LEGAL AND ETHICAL ALLIED HEALTH

Exceptions to informed consent

- emergencies (pt. can't communicate) -minor procedures and simple tests with minimal risks and consequences if not performed.

Informed consent's two parts

- first part: clear explanation of procedure/ test - second part: the permission given to perform the procedure or test by a competent and voluntary patient.

Consequences of a Breach of Confidentiality

For the patient, a breach of information can range from a slight annoyance to something as harmful as identity theft or social avoidance by friends and family. For the person responsible for the breach, penalties can vary from a simple disciplinary action to something much more serious, such as being fired or losing a professional license. Additional legal or civil actions may also be taken. For the organization, the consequences of a breach can range in the need for additional reporting to costly legal or civil actions and the loss of customers.

Human, Civil, and Client Rights

Human rights are the basic, fundamental rights that belong to all people. They include the rights to freedom, equality, justice, and peace. Civil rights are the privileges and protections given to all U.S. citizens by Constitutional, federal, state, and local law. They include the rights to freedom of speech and the press, of assembly, of petition, to free exercise of religion, to due process of law, to equal protection of the law, and to vote. These also include protection against unreasonable searches, arrests, and seizures of property; against cruel and unusual punishment; and against slavery. Client rights are the rights that people are entitled to when they are in a relationship with a professional, such as an attorney or physician. As clients, patients have specific rights.

Legal disability includes these types of people:

Minors under the age of 18 Incompetent people, such as those with mental disabilities or psychiatric illness or under the influence of alcohol or drugs Semiconscious or unconscious people M, M.I, U

errors

On the other hand, subjective statements made by patients may be included. These should be recorded in patients' exact words and quotation marks should surround them.

Signs of Abuse

Patient statements Unexplained injuries, such as bruises, abrasions, fractures, bite marks, and burns Unreasonable explanations for injuries Malnutrition and dehydration Poor personal hygiene Pain or bruising in the genital area Unexplained genital infections Emotional problems, such as anxiety, depression, aggressiveness, changes in appetite, problems at school or work

Medical records contain the following information about a patient:

Personal information, such as full name, phone number, address, work number and address, birth date, social security number, and marital status Medical history Description of symptoms Diagnoses Treatments Prescriptions and refills Records of patient's telephone calls Name of legal guardian Name of power of attorney Notes about copies of medical records

Security Rule Safeguards health care facilities must provide three types of safeguards when using electronic records.Show Image List of the three types of safeguards

Physical Safeguards: include rules for providing a safe and hazard-free environment in which to store medical records. For example: Doors should be locked. Computer server rooms should be locked and accessed by authorized personnel only. Any paper records should be stored in locked, fireproof cabinets.Show Image Cabinet being locked Technical Safeguards:include rules for protecting electronic information. For example: All medical records should be password-protected, and passwords should be updated regularly. Information that is transmitted electronically should be encrypted. All computer systems must have effective anti-virus software.Show Image List of technical safeguards: password-protected Administrative Safeguards:include rules for managing employees who have access to protected health records. For example: Policies must be in place regarding which employees are allowed to access information. All employees should complete security awareness training.Show Image Healthcare professionals at computers

To remember safeguards

Physical- locked doors Technical- encrypt everything, passwords Administrative- employees

Four main purposes of HIPAA

Privacy of Health Information Security of Electronic Records Administrative Simplification Insurance Portability PISA

When information in a medical record must be provided to a court of law

When law enforcement needs medical records to identify a suspect or missing person When reporting cases of abuse, neglect, or domestic violence When a patient contracts a serious communicable disease, such as tuberculosis When births and deaths occur When information is needed to facilitate organ transplants from deceased donors

Notice of Privacy Practice form.

When patients come to a medical facility for the first time, they must receive a copy of the facility's privacy policy. - In addition, patients must sign a Release of Information form to allow the facility to disclose medical information to authorized entities or people.

durable power of attorney for health care

document that allows a person, a principal, to give another person, an agent, the right to make decisions regarding the principal's health care if the principal is unable to make decisions or communicate because of severe illness or injury. An agent has the following rights and responsibilities: Have access to medical records Allow or deny medical treatments Hire or dismiss health care providers Spend or withhold funds for health care A durable power of attorney must be signed by the principal and the agent, and it must be witnessed by at least one adult. In addition, a living will outweighs power of attorney. In other words, a living will is followed even if an agent does not agree with a principal's decisions.

living will

document that allows people to state what medical treatments they want or do not want to prolong their life in the event that they are unable to make decisions or communicate because of severe illness or injury. living will must be signed when a person is competent, and it must be witnessed by two adults who will not benefit from the person's death.

Equal Employment Opportunity Commission

employers are not allowed to discriminate against applicants based on race, color, religion, sex, nationality, disabilities, or age.

