Lecture Medical assisting: Administrative and clinical procedures with anatomy and physiology (4e) – Chapter 3

Medical Law and Ethics• Knowledge of medical law and ethics provides insight into – The rights, responsibilities, and concerns of health-care consumers – The legal and ethical issues f

Legal and Ethical

Issues in Medical

3.1 Define ethics, bioethics, and medical law.

3.2 Discuss the measures a medical practice

must take to avoid malpractice claims.

3.3 Discuss medical documentation and how

it applies to medical law.

Learning Outcomes

3.4 Discuss the various types of health-care

legislation.

3.5 Describe OSHA requirements for a

medical office.

3.6 Describe procedures for handling an

incident of exposure to hazardous materials.

Learning Outcomes (cont.)

3.7 Compare and contrast quality control and

quality assurance procedures.

3.8 Discuss the impact that HIPAA regulations

have in the medical office.

3.9 Explain how to protect patient

confidentiality.

3.10 Describe the different practice

Learning Outcomes (cont.)

• Reasons to study medical

– Function at the highest

professional level – Avoid legal problems

Medical Law and Ethics

• Knowledge of medical law and ethics provides

insight into

– The rights, responsibilities, and concerns of

health-care consumers

– The legal and ethical issues facing society, patients,

and health-care professionals as the world changes– The impact of rising costs on the laws and ethics of

health-care delivery

Medical Law and Ethics (cont.)

Ethics is a standard of behavior and a concept

Medical Law and Ethics (cont.)

– Torts are either:

• Intentional (willful) or

• Unintentional (accidental)

False imprisonment

Assault

Defamation of character

Fraud Invasion of privacy

Open threat of bodily harm

Interference with a person’s

right to be left alone

Damaging a person’s reputation

by making false and malicious public

An action that causes bodily harm to another, including touching

Battery

 Acts that are committed with no intent to

cause harm but done with a disregard for the

consequences

 The term negligence is used to describe such

actions when health-care practitioners fail to

exercise ordinary care, resulting in patient injury

 Malpractice is the negligent delivery of

professional services

Unintentional Torts

A contract is a voluntary agreement between two

parties in which specific promises are made for a

consideration.

Elements of a Contract

Types of Contracts

• Expressed contracts

– Clearly stated in written or spoken

words – An example is a payment contract

• Implied contracts

– Actions or conduct of the parties,

rather than words, create the contract – An example is a patient rolling up his

Apply Your Knowledge

What is the difference between law and

ethics?

ANSWER: A law is a rule of conduct or action and is

enacted by governments to maintain order and public

safety

Ethics is a standard of behavior based on moral

values that are influenced by family, culture, and

society

Physician/Patient Contract

• Reasonable limitations

• Both parties have rights and

responsibilities related to the contract

Physician Rights

• Set up a practice within

the boundaries of his or

her license to practice

medicine

• Select where to set up an

office and establish office

hours

• Specialize

• Decide which services to

provide and how those

services will be provided

Physician Responsibilities

• Physician responsibilities

– Use due care, skill, judgment, and diligence

– Keep knowledge up-to-date

– Perform to the best of his or her ability

– Furnish complete information and instructions to the

patient

Patient Rights/Responsibilities

• Patient responsibilities

– Follow physician’s instructions and cooperate with care

– Provide relevant information to the physician

– Follow the physician’s orders for treatment – Pay the fees charged for services provided

Patient-Physician Contract (cont.)

• Consent

– Implied – actions imply permission

– Informed

• Patient receives all information necessary

to make a decision regarding treatment

• Understand standard of care and duty of care

– Medical assistants are

all held to the

“reasonable person standard”

Special Circumstances – Closing of a Practice

• Comply with HIPAA

• Notify patients in writing

• Give option of choosing another physician

or make referral

• Secure or dispose of records appropriately

• Remain up-to-date on HIPAA laws

Apply Your Knowledge

ANSWER: Patient responsibilities are:

– Follow physician’s instructions and cooperate with plan of

care – Provide relevant information to the physician

– Follow the physician’s orders for treatment

– Pay the fees charged for services provided

Patients have rights and responsibilities relating to health

care The rights are determined by the Patient Care

Partnership What are the patient’s responsibilities?

