Y khoa - Dược - Chapter 3: Legal and ethical issues in medical practice, including hipaa

3Legal and Ethical Issues in Medical Practice, Including HIPAA3-*3.1 Define ethics, bioethics, and medical law.3.2 Discuss the measures a medical practice must take to avoid malpractice claims.3.3 Discuss medical documentation and how it applies to medical law.Learning Outcomes3-*3.4 Discuss the various types of health-care legislation.3.5 Describe OSHA requirements for a medical office.3.6 Describe procedures for handling an incident of exposure to hazardous materials.Learning Outcomes (cont.)3-*3.7 Compare and contrast quality control and quality assurance procedures.3.8 Discuss the impact that HIPAA regulations have in the medical office.3.9 Explain how to protect patient confidentiality.3.10 Describe the different practice management models.Learning Outcomes (cont.)3-*IntroductionReasons to study medical law and ethicsFunction at the highest professional levelAvoid legal problems3-*Medical Law and EthicsKnowledge of medical law and ethics provides insight intoThe rights, responsibilities, and concerns of health-care consumersThe legal and ethical issues facing society, patients, and health-care professionals as the world changesThe impact of rising costs on the laws and ethics of health-care delivery3-*Medical Law and Ethics (cont.)LawEthicsEthics is a standard of behavior and a concept of right or wrong.Moral values serve as the basis for ethical conduct.Family, culture, and society help form an individual’s moral values. A law is a rule of conductor action prescribed or formally recognized as binding or enforced by a controlling authority.3-*Medical Law and Ethics (cont.)Criminal lawCrime against the stateCriminal acts are Felonies or MisdemeanorsExamples include:MurderArsonSexual assaultBurglary Civil lawCrimes against the personIncludes a general category of laws known as tortsTorts are either:Intentional (willful) orUnintentional (accidental)3-*False imprisonmentAssaultDefamation of character FraudInvasion of privacy Open threat of bodily harmInterference with a person’sright to be left aloneDamaging a person’s reputation by making false and malicious public statementsAn action that causes bodily harm to another, including touching without permissionIntentional, unlawful restraint or confinement of a personIntentional TortsDepriving or attempting to deprive a person of his or her rightsBattery3-* Acts that are committed with no intent to cause harm but done with a disregard for the consequences The term negligence is used to describe such actions when health-care practitioners fail to exercise ordinary care, resulting in patient injury Malpractice is the negligent delivery of professional servicesUnintentional Torts3-*ContractsA contract is a voluntary agreement between two parties in which specific promises are made for a consideration.AgreementConsiderationContractual CapacityLegal Subject Matter Elements of a Contract3-*Types of ContractsExpressed contractsClearly stated in written or spoken wordsAn example is a payment contractImplied contractsActions or conduct of the parties, rather than words, create the contractAn example is a patient rolling up his or her sleeve to receive an injection3-*Apply Your KnowledgeWhat is the difference between law and ethics?ANSWER: A law is a rule of conduct or action and is enacted by governments to maintain order and public safety. Ethics is a standard of behavior based on moral values that are influenced by family, culture, and society.Good Answer!3-*Physician/Patient ContractReasonable limitationsBoth parties have rights and responsibilities related to the contract3-*Physician RightsSet up a practice within the boundaries of his or her license to practice medicineSelect where to set up an office and establish office hoursSpecializeDecide which services to provide and how those services will be provided3-*Physician ResponsibilitiesPhysician responsibilitiesUse due care, skill, judgment, and diligence Keep knowledge up-to-datePerform to the best of his or her abilityFurnish complete information and instructions to the patient3-*Patient Rights/ResponsibilitiesPatient responsibilitiesFollow physician’s instructions and cooperate with careProvide relevant information to the physician Follow the physician’s orders for treatmentPay the fees charged for services provided3-*Patient-Physician Contract (cont.)ConsentImplied – actions imply permissionInformed Patient receives all information necessary to make a decision regarding treatmentDoctrine of informed consent – legal basis for informed consentLiabilityLegal responsibility for actionsUnderstand scope of practiceUnderstand standard of care and duty of careMedical assistants are all held to the “reasonable person standard”3-*Special Circumstances – Closing of a PracticeComply with HIPAANotify patients in writingGive option of choosing another physician or make referralSecure or dispose of records appropriatelyRemain up-to-date on HIPAA laws3-*Apply