Clinical Laboratories Improvement Amendments,

establish quality standards for laboratories. Each lab must meet the standards in order to perform testing on human specimens.

Defamation of character

intentionally damaging a person's reputation by making false statements about the person

Invasion of privacy

intentionally interfering with a person's right to be left alone

Assault

intentionally threatening or attempting to harm a person

Battery

intentionally touching another person without the person's permission, even if the contact does not cause harm.

False imprisonment

intentionally violating a person's freedom.

Protected health information (PHI)

is any individually identifiable health information about a patient. This is information about a patient's health status, provision of health care, and payment for health care that also identifies the patient's name, social security number, address, telephone number, date of birth, etc. PHI can be oral-, paper-, or electronic-based.

All people entering a contract must be free of _____

legal disability

Advance directives

legal documents that allow people to state what medical treatments they want or do not want in the event that they are unable to make decisions or communicate because of severe illness or injury.

code of ethics

list of written statements describing proper conduct for a group of people.

Patient's Bill of Rights

lists patients' rights that are honored by health care providers The Patient's Bill of Rights states that patients have a right to: Information disclosure Choose providers Emergency services Make health care decisions Respectful treatment Privacy Make a grievance

Proper Maintenance

medical records must be complete, legible, and timely. In addition, all information in records must be objective and the information must be initialed and dated. Subjective observations made by health care workers should never be included On the other hand, subjective statements made by patients may be included. These should be recorded in patients' exact words and quotation marks should surround them.

Procedures

methods the facility uses to carry out its policies. Procedures explain how the facility operates.

Transaction and Code Set Rule

national standards for health transactions. -standardized medical transactions and codes - As a result of this rule, all medical transactions and codes have become the same nationwide

Ethical dilemmas

occur when moral beliefs conflict.

contracts three parts

offer, acceptance, and consideration

privacy

patient's right to control the use of protected health information.

Authorization

permission that patients give in order to disclose protected health information.

in civil law who is plaintiff

person who claims harm

Morals,

personal ethics, are an individual's personal values. Morals are reflected in people's personal beliefs about what is right and wrong conduct.

three types of abuse

physical, emotional, sexual

Policies

principles that direct the facility's activities

Malpractice

professional negligence Malpractice occurs when health care workers unintentionally harm patients as a result of not following their profession's scope of practice.

Criminal law

protects all citizens from people who pose a threat to society.

the Privacy Rule

provides detailed instructions for handling and protecting a patient's personal health information.

Libel

publishing false text or images.

Liability

refers to being legally responsible for causing harm Personal liability Supervisory liability Employer liability

The Right to Information Disclosure

refers to the responsibility of health care providers to give accurate information about themselves to patients. For example, a hospital must reveal that it has a relationship with a research institution.

Employee Retirement Income Security Act,

regulates health care and pension plans that private-sector employers provide to their employees.

Disclosure

release, transfer, or provision of access to protected health information.

Worker compensation

require employers to insure employees in the event that they are injured at work or become ill due to work-related causes workers' compensation will reimburse employees for their medical costs and lost wages.

Family and Medical Leave Act

requires employers to allow employees to take up to 12 weeks unpaid leave per year for any of the following reasons: Personal illness Maternity Adoption Foster care Family health needs

Fair Labor Standards Act

requires employers to pay employees at least the federal minimum wage and overtime pay of one-and-one-half times their regular rate of pay. It also ensures equal pay for men and women performing the same job in the same workplace. In addition, the act restricts the types of jobs that minors may perform and the hours that they may work.

Patient Self-Determination Act of 1990

requires health care providers to provide information to patients about their rights to make decisions regarding their health care and to have advance directives. This information must be provided in writing. This act applies to health care providers who accept Medicare and Medicaid money. Specifically, the Patient Self-Determination Act states that health care providers must: Tell adult patients of their rights to make decisions regarding their health care and to have advance directives Assist in preparing advance directives Document patients' decisions regarding health care and any advance directives in their medical record Implement patients' decisions regarding health care and any advance directives Never discriminate against patients based on whether or not they have advance directives Educate staff and the community on advance directives

Scope of practice

requires that health care workers know the duties and limits of their profession.

Laws

rules of conduct enacted and enforced by governments

Ethics

rules of proper conduct among a group of people, such as a religion or profession.

