Medical Law and Ethics

Conglomerate

A corporation of a number of different companies operating in a number of different fields.

Deductible

A cost-sharing arrangement in which the member pays a set amount toward covered services before the insurer begins to make any payments. Typically, HMO members do not pay deductibles.

Subpoena duces tecum

A court order requiring a witness to appear and bring certain records or tangible items to a trial or deposition.

Litigation

A lawsuit; a contest in court.

Business license

A license for business or operation may be required. An annual renewal fee may be necessary.

Patient Bill of Rights

A list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights.

Co-payment

A medical expense that is a member's responsibility; usually a fixed amount of $5 to $20.

Judge

A public official who directs court proceedings, instructs the jury on the law governing the case, and pronounces sentence.

Felony

A serious crime such as murder, larceny, assault, or rape. The punishment is usually severe.

Declaration of Helsinki

A set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association (WMA). It is widely regarded as the cornerstone document on human research ethics.

Ethics

A set of moral standards and a code for behavior that govern an individuals interactions with other individuals and within society. It is a critical reflection about morality and the rational analysis of it.

The Nuremberg Code

A set of research ethics principles for human experimentation set as a result of the Subsequent Nuremberg Trials at the end of the Second World War.

Gatekeeper

A term referring to HMO primary care providers responsible for referring members to specialists with the intent of matching the client's needs and preferences with the appropriate and cost-effective use of those specialists' services.

Preferred Provider Organization (PPO)

A type of business agreement between a medical service provider and an insurer organization in which the fess for specific services are predetermined for an already established group of clients assigned to or selected by the provider.

Joint venture

A type of business management where hospitals, physicians, and clinics form to offer client care.

Managed care

A type of health care plan; generally one of two types, namely HMO or preferred provider organization (PPO).

Pay for Performance (P4P)

A type of managed care to encourage providers to improve the quality of their clients' care, and reimburses them for their progress towards a fixed goal.

Deposition

A written record of oral testimony made before a public officer for use in a lawsuit.

Theft

Actual taking and carrying of someone else's personal property without consent or authority and with the intent to permanently deprive a person of it.

Reciprocity

An agreement by which the states recognize the licensing procedures of each other, consider them valid, and grant licenses to practice based on the other state's licensure. In some states, it is referred to as endorsement.

Endorsement

An agreement in which one state recognizes the licensing procedure of another state, consider it valid, and granted a license to practice. Sometimes referred to as a reciprocity.

Registration

An entry in an official record listing names of persons satisfying certain requirements and level of education.

Bond

An insurance contract by which a bonding agency guarantees payment of a specified sum to an employer in the event of a financial loss to the employer caused by the act of a specified employee; a legal obligation to pay specific sums.

Hippocratic oath

An oath historically taken by physicians. It is one of the most widely known of Greek medical texts. It requires a new physician to swear on a number of healing gods to uphold specific ethical standards.

Court order

An order issued only by a judge to appear or request certain records. The release of any records requested in a court order does not require the clients permission.

Subpoena

An order to appear in court under penalty for failure to do so.

Summons

An order, in a civil case, from the court directing the sheriff or other appropriate official to notify the defendant where and when to appear.

Blanchard & Peale's The Power of Ethical Management

Book on ethics that includes a three-step decision check: Is it legal or in accordance with institutional or company policy? Does it promote a win-win situation with as many individuals (client/employee/employer) as possible? How would I feel about myself were I to read about my decision in the daily paper? How would my family feel? Can I look myself in the mirror?

Burglary

Breaking and entering with intent to commit a felony.

Professional coder

Coders are responsible for the correct application of procedures, supplies, and diagnostic codes used for billing professional medical services.

Disadvantages of professional service organizations

Complex with many detail requirements requires lawyers and accountants to monitor the practice making it more expensive than other types. Decision making can be more complicated because of more people.

Advantages of professional service corporations

Contributions to pension or profit sharing plans can be made for all employees. Corporate medical reimbursement. May pay professional liability premiums for physicians and their employee

Civil case

Court action between private parties, corporations, government bodies. or other organizations. Compensation is usually monetary. Recovery of private rights is sought.

