Copyright 2003 by Mosby, Inc. All rights reserved. CHAPTER 11 LEGAL AND ETHICAL PRINCIPLES

Copyright 2003 by Mosby, Inc. All rights reserved.

CHAPTER 11

LEGAL AND ETHICAL PRINCIPLES

The Qualities of a Successful Health Care Worker

• Qualities for Success• Understanding Laws, Morals, and Ethics• Licensure, Registration, and Certification• Standard of Care and Scope of Practice• Informed Consent• Confidentiality


Qualities for Success

• Successful health care providers use the 3 Cs:– Courtesy– Compassion– Common sense


Qualities for Success

• Other helpful qualities include:– A relaxed attitude when meeting new people.– A willingness to learn new skills and

techniques.– An aptitude for working with the hands.– Empathy for others.– Good communication and listening skills.– Patience in dealing with others.


Qualities for Success– The ability to work as a member of a health

care team.– Proficiency in English, science, and

mathematics.– Tact.– The ability to keep information confidential.– The ability to leave private concerns at

home.– Trustworthiness.– A sense of responsibility.


Understanding Laws, Morals, and Ethics

• Laws – a law, or statute, is a rule of conduct or action. – Criminal Laws – protect members of

society from certain harmful acts of others. A criminal act may be one of:

• Commission, if there is a law forbidding a certain act.

• Omission, in violation of a law requiring a certain act.



– Civil Laws – are concerned with private rights and remedies. Examples of the causes of civil disputes include:

• Contract violation.• Slander or libel.• Trespassing.• Product liability.• Automobile accidents.• Family matters such as divorce, child support, and

child custody.



– Torts• A tort is broadly defined as a civil wrong committed

against a person or property, excluding a breach of contract. (Personal Injury)

• Torts may be intentional (willful) or unintentional (accidental) and, if intentional, may also be crimes.

• Unintentional torts are acts that were not intended to cause harm. However, they are committed without regard for consequences.

• Ex: A health care facility inappropriately left out equipment in the hallway and an employee tripped and was injured.



Box 4-1 Code of Ethics


Health Careers and the Law• Health care provider is legally

responsible (liable) for his or her behavior and the care given

• The law of Agency- Employer may also be liable for the actions of a health care provider that are not reasonably prudent (negligent) or that reflect bad practice (malpractice)


Definitions• Malpractice- failure of professional skill that results in

injury, loss or damage• An unintentional tort is caused by negligence. Negligence

is also called medical malpractice.• Negligence- failure to execute the care that a reasonable

person exercises; An unintentional tort. Ex: leaving the bed rails down when caring for a confused patient

• The 3 Ds must be present for negligence to occur:– Duty – health care practitioner/client relationship exists.– Derelict – health care practitioner did not live up to the

obligation of caring for a client.– Damage – the breach of duty results in damages to the client

or plaintiff.


– Physicians are most likely to be charged with negligence. However, other health care practitioners may be subject to such charges.

– Medical practice acts are state statutes that govern medical practices. They do the following:

» Cover requirements and methods for licensing health care providers.

» Establish medical licensing boards. » List grounds for revoking licenses.



Malpractice Liability

• It is considered malpractice when the health care worker is:– Performing skills that are beyond the level of the health care worker’s education and training– Neglecting to do something that is

considered to be common practice such as leaving the client in an unsafe situation

Standard of Care and Scope of Practice

• Standard of care is the level of performance expected of a health care worker in carrying out his or her professional duties.

– Working outside your scope of practice can make you liable.– Working within your scope of practice ensures that you:

• Do not injure clients or put them at risk by performing procedures that are beyond your ability.

• Will not be held liable for a standard of care that is beyond your training, experience, and job description if a legal situation arises.



Jurisprudence

• When you are a healthcare provider or professional- You MUST be jurisprudent!!

• What does that mean???– The healthcare professional is aware of the laws

that affect the industry and their scope of practice.

Informed Consent

• Informed Consent – in order for a client to make an informed decision regarding treatment, the client needs to be told the following:


A SAMPLE CONSENT FORM

Consent• Informed Consent

– The proposed methods of treatment.– Why the treatment is necessary.– The risks involved in the proposed treatment.– All available alternative types of treatment.– The risks of any alternative methods of treatment.– The risks involved if treatment is refused.

When must written consent be obtained?• Answer

• Consent must be obtained for many procedures such as surgery and tests.


Standard of Care and Scope of Practice

– People who cannot give informed consent include:

• Minors – individuals under 18 years of age (21 in some states). Exceptions include those deemed mature minors by the court.

• Mentally incompetent individuals – persons judged by the court to be insane, senile, mentally retarded, or under the influence of drugs or alcohol.

• Speakers of a foreign language who do not speak English.



Professional Codes of Conduct • Ethics are the principles and values

that determine appropriate behavior – Respect for cultural, social, and ethical differences of the clients and other workers– Practicing within the guidelines of laws, policies, and regulations established for each type of employment

• Morals are based on the experience, religion, and philosophy of the individual and the society


Box 4-1 Code of Ethics


• Noncompliance– Noncompliant health care workers may face

fines or prison sentences and can lose their licenses to practice their profession.

– Unethical conduct may result in expulsion or censure from your professional organization, but only the state can revoke a license.

IRB- Internal Review Board- panel of experts reviewing cases pertaining to legal and ethical matters



Confidentiality

• A patient’s health care is considered confidential, or private

• The health care worker is ethically responsible to maintain the patient’s privacy

• “Privacy of Individually Identifiable Health Information.” The rule applies to all agencies sharing personal health information (paper, oral, and electronic) for people who are insured privately, by public programs, or uninsured.

