Ethics Exam 1 Review: Set 3

Sexual misconduct in the practice of medicine means violation of the physician-patient relationship through which the physician uses said relationship to induce or attempt to inducethe patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of medicine is prohibited. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0458/Sections/0458.329.ht

458.329 Sexual misconduct in the practice of medicine.—The physician-patient relationship is founded on mutual trust.

Signs of Abuse or Neglect - Physical, Sexual, Emotional/Psychological ______ - Neglect/ Self-Neglect, abandonment, exploitation (financial or material) - ______ used instead of adequate staffing - Pressure sores, broken bones, bruises, welts, discoloration, burns, absence of hair, dehydration - Sudden _____, ______ to talk openly, _____ stories - Unusual ______ account activity. http://abc7ny.com/news/3-workers-at-far-rockaway-nursing-home-charged-with-abuse/803181/ursing-home-charged-with-abuse/803181/ https://www.youtube.com/watch?v=QI13TbPZk0s https://www.youtube.com/watch?v=QI13TbPZk0s

Abuse Sedation Outbursts hesitation implausible bank

Important Considerations Ethics Committee Members ______ the patient's wishes. ______ the dialogue of committee members with varying beliefs. Help the ethics committee seek a morally acceptable resolution to an ______ dilemma. Do not be _____ to seek clarification of issues and ask questions. Contribute to making ______ meaningful and not argumentative. Allow ______ to outweigh the need to be right. The ultimate decision is ______ committee members to make. Provide guidance, consultation, and education.

Accept Accept ethical fearful consultations compassion not

Education - I Ethics committee members Community Patients and family Staff --> ______ care facilities --> _____ health agencies --> ______-_____ care facilities --> _____ office practices

Ambulatory Home Long-term Physician

C. Definition of Possible Responsible Person (Vulnerable Adult): a _______ to the victim, or a _______ ADULT in need of services, or a PERSON who stands in a position of trust and ______, or a PERSON who knows or should know that the vulnerable adult lacks _______ to consent.

CAREGIVER VULNERABLE confidence capacity

Committee Composition Committee should include a wide range of community leaders in positions of political stature, respect and diversity. ______ Educator Caregiver Legal advisor _____ leader _____ leader _____ leader

Ethicist Political Religious Corporate

Reporter name (this is required for professionally mandated reporters). --> View a list of professionally mandated reporters --> Download the professionally mandated reporters packet. Victim name, possible responsible person, or alleged perpetrator name(s). Complete addresses for subjects, including a numbered street address, apartment or lot number, city, state, and zip code and/or directions to their location. Telephone numbers, including area code. Estimated or actual dates of birth. Social Security numbers, if available. A brief, yet concise, description of the abuse, neglect, abandonment, or exploitation, including physical, mental or sexual injuries, if any. Names of other residents and their relationship to the victim(s), if available. A brief description of the victim's disability or infirmity (required for vulnerable adults). The relationship of the alleged perpetrator to the victim.

Florida: Abuse Reporting Information Requested

Mandated Reporter (_______): o Any person who knows, or has reasonable cause to suspect, that a child is abused, abandoned, or neglected by a parent, legal custodian, caregiver, or other person responsible for the child's welfare is a mandatory reporter. § 39.201(1)(a). o Any person, including but not limited to state, county, or municipal criminal justice employees or law enforcement officers, who knows or has reasonable cause to suspect that a vulnerable adult has been or is being abused, neglected, or exploited must make a report. § 415.1034(1)(a)5. •

General

B. Definition of Caretaker Responsible (Child): Every child should expect to be safe and protected when in the care of: a ______, even if the parent is a minor; or a LEGAL _______; or an ADULT ______ MEMBER found in the home continually or at regular intervals; or ANOTHER ______ who has been entrusted with, or voluntarily assumed responsibility for the care of the child; or. ANOTHER _______ who is an employee or volunteer of a daycare, public or private school, agency, summer camp or similar facility when given sole responsibility for the care of the child

PARENT CUSTODIAN HOUSEHOLD ADULT CHILD

Requests for Consultation - II Who may request a consultation? ______ ______ member _____ _____