Criminal case

Court action brought by the state against individual(s) or groups of people accused of committing a crime; punishment usually imprisonment or a fine; recovery of rights of society.

Roe v. Wade

Court case that was a landmark decision by the United States Supreme Court on the issue of abortion. Decided simultaneously with a companion case, Doe v. Bolton, the Court ruled 7-2 that a right to privacy under the due process clause of the 14th Amendment extended to a woman's decision to have an abortion, but that this right must be balanced against the state's two legitimate interests in regulating abortions: protecting prenatal life and protecting women's health.

Court of appeals

Court that reviews decisions made by a lower court; may reverse, remand, or affirm lower court decision.

Disadvantages of sole proprietorship

Difficulties in raising sufficient capital to begin/expand. Profits may be insufficient for expansion. If the business's fails in a sole proprietorship or if a liability claim surpasses insurance protection, their personal property may be attached, and they may lose virtually all personal saving and possessions. They also perform all or most of the managerial functions in the business and works more than a standard 40-hour work week.

Certification

Documentation, usually from a professional organization, that an individual has met certain requirements set forth by that organization.

Bioethics

Ethical implications of bio-medical technology and its practices.

Cross-examination

Examination of a witness by an opposing attorney at a hearing or trial.

Direct examination

Examination of a witness by the attorney calling the witness at a hearing or trial.

Controlled Substances Act

Federal law regulating the administration, dispensing, and prescription of particular substances that are categorized in five schedules.

Verdict

Finding or decision of a jury.

Capitation

Health care providers are paid a fixed monthly fee for a range of services for each HMO member in their care.

Schedule 1

High potential for abuse and have no current accepted medical use. Only prescribed for research purposes which must be approved by DEA and the FDA. These have a high potential for abuse and are not refillable. E.g.. Heroin, LSD

Sentencing

Imposition of punishment in a criminal proceeding.

Disadvantages of partnership

It has to be a balanced relationship. If the partnership fails, usually one partner can be liable for all debts

The Geneva Convention Code of Medical Ethics

It is a declaration of a physician's dedication to the humanitarian goals of medicine, a declaration that was especially important in view of the medical crimes which had just been committed in Nazi Germany. The Declaration of Geneva was intended as a revision[2] of the Hippocratic Oath to a formulation of that oath's moral truths that could be comprehended and acknowledged in a modern way.

Common law

Law developed by judges through decisions of courts and similar tribunals that decide individual cases, as opposed to statutes adopted through the legislative process or regulations issued by the executive branch.

Statutory law

Law or statute law is written law set down by a legislature or by a legislator. Statutes may originate with national, state legislatures or local municipalities. Statutory laws are subordinate to the higher constitutional laws of the land.

Licensure

Legal permission, granted by state statues, to perform specific acts; for instance, a physician is licensed to practice medicine.

General liability

Liability for building, automobile, theft, fire and enployees' safety. Office employees will be involved in payments of insurance premiums and submission of claims or in the establishment of physician in practice.

Opt-out option

Members or clients can seek treatment from providers outside the health care plan but pay more to do so.

Advantages of partnership

More financial strength than a sole proprietorship. Partners are likely to bring additional managerial skill and a sharing of workload. The organizational is relatively simple.

Automobile

Non-owner liability insurance should be considered to protect the physician/employers if an employee has an automobile accident while performing some duty related to the business

Nurse Practitioner (NP)

Nurse practitioner is an RN (usually a bachelor's degree) who has successfully completed additional training in an NP program at the masters or doctoral level.

Appellant

One who appeals a court decision to a higher court.

Disadvantages of group practices

Pay is not as good. Conflict of personalities.

Fee-for-service

Pays providers for each service performed.

Expert witness (medical)

Person trained in medicine who can testify in a court of law as to what the professional standard of care is in the same or similar communities.

Medical Assistant (MA)

Person who assists the physician in both administration and clinical duties; education varies from on-the-job training to two years in an accredited program for medical assisting. May be certified (CMA) or registered (RMA) by successfully passing the professional organization examination.