Preventing Lawsuits

• Lawsuits

– Add to cost of health care

– Take a psychological toll on all

involved

• Prevention

– Use of reasonable care to

prevent professional liability

• Malpractice claims are lawsuits by a patient

against a physician for errors in diagnosis or

treatment

– Examples: post-operative complications, Res ipsa

loquitur (the thing speaks for itself)

• Negligence cases are those in which a person

believes a medical professional’s actions, or lack

thereof, caused harm to the patient

– Examples: abandonment, delayed treatment

Malpractice (cont.)

uty Patients must show that a physician-patient relationship existed.

erelict Patients must show that the physician failed to comply with the standards of the profession.

irect Cause Patients must show that any damages were a direct cause of a physician’s breach of duty

amages Patients must prove that they suffered injury

Patients must be able to prove all 4 Ds in order

to move forward with a malpractice suit

The 4 Ds of Negligence

• Subpoena duces tecum is

a court order to produce documents such as patient

• Civil law

– Concerned with an

individual’s private rights

Malpractice (cont.)

• Law of Agency

– Employees are considered to be agents of the

physician while performing professional tasks

– Physicians are responsible or liable for the

negligence of employees

– Respondeat superior is a Latin term meaning “Let

the master answer”

Employees are also legally responsible for their

Courtroom Conduct

• Attend court proceedings as required and do not be late

for scheduled hearings

• Bring required documents to court and present them

when requested to

• Refresh your memory before testifying

• Speak slowly, clearly, and professionally

• Answer all questions in a straightforward manner

• Answer only the question asked

• Appear well groomed, and dress in clean, conservative

clothing

Malpractice (cont.)

• Reasons patients sue

– Unrealistic expectations

– Poor rapport and poor communication

– Greed and our litigious society

• Professional Liability

Coverage – protects

the physician and staff

against financial losses

from lawsuits filed against

Malpractice (cont.)

• Statute of limitations

– Laws that set the deadline or maximum period

of time within which a lawsuit or claim may be filed

– Deadlines vary

• Type of case

• State vs federal court

The 4 Cs of Malpractice Prevention

aring Sincere caring decreases the likelihood that a patient

will sue if outcomes are unsatisfactory or adverse events occur.

ommunication Develop trust and respect with patients

by communicating professionally and confirming that you have been

understood.

ompetence Maintain competence and update knowledge

and skills frequently.

harting Documentation is proof of competence Chart every

conversation and interaction you have with a

Terminating Care of a Patient

• Reasons for terminating

– Failure to pay for services

– Provide written notification

• Reasons for withdrawing

• Recommend that the patient find another physician

– Send by certified mail with return receipt requested

– Document in the patient record reasons for

terminating care and

– Documenting accurately

Standard of Care (cont.)

• Apply legal concepts to practice by

– Following legal guidelines and maintaining

awareness of health-care legislation and regulations

– Maintaining and disposing of regulated substances

appropriately

– Following risk-management and safety procedures

– Recognizing professional credentialing criteria

Administrative Duties and the Law

• Duties related to legal requirements

– Doctrine of Professional Discretion

– Retention and storage

Controlled Substances and the Law

Medical assistants must follow the correct

procedure for keeping and disposing of

controlled substances.

Be familiar with correct dosages, potential

complications, and refill rules.

Legal Documents and the Patient

States the types of treatment the patient does and does not want in an event of terminal

illness, unconsciousness, or comatose state

Patients with living wills are asked to name someone that will make decisions on their behalf (durable power of attorney) if they are unable to do so

Uniform Donor Card

A legal document that states a person’s wish to donate one or more organs or

Confidentiality Issues

• Legal obligation to maintain confidentiality of

patient information

• Discuss with patient privately

• Share patient information only when appropriate

• Do not discuss the case with anyone outside the

medical office

Apply Your Knowledge

What are the 4 Cs of malpractice prevention?

ANSWER: The 4 Cs of malpractice prevention are

caring, communication, competence, and charting.

Bravo!

Federal Legislation Affecting Health Care

• Health Care Quality

Improvement Act

(1986)

– Purpose: Improve the

quality of medical care nationwide

OSHA Regulations

• The Occupational Safety and Health Administration

(OSHA) is a division of the U.S Department of Labor

• Regulations describe precautions that must be taken to

protect workers from exposure to health hazards on the

job, including exposure to infectious diseases such as

– Human immunodeficiency virus (HIV)

– AIDS

– Hepatitis B virus (HBV)

Exposure Plan

• Personal protective equipment or gear

• Immunizations against hepatitis B virus (HBV)

• Information on what to do in case of exposure

• Information on decontamination of waste

products

• Information on how to dispose of sharp

equipment (needles, etc.)