Patient Family Staff Physician

Know one's rights / Health Insurance Portability and Accountability Act (HIPAA) / Ask questions / Examination and treatment / Emergency care Admission / Special needs addressed / Execute advance directive / Know and trust caregivers / Access a patient advocate/ Chaplaincy services / Ethics consultation / Choose treatment / Informed consent / Refuse treatment / Timely response to care needs / Receive quality care / Compassionate care / Respect / Pain management / Privacy and confidentiality /Know hospital's adverse events/ Discharge / Transfer/ Access medical records/ Know of third-party care relationships / Know hospital charges

Patient Rights

Mandated Reporter (________) o Anyone who is legally obligated to report known abuse and must also identify themselves when reporting. These include: o Physician, osteopathic physician, medical examiner, chiropractic physician, nurse, paramedic, emergency medical technician, or hospital personnel engaged in the admission, examination, care, or treatment of persons. §§ 39.201(1)(d)1 and 415.1034(1)(a)1; o Health or mental health professional other than listed in paragraph above; o Practitioner who relies solely on spiritual means for healing, §§ 39.201(1)(d)3 and 415.1034(1)(a)3; o School teacher or other school official or personnel (child), § 39.201(1)(d)4; o Social worker, day care center worker, or other professional childcare, foster care, residential or institutional worker (child), § 39.201(1)(d)5; o Nursing home staff; assisted living facilities staff; adult day care center staff etc. (vulnerable adults), § 415.1034(1)(a)4; o Employees of Department of Business and Professional Regulation conducting inspections of public lodging establishments, § 415.1034(1)(a)6; o Law enforcement officer, §§ 39.201(1)(d)6 and 415.1034(1)(a)5; Judge, § 39.201(1)(d)(7) and 415.1034(1)(a)5; and 2 o Mediators. § 44.405(4)(a)3.

Professional

Seniors Fail to Report Abuse Fear of --> ______ --> Not being ______ --> Threats of being placed in a nursing facility --> Physical and mental abuse

Retaliation believed

Cases ______ Neglect of Residents Abuse of ______ Abusive Search Forcible Administration of Medications Intimidation of Abusive Resident --> Disciplinary Overkill Deficient Care

Wanton Residents

https://vaw.msu.edu/wp-content/uploads/2013/10/Mandatory-Reporting-Affilia.pdf ---> "Of the 61 participants, 60 did not support mandatory reporting by health care providers to the police until a number of system-level changes have occurred. Florida Bar Journal: The Case Against Mandatory Reporting of Domestic Violence Injuries ---> https://www.floridabar.org/news/tfb-journal/?durl=%2Fdivcom%2Fjn%2Fjnjournal01.nsf%2FAuthor%2FB1EA37227988F5D585256ADB005D62CE

What about Adults? (Gunshots must be reported, but the rest...)

Education - III Promote patient rights. --> Right to self-determination (______) ----> Accept or reject care and treatment Right to ethics committee consultation.

autonomy

Conducting a Consultation Identify the ______. Identify ______ facts. Identify ______. Identify _____ issues. Identify ______ issues. Conduct consultation.

dilemma relevant stakeholders moral legal

Documentation Document symptoms/conditions of abuse. -- Be thorough in ______. -- ______ document signs of suspected abuse. -- Be objective and clear when defining physical and physiological findings.

documentation Accurately

Florida: Report Abuse: Child - any born, unmarried person less than 18 years old who has not been ______ by order of the court. (Definitions for Children) Vulnerable Adult - a person age 18 years or older who has a _____ or is suffering from the ______ of aging. (Definitions for Adults)

emancipated disability infirmities

Committee Goals Provide a ______ for review and discussion of ethical and moral _____ relative to patient care. Provide information to ______ as to the functioning of the ethics committee and how to access the committee at the time of admission. Serve as support and resource for hospital staff, families, and patients. Provide consultation, as requested, when there are conflicts in care options. Provide assistance in ______ situations that are ethical, legal, or religious in nature that extend beyond the scope of daily practice. Clarify issues and discuss alternatives to ethical dilemmas. Promote patient rights. Assist the patient and family in coming to consensus with the options that best meet the patient's care needs. Review cases for educational purposes. Enhance the ethical tenor of both the hospital and health care professionals.

forum issues patients clarifying

Consultation and Conflict Resolution Requests for committee consultations. Provide ______, not decisions. Strive to achieve consensus when addressing care dilemmas.

