Standards of Conduct

OBJECTIVES

Analyze major concepts inherent in professional law practice.

Interpret the legal responsibilities of the surgical technologist and other team members.

Discuss the Patient Bill of Rights

OBJECTIVESAnalyze the key elements related to

developing a surgical conscience.Develop an increased sensitivity to

the influence of ethics in professional practice.

Analyze the role of morality during ethical decision making.

OBJECTIVESCite examples of ethical situations

and problems in the health professions.

Analyze scope of practice issues as they relate to surgery.

Apply principles of problem solving in ethical decision making.

OBJECTIVES

Assess errors that may occur in the operating room and devise a plan for investigation, correction, and notification.

TERMINOLOGY

Terminology

Accountability – Held responsible forAffidavit – Voluntary statementAllegation – Expected true statementAssault – Act intended to cause fearBattery – Intentional touchingBona fide – Good faith

Terminology

Case law – Legal decisionsComplaint – First pleading by plaintiffDefamation – Injury to reputationDefendant – Person accusedDeposition – Pretrial question under

oath.

Terminology

Federal law – Cases involving Constitution/Congress

Guardian – Court appointed protectorIatrogenic injury – Injury from

healthcare activity.Indictment – Formal written accusation

Terminology

Jury – Citizens decide outcome of trialLarceny – Taking another’s propertyCommon law – Principles based on

court decisionsStatutory law – Law prescribed by

legislature

TerminologyLiability – Obligation to do or not to do

Corporate Liability Personal Liability

Malpractice – Professional misconduct causing harm

Negligence – Doing something that a prudent person would not do Criminal Negligence

Terminology

Perjury – Lying under oathPlaintiff – Person initiating lawsuitPrecedent – Legal principle as exampleStandard of care – Expected conductState law – State regulationsSubpoena – Court order to appear

Terminology

Tort – Civil wrongTort-feasor – One who commits tort

Steps of a Trial

Opening statementsPlaintiff presentationCross exam by

defendantDefendant

presentationCross exam by

plaintiff

Closing statementsJury instructionJury deliberationVerdictAppealExecution of

judgment

Aeger Primo

“The Patient First”

DOCTRINE OFBORROWED SERVANT

Surgeon is not liable for acts of registered nurse or surgical technologist in which they were properly educated to perform.

DOCTRINE OFCORPORATE NEGLIGENCE

Health institution may be negligent for failing to ensure acceptable level of care provided.

Back ground checksMonitoring performance

DOCTRINE OFFORESEEABILITY

Ability to reasonably anticipate harm because of certain acts or omissions.

DOCTRINE OFPERSONAL LIABILITY

Each person is responsible for their own conduct.

Physician cannot assume all responsibility.

DOCTRINE OF THE REASONABLY

PRUDANT MANAll personnel will use knowledge,

skill, and judgement in performing duties that meet standards exercised by other reasonably prudent persons involved in similar circumstances.

PRIMUM NON NOCERE

“Above all, do no harm”

DOCTRINE OF RES IPSA LOQUITOR“The thing speaks for itself”Used in medical malpractice to

circumvent need for expert testimony

DOCTRINE OF RESPONDENT SUPERIOR

“Let the Master answer”Employer may be liable for

employee’s negligent act

DOCTRINE OF INFORMED CONSENT

Physician’s duty to inform the patient and to obtain consent prior to treatment.

Intentional TortsAssaultBatteryDefamationFalse ImprisonmentIntentional infliction of emotional

distressInvasion of privacy

Intentional TortsRequire proof of willful action in three

elements: Defendants action was intended to interfere

with plaintiff Consequences of the act were also intended. Act was a substantial factor in bringing of

consequences.

Unintentional TortsIn spite of best efforts, individuals make

mistakes.Most common type of patient

indiscretions committed. Malpractice Negligence

Common errors and incidents

Patient misidentificationPerforming an incorrect procedure

(wrong side surgery)Foreign bodies left in patient

(incorrect counts)Patient burnsFalls or positioning errors with injury

Common errors and incidents

Improper handling, identification, or loss of specimens.

Incorrect drugs or incorrect administration

Harm secondary to use of defective equipment/instrument.

Loss of or damage to patients property.

Common errors and incidents

Harm secondary to a major break in sterile technique.

Exceeding authority or accepted functions; violation of hospital policy.(scope of practice)

Abandonment of a patient.

Consent for SurgeryConsent refers to permission being given

for an action.The patient has the right to have control

over their life.Consent may be:

Expressed – Written or Verbal Implied – Manifested by some action or

inaction of silence. Presumption of consent.

Consent for Surgery

In health care, express consent of the written form is desired.

Informed consent is necessary before surgical intervention.

Liable to the charge of battery without consent.

Consent for Surgery

Written, informed consent protects the patient in that it guarantees that the patient is aware of their condition, the proposed intervention, the risks, and the variables that may occur.

Consent for Surgery

Physician must keep in mind any language or cultural differences that may affect the understanding.

Hospitals will use General and Special consents for treatment during the patients stay.

Consent for Surgery

General consent is for all general diagnostic, and routine services and “touching” expected during hospitalization.

Special consent is for any procedures with higher risks. Surgery, Anesthesia, Transfusion, Chemo

Consent for Surgery

Surgeon is responsible: Information to be given in understandable

language No coercion or intimidation. Proposed procedure/treatment must be

explained. Complications and Risks/Benefits explained. Alternatives explained.

Consent for Surgery

Written consent must contain: Patients legal name Surgeon’s name Procedure to be performed Patients signature Signature of witness Date and time of signatures

Consent for Surgery

Witnesses may include: Physician/surgeon Registered nurse Other hospital employee

Must not include any member of the surgical team.

