medical law and ethics 2

Helping Victims of Abuse

-be a friend, seek privacy, gently ask questions, provide support and be honest

Fraud

A deliberate deception intended to secure an unfair or unlawful gain types of fraud== -Billing for services not needed, services not performed, a nonexistent patient, or supplies that are not needed or supplied to patients. -Ordering laboratory tests, procedures, treatments, or office visits unnecessarily. -Billing for prescriptions or supplies that were not provided or charging a rate for brand name medications when generic versions were provided. -Billing the patient for covered items or unnecessary supplies -False injury claims or workman's compensation fraud. -Payment or other gifts to health care professionals to entice or in exchange for patient referrals to a facility, practice, or insurance program.

Gathering Evidence in Cases of Abuse

Healthcare workers may be asked to gather evidence in abuse cases. It is important that the documentation be precise and thorough. If the court issues a subpoena for your documentation, you will be glad that your documentation is professional and thorough. For example, when documenting a bruise, you want to document the location, measurements, color, and shape. If the patients tell you what happened, write their words in quotation marks to indicate it is the patients' words and not your interpretation of those words. -evidence handled by one employee

Drug Enforcement Agency

Drugs that have potential for addiction or habituation are also regulated by the Drug Enforcement Administration. There are different rules for each state that guide physicians and health care facilities in obeying the Controlled Substances Act of 1970. Violations of these rules can result in fines, imprisonment, and loss of license to practice medicine.

Illegal Interview Questions

When it comes to interviewing, there are a many do's and don'ts delineated by the Equal Employment Opportunity Commission (EEOC). Basically, any question that could create a bias or discriminatory judgment about an applicant is off limits. Children Arrests Handicaps Religion Race Specific age

Sexually Transmitted Diseases

also reportable to the health department so that the health department can alert the public if there is an increase in cases reported. Several states require reporting. Examples of communicable diseases in this category include the following: Syphilis Gonorrhea Genital warts Herpes Hepatitis Human immunodeficiency virus (HIV)

Coroner's Cases

diseases that can be passed from one organism to another, of the same or different species.

Types of Negligence

-Contributory negligence is a defense in which the practitioner claims that an action of the patient contributed to the negative outcome. -comparative negligence, the patient's behavior is found to have contributed to the negative outcome, but the difference is in the compensation for the physician's contribution to the negative outcome. In Sandy's example, she could be found 40% responsible because she didn't follow instructions, and the physician could be found 60% responsible because he performed the procedure anyway.

Credibility of the Medical Record

-Print in black ink, use correct spelling and grammar, and write in complete sentences. -Draw a single line through an error and then initial and date the error. In electronic records, you can draft entries and correct them, and they become permanent once saved to the system. -If you realize that you have left something out of a medical note, write another entry that says "Addendum to above note" and then write the information necessary to clarify your previous note. Insertions, arrows drawn to show insertions, and/or writing over words that are already there can make a document look illegally altered. -If you forget to write something when it occurred (which is the best practice), you can write a late entry. Make sure to indicate, "late entry for xx/xx/xx" so that the time frame to which the information relates is obvious.

Storage and Destruction of Medical Records

-Storing non-electronic medical records requires physical space that is secure and protects the records from damage caused by weather or other disasters. -When the state-allotted time frame for keeping records has passed, the facility has the option of destroying the records. Usually this is done once a year by a company that follows Health Information Portability and Accountability Act destruction guidelines ensuring that all protected health information is destroyed completely. Allowable destruction methods include shredding, pulping, or incinerating the record. The destruction method must be documented, as well as the inventory of what time frame the record covered. This destruction log must be kept indefinitely.

1, To begin to investigate questions of neglect and child abuse, the state must have ________. 2. Waste material that has the potential to carry disease is called ________ waste. 3. The mortality rate is the ratio of ________ in a given location. 4. A communicable disease report does NOT need to include the ________. 5. In order to assist the physician in maintaining compliance with the Controlled Substances Act, medical office personnel should NOT ________. 6. If a death is from an unknown or violent cause, the coroner holds a(n) ________. 7. The physician does NOT need to include ________ on the death certificate. 8. Children are NOT required to be vaccinated against ________. 9. Which of the following is NOT a recommendation for completing legal records and certificates? 10. Which of the following is NOT one of the questions that are frequently asked of a suspected abused spouse?