Slander

speaking false words

malfeasance

the performance of a totally wrongful and unlawful act

two types of civil laws

torts and contracts

Health care workers are able to restrain patients without their consent if the patients are threatening their own safety or the safety of others. In such cases, a physician must deem the restraint necessary. true or false

true

Health care workers are able to restrain patients without their permission if the patients are threatening their own safety or the safety of others. In such cases, a physician must deem the restraint necessary. true or false

true

Patients must have serious injuries in order for health care workers to be guilty of malpractice. true or false

true

Negligence

unintentionally harming a person by acting in an improper way.

invasion of privacy examples

unnecessarily exposing a patient, using a patient's name or picture without the patient's permission, and breaching confidentiality of a patient's medical information. For example, invasion of privacy may occur when a physician uses pictures of a patient before and after treatment in a pamphlet without the patient's permission.

Confidentiality

using discretion when handling protected health information

contract

voluntary agreement between two or more people

ways in which a contract is breached

-If a contract is not performed according to the agreement For example, a contract is breached if a health care provider does not provide the agreed-upon services or provides improper care. -A contract is also breached if a patient does not pay for the services.

Authorization must include

-writing and plain language -name entities that are allowed to recieve health info -state the people that are allowed to view health information, such as a spouse or other relatives. -state the extent of health information that approved entities and people are allowed to access. -must include a statement that patients have the right to refuse authorization. As a result, health care providers have the right to limit treatment to that patient. -Authorization must have an expiration date. -Authorization must be signed and dated by the patient.

4 D's of negligence

1. Duty, 2. Dereliction, 3. Damage, and 4. Direct cause

code of ethics for healthcare workers

A code of ethics for health care workers includes the following behaviors: Autonomy - Health care workers respect patients' dignity and rights, including their right to make decisions regarding their health care. Fidelity - Health care workers care for patients according to their profession's scope of practice. Beneficence - Health care workers promote patients' health and well being. Nonmaleficence - Health care workers refrain from harming patients. Veracity - Health care workers communicate with patients truthfully. Confidentiality - Health care workers maintain confidentiality of patients' health information. Justice - Health care workers treat patients equally and without discrimination. AFBNVCJ Are for big ninjas vocalizing cranberry juice

What is a process of identification, evaluation, and prevention?

Applying risk management

types of torts

Assault and battery False imprisonment Defamation of character Invasion of privacy Malpractice MID AF

Ethical Principles

Be honest Be discreet Do no harm do good respect autonomy keep promises preserve life uphold justice HDDDRKPU HDDD PK RU

offenses of criminal law can be

Community service Fines paid to the government Loss of license Probation Imprisonment Execution

scope of practice for nurse assistants, licensed practical nurses, and registered nurses includes these areas:

Qualifications Implementing Care Delegating Care Teaching Nursing Q- DIT

Patient Rights under the Privacy Rule

The Privacy Rule grants six rights to patients that allow them to control how their protected health information is used. These rights include: 0-Right to Notice of Privacy Practices: At a patient's first visit to a health care facility, the patient must be given a written copy of the facility's rules and the patient's rights regarding protected health information -Right to request restrictions on certain uses of protected health information -Right to request confidential communications: Patients may request reasonable, alternative forms of communication. For example, a patient may ask to be contacted at a work phone number -Right to access a copy of protected health information: With the exception of psychotherapy notes -Right to request an amendment of protected health information: (if something incorrect) -Right to receive an accounting of disclosures of protected health information (Patients may request a record of all the instances in which their personal information was disclosed)

Disclosure without Authorization

The Privacy Rule provides six situations for when disclosure of protected health information is allowed without authorization. -When a patient requests to see his or her own personal information: -When permission to disclose is obtained -When information is used for treatment, payment, and health care operations: -When disclosures are obtained incidentally -When information is needed for research: -when there are legal or public interest issues involved

nonfeasance

The failure to act when one should

Scope of Practice: Implementing Care

The following are duties of implementing care for nurse assistants, licensed practical nurses, and registered nurses. Nurse assistants should provide care according to their level of training, record and report care and patient responses, follow principles of infection control, perform CPR, and review the patient education taught by advanced practice staff. Licensed practical nurses should provide care according to their level of training, record and report care and patient responses, and follow principles of infection control as well as administer prescribed medications, perform some IV therapies, perform medical orders and procedures as specified by physicians, perform standard emergency procedures, and assist advanced practice staff in patient education. Registered nurses should provide care according to their level of training, record and report care and patient responses, follow principles of infection control, administer prescribed medications, and perform medical orders and procedures as specified by physicians as well as perform IV therapies; verify medical orders for proper authorization, accuracy, and risks; perform emergency procedures; and provide patient education and counseling. Audio Player

bioethical dilemmas examples

The following are other bioethical dilemmas: Genetic testing, gene therapy, somatic (adult) stem cell research, embryonic stem cell research, fetal tissue research, and cloning Organ donation and selection of transplant patients Xenotransplantation Withholding or withdrawing of life support Marijuana for pain relief Experimental treatments Human research subjects Animal testing Birth control, emergency contraception, and abortion Artificial insemination, in vitro fertilization, frozen embryos, and surrogate mothers Managed health care and access to health care

Scope of Practice: Qualifications

The following are qualifications for nurse assistants, licensed practical nurses, and registered nurses. Nurse assistants must complete a secondary health occupations education program. Some nurse assistants must complete a state-approved program and obtain certification or registration. Licensed practical nurses must complete a state-approved practical nurse program and obtain a license. Registered nurses must complete a state-approved registered nurse program and obtain a license. Some registered nurses must complete a degree.