Your KnowledgeANSWER: Patient responsibilities are:Follow physician’s instructions and cooperate with plan of careProvide relevant information to the physicianFollow the physician’s orders for treatmentPay the fees charged for services providedPatients have rights and responsibilities relating to health care. The rights are determined by the Patient Care Partnership. What are the patient’s responsibilities?Good Job!3-*Preventing LawsuitsLawsuits Add to cost of health careTake a psychological toll on all involvedPrevention Use of reasonable care to prevent professional liability3-*MalpracticeMalpractice claims are lawsuits by a patient against a physician for errors in diagnosis or treatmentExamples: post-operative complications, Res ipsa loquitur (the thing speaks for itself)Negligence cases are those in which a person believes a medical professional’s actions, or lack thereof, caused harm to the patientExamples: abandonment, delayed treatment3-*Malpractice (cont.)3-*DutyPatients must show that a physician-patient relationship existed.erelictPatients must show that the physician failed to comply with the standards of the profession.irect CausePatients must show that any damages were a direct cause of a physician’s breach of duty. amagesPatients must prove that they suffered injury. Patients must be able to prove all 4 Ds in order to move forward with a malpractice suit.The 4 Ds of Negligence3-*Malpractice (cont.)Settling malpractice suitsArbitrationPeople with special knowledge in the field listen to the case and decide the disputeCourtWritten court orders (subpoena) are delivered to involved parties.Subpoena duces tecum is a court order to produce documents such as patient recordsCivil lawConcerned with an individual’s private rightsTortsNegligence Breach of contractFailure to adhere to a contract’s terms3-*Malpractice (cont.)Law of AgencyEmployees are considered to be agents of the physician while performing professional tasksPhysicians are responsible or liable for the negligence of employeesRespondeat superior is a Latin term meaning “Let the master answer”Employees are also legally responsible for their own actions, and they can be sued directly.3-*Courtroom ConductAttend court proceedings as required and do not be late for scheduled hearingsBring required documents to court and present them when requested toRefresh your memory before testifyingSpeak slowly, clearly, and professionallyAnswer all questions in a straightforward mannerAnswer only the question askedAppear well groomed, and dress in clean, conservative clothing3-*Malpractice (cont.)Reasons patients sueUnrealistic expectationsPoor rapport and poor communication Greed and our litigious societyPoor quality of careProfessional Liability Coverage – protects the physician and staff against financial losses from lawsuits filed against them 3-*Malpractice (cont.)Statute of limitationsLaws that set the deadline or maximum period of time within which a lawsuit or claim may be filedDeadlines vary Type of caseState vs. federal court3-*The 4 Cs of Malpractice PreventionCaringSincere caring decreases the likelihood that a patient will sue if outcomes are unsatisfactory or adverse events occur.ommunicationDevelop trust and respect with patients by communicating professionally and confirming that you have been understood.ompetenceMaintain competence and update knowledge and skills frequently.harting Documentation is proof of competence. Chart every conversation and interaction you have with a patient.3-*Terminating Care of a PatientReasons for terminating care of a patientRefusal to follow physician instructionsPatient family member complaintsPersonality conflictsFailure to pay for services renderedRepeated failure to keep appointmentsWhen withdrawing from care, a physician mustProvide written notification Reasons for withdrawingRecommend that the patient find another physicianSend by certified mail with return receipt requestedDocument in the patient record reasons for terminating care and actions taken to inform the patient3-*Standard of CareApply legal concepts to practice byMaintaining confidentialityPracticing within the scope of training and capabilitiesPreparing and maintaining medical recordsDocumenting accuratelyUsing proper guidelines when releasing information3-*Standard of Care (cont.)Apply legal concepts to practice byFollowing legal guidelines and maintaining awareness of health-care legislation and regulationsMaintaining and disposing of regulated substances appropriatelyFollowing risk-management and safety proceduresRecognizing professional credentialing criteria3-*Administrative Duties and the LawDuties related to legal requirementsInsurance billingPatient consent formsDocumentation in the medical recordMaking appointmentsAppointment books are a legal documentState reporting requirementsBirthsAbuseCertain diseasesInjuries from violent actsDeathsPhone callsMaintain privacy3-*DocumentationClear and completeReferralsMissed appointmentsDismissalsPatient