1. probable cause 2. infectious 3. death to total population 4. names of family members 5. keep prescription blanks and pads in an easily accessible area 6. inquest 7. the amount of times the patient had seen the physician prior to death 8. hepatitis A 9. Use abbreviations wherever possible. 10. Has your partner ever left you alone in a public place?

Communicable Diseases

Although state regulations differ, the most common examples of reportable communicable diseases include the following -Tuberculosis Rubeola, rubella (measles) Tetanus Diphtheria Cholera Poliomyelitis (Polio) Acquired immune deficiency syndrome (AIDS) Meningococcal meningitis Rheumatic fever Hepatitis

Importance of Regulatory Laws

Every medical provider should be familiar with specific statues that apply to their profession. These can be found via the Internet by searching for health care statues within your state government website. Many of these regulatory laws (statues) can help prevent a potential negligence or malpractice lawsuit or professional licensing issues.

Consumer-protection-and-collection-practice-related legislation laws and regulations are designed to protect patients as health care consumers from unfair practices. As with all of these regulations, the companies violating these practice acts are open to lawsuits for compensation to the patient for any damages the court finds result from the violation. Physicians associated with these actions are open to sanctions against their medical license

Fair Debt Collection Practices Act of 1978 Prohibits unfair collection practices by creditors Fair Credit Reporting Act of 1971 Regulates the use of an individual's credit information Equal Credit Opportunity Act of 1975 Prohibits discrimination in extending credit to consumers Truth in Lending Act of 1969 Requires a written disclosure about interest rates or finance charges that will be collected in more than four installments Fair Debt Collection Practices Act of 1978 Prohibits unfair collection practices by creditors

Unnecessary Medical, Pharmacy, or Equipment Services

Fraudulent practices related to insurance fraud are investigated by the Office of Inspector General (OIG). The OIG has an Office of Counsel to the Inspector General that represents the OIG in civil cases tried under the False Claims Act, imposes monetary penalties on health care providers found guilty of fraud, issues fraud alerts, and provides other legal services necessary to the OIG.

language

If patients do not speak the same language as the health care professional, interpreters should be used. If possible, relatives should not serve as interpreters because, in some cultures, certain information may not be shared with the person receiving the information or the interpreters may choose to slant the information to get a response that matches their belief about the patient. Pamphlets, office policies, and discharge instructions are just a few of the documents that should be translated into the primary language of the patient. Remember that, in many cultures, it is inappropriate to discuss medical issues, pain, or complaints, so privacy is a must.

release of infomation

If patients want their medical information to be released to another physician, facility, or family member, it is prudent to get the release of information in writing and to include this permission in the medical record. There are forms that allow the patient to mark what types of information can be shared and for what purpose. For example, if Melissa wants her insurance to pay for a doctor's exam, she will need to sign a release of information for billing purposes. This means that only the information necessary for the insurance company to process a claim can be released.

Liability and Malpractice Insurance

Liability and malpractice insurance are common in the health care field. Liability insurance protects healthcare professionals from the risk of damages from a lawsuit. The coverage applies to errors or accidents that occur when people are injured while performing their job or when a patient is visiting the medical office or facility. Malpractice insurance covers the compensation a physician would be required to pay if sued for malpractice and loses.

Religious Considerations

Many religions have beliefs that affect peoples' health care. For example, some religions do not believe in having a blood transfusion. Even if the health care practitioner believes the blood transfusion is the only way the patient will live, they must respect the decision of the patient to decline the transfusion. The only exception is when a guardian has been appointed by the court because the court officer deems the patient is too incapacitated to make decisions on their own. In these cases, the permission for procedures has to be approved by the court-appointed guardian. In the case of children, the courts may also need to be involved. It is difficult to withhold treatment from a child who may or may not decide to practice the religious belief regarding a medical treatment. However, the physician or facility administrator must petition the court for a court order to perform the treatment.

