Chapter 3 Medicolegal and Ethical Issues Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

Chapter 3Chapter 3

Medicolegal and Ethical IssuesMedicolegal and Ethical Issues

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company2


Learning ObjectivesLearning Objectives

Explain the importance, necessity, legality of Explain the importance, necessity, legality of patient confidentialitypatient confidentiality

State conditions that require EMT to notify State conditions that require EMT to notify local law enforcement officialslocal law enforcement officials

Define EMT Define EMT scope of practicescope of practice

State conditions necessary for EMT to have State conditions necessary for EMT to have duty to actduty to act




Discuss issues of abandonment, negligence, Discuss issues of abandonment, negligence, battery, and their implications to EMTbattery, and their implications to EMT

Define Define consent;consent; discuss methods of obtaining discuss methods of obtaining consentconsent

Differentiate between expressed (informed) Differentiate between expressed (informed) and implied consentand implied consent




Explain role of consent by minors in issues of Explain role of consent by minors in issues of carecare

Discuss implications for EMT in patient Discuss implications for EMT in patient refusal of transportrefusal of transport

Discuss importance of Do Not Resuscitate Discuss importance of Do Not Resuscitate (DNR) orders, advance directives, and local (DNR) orders, advance directives, and local or state provisions regarding EMS applicationor state provisions regarding EMS application




Discuss considerations of EMT regarding Discuss considerations of EMT regarding issues of organ retrievalissues of organ retrieval

Delineate actions that an EMT should take to Delineate actions that an EMT should take to assist in preserving crime scenesassist in preserving crime scenes



Ethical ResponsibilitiesEthical Responsibilities

The Golden RuleThe Golden Rule ““Do unto others as you would have them do unto Do unto others as you would have them do unto

you”you” Act in best interest of patientAct in best interest of patient




Ethics & competenceEthics & competence Quality careQuality care

• Caring, competentCaring, competent• Responsible to maintain competenceResponsible to maintain competence• Strive for level of masteryStrive for level of mastery• Requires diligence, self-evaluationRequires diligence, self-evaluation• Keep knowledge, skills currentKeep knowledge, skills current• Participate in quality improvement processParticipate in quality improvement process• I CAREI CARE




ConfidentialityConfidentiality Patients have right to know information Patients have right to know information

given will be kept confidentialgiven will be kept confidential Information release must be writtenInformation release must be written

• ExceptionsExceptions Information to press/mediaInformation to press/media




Health Insurance Portability & Accountability Health Insurance Portability & Accountability Act (HIPAA)Act (HIPAA) Widespread –use of electronic recordsWidespread –use of electronic records Potential of patient information transmitted without Potential of patient information transmitted without

knowledge/consentknowledge/consent Outlines how private information used, disclosedOutlines how private information used, disclosed



Ethical ResponsibilitiesEthical Responsibilities Reporting requirementsReporting requirements

Reportable circumstancesReportable circumstances• Child abuseChild abuse• Geriatric abuseGeriatric abuse• Family violence, abuseFamily violence, abuse• Violent crimesViolent crimes• Certain infectious diseasesCertain infectious diseases• Patients transported against their willPatients transported against their will• Mentally incompetentMentally incompetent• Animal bitesAnimal bites• Wounds from guns/knivesWounds from guns/knives• DeathsDeaths



Scope of PracticeScope of Practice

Range of activities, limitations of medical Range of activities, limitations of medical providerprovider State EMS laws address:State EMS laws address:

• Minimum training standardsMinimum training standards• Medical controlMedical control• Vehicle/equipment specificationsVehicle/equipment specifications• Licensure/certification requirementsLicensure/certification requirements• May specify formation, duties of EMS councils/medical May specify formation, duties of EMS councils/medical

advisory committeesadvisory committees




Establishes what EMT legally can, cannot do Establishes what EMT legally can, cannot do in emergency medical evaluation, treatmentin emergency medical evaluation, treatment

