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Medical/Legal Aspects of Prehospital Care. Topics to Discuss. Legal vs. Ethical vs. Moral Responsibilities Review of the Legal System Specific Laws Applicable to EMS Accountability & Malpractice Specific Paramedic-Patient Issues Operational Issues Documentation. - PowerPoint PPT Presentation
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Topics to Discuss Legal vs. Ethical vs. Moral
Responsibilities Review of the Legal System Specific Laws Applicable to EMS Accountability & Malpractice Specific Paramedic-Patient Issues Operational Issues Documentation
Legal vs. Ethical vs. Moral Responsibilities
What are the differences?
Legal Responsibilities
Ethical Standards Morality
The Legal System Sources of Law
Constitutional Common Legislative Administrative
Legislative and Administrative are often the focus of EMS Providers
The Legal System
Federal vs. State Court Categories of Law
Criminal Law Civil Law
Tort Law
What are examples of how each of these may affect the paramedic?
The Legal System Terminology
Plaintiff Defendant Discovery phase
Deposition Interrogation Documentation
Appeal
Laws Affecting EMS Scope of Practice
Texas Medical Direction Intervener physician
Ability to Practice Certification or Licensure Authorization to Practice
Laws Affecting EMS Motor Vehicle Laws Infectious Disease Exposure Assault against Public Safety Officer Obstruction of Duty Good Samaritan Law Ryan White CARE Act
Laws Affecting EMS Mandatory Reporting
Domestic violence Child & Elder abuse Criminal Acts GSW, Stabbing & Assault Animal Bites Communicable Diseases Out of hospital deaths Possession of Controlled Substances
Accountability & Malpractice Issues Standard of Care Negligence Civil Litigation Specifics Borrowed Servant Doctrine Patient Civil Rights Liability when off-duty
Accountability & Malpractice Standard of Care
The expected care, skill, & judgment under similar circumstances by a similarly trained, reasonable paramedic
Negligence Deviation from accepted or expected
standards of care expected to protect from unreasonable risk of harm
What are the required components for proof of a negligence claim in EMS?
Accountability & Malpractice Civil Cases
Proof of guilt required by a “preponderance of evidence”
“res ipsa loquitur” Burden of proof shifts to the defendant
Simple vs. Gross Negligence
Accountability & Malpractice How do these affect the
Paramedic’s Practice? Borrowed Servant Doctrine Patient Civil Rights Liability when Off-Duty
Specific Paramedic-Patient Issues Issues
Surrounding Consent
Refusals Restraint Abandonment Transfer of
Patient Care
Advance Directives & End of Life Decisions
Out of Hospital Death
Confidentiality & Privacy
Specific Paramedic-Patient Issues Issues Surrounding Consent
Patient has legal & mental capacity Patient understands consequences Types of Consent
Informed Expressed Implied Involuntary
Specific Paramedic-Patient Issues Issues Surrounding Consent
Specific Consent Issues Minors Emancipated Minor Prisoners
Specific Paramedic-Patient Issues Refusals
Consent for Transport vs. Treatment Withdrawing Consent Refusal of Service
Has legal & mental capacity Is informed of risks & benefits Offer alternatives All of the above are well documented &
witnessed
Specific Paramedic-Patient Issues Refusals
Incompetent Persons Unable to understand the nature &
consequences of his/her injury/illness Unable to make rational decisions
regarding medical care due to physical or mental conditions
Do not assume incompetence unless obvious
Specific Paramedic-Patient Issues Restraint
In Custody of Law Enforcement or Corrections
Patient is not competent to refuse & requires care
Patient is a danger to self or others (involve law enforcement)
Does not provide authorization to harm!
Specific Paramedic-Patient Issues Restraint
Involve Law Enforcement Early Have a plan of action Ensure safety of all Reasonable force Physical restraints Chemical restraints Document well
Specific Paramedic-Patient Issues Patient Abandonment
Unilateral termination of the patient-provider relationship
Still needed and desired Exceptions
MCI Risks to well-being
Can a paramedic turn over care of a patient to an EMT?
Specific Paramedic-Patient Issues Transfer of Patient Care
Transfer of Care to other Providers Transfer of Care at the ED
Specific Paramedic-Patient Issues Advanced Directives & End of Life
Decisions Definitions
Advanced Directive Out of Hospital DNR DNR vs. DNAR Living Will Durable Power of Attorney for Health
Care Patient Self-Determination Act
Specific Paramedic-Patient Issues Advanced Directives & End of Life
Decisions Living Will Durable Power of Attorney for Health Care Texas Out of Hospital DNR
Terminal Condition no longer required Identification Devices EMS requirements Revocation
Can a Texas Paramedic honor an Advanced Directive (other than a DNR)?