Loss of Medical Records

Medical facilities will almost always lose a court case if they lose a medical record, regardless of cause. Because there are so many safeguards to protect medical records, there is little room for error. Electronic records that are frequently backed up and kept in a separate location will minimize lost records, if not eliminate them.

Health-and-Safety-Related Legislation

OSHA 1970-Requires an employer to provide a safe and healthy work environment -right to know laws- Requires employers to post safety information, such as the use of hazardous or toxic substances, for easy access by employees who might use such chemicals --OSHA blood bourne pathogens-Requires employers to provide education regarding blood-borne pathogens to employees who will reasonably come in contact with such pathogens and must offer free hepatitis B vaccines to these employees -OSHA hazard communications signs=Requires employers to alert employees to potential dangers in the workplace -clinical lab improvement act of 1988=Provides minimum standards for laboratories testing on human specimens -drug free workplace 1988=Requires employers who receive grant money from the federal government or provide goods or services to the federal government to certify that they maintain a drug-free workplace

Substance Abuse

Physicians are required to report abuse of prescription medications, including a stolen prescription pad, knowledge of an altered prescription, discovery of a patient visiting several physicians to get the same medications, or finding that someone is selling prescription drugs. These cases are difficult to investigate and/or prove without evidence, but if physicians have knowledge of these abuses, they must report them to the police immediately. If you suspect a co-worker is abusing substances, check with your employer for employee assistance programs that commonly offer help with substance abuse issues.

Public Health Records and Vital Statistics

Physicians are responsible to report all births and deaths to which they are present. Physicians normally charge an office worker to do this reporting on their behalf, but ultimately the presiding physicians have to sign the birth certificate or death certificate as the case dictates. These statistics are reported to the local health department, and eventually the information makes it to the Centers for Disease Control and Prevention (CDC). The CDC and other public health agencies compile these statistics into data that can be used to report trends in population and illnesses.

Compliance with Health Care Regulatory Laws

Studies show that nearly 90,000 Americans die each year as a result of preventable medical errors. In addition to medication errors, which is the number one medical error (namely, prescribing the wrong medication, dispensing the wrong medication, or receiving a combination of medications that interact negatively), there are errors that relate to lapses in judgment by the practitioner and are considered malpractice. According to an analysis of diagnostic errors published in the Journal of the American Medical Association, a lapse in judgment resulting in misdiagnosis is responsible for 10% of all hospital deaths.

S.O.A.P Note Documentation

Subjective Ms. Tarey came to the office today with a sore throat that she reports has worsened over the past three days. Objective Ms. Tarey's throat was red with white excretions. She was given a rapid strep test that was positive for strep throat. Assessment Ms. Tarey has strep throat. Plans Prescribed antibiotics and pain medication and gave education on preventing the spread of strep throat to others.

The False Claims Act

The False Claims Act requires that someone found liable of providing false claims to a government program is liable for three times the amount of the government's damages, resulting in civil penalties of $5,500 to $11,000 per claim, plus three times the government's damages. --you can't incorrectly code

Privileged Communication

The right to privacy was established with the Privacy Act of 1974, but with implementation of new technologies, such as email, fax machines, scanners, and copiers, rules specific to communicating about patient health information became necessary. Patients have the right to confidential communication with their physician. As part of this right, the patients also have the right to view and obtain a copy of their medical record. According to cases brought to court involving a medical record, it is the physician or owner of a health care facility that actually "owns" the medical record and would testify to the contents of the file. Patients knowing that they have the right to view their medical record provides safety within the physician-patient relationship. There are times when patients could be traumatized or otherwise hurt by information in their medical record, such as if the medical record contains details of a patient's suicide attempt or another psychiatric incident that, when read, could trigger another psychiatric episode. In cases such as this, the law allows the physician or other health care practitioner to sit with patients to answer any questions they may have.