guidance

A. The Florida Abuse Hotline will accept a report when :There is reasonable cause to suspect that a child who can be located in Florida, or is temporarily out of the state but expected to return in the immediate future, has been _____ or is believed to be ______ with harm from a person responsible for the care of the child. OR Any vulnerable adult who is a resident of Florida or currently located in Florida who is believed to have been abused or ______ by a caregiver in Florida, or suffering from the ill effects of ______ by self and is need of service, or exploited by any person who stands in a position of trust or _______, or any person who knows or should know that a vulnerable adult lacks _____ to consent and who obtains or uses, or endeavors to obtain or use, their funds, assets or property.

harmed threatened neglected neglect confidence capacity

Patient Responsibilities - I Patients have responsibilities, as well as rights. Maintain a ______ lifestyle. Keep ______. Maintain ______ medication records. Provide full ______ of medical history. Report unexpected ______ in health status. --> Case: Rights and Responsibilities Conflict Adhere to treatment plan. When in doubt, seek second opinion. Stay _____. Ask questions. Accurately describe ______.

healthy appointments current disclosure changes informed symptoms

Facing Ethical Dilemmas:Guidelines Seek to diagnose before you prescribe. Not sure what to do - discuss your dilemma with other committee members. Do not ______ your beliefs on others. Help guide others to make choices. Ask the patient how you might help.

impose

Requests for Consultation - I Clarification of _______ Determining decision-making ______ Informed consent Advance directives Withdrawal of ______ Should be conducted in a timely manner

issues capacity treatment

Advisory Commission Describes Patient Responsibilities - II Use health plan's internal complaint and appeal processes to address concerns that may arise. Avoid _______ spreading disease. Recognize the reality of risks and ______ of the science of medical care and the human ______ of the health care professional. Be aware of a health care provider's obligation to be reasonably _____ and ______ in providing care to other patients and the community.

knowingly limits fallibility efficient equitable

Advisory Commission Describes Patient Responsibilities - III Become _______ about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions. Show ______ for other patients and health workers. Make good-faith effort to meet financial ______.

knowledgeable respect obligations

Advisory Commission Describes Patient Responsibilities - I Take responsibility for _______ healthy habits, such as exercising, not smoking, and eating a healthy diet. Become ______ in specific health care decisions. Work ______ with health care providers in developing and carrying out agreed upon treatment plans. ______ relevant information and clearly communicate wants and needs.

maximizing involved collaboratively Disclose

Resolution of Ethical Dilemmas Perplexing task. Ethics committee member must be prepared to understand the challenge by actively _______ in the decision-making process without bias.

participating

Education - II Recognize time commitment. Include training in _____, _____, _____, and _____. Include formal training and experience in clinical ethics. Develop and distribute appropriate materials for committee members, caregivers, patients, and family.

philosophy religion medicine law

Committee Functions Develop ______ and ______. Provide ______. Consultation and conflict ______. Review ethics committee's _______.

policies procedures education resolution effectiveness

Ethics Committee A health care ethics committee is an advisory body whose purpose is to facilitate discussion and consultation on ethical issues arising in the patient care setting. The make _______ NOT decisions Development of policy and procedure guidelines to assist in resolving ethical dilemmas; staff and community education; conflict resolution; case reviews, support and consultation and political advocacy.

recommendations

Convening the Ethics Committee:Rules to Follow Serve as a ______ when there are no clear choices. Be ______ to patient and family values. ______ for the best path to conflict resolution. ______ family in reaching for consensus. _______ and guide the process without personal biases.

resource sensitive Search Assist Educate

Patients in Restraints Signs of Abuse Physician's order for _____ Time-limited orders ______ of patients physically restrained _____ of restraints used Are ______ applied correctly? How often restrained patients observed by staff Signs of _____ Signs of mental and physical ______ of patients Signs of ______, ______, or threats from staff or patients Whether patients are comfortable with staff Number of patients with bruises/injuries Patients left in urine or feces without cleaning

restraints Number Types restraints overmedication abuse harassment humiliation

Good-Faith Reporting Suspected child abuse must be made with a good-faith belief that the facts reported are ______. Definition of good faith as used in a child abuse statute may vary from state to state.

true

Advisory Commission Describes Patient Responsibilities - IV Abide by administrative and operational procedures of health plans, health care providers, and government health benefit programs. Report ______ and _____ to appropriate resources or legal authorities.

wrongdoing fraud