith, or allegiance and can be caused by sex, money, drugs, food, etc)
- being unprepared
You cannot turn over care to _____?
Anyone with less training than you
Assault Vs Battery
You can have assault and or battery claims against you if you do not get consent to treat
Assault : unlawfully placing someone in the apprehension of immediate bodily harm
Battery : unlawful touching of a person
When might you be charged with false imprisonment?
If you transport someone without consent
Reasonable Force = ?
minimum required force necessary to ensure your Pt does not hurt themselves or others
Restraining devices include ? (3)
- straps
- jackets
- restraining blankets
One of the greatest risks to liability a medic runs into involves?
Motor vehicle operation
In general, facility selection should be based on what 3 things?
- Pt request
- Pt need
- Facility capability
Usually follow the Pt’s facility preference especially if required by insurance
What are some examples of when resuscitation is not required? (4)
- Valid DNR order
- Obviously dead Pts
- Obvious tissue decay or extreme dependent lividity
- Pt in a scene too hazardous to enter
Patient Self-Determination Act of 1990
Requires hospitals and physicians to provide patients and families with sufficient info to make informed decisions about medical treatment and use of life support measures
Advanced Directive = ?
A document created to ensure that certain treatment choices are honored when a Pt is unconscious or unable to express his choice of treatment
Most common advanced directives include ? (4)
- Living wills
- durable power of attorney for health care or health care proxy
- DNR orders
- Organ donor cards
Living will = ?
Legal document that allows a person to specify the kinds of medical treatment he wishes to receive
Who signs the DNR order?
A Pt and their physician
Physician orders for life sustaining treatment (POLST) = ?
usually used for terminally ill Pts and it is a set of directions of what care to provide made between the Pt and Doctor
What should you do when you have a Pt that is an organ donor?
- Make sure you try to maintain organ viability through IV fluids, CPR, and ventilation
- Contact Medical direction
Treatment of the Pt does not end until?
You have completed your report documenting from the initial response to the transfer of the Pt to a hospital
A well documented Pt care report includes ? (5)
- it is completed promptly after patient contact
- it is thorough
- it is objective
- it is accurate
- it maintains patient confidentiality
What should you do if a Pt care report is incomplete or poorly written and found to be at a later date
Update it as quick an accurately as possible WITH AN AMENDMENT, do not alter the original. Place date and time of amendment and send to needed staff for updates
Employment Laws = ?
Laws that address employee-employer relationships
Examples of federal laws that protect employee rights (7)
- Americans with Disabilities Act (15+ employees; prevents discriminations on employees with disabilities)
- Title VII (prohibits workplace harassment/discimination, applies to comps with 15+ employees)
- Amendments to Title VII
- Family medical care act
- Fair labor standards act
- Occupational Safety and Health Act
- Ryan White CARE Act