HIV, AIDS, and AIDS-Related Complex

This category of reporting is especially important because there is no cure and the treatment is costly. HIV is the virus that leads to the disease of AIDS. ARC is the AIDS-related complex that may be displayed even before a diagnosis of AIDS is given (including AIDS-related dementia, lymphadenopathy, diarrhea, or weight loss). The difficulty in requiring reporting of such a serious illness is that people are afraid that family, friends, and co-workers will hear the news of this diagnosis. Some states have regulations that require a physician to report whether a person is with AIDS is engaged in activity that includes an exchange of bodily fluids with someone else. Other states have penalties for people who have HIV and participate in activities that can spread the virus without notifying the other person. Even more difficult is the question of whether or not health care workers who have HIV, AIDS, or ARC should be required to report their status to the health department, employer, and even the patients they treat. The jury is still out on this one, and future legislation will certainly come as the number of people infected rises.

Drugs

any substance that is taken in an effort to alter a person's body, thoughts, or moods. Drugs include prescription medications, illicit street drugs, and over-the-counter medications. The Food and Drug Administration (FDA) is the agency that approves drugs to go on the market and for them to become over-the-counter medications. The FDA's purpose was to prevent interstate commerce in adulterated and misbranded food and drugs. There are five categories (called schedules) of drugs: S1-highly addictive S2-High potential for addiction or abuse and can only be obtained legally through a hand-written prescription (such as Darvocet, Percocet, and Vicodin). S3-Moderate to low potential for addiction and can only be obtained legally through a hand-written prescription (such as butabarbital or anabolic steroids). S4-Lower potential for addiction and abuse, only have to be signed by the physician (versus the physician handwriting the entire prescription), are only allowed five refills in a six-month time period (such as diazepam and phenobarbital). S5-Low potential for addiction and abuse with some needing to be obtained through a prescription (such as Lomotil and cough syrup with codeine).

Culture

comprises our values, beliefs, principles, and every other reason for why we act the way we do. Our heritage, national origin, race, gender, religion, education, and experiences in life affect the way we express our cultural beliefs. -Be aware of other's beliefs. -Learn about other cultures. -Be sensitive to others feelings. -Be open to differences in people. -Learn the ways of communicating in various cultures. -Avoid jokes that target people because of their culture.

Health Insurance Portability and Accountability Act

provides fines and penalties for cases in which a patient's privacy is violated. Privacy is not a relative term; just because health care workers have access to patient information, they shouldn't access such information out of curiosity

medical records

rules for physicians to follow -Correct errors by crossing them out with one line and initialing the error. -Draw a line after the signature to the end of that line so that no one can change the documentation. -Do not alter the medical record. When making a late entry, date it for the day the entry was written and label the entry "late entry for..." -Document any clarifications needed to show the health care professionals' actions. -Never scribble out, white out, or write over an entry but use the error correction technique above.

Stark laws

similar to anti-kickback laws, but they relate to physicians benefiting from referring their patients to providers in which they have a financial interest. These referrals could be for laboratory services, a pharmacy, an X-ray, or medical equipment. Recent changes to Stark laws allow physicians to refer patients for computed tomography, magnetic resonance imaging, or positron emission tomography scans to a provider in which they have a financial interest if they disclose such interest and provide a list of providers from which the patient can also choose for the same service.

Other Guidelines for Documentation

thoroughness, fact vs opinion, if it wasn't written it didn't happen, and refer to yourself in med record as "writer" not nurse sally saw this patient

Negligence

when a person either performs or fails to perform an action that causes harm to a patient.

Malpractice

when there is professional misconduct or demonstration of an unreasonable lack of skill that results in harm to the patient.