Consent for SurgeryConsent is given to:

Competent adult speaking for themselves

Parent or guardian for a minor Guardian of the physical inability or

legal incompetence. Hospital administrator Courts

Consent for SurgeryEmergency situations consent may be

secured: Telephone Telegram Agreement of two consulting physicians(not including surgeon) Administrative consent

DocumentationThe patients medical chart should

include anything of clinical significance to provide a continuity of care. History and Physical Diagnosis Treatment plan Medication record Physical findings Discharge condition and follow up plan

DocumentationThe patients requiring surgery must have

special documentation entered into the medical record. H & P before surgery Consent Operation report(Start/Stop times, Procedure) Count sheet Anesthesia record Laboratory studies

DocumentationAll documentation are considered legal

documents and may be used to discover negligent acts.

Always ensure documentation is completed and correct!! Approved terminology and abbreviations Correct spelling Factual not subjective No erasures – marked through with single line

and initials

Event/Incident ReportsDocumentation of unusual event that has

occurred. Falls Medication errors Burns Loss of specimen

Submitted to risk management department to attempt to identify factors that caused the incident and ways to prevent future incidents.

Medical ErrorsBrought to light in the 1990’s, the Institute of

Medicine claimed that more people die each year from medical errors than car accidents, AIDS, and breast cancer combined.

Technology has helped to reduce these errors. (Barcodes, Computers)

The ST must follow policies and procedures closely to prevent errors.

Safe Medical Device ActRequires medical device user to report to

the manufacturer and the FDA any link in cause to injury, illness, or death of a patient because of use of the device.

Ex. Equipment, Implants, Supplies.

Malpractice InsuranceHospital insurance will typically cover

employees who commit negligent acts as long as you work within your scope of practice.

If sued as an individual, having malpractice insurance should cover any difference not paid by the hospital.

ADVANCE DIRECTIVES

Patient Self-Determination Act enacted in 1990

Written instructions for medical care when dealing with an incapacitated patient that can no longer make decisions. Carries the weight of state law.

ETHICS

ETHICS

System of moral principles and rules, that become standards for professional conduct.

Not to be confused with morality.

Concepts of “right and wrong”.

Ethical Decision Makingon Informed Consent

Formalist – Believes informed consent is right, because it is an act intended to protect autonomy and honor obligation.

Utilitarian – Believes that informed consent is only good if the patient is better off having been giving all the information. Wrong because if patient refuses treatment

and is damaged because of the action.

MORAL PRINCIPLES

Guide ethical decision making.Principles we try and instill in

our children. Well being of others Honesty Trustworthiness

BIOETHICAL SITUATIONS

May create a conflict between an individual’s value system and moral obligation to maximize total human benefits

Ex: Elective Sterilization, Abortion, Assisted suicide, Genetic engineering.

American Hospital AssociationPatient’s Bill of Rights

Adopted in 1972, revised and approved in 1992.

Series of 12 rights for the patient.Several important concepts or

assumptions make up its content.

American Hospital AssociationPatient’s Bill of Rights

Receive considerate and respectful careObtain relevant, current, and understandable

information concerning diagnosis, treatment, and prognosis.

Make decisions about care received before, and during treatment, or to refuse a course of treatment or plan of care.

Expect every consideration of privacy.

The patient has a right to:

American Hospital AssociationPatient’s Bill of Rights

Prepare an advance directive concerning treatment or designing a surrogate decision maker and to the expectation that the intent of the advance directive will be honored.

Expect that all communications and records pertaining to their care will be treated as confidential.

Review records concerning medical care and receive an explanation or interpretation.

The patient has a right to:

American Hospital AssociationPatient’s Bill of Rights

Receive appropriate and medically indicated care and services within the capacity and policies of the hospital.

Ask and be informed about the existence of business relationships among any and all of the care providers.

Consent or decline to participate in research studies or human experimentation.

The patient has a right to:

American Hospital AssociationPatient’s Bill of Rights

Expect a reasonable continuity of care.Be informed of hospital policies and practices

related to patient care.

The patient has a right to:

AST Code of Ethics

To maintain the highest standards of professional conduct and patient care.

To hold in confidence, with respect to the patient’s beliefs, all personal matters.

To respect and protect the patient’s legal and moral rights to quality patient care.

To not knowingly cause injury or any injustice to those entrusted to our care.

Guidelines for the ST:

AST Code of Ethics

To work with fellow technologists and other professional health groups to promote harmony and unity for better patient care.

To always follow the principles of asepsis.To maintain a high degree of efficiency through

continuing education.To maintain and practice surgical technology

willingly, with pride and dignity.

Guidelines for the ST:

AST Code of Ethics

To report any unethical conduct or practice to the proper authority.

To adhere to the Code of Ethics at all times with all members of the health care team.

Guidelines for the ST:

SURGICAL CONSCIENCE

Inner voice for conscientious practice of asepsis, avoid discrimination, keeping with patient’s confidence, and committed to cost control.

Scope of Practice

Was the skill taught in your accredited surgical tech program.

If it was not included in your basic surgical technology education, have you since completed a comprehensive educational program, which included clinical experience.

Scope of Practice

Has this task become so routine in surgical technology practice that it can be reasonably and prudently assumed within scope.

Does the professional literature and/or research support this activity as being within the scope of practice.

Scope of Practice

Is the skill prohibited by hospital policy or state law.

Does it require state license to perform.Does carrying out the duty pass the

“reasonable and prudent” standard.

Scope of Practice

Are there professional association standards or position statements that support this activity with additional education and experience.

Are you prepared to accept responsibility and accountability for performing the activity competently and safely.

SummaryLegal terminology and principles.Torts and common errors in medicine. Informed consent.Documentation.Ethics.Patients bill of rights.Code of ethics.Scope of practice.