• Information on post-exposure evaluation and

Exposure Plan (cont.)

• Information on how to keep an inventory of

hazardous materials

• Labeling for bio-hazardous wastes

• Training, annual updates regarding hazardous

materials and infectious substances

• Recordkeeping and documentation to protect the legal rights and safety of employees

Apply Your Knowledge

ANSWER: OSHA regulations describe precautions that

must be taken to protect workers from exposure to

health hazards on the job

What do OSHA regulations describe?

– Protect and enhance the rights of patients

• Access to health-care information

• Control inappropriate use or disclosure

– Improve the quality of health care by restoring trust in

the health-care system

Title I: Health Care Portability

• Increases workers’ ability to get health-care coverage

when starting a new job

• Reduces workers’ probability of losing existing

health-care coverage

• Helps workers maintain continuous health-care coverage

when changing jobs

• Helps workers purchase health insurance on their own if

they lose coverage under an employer’s group plan and

have no other health-care coverage available

Administrative Simplification and Medical Liability Reform

• HIPAA privacy rules

– Give patients more control over their health

information

– Set boundaries on the use and release of health-care

records

– Establish appropriate safeguards to protect the

privacy of health information– Hold violators accountable if they violate patients’

privacy rights

HIPAA (cont.)

• Privacy Rule – protected health information (PHI)

 Use – movement within

an organization

 Disclosure –

transmitted between or among organizations

 Managing and storing

 Chart

Reception area and

HIPAA (cont.)

Apply Your Knowledge

While you are documenting on the computer, you are

called to a patient room for an emergency What should

you do before leaving the computer?

ANSWER: You should close the patient record and log off the

computer to protect the confidentiality of patient information.

Principles for preventing improper release of information

Disclosure (cont.)

Principles for preventing improper release of information

is a conflict between ethics and confidentiality:

 Discuss it with the patient

 If the law does not dictate what to do in the situation, the attending physician should make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others

information

A police officer enters the physician’s office where you work

and requests information about a patient May you release

this information? What should you do?

Apply Your Knowledge

ANSWER: No, you should not be the person to release this

information You should refer the officer to the patient’s

physician, who will make the judgment based on the

urgency of the situation and any danger that might be posed

to the patient or others.

Code of Ethics

• Principles of right and wrong

– Laws are often based on

ethical considerations

• Medical professionals are expected to act

ethically

Code of Ethics (cont.)

Legal Contract Elements

• An agreement between two or more competent

people to do something legal

• Names and addresses of the people involved

• Consideration (whatever is given in exchange,

such as money, work, or property)

• Starting and ending dates, as well as date(s) the

contract was signed

• Signature of the employer and employee

Apply Your Knowledge

Mr Jones would like to try a new treatment for his

Parkinsonism, but his physician refuses to discuss a new

treatment with Mr Jones because he morally disagrees with

this type of treatment This is an example of what type of

issue, and what should the physician do?

ANSWER: This is an example of a bioethical issue The

physician should refer the patient to another physician who

specializes in this treatment.

Labor and Employment Laws

• Title VII of the Civil Rights

Act of 1964

– Law prevents employers

from discriminating in hiring

or firing on the basis of race, color, religion, sex, or national origin

– The victim should also report any instance of sexual harassment to a supervisor or the personnel department

Labor and Employment Laws (cont.)

• 1976 Pregnancy Discrimination Act

– Makes it illegal to fire an employee based on

pregnancy, childbirth, or related medical conditions

• Civil Rights Act of 1991

– Provides monetary damages in cases of intentional

employment discrimination

Labor and Employment Laws (cont.)

• Titles I and V of the Americans with

Disabilities Act of 1990

– Ban discrimination against disabled persons

in the workplace

– Mandate equal access for the disabled to

certain public facilities

– Require all commercial firms to make existing

facilities and grounds more accessible to the

Labor and Employment Laws (cont.)

• 1938 Fair Labor Standards Act

– Prohibits child labor and firing employees for

exercising their rights under the act’s wage and hour standards

– Provides for overtime pay and a minimum wage

• Equal Pay Act of 1963

– Requires equal pay for men and women doing equal

work

• Family Leave Act of 1991

– Allows employees to take unpaid leave time for

maternity, for adoption, or for caring for ill family