3310 Module 8 -Legal Responsibilities
Which legal doctrine would apply in a situation in which a patient's fingers are cut after a technologist accidentally runs the Bucky tray into them while they are curled, grasping the edge of the table?
Res ipsa loquitur
Which of the following means "the thing speaks for itself?"
Res ipsa loquitur
Patient Confidentiality Guidelines
Verbal Communication Written information Computer information Reproduction and faxing of patient information Receipt of faxed information Sensitive Information Employee Conduct
Res Ipsa Loquitur
the thing speaks for itself This is the basis of malpractice lawsuits filed when sponges or other instruments are left inside a patient following surgery. Res ipsa loquitur is applicable because the injury could not occur without negligence of someone involved in the surgical procedure. The cause of the injury is obvious; however, the outcome of the claim is not always as obvious.
A civil wrong in which liability is based on unreasonable conduct defines:
tort
The phase of the lawsuit that involves the case being brought before a judge and/or a jury for a decision is termed the ____ phase.
trial
Doctrine of the Reasonably Prudent Man
applies to both the patient and the health care professional and states that the expectations are that an individual will perform an act with equal care as any other reasonable person
Legal Doctrines
are generally established by common law
Misdemeanors
are less serious than felonies and usually are punished by fines, but may also warrant incarceration.
Judicial Decisions
are rulings made in court cases that interpret statutes, reinforce common law, or change common laws to match the current societal norms.
Incident report
are the formal documentation process for reporting accidents that involve patients, visitors, other health care employees, and yourself.
Quasi-intentional torts
are voluntary acts, without the intention for injury or distress to a patient, but that still result in injury or damage. Examples: defamation of character and invasion of privacy
Examples of intentional tort
assault, battery, false imprisonment , intentional infliction of emotional distress
Patient Care Partnership
formerly known as the Patient Bill of Rights, is a document provided by the American Hospital Association explaining what patients can expect during their hospital stay. informs the patients of their rights and responsibilities regarding their health care.
Incarceration generally occurs
in a local or county jail, not in a penitentiary, and for a time period of less than 1 year.
Restraining a patient during a myelogram, without his consent, might result in a(n) ______ tort claim of ________.
intentional; false imprisonment
Doctrine of personal liability
is a basic rule of law that holds each person accountable for his or her own actions, regardless of who else might be liable. basis for a radiographer being held responsible even though the radiographer was following a physician's orders.
Confidentiality
is a patient's right by law and our ethical responsibility as health care professionals. Confidentiality is defined as a patient's legal right that ensures private, personal information will be withheld from all, except those professionals directly involved in care.
Documentation
is one of the best methods to reduce risk of legal liability; other methods will be discussed in the next section. consent form cannot take the place of a proper verbal procedure explanation and documentation of the patient's pertinent history prior to the performance of the imaging procedure.
Informed Consent
is required and must be obtained for all invasive procedures. Informed consent requires that the patient be given sufficient information to understand what is involved with the procedure.
Statutory Law
is the body of written laws developed and defined by elected officials at all levels of city, county, state, and federal governments. The body of written laws developed and defined by the legislature.
Assault
is the threat to harm another person and the person believes the other capable of carrying out the threat.
False Imprisonment
is the unlawful detention or confinement of a person. In medical imaging procedures, the inappropriate and unnecessary use of physical restraints is a common example of false imprisonment.
Battery
is touching another without consent. Battery may be claimed if a patient is palpated for positioning without a proper explanation of the necessity or in an inappropriate manner or part of the body.
Health care professionals found guilty of felony crimes
lose their certification and licensure and are no longer allowed to practice.
Crimes are divided into
misdemeanors or felonies.
Doctrine of Borrowed Servant
often used in conjunction with respondeat superior. The doctrine implies that greater liability is owed to the one overseeing and directing the employee rather than the one paying the employee. Holds that the one supervising or directing the employee has more responsibility than the one paying the employee
Felonies
serious violations of law that can be punished by incarceration in a penitentiary for a period of time in excess of 1 year and/or with fines in excess of $1,000
Patient Chart
should contain the patient history of allergies, the type of contrast, the amount of contrast administered, the route and time of administration, the venipuncture site person performing venipuncture and contrast administration.