the four D's of negligence

- Duty implies obligation. Obligation in the medical field means that there is an agreed on relationship between the professional and the patient.Duty can also be attributed to the due care that is required because of a professional's training -Dereliction means that a medical professional has failed to act as any other professional of similar training regarding acceptable standard of care. For this category of negligence, the patient will have to prove that the physician's actions did not comply with these standards. As a result of medically related lawsuits, the health care industry has implemented multiple forms and statements of understanding for the patient to sign. -direct or proximate cause, in which the action of the practitioner is directly linked to the patient's negative outcome. Proximate relates to the last negligent action that causes harm and is qualified by the injury not occurring without this negligent action. -Damages=This portion of a negligence suit is what the patients or their representatives seek as compensation for the harm they have endured. Compensatory damages (compensation for actual loss of income, pain, and past, present, and future suffering) Punitive damages (compensation if the harm is especially malicious or willful) Nominal damages (compensation because the patient's rights were violated but not necessarily because the practitioner caused the harm) ==Some types of harm include the following: Permanent physical disability Permanent mental disability Loss of enjoyment of life Personal injuries Past and future loss of earnings Medical and hospital expenses Pain and suffering

Contents of the Medical Record Most health care facilities follow the standards set forth by the Joint Commission (previously known as the Joint Commission on Accreditation of Healthcare Organizations) for what should be included in the medical record. These requirements include legal documents that serve as protections for the medical provider, including the following:

-Consents to treatment and/or procedures -Personal identifying information -Financial agreements -Acknowledgement of disclosure of privacy practices -All laboratory, X-ray, and procedure reports -Records of communication between physician and patient -Physician, nurse, and any other health care provider involvement -Consultations -Assessments, diagnoses, and treatment/medications recommended -Discharge summary

Liability

-Liable means that people are legally responsible for actions and accidents or injury that occur on their premises. The first related topic is civil liability. In civil liability cases, health care practitioners are liable for not following directives of a patient. -Promising to cure an ailment is seen by the law as a contract. If the ailment is not cured, even if the practitioner is not found negligent, the contract is considered breached. -drug tests, and keeping the premisies (hospital) clean

Purpose of the Medical Record

-Medical history A record of a patient's medical history includes the following: Vaccinations, Major illnesses, Medical and genetic testing, injuries, Treatments and effectiveness -Data collection Data collection includes the following: Research data, Births and deaths, Health and disease trends, Acute illness outbreaks -Management of the patient's health Managing the patient's health includes the following: Tracking of laboratory results, Evidence of medical diagnoses that have been ruled out, History of medications prescribed Alerts related to medical issues, allergies, or other conditions -Legal documents Legal documents can be used for or by the following: Malpractice lawsuits, Government agencies, Investigations, Healthcare regulatory inspection -Communication tool Medical practitioners can use medical records as a tool for the following: Prescription records, Laboratory and other test results, Planned treatment or procedures

Reporting Births

-Physicians are also asked to report any illnesses in newborns. Specifically, the physician must test for phenylketonuria and eye diseases that are apparent -If you are asked to complete any of this paperwork, you should follow these guidelines to prevent errors: -Follow the state guidelines for completing birth certificates. -Type the information and do not add or erase anything from the certificate. -Make sure that all blank spaces are completed. -Verify the correct spelling for all parties listed on the certificate. -Use full signatures (no abbreviations or stamps). Keep a copy in the patient's chart.

Types of Waste

-Solid waste is general trash that is created in the practice of any business, including health care. Mandatory recycling programs could make a huge difference in the pollution this trash causes. -Chemical waste includes pharmaceuticals, cleaning products, and germicides. The danger in these chemicals are the fumes, flammability, and potential to burn the skin. Having any of these chemicals on the premises of the health care facility or physician's office requires a Material Safety Data Sheet, which shows how to dispose of these items safely and how to treat a patient exposed to the chemical. -Radioactive waste comes from liquid or solid radioactive material. These products (usually found in chemotherapy type treatments) are dangerous and require disposal by a licensed radioactive disposal company. Health care facilities are required to keep such waste material in secured areas labeled with biohazard waste material. -Waste from patients who have infectious diseases, such as human immunodeficiency virus or acquired immune deficiency syndrome (AIDS), require separating from other waste disposal. Linens waiting to be laundered that contain bodily fluids from someone with an infectious disease must also be stored separately from other linen to prevent contamination. Waste must be removed by a licensed disposal company similar to the radioactive waste.