contactMedical record correctionMedical recordsProperty of facility or physicianDoctrine of Professional DiscretionRetention and storageBased on state law3-*Controlled Substances and the LawMedical assistants must follow the correct procedure for keeping and disposing of controlled substances. Be familiar with correct dosages, potential complications, and  refill rules.3-*Legal Documents and the PatientStates the types of treatment the patient does and does not want in an event of terminal illness, unconsciousness, or comatose state. Patients with living wills are asked to name someone that will make decisions on their behalf (durable power of attorney) if they are unable to do so.UniformDonorCard A legal document that states a person’s wish to donate one or more organs or whole body.LivingWill(Advance Directive)3-*Confidentiality IssuesLegal obligation to maintain confidentiality of patient informationDiscuss with patient privatelyShare patient information only when appropriateDo not discuss the case with anyone outside the medical officeConfidential3-*Apply Your KnowledgeWhat are the 4 Cs of malpractice prevention?ANSWER: The 4 Cs of malpractice prevention are caring, communication, competence, and charting.Bravo!3-*Federal Legislation Affecting Health CareHealth Care Quality Improvement Act (1986) Purpose: Improve the quality of medical care nationwideNational Practitioner Data BankFederal False Claims ActQui tamTo bring action for the king and one’s selfControl three types of illegal conductFalse billing claimsKickbacksSelf-referrals3-*OSHA RegulationsThe Occupational Safety and Health Administration (OSHA) is a division of the U.S. Department of Labor Regulations describe precautions that must be taken to protect workers from exposure to health hazards on the job, including exposure to infectious diseases such asHuman immunodeficiency virus (HIV)AIDSHepatitis B virus (HBV)3-*Exposure PlanPersonal protective equipment or gearImmunizations against hepatitis B virus (HBV)Information on what to do in case of exposureInformation on decontamination of waste productsInformation on how to dispose of sharp equipment (needles, etc.)Information on post-exposure evaluation and follow-up3-*Exposure Plan (cont.)Information on how to keep an inventory of hazardous materialsLabeling for bio-hazardous wastesTraining, annual updates regarding hazardous materials and infectious substancesRecordkeeping and documentation to protect the legal rights and safety of employees3-*Apply Your KnowledgeANSWER: OSHA regulations describe precautions that must be taken to protect workers from exposure to health hazards on the job.Correct!What do OSHA regulations describe?3-*HIPAAHealth Insurance Portability and Accountability Act (1996)Improve efficiency and effectiveness of health-care deliveryProtect and enhance the rights of patientsAccess to health-care informationControl inappropriate use or disclosureImprove the quality of health care by restoring trust in the health-care system3-*Title I: Health Care PortabilityIncreases workers’ ability to get health-care coverage when starting a new jobReduces workers’ probability of losing existing health-care coverageHelps workers maintain continuous health-care coverage when changing jobsHelps workers purchase health insurance on their own if they lose coverage under an employer’s group plan and have no other health-care coverage available3-*Title II: Prevention of Health Care Fraud and Abuse, Administrative Simplification and Medical Liability ReformHIPAA privacy rulesGive patients more control over their health informationSet boundaries on the use and release of health-care recordsEstablish appropriate safeguards to protect the privacy of health informationHold violators accountable if they violate patients’ privacy rightsStrike a balance when public responsibility supports disclosure of some forms of data 3-*HIPAA (cont.)Privacy Rule – protected health information (PHI)Use – movement within an organization Disclosure – transmitted between or among organizationsManaging and storingSharingNotice of Privacy Practices (NPP)Protection – security measuresHIPAA Security RuleComputer networksThe InternetDisks, other storage media, and extranetsChart Reception area and clinical stationsFax, copier, and printer3-*HIPAA (cont.)3-*Apply Your KnowledgeWhile you are documenting on the computer, you are called to a patient room for an emergency. What should you do before leaving the computer?ANSWER: You should close the patient record and log off the computer to protect the confidentiality of patient information.Good Answer!3-*Confidentiality Issues and MandatoryDisclosurePrinciples for preventing improper release of informationWhen in doubt, do not release informationIt is the patient’s right to keep patient information confidential or disclose itAll patients should be treated with the same degree of confidentialityBe aware of all applicable laws and of the regulations3-*Confidentiality Issues and MandatoryDisclosure (cont.)Principles for preventing improper release of informationWhen necessary to break confidentiality and when there is a conflict between ethics and confidentiality:Discuss it with the patientIf the law does not dictate what to do in the situation, the attending physician should make the judgment based on the urgency of the situation and any danger that might be posed to the patient or othersGet written approval from the patient before releasing information3-*A police officer enters the physician’s office where you work and requests information about a patient. May you release this information? What should you do?Apply Your KnowledgeANSWER: No, you should not be the person to release this information. You should refer the officer to the patient’s physician, who will make the judgment based on the urgency of the situation and any danger that might be posed to the patient or others.YES!3-*Code of EthicsPrinciples of right and wrongLaws are often based on ethical considerationsMedical professionals are expected to act ethically3-*Code of Ethics (cont.)3-*Legal Contract ElementsAn agreement between two or more competent people to do something legalNames and addresses of the people involvedConsideration (whatever is given in exchange, such as money, work, or property)Starting and ending dates, as well as date(s) the contract was signedSignature of the employer and employee3-*Apply Your Knowledge Mr. Jones would like to try a new treatment for his Parkinsonism, but his physician refuses to discuss a new treatment with Mr. Jones because he morally disagrees with this type of treatment. This is an example of what type of issue, and what should the physician do?ANSWER: This is an example of a bioethical issue. The physician should refer the patient to another physician who specializes in this treatment.Good Answer!3-*Labor and Employment LawsTitle VII of the Civil Rights Act of 1964Law prevents employers from discriminating in hiring or firing on the basis of race, color, religion, sex, or national origin Age Discrimination in Employment Act (ADEA) of 1967Prohibits discrimination in hiring or firing based on age for persons aged 40 or olderSexual harassmentThe victim has the responsibility to let the harasser know that the conduct is offensiveThe victim should also report any instance of sexual harassment to a supervisor or the personnel department 3-*Labor and Employment Laws (cont.)1976 Pregnancy Discrimination ActMakes it illegal to fire an employee based on pregnancy, childbirth, or related medical conditions Civil Rights Act of 1991Provides monetary damages in cases of intentional employment discrimination 3-*Labor and Employment Laws (cont.)Titles I and V of the Americans with Disabilities Act of 1990Ban discrimination against disabled persons in the workplaceMandate equal access for the disabled to certain public facilitiesRequire all commercial firms to make existing facilities and grounds more accessible to the disabled3-*Labor and Employment Laws (cont.)1938 Fair Labor Standards ActProhibits child labor and firing employees for exercising their rights under the act’s wage and hour standardsProvides for overtime pay and a minimum wage Equal Pay Act of 1963Requires equal pay for men and women doing equal work Family Leave Act of 1991Allows employees to take unpaid leave time for maternity, for adoption, or for caring for ill family members 3-*Apply Your Knowledge What are your responsibilities if you feel you have been a victim of sexual harassment?ANSWER: The victim has the responsibility to let the harasser know that the conduct is offensive and should also report any instance of sexual harassment to a supervisor or the personnel department.Good Job!3-*Legal Medical Practice ModelsBe aware of laws governing the practice model of your place of employmentFive types of practice modelsSole proprietorshipSingle physicianPartnershipTwo or more physicians practice togetherContract specifies rights, obligations, and responsibilities3-*Legal Medical Practice Models (cont.)Group practiceThree or more licensed physicians Physicians share the collective income, expenses, facilities, equipment, records, and personnel for the practiceProfessional corporationCorporation is a body formed and authorized by law to act as a single entityPhysicians who form corporations are shareholders and employees of the organizationIncorporators and owners have limited liability in case lawsuits are filed3-*Legal Medical Practice Models (cont.)ClinicsBroad in their range of specialties and sub-specialtiesLocationsIn hospitalFreestanding – urgent care In-store 3-*Apply Your KnowledgeWhat is the difference between a group practice and a professional corporation?ANSWER: A group practice is three or more physicians who share the practice income, expenses, and facilities. In a professional corporation the physicians are shareholders and employees of the corporation.Right!3-*In Summary3.1 Ethics deals with general principles of right and wrong. Allied health prof