How HIPAA Works
specific security mandates patient controls health info Info released should be "minimum necessary" Provides for civil and criminal penalties for improper use
Doctrine of Corporate Responsibility
the basis to sue the hospital for the actions of the health care providers
Which of the following would be included on the chart of a patient who had an excretory urogram procedure? (1) Time of contrast administration (2) Venipuncture site (3) Amount of contrast administered
1, 2, and 3
Which of the following would be required when obtaining informed consent for an imaging procedure?(1) Consent provided voluntarily without coercion(2) A description of risks and benefits(3) Signature of patient or authorized representative Correct!
1, 2, and 3
Incident reports are valuable for:
Identifying high-risk or problem areas
Which of the following is often used in emergency situations to treat life-threatening injuries?
Implied consent
Which of the following is/are useful in identifying a high-risk area in a health care facility?
Incident reports
All of the following must occur to claim negligence except for:
Intent to injure
A violation of confidentiality could be a claim for which type of tort?
Unintentional
Types of Tort Law
Unintentional Intentional Quasi-Intentional
Defamation of character
Written or spoken actions that injure another's reputation; two types: slander and libel.
Current Law
combination of common law and statutes and judicial decisions
Two elements are essential to prove a crime:
criminal intent and criminal act.
List two ways Maurice could have prevented this injury to Mr. Takaki.
1) Maurice could have asked a nurse or nurses' aide to help him position Mr. Takaki after realizing the patient was impaired by the narcotic pain medicines. 2) Maurice could have placed the exposed IR on the floor without taking his hand off of Mr. Takaki, and then assisted the patient into a supine position. Once Mr. Takaki's bed rails were in the upright position, Maurice could then take the exposed IR away. 3) Immediately after making the exposure, Maurice could have moved the hot collimator away from the patient's bed and raised the bed rail on that side before moving the exposed IR.
Which of the following are exceptions to confidentiality and may be reported without patient consent?(1) Certain wounds(2) Automobile accidents(3) Birth defects
1, 2, and 3
Which of the following might be a penalty for a criminal violation?(1) Incarceration(2) Monetary fines(3) Community service
1, 2, and 3
HIPAA stands for:
Health Insurance Portability and Accountability Act
What does the acronym HIPAA mean?
Health Insurance Portability and Accountability Act
Tort Law - foundation for most lawsuits affecting imaging technologists
"a private or civil wrong or injury, and not a breach of contract, for which the court provides a remedy for damages. There must always be a violation of some duty owed to the plaintiff, and generally such duty must arise by operation of law and not by mere agreement of the parties."
Respondeat Superior
"let the master answer." The contention in this legal doctrine is that the employer is responsible for the negligent action of the employees. The basis for this contention is that the employer is "in control" (or should be) of the actions of the employees.
Three branches of Law
-Administrative -Criminal -Civil
What elements must be proven for Maurice to be found negligent in Mr. Takaki's injury?
1) Mr. Takaki was in Maurice's care. 2) Maurice failed to provide reasonable care. 3) Mr. Takaki suffered an injury. 4) Maurice's breach of duty of care resulted in Mr. Takaki's injury.
Three Phases of a lawsuit
1) pleading-Complaint lodgedAnswer given, composed of a complaint lodged against the perceived wrongdoer and a return answer. 2) discovery-Facts sought in several ways: Written questions: requests for information,including interrogatories, request foradmissions, requests for production of documents, email, audio and video information Oral questions (deposition) 3) trial -Presentation of facts to judge or jury, when the case is presented to a judge and/or jury to obtain a legal, binding decision.
Related to sensitive patient information, which of the following can only be released by the health information department of the facility?(1) Test results or visit notes related to sexually transmitted diseases(2) HIV test results(3) Substance abuse treatment records
1, 2, and 3
Which of the following might be a penalty for a violation of an administrative law?(1) License suspension(2) License revocation(3) Community service
1 and 2 only
Which of the following must occur to claim negligence?(1) A breach of the duty of reasonable care(2) A resultant injury from the duty breach(3) Proof of intent to injure
1 and 2 only
Which of the following legal doctrines are often applied together when a clinician is negligent while under the supervision of a physician?(1) Respondeat superior(2) Res ipsa loquitur(3) Doctrine of borrowed servant
1 and 3 only
Which of the following would be included on the chart of a patient who had a lumbar myelogram procedure?(1) Type of contrast(2) Technical factors used(3) Amount of contrast administered
1 and 3 only
Which of the following are criteria used for the legal use of patient restraints?(1) Restraints may be used without consent if needed to protect members of the health care team.(2) Restraints must be frequently assessed.(3) Restraints should be applied in the least intrusive manner as possible.