Borrowed Servant

-The borrowed servant doctrine is a special application of respondeat superior. This involves an employee of one physician who is "loaned" temporarily to another physician. If this borrowed employee is found negligent, the initial hiring physician is not responsible, but the borrowing physician is responsible for the employee's behavior. This becomes especially important when practitioners work for a temporary agency. Each time the practitioners go to a different facility to work, they will be held accountable by both their employer and the temporary institution for whom they are working. -A statute of limitation is designed to protect a practitioner from being used after a certain time frame has passed. In some cases, the time does not begin running until the fraud is known or should have been known. -Res judicata means that, once a matter is decided in the court system, the patient cannot bring a suit against the physician again at a later date. For example, if physicians are found guilty of malpractice because they cut a nerve of a patient's shoulder during surgery and the patient is granted $120,000 in compensation, the patient cannot come back in a few years and sue for more money for the same situation.

Defending Against a Malpractice Suit

-The denial defense is just as it sounds: the practitioner denies that the allegations are true. -The assumption of risk defense states that, when a patient has given informed consent of the risks and consequences and understood that the negative outcome was a possibility, the practitioner is not negligent.

1. Under the Fair Credit Reporting Act, if a patient has been denied credit based on a poor rating from a credit agency, the patient ________. 2. Which of the following is NOT among the guidelines for collection efforts? 3. Under the Fair Debt Collections Practices Act, telephone calls for purposes of collections must be made between the hours of ________. 4. Which of the following is NOT one of the basic accommodations that should be made for persons with disabilities? 5. Which of the following is NOT one of the Clinical Laboratories Improvement Act requirements? 6. Which of the following behaviors can lead to stereotyping and prejudging people? 7. The Age Discrimination in Employment Act protects persons ________ or older against employment discrimination because of age. 8. The principle of independence for a patient's beliefs is known as patient ________. 9. Under the Pregnancy Discrimination Act, employers must treat pregnant women as they would any other employee, providing ________. 10. The Civil Rights Act permits the court to award ________.

1. must be notified of this fact 2. Request payment by telephone after the patient leaves the health care facility. 3. 8:00 a.m. and 9:00 p.m. 4. building hallways with at least 10 feet of clearance for wheelchairs 5. Document employee training without assessment. 6. joining coworkers in making ethnic jokes 7. 40 years 8. automony 9. the pregnant woman can still do the job 10. both compensatory and punitive damages

1. A hospital may face charges for improper disclosure if ________. 2. By doctrine of professional discretion, a physician has the power to ________. 3. A hospital has lost patient records before and wishes to prevent this from happening in the future. What steps should they NOT take? 4. For health- care facilities, it is illegal to undertake any of the following practices EXCEPT ________ 5. Under the Privacy Act of 1974, patients were given the right to ________. 6. In managing a medical record, the physician should NOT ________. 7. The MOST important aspect of maintaining the medical record is to ________. 8. Generally, the medical record is owned by ________. 9. A subpoena duces tecum is ________. 10. Dr. Epstein realizes he made an error on his patient's medical chart. What should he do in order to remedy the situation? 11. The ________ ensures that all medical records are completed within 30 days of a patient's discharge from the hospital. 12. A medical record should NOT be altered ________.

1. they released medical records without patient consent 2. withhold a medical record from a patient with mental problems 3. Assign multiple people the responsibility of maintaining the list of removed files. 4. releasing medical records to a third party after receiving patient consent 5. discover the information collected about them by the government 6. include speculation or opinion 7. document everything that is done 8. the physician, or health care facility 9. an order requiring a person to give testimony and bring documents to court 10. Draw a line through the error, writing the correction above with the date and his initials. 11. timeliness of documentation 12. under any circumstanses

1. When does the statute of limitations begin to run? 2. Now that tort immunity is rejected in almost all states, there is a current push for large-scale charitable organizations to include the expense of ________. 3. Which of the following is NOT among the communication guidelines for malpractice prevention? 4. Which legal defense allows the defendant to present evidence that the patient's condition was the result of factors other than the defendant's negligence? 5. When a poor technique is used by a nurse, medical assistant, or phlebotomist to perform a venipuncture, and the patient suffers nerve damage, this is an example of ________. 6. A ________ is NOT an agent for the physician. 7. Billing fraud does NOT include billing for ________. 8. Which of the following is NOT one of the "four Ds" of negligence? 9. Many physicians practice defensive medicine to ________. 10. Compensatory damages cover ________. 11. The determination of duty in a court room is the responsibility of the ________. 12. Which of the following allows the plaintiff to recover damages based on the amount of the plaintiff's fault?