Medical Laboratory Technician (MLT)

Person who has graduated from a certificate program or associate degree program that works under the supervision of a physician or medical technologist in a laboratory. May be certified by a professional organization examination.

Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)

Person who has graduated from a one year practical nurse vocational or college program and has passed the state licensing organization for practical or vocational nurses. An LPN or LVN works under the direct supervision of a registered nurse (RN) or a physician.

Medical technologist (MT)

Person who has graduated from a two to four year college or university program in medical technology that includes one year of training in the laboratory.

Registered Nurse (RN)

Person who has graduated from a two years associate degree, three year diploma, or four to five year bachelor's degree program and passed the state licensing examination for RNs. An RN works under the direction of a physician.

Medical transcriptionist

Person who may, or may not, have formal training; will have superior keyboarding and grammar skills; transcribes medical dictation on or off site.

Physician Assistant (PA)

Person with one to four years of education in an approved program for PAs; a PA works under the supervision of a physician.

Co-insurance

Plan dictates that the owner is responsible for payment of a certain percentage of the loss, such as 20 to 30 percent.

Health Maintenance Organization (HMO)

Prepaid health care services rendered by participating physicians and providers to an enrolled group of persons.

Examination of a witness

Questioning of a witness by attorneys during a court action.

Pluralistic

Referring to numerous distinct ethnic, religious, and cultural groups that coexist in society.

Building

Responsible for the building and the grounds where business is conducted.

Law

Rule or regulation that is advisable or obligatory to observe.

Medical Assistant Code of Ethics

Sets forth principles of ethical and moral conduct as they relate to the medical profession and the particular practice of medical assisting.

Advantages of group practice

Share financial investment for diagnostic and therapeutic equipment. Little administrative responsibility. More social and intellectual stimulation at work. More family time at home for physicians

Advantages of sole proprietorship

Simplicity of organization; being one's own boss; being the sole receiver of all profits that are generally larger than any other forms of business management; and having lower organizational costs, greater flexibility in operation, and fewer government regulations than other forms of business management.

Jury

Six to 12 individuals, usually randomly selected, who are administered an oath and serve in court proceedings to reach affair verdict on the basis of the evidence presented.

Laws

Societal rules or regulations that are advisable or obligatory to observe.

Small claims court

Special court intended to simplify and expedite the handling of small claims or debts.

Professional service corporation

Specific type of corporation in which licensed individuals organize to render a professional service to the public. Such licensed individuals include physicians, lawyers, and dentists.

Principle of Medical Ethics (AMA)

Standards of conduct which define the essentials of honorable behavior for the physician.

Probate (estate) court

State court that handles wills and settles estates.

Opening statements

Statements made by opposing attorneys at the beginning of a court action to outline what they hope to establish in the trial.

Closing arguments

Summary and last statements made by opposing attorneys at a hearing or trial.

What qualities must a Health Care Practitioner have?

Tact, diligence & knowledge, caring & sensitivity, compassion, honesty & integrity.

Higher (superior) court

The court to which appeals of trial court decisions can be made; a court with broader judicial authority than a lower or inferior court.

Defendant

The person or group accused in a court action.

Plaintiff

The person or group initiating the action in litigation.

Arraignment

The procedure of calling someone before a court to answer a charge.

Liability

The state of being liable, responsible, legally bound or obligated, as to make good any loss or damage that occurs.

Dispense a drug

To deliver controlled substances in a bottle, box, or some other container to the client. Under the Controlled Substances Act, the definition also includes the administering of controlled substances.

Administer a drug

To introduce a drug into the body of a client.

Prescribe a drug

To issue a drug order for a client.

Group practice

Type of business management in which three or more individuals organize to render professional service and share the same equipment and personnel.

Partnership

Type of business management involving the association of two or more individuals who are co-owners of their business.

Sole proprietorship

Type of business management owned by a single individual.

Misdemeanor

Type of crime less serious than a felony.

Lower (inferior) court

Usually, the court in which a case is first presented to the trial court; a court with limited judicial authority.

Morality

What people do in fact believe to be right and good.

United States Code of Federal Regulation

is the official compilation and codification of the general and permanent federal statutes of the United States.