1, 2, and 3
7 C's of Malpractice Prevention
1. Competence-Participate in continuing education programs and read current professional research and literature. 2. Compliance-Closely follow the policies and procedures for the imaging department; be sure to review these annually. 3. Charting-Practice accurate and timely charting; keep in mind that the chart is a legal document. 4. Communication-Interpersonal communication skills, both verbal and nonverbal, are critical to preventing malpractice; one estimate is that 90% of malpractice claims could be prevented through proper communications. 5. Confidentiality-Take precaution to only discuss medical information with other medical professionals directly involved in the care of the patient or when there is a properly signed release, authorized consent, and/or a court subpoena. 6. Courtesy-Treat patients, family, and other health care professionals with respect, dignity, and caring. 7. Caution-The proper practices that you have been taught in your educational program are the best basis for safe, competent imaging practice, but staying current with technology and new techniques and procedures is also critical.
Simple Consent
A type of consent that does not require a signature and may be implied by the patient's actions, such as showing up for the procedure or getting onto the x-ray table. does not require a signature and may be implied by the patient's actions, such as showing up for the procedure or getting onto the x-ray table; however, the patient may withdraw consent at any time during the procedure, at which time the technologist must stop the procedure until consent is re-obtained.
Which of the following legal doctrines holds the hospital as well as its employees liable in patient lawsuits?(1) Doctrine of personal liability(2) Doctrine of corporate responsibility(3) Respondeat superior
2 and 3 only
Implied Consent
A type of consent used in emergency situations when the patient is unable to provide informed consent and no legal surrogate is available. It is based on a reasonable person's actions and is used when the patient is in imminent danger of death or serious impairment.
Tort
A civil wrong, such as negligence, false imprisonment, assault, or battery
Which of the following conditions should exist if implied consent is to be used in place of informed consent?
A competent patient's actions, such as getting on the x-ray table
Lawsuit
A complaint brought before a court in order to obtain a punishment, solution, or recover damages resulting from the wrongs of another.
Libel
A false accusation written, printed, or typewritten, or presented in a picture or a sign, that is made with malicious intent to defame the reputation of a person who is living or the memory of a person who is dead, resulting in public embarrassment, contempt, ridicule, or hatred
5 essential elements of informed consent
A mentally competent adult must give consent voluntarily and without coercion. The patient must understand the explanation. Interpreters must be provided for those who are deaf or who speak a foreign language. A description of the risks and benefits, other options for treatment or diagnosis, and expected outcome with and without the procedure for which consent is needed must be included and explained. The consent must be written, signed, and dated by the patient or authorized representative and a witness. If the patient is younger than 18 years of age, a parent or guardian gives consent. If the minor is 7 years or older, the patient should be included in the decision.
Plantiff
A person who files a civil lawsuit initiating a legal action makes the complaint, and the claim is made against the defendant
Which branch of law deals with licensing and regulation?
Administrative
The type of law that forms the basis for our current law and is defined as the system of laws originated and developed in England and based on court decisions, on the doctrines implicit in those decisions, and on customs and usages rather than on codified written laws is called:
Common law
It is an extremely busy day in the imaging department. Lashonda complains that she hardly has time to log her procedures into the computer properly. Her friend, Anita, who is a transporter for the department, says, "Give me your password and I'll do the computer work for you." Lashonda writes her password down for Anita and puts it in Anita's lab coat pocket saying, "You're a life saver!" Which of the following statements describes this scenario best?
Anita and Lashonda should both know that sharing passwords violates confidentiality guidelines regarding computer information.
Slander
Any words spoken with malice that are untrue and prejudicial to the reputation, professional practice, commercial trade, office, or business of another person
A threat to harm another is termed:
Assault
Confidentiality Exceptions
Automobile accidents Birth Defects Communicable diseases Certain types of wounds
One of the ways to reduce legal liability when obtaining informed consent for an imaging procedure is to:
Document informed consent on the appropriate form and have the patient's signature witnessed by a third party.