National EMS Scope of Practice ModelNational EMS Scope of Practice Model




Standard of careStandard of care ““Did you do the right thing & did you do it Did you do the right thing & did you do it

properly?”properly?” Describes body of knowledge, laws, policies, Describes body of knowledge, laws, policies,

common practices, standards, guidelinescommon practices, standards, guidelines Laws, rules, regulations govern EMT practiceLaws, rules, regulations govern EMT practice ProtocolsProtocols




Standard of careStandard of care EquipmentEquipment

• MedicationsMedications• Medical devicesMedical devices• Check equipment, document equipment failure, reportCheck equipment, document equipment failure, report



NegligenceNegligence

Deviation from accepted standard of care, Deviation from accepted standard of care, results in injury to patientresults in injury to patient

To prove negligence, must show:To prove negligence, must show:• Duty to actDuty to act• Breach of dutyBreach of duty• DamageDamage• Causal connectionCausal connection



NegligenceNegligence

““Good Samaritan” legislationGood Samaritan” legislation Protects private citizenProtects private citizen Provides aid without undue fear of Provides aid without undue fear of

litigationlitigation Protects EMT from civil chargesProtects EMT from civil charges Does not protect from gross negligenceDoes not protect from gross negligence



ConsentConsent

Before treating a patient, must obtain consent Before treating a patient, must obtain consent from patient, parent, guardianfrom patient, parent, guardian Principle of autonomy, self-determinationPrinciple of autonomy, self-determination

• Right to be self-directingRight to be self-directing



ConsentConsent

Consent not always possibleConsent not always possible DisorientedDisoriented Minors with no parent/guardian availableMinors with no parent/guardian available Mentally handicappedMentally handicapped



ConsentConsent

Expressed (informed) consentExpressed (informed) consent Must be obtained from every conscious, Must be obtained from every conscious,

competent adultcompetent adult Document when patient withholds consentDocument when patient withholds consent



ConsentConsent

Prehospital researchPrehospital research Research studies evaluate effectiveness of Research studies evaluate effectiveness of

procedures/treatmentsprocedures/treatments Research studies must be approved by IRBsResearch studies must be approved by IRBs

• Acquire patient consentAcquire patient consent• Purpose: Respect of patient autonomyPurpose: Respect of patient autonomy



ConsentConsent

Implied consentImplied consent Verbal/written consent not possibleVerbal/written consent not possible Reasonable person would want emergency Reasonable person would want emergency

treatmenttreatment



ConsentConsent

Other types of consentOther types of consent Children, mentally incompetent individuals not Children, mentally incompetent individuals not

legally able to give expressed consent legally able to give expressed consent • Must obtain consent from parent/guardianMust obtain consent from parent/guardian

Unless implied consent more appropriateUnless implied consent more appropriate Emancipated minorEmancipated minor



Refusal of Treatment & TransportRefusal of Treatment & Transport

Person has right to refuse carePerson has right to refuse care Must be competent, able to make clear judgmentMust be competent, able to make clear judgment

Patient has right to withdraw from treatmentPatient has right to withdraw from treatment

““False imprisonment” if transferred against False imprisonment” if transferred against willwill




Assault/battery if you touch, provide care to Assault/battery if you touch, provide care to patient without consentpatient without consent

Try to convince patient to go to hospital Try to convince patient to go to hospital

Ensure patient understands consequences of Ensure patient understands consequences of not seeking medical attentionnot seeking medical attention




Sign “refusal of treatment” release formSign “refusal of treatment” release form

Use best judgment with mental incompetenceUse best judgment with mental incompetence






AbandonmentAbandonment

EMT discontinues patient-provider EMT discontinues patient-provider relationship without giving patient opportunity relationship without giving patient opportunity to obtain continued care at the same level or to obtain continued care at the same level or higherhigher

Plaintiff must prove patient was owed duty Plaintiff must prove patient was owed duty and duty was breachedand duty was breached

Charges possible if patient who refused care Charges possible if patient who refused care is incompetentis incompetent