Confidentiality• Confidentiality

– It is illegal and unethical if a health care worker does not observe confidentiality.

– Privileged communication refers to information held confidential within a protected relationship.

• Written consent must be obtained before releasing information to a third party.


CONSENT TO RELEASE INFORMATION

Patient Confidentiality– Guidelines to follow if you have access to a client’s

information:• Do not decide if information is confidential based on your

approval or agreement.• Do not reveal financial information about a client.• Do not use the client’s name or other information if others in the

room might overhear.• Use caution in giving the results of medical tests to clients over

the telephone.• Do not leave medical charts or insurance reports where clients or

others can see them.• If the client has not given written permission to release

information, do not release it.• Do not discuss clients in public places where others may

overhear, such as the cafeteria or elevator.


Exceptions to Confidentiality

– Confidentiality for client medical records may be waived under the following circumstances:

• When a third party requests a medical examination, such as a preemployment examination, and that third party pays the client’s bill.

• When a client sues a physician or other health care practitioner for malpractice.

• When the client signs a waiver allowing the release of information.

• When you suspect abuse or neglect of a patient; must report to legal authority

• When there is an infectious disease or STD that must be reported to the health department



HIPAA/Confidentiality

• HIPAA- Health Insurance Portability and Accountability Act (1996)

• *Insurance portability- making sure that people who move from one health plan to another will maintain coverage and not be denied

• *Fraud enforcement (accountability)- increases federal government’s fraud enforcement authority

• *Administrative simplification (reduction in health care costs)- provide standards for electronic exchange of health information, assures privacy and security of health information


HIPAA/Confidentiality

• **Failure to comply can mean either civil or criminal sanction. These can be up to $250,000 or prison up to 10 yrs

• Patient Rights Under HIPAA• Access- Patients may ask to inspect or get a copy of their health info

that is maintained by the entity• Amendment- Patients may request that amendments be made to their

health info• Restrictions- Patients may want further restrictions placed upon

sharing their records beyond what is required by law• Accounting of Disclosures- Patients have the right to know how their

health info has been shared with others • (ex: Notice of Privacy Practices)


Patient’s Bill of Rights • The American Hospital Association’s Patient’s Bill of

Rights is followed in most states. It guarantees the client’s right to:

• Receive considerate and respectful care.• Receive complete and current information concerning his or

her diagnosis, treatment, and prognosis.• Know the identity of physicians, nurses, and others involved

with his or her care, as well as when those involved are students, residents, or trainees.

• Know the immediate and long-term costs of treatment choices.• Receive information necessary to give informed consent prior

to the start of any procedure or treatment.• Have an advance directive concerning treatment or be able to

choose a representative to make decisions.

Patient’s Bill of Rights• Refuse treatment to the extent permitted by law.• Receive every consideration of his or her privacy.• Be assured of confidentiality.• Obtain reasonable responses to requests for services.• Obtain information about his or her health care and be allowed

to review his or her medical record and to have any information explained or interpreted.

• Know whether treatment is experimental and be able to consent or decline to participate in proposed research studies or human experimentation.

• Expect reasonable continuity of care.• Ask about and be informed of the existence of business

relationships between the hospital and others that may influence the client’s treatment and care.

• Know which hospital policies and practices relate to client care, treatment, and responsibilities.

Patient’s Bill of Rights• Be informed of available resources for resolving

disputes, grievances, and conflicts, such as ethics committees or patient representatives.

• Examine his or her bill and have it explained and be informed of available payment methods.

• Providing information about past illnesses, hospitalizations, medications, and other matters related to their health status.

• Following a physician’s orders for treatment. The client has the right to refuse treatment to the extent permitted by law.

• Providing health care agencies with necessary information for insurance claims and working with the health care facility to make arrangements to pay fees when necessary.



Legal Directives• Legal documents that allow patients to express

their wishes about their health care and treatment and are three types of advance directives

1. Living will allows a person to state in advance whether to receive life support and what life-support procedures to withhold if the person is terminally ill and permanently unconscious; provides instructions directly to physicians, hospitals, and other health care providers involved in a client’s medical treatment.

2. Durable Power of Attorney – not specifically a medical document, but it may serve that purpose. It gives a person, called a designee, the authority to make a variety of legal decisions on behalf of another person, called the grantor.

Legal Directives

3. Health Care Proxy – or health care power of attorney, is also an end-of-life document. With it, clients specify an agent to make medical decisions for them in the event that they lose the ability to reason or communicate.


SAMPLE HEALTH CARE PROXY


Health Care and the Internet

• Patients can:– Access health care information– Join chat groups– Purchase drugs and other medical

items– Consult a health care practitioner

online

Medical Records• Facilities providing health care services are required by licensing

authorities to keep and maintain health care records of clients. • Medical records provide:

– A format for tracking, documenting, and maintaining a client’s health data.

– Documentation of a client’s lifelong health care.– A basis for managing a client’s health care.– Background information in the event of a lawsuit.– Clinical data for education, research, statistical tracking, and

assessing the quality of health care. – Medical records may be kept on paper, microfilm, or computer

tapes or disks. They belong to the owners of the facility, even though the client owns the information contained in them



Documentation

• A chart is the written documentation that serves as the legal record of the care given to the client

• A chart must be precise, clear, and concise to show the activities of care (typically written in black ink)

• Charting is the main technique used by health care workers to communicate about patients

• **Charting is the most common incident of liability for health care workers

Documents

Copyright 2003 by Mosby, Inc. All rights reserved. CHAPTER 11 LEGAL AND ETHICAL PRINCIPLES