Specific Paramedic-Patient Issues Advanced Directives & End of Life
Decisions Patient does not surrender rights to
receive medical care Comfort measures appropriate Provide Family support and guidance When in doubt, resuscitate & contact
medical control Termination of efforts allowed
Specific Paramedic-Patient Issues Out of Hospital Death
Initiation of care? Many counties and cities require:
law enforcement response and/or Justice of the peace pronouncement
Some jurisdictions use a medical examiner or coroner system
Required medical control authorization Survivors may now be the patients
Specific Paramedic-Patient Issues Patient Confidentiality & Privacy
“Medical information about a patient will not be shared with a third party without consent, statute, or court order”
Not all information is protected In some states, QA/QI information is
not discoverable
Specific Paramedic-Patient Issues Patient Confidentiality & Privacy
Colleague & Station Talk Must not identify the patient Maintains confidentiality of specific
medical info Scene or Patient Photographs EMS Radio Dispatch & Discussions “Need to Know” Basis
Specific Paramedic-Patient Issues Patient Confidentiality & Privacy
You have treated & transported a 50-year-old local salesman who is originally diagnosed in the ED with PCP. At the station, you discuss this case including the name of the patient’s business. Since PCP is associated with HIV/AIDS, your coworker suspects this man is infected. Your coworker discusses this case with a friend (the patient’s employer) who then discusses this matter with your patient (his employee). (cont’d)
Specific Paramedic-Patient Issues
Group Discussion: Patient
Confidentiality & Privacy
1. What are the possible
consequences for you?
2. What if the patient does not have
HIV/AIDS?
Specific Paramedic-Patient Issues Patient Confidentiality & Privacy
Defamation “Communication of false information
knowing the information to be false or with reckless disregard of whether it is true or false”
Slander Libel
Protected Classes/Diseases
Operational Issues Equipment failure Interaction with
Law Enforcement Crime Scenes Preservation of
Evidence Vehicle Operation Medical Control
Instructor Liability Hospital Selection Dispatch Interfacility
Transfers OSHA Risk Management
Operational Issues Equipment Failure
Product Liability Design flaw in ventilator
Failure on part of owner/operator No backup battery for defibrillator
Operational Issues Interaction with Law Enforcement
Crime Scenes Request law enforcement Await law enforcement arrival if possible Minimize areas of travel and contact with
scene Document any alterations to the scene
created by EMS personnel Minimize personnel within scene if possible Document pertinent observations
Operational Issues Interaction with Law Enforcement
Evidence Preservation Avoid cutting through penetrations in the
clothing Save everything – clothing of assault
victim, items found on person, etc Prevent sexual assault victim from
washing Follow sound chain of evidence procedures
Operational Issues Vehicle Operation
It is 3:00 am. While responding to a MVC, a driver fails to yield the right of way at an intersection. The driver’s traffic signal is green. You attempt to stop but are unable to do so. Witnesses state your emergency lights were on but do not recall hearing your siren. The driver is injured.(cont’d)
Operational Issues Vehicle Operation
What issues might the driver’s attorney consider?
Were all of your emergency lights really operational? Are daily inspections performed?
Why was the siren not working? Were poorly maintained brakes responsible
for your inability to stop? What type of PM is performed on your ambulance?
Did you exercise due regard for the safety of others?
Operational Issues Medical Control Issues
Failure to follow med contr direction Following obviously harmful direction Implementing therapies without prior
authorization Following direction of an unauthorized person Med Contr directs EMS to an inappropriate
hospital The paramedic exceeds the scope of his
training or medical authorization
Operational Issues Instructor Liability
Student discrimination Sexual harassment Student injury during laboratory Patient claim re. Failure to properly
train graduate or supervise student Instructors – Follow curriculum,
document student attendance & competency
Operational Issues Hospital Selection
Paramedic & Medical Control decision Closest & Appropriate Facility Written policies or guidelines
What is the closest & most appropriate facility? What does this mean?
Operational Issues Dispatch Issues
Untimely dispatch Failure to provide responding units with
adequate directions (incorrect address) Dispatch of inadequate level of care Failure to provide pre-arrival
instructions Inadequate recordkeeping
Operational Issues Interfacility Transfer Issues
Do you have the necessary equipment & training? Should any specialized providers accompany you? Do you have a patient report including history? Is the patient “stable”? What are the potential
complications? Are there any specific physician orders? Does the patient have a DNR order? Has the patient been accepted (MOT)? Who are
the transferring & accepting physicians?
Operational Issues OSHA & Risk Management
OSHA generally not applicable to government employees
New Texas Sharp Injury Prevention Rules In many States, State OSHA Rules are
applicable to nearly all “Each employee shall comply with
occupational safety and health standards and all rules, regulations, and orders issued persuant to this Act which are applicable to his own actions and conduct”
Documentation Patient Confidentiality Securing/Sharing/Requests for
Information Protected Classes Quality & Effectiveness
Documentation Patient Confidentiality
Written report only intended for those with a need to know
Personal identifiers may be removed for QA/QI uses
Patient radio reports should not contain personal identifiers
Documentation Securing/Sharing/Requests for
Information Where are completed patient reports
stored? Who received the report at the ED? Requests for copies should be routed
through an accepted policy or an attorney
Does the requestor have a need to know?
Documentation Protected Classes
In some states, patient information related to sexually transmitted diseases or other specific diseases has become protected as confidential
Washington state Can not refer to HIV/AIDS or STD status in
report without consent Then, only with a clear need to know
Documentation Quality & Effectiveness
Complete soon after the patient contact
Be thorough and accurate Be honest, objective and factual Caution with abbreviations Maintain confidentiality Do not alter
Documentation Quality & Effectiveness
Does your report relay to future healthcare providers the information you obtained regarding this patient?
Is the information clear and concise? Will the report help you recall this
incident if necessary 3 years from now?
Are you willing to sit in court with only this document?
Summary There are many legal
issues surrounding the EMS environment
The paramedic should attempt to keep up-to-date with local legal requirements
Ignorance is not acceptable!