Intoxicated, Irrational, and Intoxicated, Irrational, and Emotionally Disturbed PatientsEmotionally Disturbed Patients

High legal riskHigh legal risk Held against wishes, charges can resultHeld against wishes, charges can result

““Protective custody”Protective custody” Violent/suicidal patientsViolent/suicidal patients

Forcible removalForcible removal ““Soft” restraintsSoft” restraints Precise documentationPrecise documentation



Resuscitation IssuesResuscitation Issues

ProxiesProxies DNR ordersDNR orders Advance directivesAdvance directives Healthcare proxyHealthcare proxy



Resuscitation IssuesResuscitation Issues

Extended transportExtended transport EMTs must have original DNR orderEMTs must have original DNR order If patient dies during transport:If patient dies during transport:

• Ambulance must stop where patient died• Coroner must be notified



Donor & Organ HarvestingDonor & Organ Harvesting

Individuals may decide in advance to donate Individuals may decide in advance to donate organsorgans Driver’s license/separate donor cardDriver’s license/separate donor card Treat donor same as any other patientTreat donor same as any other patient Communicate information to hospital/medical Communicate information to hospital/medical

directiondirection



Medical Identification InsigniaMedical Identification Insignia

Advance directive by medical identification Advance directive by medical identification insigniainsignia Bracelet/necklacesBracelet/necklaces

• Also for other medical conditionsAlso for other medical conditions



Crime ScenesCrime Scenes

Emergency careEmergency care Ensure safety for self, fellow respondersEnsure safety for self, fellow responders Notify police through dispatchNotify police through dispatch Try not to disturb any item at sceneTry not to disturb any item at scene Do not cut through holes in clothing, if possibleDo not cut through holes in clothing, if possible Chain of evidence/custodyChain of evidence/custody



Risk ManagementRisk Management

Practices by healthcare providers that reduce Practices by healthcare providers that reduce possibility of lawsuit/other legal/professional possibility of lawsuit/other legal/professional actions taken against EMT/medical actions taken against EMT/medical director/agencydirector/agency

Act according to standard of careAct according to standard of care



Risk ManagementRisk Management

Document actions carefullyDocument actions carefully Prehospital care record is backbone of defensePrehospital care record is backbone of defense

Act in patient’s best interestAct in patient’s best interest



SummarySummary

Practice Golden Rule Practice Golden Rule

EMTs have ethical, professional duty to EMTs have ethical, professional duty to remain competentremain competent

EMTs are responsible for confidentialityEMTs are responsible for confidentiality



SummarySummary

May be required by law to report certain May be required by law to report certain conditionsconditions

Must function with scope of practiceMust function with scope of practice

Follow standard of careFollow standard of care



SummarySummary

Negligence is deviation from accepted Negligence is deviation from accepted standards of care resulting in injury to patientstandards of care resulting in injury to patient

Federal, state, Good Samaritan laws provide Federal, state, Good Samaritan laws provide degree of protection from lawsuitsdegree of protection from lawsuits

Must obtain consent before treating patient Must obtain consent before treating patient (implied or expressed)(implied or expressed)



SummarySummary

Patient may refuse care if mentally competent Patient may refuse care if mentally competent adultadult Make every attempt to convince patient otherwiseMake every attempt to convince patient otherwise Patient must sign releasePatient must sign release

Prematurely discontinuing care is abandonmentPrematurely discontinuing care is abandonment

Terminal patients may have DNR, advance Terminal patients may have DNR, advance directive, healthcare proxiesdirective, healthcare proxies



SummarySummary

If organ donation indicated on driver’s license, If organ donation indicated on driver’s license, donor card, communicate with hospitaldonor card, communicate with hospital

Do not disturb crime scene unless required for Do not disturb crime scene unless required for patient care; maintain & document chain of patient care; maintain & document chain of evidenceevidence

Prevent lawsuits - act according to standard of Prevent lawsuits - act according to standard of carecare



Questions?

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Chapter 3 Medicolegal and Ethical Issues Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company