Touching a person without consent defines
Battery
Which of the following will help prevent malpractice claims?
Being competent in your profession and compliant with all policies and procedures
Which of the following will help prevent malpractice claims?
Being courteous and a good communicator
Examples of conditions that are exceptions to confidentiality include:
Certain types of wounds (gunshots, knife wounds) Suspected abuse Communicable diseases (TB, STDs) Automobile accidents Industrial accidents (explosions, chemical spills, etc.) Birth defects Drug addictions
What type of law would preside when one party commits an act, either voluntarily or involuntarily, that harms another?
Civil
The ethical principle or legal right that requires radiographers to hold secret all information relating to a patient, unless the patient gives consent permitting disclosure, defines:
Confidentiality
Civil Law - basis for most lawsuits
Contract law Tort Law Property Law
Which branch of law addresses wrongs committed against the state?
Criminal
Post-decision appeal process
Decision may be reversed or reviewed
Which phase of the lawsuit involves attorneys for both sides gathering facts and information about the case?
Discovery
Confidentiality Guidelines
Do not discuss patient information in public places Do not access data to satisfy curiosity Confidential records should be properly disposed of Do not share computer passwords
Which of the following imaging procedures would require implied consent rather than informed consent?
Emergency angiogram on an unconscious patient with a badly wounded limb
All of the following procedures would require a signed informed consent except for:
Emergency chest tube placement to treat a collapsed lung for a victim of a car accident
When obtaining informed consent, the procedure must be explained in the appropriate and precise medical terms so that the physician and other members of the health care team understand to what consent is being given.
FALSE
Violations of HIPAA rules for improper disclosure of private medical information can only be penalized with a fine of less than $1,000.
False
A serious criminal offense is termed a:
Felony
Minor violations of laws are classified as:
Misdemeanors
It is an extremely busy day in the imaging department, so many registered technologists, including Nathasha, are helping out in records, scheduling and transporting of patients. While passing by the temporarily unoccupied reception desk, Natasha hears the fax machine printing. She notes that the document contains patient information. Natasha retrieves the page from the machine and puts into an envelope, stamps it as "confidential," and places the envelope on the radiologist's desk. Which of the following statements is true regarding Natasha's actions?
Natasha's actions were appropriate since she took confidential information out of plain sight and delivered it to the intended recipient.
A patient is left alone on an imaging table while the technologist checks image quality. The patient feels nauseous, so he turns to vomit and rolls off of the table. Which of the following might result from this situation?
Negligence
As a patient is being assisted from the wheelchair to the imaging table, the patient trips on the footrest of the wheelchair, falls, and suffers a laceration to her eyebrow when her head hits the table. Which of the following might result from this situation?
Negligence
Documentation of informed consent on the proper forms with the required signatures is:
One of the ways to reduce legal liability.
Which of the following informs the patients of their rights and responsibilities regarding their health care?
Patient Care Partnership
All of the following sensitive patient information is to only be released by the health information department of the health care facility except for:
Radiologists' dictation reports on imaging procedures
Which legal doctrine would apply if a patient's family sued the hospital where their family member claims they were emotionally distressed by a CT technologist who did not stop the imaging procedure when the patient changed his mind about continuing the procedure after Velcro straps were placed on his head?
Respondeat superior
Which legal doctrines are often applied in conjunction with each other when a clinician is negligent while under the supervision of a physician?
Respondeat superior and doctrine of borrowed servant
Civil Branch of Law
Responsibilities- addresses wrongs committed by one party harming others Penalties for violation- can include monetary damages to compensate for loss and to punish
Criminal Branch of Law
Responsibility- addresses wrongs against the state Penalties for violation- can include fines, restitution, community service and incarceration
Administrative Branch of Law
Responsibility- deals with licensing and regulation Penalties for Violation - can include suspension and revocation of license
All of the following are criteria used for the legal use of patient restraints except for:
Restraints should be left in place until the patient is released from the care of the health care team.