Scope of Practice: Teaching Nursing

The following are rules for teaching nursing for nurse assistants, licensed practical nurses, and registered nurses. Nurse assistants cannot assist staff to improve their care or teach nursing theory and practice in educational programs. Licensed practical nurses cannot assist staff to improve their care or teach nursing theory and practice in educational programs. Registered nurses should assist staff to improve their care and teach nursing theory and practice in educational programs when qualified.

Misfeasance

The performance of a lawful act in an illegal or improper manner

tort

a case in which a person is harmed because of another person's actions or failure to act.

In criminal law who defendant

alleged offender

in civil law who is defendant

alleged offender

Uniform Anatomical Gift Act (UAGA) of 1968

allows people to donate their body or parts of their body after death for transplantation or medical research. people do not indicate their decision prior to death, the act also recognizes the legal status of an agent's permission in the case of durable power of attorney for health care. In the absence of power of attorney, the act recognizes the permission of a deceased person's closest living relative, guardian, or other authorized person.

expressed contract

an agreement that is specifically and clearly stated ex: when a physician recommends surgery and a patient signs a consent form giving her permission.

implied contract

an agreement that is understood without being stated in words or writing ex: physician prescribes a medication and a patient takes the medication.

tort

civil wrong committed against person or property, excluding breach of contract

Health Insurance Access, Portability, and Renewability section of HIPAA

created to provide continuous insurance coverage for people when they change or lose a job HIPAA prevents health insurance companies from denying or limiting coverage for people who have pre-existing conditions.

Bioethical dilemmas

dilemmas that involve health care and biological sciences ex: euthanasia Euthanasia is the act of painlessly ending the life of a terminally ill patient at the patient's request due to intense suffering.

the Privacy Rule

established nationwide standards that are used to protect private patient information. For example, personal health information may only be shared among the members of a patient's health care team. Under most circumstances, it may not be disclosed to anyone else without the patient's permission. Violations of the Privacy Rule may include civil and criminal penalties, such as fines and loss of license.

Reduce liability

event reports proper documentation problem solving method apply risk management EPPA

Civil Law

focuses on disputes between people.

In criminal law who is the plaintiff

government

Occupational Safety and Health Administration, or OSHA,

government agency that enforces safety and health standards in the workplace.

Centers for Disease Control and Prevention

government agency that protects all people from infectious, occupational, environmental, and terrorist threats\ These guidelines include the prevention of these threats: Biological hazards, such as bloodborne pathogens Chemical hazards, such as latex allergies Physical hazards, such as violence Psychological hazards, such as stress

Electronic medical records (EMR)

help the health care industry to operate more efficiently. However, EMR creates many security and privacy issues. As a result, HIPAA provides regulations to make sure that confidential records are kept secure. This is called the Security Rule.

two types of contracts

implied and expressed

examples of criminal offenses by health care workers

include falsifying medical records, insurance fraud, practicing without the required license, misuse of drugs, stealing of drugs, abuse, and murder.

Omnibus Budget Reconciliation Act (OBRA) of 1987

includes many regulations regarding long-term health care residents in long-term health care facilities have additional rights. These rights are referred to as the Residents' Bill of Rights. It states that residents have the following rights: To be properly sheltered, fed, clothed, groomed, and cared for To live in a safe and clean environment To have and use personal possessions in keeping with safety requirements and other residents' rights To share a room with their spouse, if both are residents To consult with other residents in private and without interference To use a telephone in private and to be able to send and receive mail To have access to immediate family To refuse and receive visitors of their choice and to consult in private and without interference To manage their own personal finances or to authorize the facility to manage their affairs for them while being able to examine their account at any time To pursue social, cultural, religious, political, and community interests and activities To choose their own physicians and pharmacies The Residents' Bill of Rights states that residents have the following additional rights: To be free from mental and physical abuse, including inappropriate restraint and exploitation To voice grievances and recommend changes without fear of retaliation To expect reasonable continuity of care To be discharged or transferred only for medical reasons, their own or other residents' welfare, or nonpayment To be informed of available care options if the facility's care is no longer appropriate

Privileged communication

information that is shared within a protected relationship ex:physician and patient, attorney and client, and clergy and counselee.