1. when the injury is discovered 2. insurance liability 3. Ignore frivolous patient complaints. 4. affirmative risk 5. misfeasance 6. pharmacist 7. bundling services 8. discrete or proximate cause 9. protect themselves from lawsuits 10. past, current, and future losses 11. judge or jury 12. comparative negligence

Compensation-Related Legislation This set of regulations is related to paying employees and the benefits that must be offered to employees. The Department of Labor oversees most of these regulations, and, when complaints are made by employees to the Department of Labor, the company is subject to investigations, restitution, and fines for not adhering to these laws.

Health Maintenance Organization Act of 1973 Requires employers with 25 or more employees to offer a health maintenance organization insurance as an alternative to the regularly offered insurance if one is available in the area Consolidated Omnibus Budget Reconciliation Act of 1985 Requires employers with 20 or more employees to allow employees laid off or leaving the job to keep their health insurance benefits for 18 months, but the employees are required to pay the full amount of the insurance Fair Labor Standards Act of 1938 Establishes the minimum wage, requires payment for overtime, and sets maximum hours employees can be required to work Equal Pay Act of 1963 Requires employers to pay males and females with the same skill, responsibility, and effort performing the same job to be paid the same amount Unemployment compensation Provides temporary payment to unemployed workers Federal Insurance Contribution Act of 1935 Requires employers to contribute to the social security plans of their employees Workers' Compensation Act Protects workers and their families from financial problems resulting from employment-related injury, disease, or death Employee Retirement Income Security Act of 1974 Regulates private pension and health plans Federal Wage Garnishment Law of 1970 Addresses the court-ordered amount of a paycheck that can be used to pay off a debt

Electronic Health Records

Here are some tips to keep electronic information private: -Ensure that faxes are being sent to the accurate number with a specific person or department indicated. -Log out of computers when you are done working on them. -Do not give your password to others. -Be alert to who is near you when you access medical records and ensure that they are not able to see what you are reading. -Do not tell anecdotal stories about patients to your family, friends, or co-workers. --Ask for identification before providing personal health information to family or friends (and only provide what the patient has authorized). Ensure that your electronic communications about patients (such as text messages, emails, phone calls, and faxes) are secure from others accessing the information.

Treatment for Psychiatric or Drug/Alcohol Abuse Records regarding treatment for psychiatric reasons or for drug/alcohol abuse are protected by both the Public Health Services Act and confidentiality laws.

If someone is receiving treatment for drug or alcohol abuse or for psychiatric reasons, the facility cannot divulge that the patient is or has ever received such treatment. A patient has to provide a written release specifically indicating that psychiatric or drug/alcohol treatment records can be included in medical record releases. If a patient in one of these programs requires emergency care, then only the necessary information can be shared without a written release.

Reporting Deaths

Physicians are required to report deaths as well as the cause of death to the health department. The requirements related to reporting stillborns (a baby that dies before it is born) vary from state to state. The following specifics must be included in the report: -Date and time of the death -Cause of death (any disease, injuries, or complications) -Length of time the person was treated for the illness before death -If the deceased is female, indicate whether pregnant -Whether an autopsy was performed

Retaining and Closing a Medical Record

Record retention is the legal responsibility of physicians and health care facilities. The record of a patient's medical history, births, illnesses, diagnoses, and reasons for mortality are held in the sanctity of these records. States vary in the amount of time records are to be kept, but most states follow the 10-year rule. Records are kept for 10 years after the last entry in the record. For those who can, records are kept permanently in case the records are ever needed. For minors, the time frame always includes keeping records until the child is 21 years of age and then 10 years after the last entry in the record. When a patient is deceased or permanently discharged from a health care facility, the medical record is closed. Some agencies re-open a record if the patient is re-admitted; others start a new record if the patient is re-admitted. When closing a medical record, all documents are collected to ensure that the record is complete. If the patient dies, a record of the death is included. If the patient is discharged, a discharge summary signed by the physician is included. When the record is put in a storage box, an inventory of the contents and date to destroy is included on the outside of the box.