The time limit in which a plaintiff may file a lawsuit against another is termed:
Statute of limitations
The body of written laws developed and defined by the legislature is:
Statutory law
Common Law
The American Heritage Dictionary defines common law as: The system of laws originated and developed in England and based on court decisions, on the doctrines implicit in those decisions, and on customs and usages rather than on codified written laws. forms the basis of current law in 49 of the 50 states in the United States. (Louisiana is the only exception.)
Unintentional Tort
The act is not intended to do harm but still results in damage to person or property. The most common medical example is malpractice, such as negligence , violation of confidentiality, and failure to acquire informed consent. generally based on reasonable care
Required for a claim of medical malpractice in the form of negligence
The breach of the duty of reasonable care, a resultant injury, and proof of causation In simple terms, for you to be found negligent, the following must be proven: -The patient was in your care. -You failed in your duty to provide proper care. -The patient suffered an injury. -The patient's injury was a result of your failure to provide proper care.
Not all law suits end in a trial
The claim may be settled or dropped by the plaintiff at any time before or during the trial. Negotiations may be attempted by both sides to come to an agreement that will settle the lawsuit without requiring the judge or jury to make the decision. The lawsuit may also be dismissed before or during the trial phase if information is discovered that indicates the plaintiff's claim cannot be substantiated.
Negligence
The commission of an act that a prudent person would not have done or the omission of a duty that a prudent person would have fulfilled, resulting in injury or harm to another person
You are a trauma radiographer for a major medical center. One of the emergency physicians that you often work with has just received news that the family of a patient who died in the ER last week has filed a lawsuit against the entire hospital. Which legal doctrine did the family use as the basis for their claim?
The doctrine of corporate responsibility
Your patient codes during a fluoroscopy procedure. As the radiologist performs CPR, she instructs you to start an IV line and administer epinephrine before the code team arrives. The state in which you practice prohibits radiographers from administering any medications, with the exception of contrast media. The doctor sees your hesitation, and says, "Just do as I say! You're okay while under the direct supervision of a physician!" Which legal doctrine contradicts the radiologist's reassurances?
The doctrine of personal liability
Confidentiality is defined as:
The ethical principle or legal right that requires health care employees to hold secret all information relating to a patient, unless the patient gives consent permitting disclosure.
Statute of Limitations
The maximum amount of time that can lapse after something happens for it to be taken to court time limit in which a person may file a lawsuit against another to seek retribution particularly violent and heinous crimes usually do not have a statute of limitations.
Reasonable Care
The measure of care a reasonable person would use in the same or a similar situation.
Defendant
The party named in a plaintiff's complaint and against whom the plaintiff's allegations are made
Conditions of Implied Consent
The patient is too ill or too injured to provide a signed informed consent. No legal surrogate is available to provide consent in patient's stead. There is obvious danger to the patient's life. There is obvious risk of serious impairment. Urgent treatment is crucial to prevent the danger to life or serious impairment.
Implied consent may be used in place of informed consent for all of the following situations except when:
The procedure is an FDA-approved treatment for the condition.
HIPAA (Health Insurance Portability and Accountability Act)
This is the first federally mandated standard enacted to protect the security of, and access to, patients' personal medical information. HIPAA is under the U.S. government's Department of Health and Human Services and the Office of Civil Rights.
What is the purpose of the Patient Care Partnership?
To inform patients of their rights and responsibilities regarding their health care
Which term is defined as "a private or civil wrong or injury, and not a breach of contract, for which the court provides a remedy for damages."
Tort
Legal criteria for the use of restraint
Touching or restraint to which the patient has not consented is needed to protect the patient, health care team members, or the property of others. The restraint used is the least intrusive method possible. Regular reassessment of the need to restrain occurs. The restrain is discontinued as soon as practicable.
Communicable diseases may be reported without patient consent.
True
HIPAA provides for criminal and civil penalties for improper use or disclosure of private medical information.
True
Which of the following are ways to reduce your legal liability?
becoming registered by the ARRT proper documentation maintaining competency through CE and reading professional journals
Invasion of Privacy
can occur when a patient is not properly covered during an imaging procedure or while in transport to the department. Providing proper covering is not only done in consideration of patient modesty, it is also a legal standard of care.
Intentional Tort
defined as an act performed with the intention of inflicting harm on another.