Week 6 - Legal Concepts in Anesthesia Flashcards
What is statutory law?
- Constitution provides for legislatures, state and federal
- Hierarchy in various aspects of law (can be more picky but not less picky than the level above)
- Division of Power – state & federal
- Legislatures make statutes
- States have “police power” over citizens
What do statues do?
- Outline standards of behavior – the LAW
- Appropriate funds
- Determine rules to live by
- Determine punishments for crimes
- Provide underlying basis for regulations
- Create agencies and jobs – give power to agencies
What laws affect CRNA practice?
Federal
State
Local (Hospital Laws – Policies)
How are Laws different from Policy?
Laws proscribe behavior
- Rules define the law and consequences
- Agencies responsible for interpreting and enforcing laws and rules
Policy is what “should” be done, may be made into law eventually
-Enforceability varies
What are Federal and State examples of administrative rules?
Federal: Supervision and Opt-Out, Medicare TEFRA
State: scope of practice
What are the TEFRA Rules for Medical Direction?
- Performs a preanesthesia exam and eval
- Prescribes the anesthesia plan
- Personally participates in the most demanding aspects of the plan
- Ensures a qualified provider performs procedures
- Monitors the anesthetic at frequent intervals
- Remains physically present and immediately available
- Provides postanesthesia care
Who makes Laws? Rules? Decisions?
Laws –> Representatives and Senators
Rules –> Agency Personnel
Decisions –> Judges
What are the roles of professional organizations?
- Provide a sense of community to a profession
- Share common goals and ideas
- Support research and professional growth
- Protect practice rights
- Support members in many ways
- Voluntary, pay dues and get benefits
How do professional organizations affect policy?
-Able to influence legislators – campaign donations, lobbying efforts, election influences
Influence results in legislation
- some organizations are very powerful
- agencies are theoretically above influence
What is CRNA practice determined by?
Legislation and Administrative Rules
- nurse practice acts
- interpretation by licensing boards
- states vary in all aspects
- licensing boards determine scope of practice based on interpretation of statutes
What are the types of Law?
Contract - binding agreement between parties to provide something for a consideration (laws different in every state) – CRNA employment contract
Criminal - statutes in each state determine what is a criminal act, and what the penalties are for breaking the law
Civil (Torts) - private party against private party (punishment may include monetary damages, court imposed actions or behavior) – Malpractice
What four elements must be present for something to be Civil Negligence (Malpractice)?
- Duty (standard of care)
- Breach of Duty (violation of standard)
- Harm/Damages (actual harm varies by situation)
- Causation (breach must have been proximate cause of harm)
*all must be met to be found negligent
What is battery?
Offensive touching without the consent of the one being touched
What are the components of a contract?
Mutual offer of something of value
Acceptance of the offer
Consideration provided for the thing of value
What is the statute of limitation in Iowa for a Malpractice claim?
Within two years after the date of injury/damage
What should you do if you are named in a malpractice claim?
Inform your malpractice insurance carrier
Establish contact with risk manager of your facility
Speak with your counsel
*do NOT discuss with friends, family, or co-workers
What is the Iowa code for expert witness criteria?
- Licensed to practice in the same or substantially similar field
- Actively practiced in the same or a substantially similar field
- Certified by a board
What are possible defenses for a malpractice claim against you?
- Absence of negligence (of course)
- Consent
- Statute of Limitations
- Comparative Negligence
- Therapeutic Innovation
- Good Samaritan Laws
How can you avoid a malpractice claim?
Best defense is safe, competent practice
Personal integrity
People skills
Understanding the standards of care and legal requirements of practice
What are the theories of law (3)?
Civil Law – contracts, torts, battery, negligence and malpractice
Criminal Law – fraud, theft, misdemeanors and felonies
Statutory Law – including Medicare
How does Medicare affect anesthesia care?
Medicare defines the rules for anesthesia care, regardless of who is paying for the care
Defines how care can be delivered and reimbursed
**These rules ARE NOT the standard of care
Who are the regulatory bodies for CRNAs?
Board of Nursing
Board of Medicine
Board of Pharmacy
Joint Commission
What determines the standards of care for CRNAs?
Nurse Practice Acts
AANA Scope & Standards
Hospital Policies