Risk Management

The final piece of risk management relates to regular reviews of the medical record to confirm that all necessary pieces of information are in place. When items are found missing, the medical practice will work to get replacements from the patients to keep their records updated. Larger corporations will use consultants and auditors to catch any questionable items before any official auditors go through the records. When records are requested from an outside agency, similar review of records for thoroughness is commonly completed. It is illegal to alter a medical record. If errors in documentation are found, addendum or clarification notes can be made as long as they are dated the day the note is written. The medical provider is only required to send the indicated records on the request for records.

-The Health Information Technology for Economic and Clinical Health Act A portion of the Health Information Technology for Economic and Clinical Health Act (HITECH) expands HIPAA by increasing privacy and privacy compliance requirements and consequences. HITECH was established to guide the nation in creating a national electronic medical records system in which patients' information can be accessed at any time by authorized personnel.

The following are ways HITECH hopes to decrease invasions: -Transferring information Stop the necessity of transferring information from one provider to another. When your information is already available to providers you authorize, there is no transfer of information through fax, mail, or even email. -Regulations Hold the business associate (insurance company, billing agencies, or pharmacies) who does receive private medical information accountable to the same regulations and fines as the health care facility.

Law of Agency

The law of agency is the law that governs the relationship between physicians and the other health care professionals working under their license. Remember that the employer can be held responsible for errors made by an employee. An employer who has been successfully sued can sue the employee for his or her damages. Also, if the employer is not found liable, the employee can be sued by the patient for monetary compensation related to the employee's actions. In order to protect the physician/employer from liability for negligence the physician must follow certain standards such as ensuring that each employee has a written job description. -the job descriptions should include the following clauses: =The employees will use extreme care when performing their job. =The employees will only perform those procedures for which they are trained. =The employees will be honest about errors or inability to perform a procedure for any reason.

People-Related Legislation There are several pieces of legislation that relate specifically to the employee. Failure to comply with these employee-related regulations can lead to Department of Labor or Equal Employment Opportunity Commission (EEOC) investigations, which can result in fines, required compliance plans, and loss of government contracts.

Title VII of the Civil Rights Act Prohibits discrimination in employment based on race, color, religion, gender, or national origin Civil Rights Act of 1991 Allows the court to award compensatory money for income lost and emotional pain and suffering, as well as punitive damages, to punish the defendant for mistreated employees Equal Employment Opportunity Act of 1972 Authorizes the EEOC to sue employers in federal court on behalf of individuals or a class of individuals whose rights have been violated under Title VII Pregnancy Discrimination Act of 1978 Prohibits employers from discriminating against a woman because she is pregnant, as long as she can still perform her duties Age Discrimination in Employment Act of 1967 Protects people over the age of 40 and older from discrimination in the workplace Rehabilitation Act of 1973 Prohibits discrimination of people with a disability by institutions receiving federal funding Americans with Disabilities Act of 1990 Provides that an employer must provide reasonable accommodations for employees with disabilities and cannot discriminate against an employee with a disability The National Labor Relations Act of 1935 Prohibits private-sector, unpaid employers from stopping employees from participating in groups such as unions Family and Medical Leave Act of 1994 Allows both the mother and father to take an unpaid leave of absence of up to 12 weeks in any 12-month period when a baby is born or for other family medical reasons

Disposal of Medications

Unused or expired medications are a topic of debate. The U.S. Food and Drug Administration regulates medication disposal and no longer allows non-narcotic medications to be flushed into the septic system. The dilemma is that other types of destruction, such as incineration, still puts toxins in the air. However, the testing of water systems across the United States shows indication of many prescription medications. Some speculate that the findings are more from people's urine waste after taking the medication versus the flushing of medications into the sewer systems.