Y khoa - Dược - Chapter 5: Legal and ethical issues

5Legal and Ethical IssuesLearning Outcomes5.1 Explain the difference between laws and ethics.5.2 Identify the responsibilities of the patient and physician  in a physician-patient contract, including the  components for informed consent that must be  understood by the patient.5.3 Describe the four Ds of negligence required to prove  malpractice and explain the four Cs of malpractice  prevention.5.5 Briefly summarize the purpose of the following federal  healthcare regulations: HCQIA, Federal False Claims  Act, OSHA and HIPAA.5.6 Identify the six principles for preventing improper  release of information from the medical office.5.7 Explain the importance of ethics in the medical office.5.8 Explain the differences among the practice  management models.Learning OutcomesIntroductionMedical law is important quality of patient careYou must understandMedical lawEthicsHealth Insurance Portability and Accountability Act (HIPAA)Introduction (cont.)Basic knowledge of medical law and ethicsRights, responsibilities, and concerns Legal and ethical issuesImpact of rising costsProtected informationLaws and EthicsLawRule of conduct or action Formally recognized as binding Enforced by a controlling authority.Ethics Standard of behavior Classification of LawCriminal lawCivil lawLaws and Ethics (cont.)AssaultBatteryDefamationFalse imprisonment FraudInvasion of privacyUnintentional TortsNegligenceMalpracticeIntentional TortsContractsContractual Capacity Elements of a ContractContracts (cont.)Types of contractsExpressed contracts – clearly statedImplied contracts – conduct of the parties indicated acceptance Legal elementsContracts (cont.)Employment ContractDescription of dutiesPlans for handling change in jobCompensation BenefitsGrievance proceduresReasons for terminationTermination proceduresSpecial provisionsApply 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!The Physician/Patient ContractReasonable limitationsBoth parties have rights and responsibilities related to the contractPhysician Rights and ResponsibilitiesRightsSet up a practiceSelect a location to practice SpecializeDetermine what services to providePhysician Rights and Responsibilities (cont.)ResponsibilitiesUse due care, skill, judgment, and diligence Keep knowledge up-to-datePerform to the best of his or her abilityEducate patientsPhysician Rights and Responsibilities (cont.)Medical Assistants and Liability Know scope of practiceUnderstand Standard of careDuty of carePatient Rights and ResponsibilitiesRightsSelect a physicianTerminate servicesPatient Care Partnership ResponsibilitiesFollow instructions and cooperate Provide relevant information Follow physician’s orders Pay feesPatient Rights and Responsibilities (cont.)ConsentImplied consent – actions imply permissionInformed consent Must receive all information necessary to make a decision regarding treatmentDoctrine of informed consentPatient Rights and Responsibilities (cont.)Those able to give consentAdults of sound mindEmancipated minorsMature minorsThose who cannot give consentMinorsMentally incompetent personsForeign language speakers without an interpreter Terminating the Physician/Patient ContractReasons for terminating careRefusal to follow instructionsComplaints by family memberPersonality conflictsFailure to payFailure to keep appointmentsTerminating the Physician/Patient Contract (cont.)When terminating careProvide written notification Send letter by certified mail, return receipt Place copy of letter medical recordDocument in the patient recordStandard of CareMaintain confidentialityPractice within scope of training and capabilitiesPrepare and maintain medical recordsDocument accuratelyUse proper guidelines when releasing informationStandard of Care (cont.)Follow legal guidelinesMaintain and dispose of regulated substances appropriatelyFollow risk-management and safety proceduresMeet criteria for professional credentialingClosing a Medical PracticeComply with and stay current on HIPAA laws Notify patients in writingGive option of choosing another physician or make referralSecure or dispose of records appropriatelyApply 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!Preventing Malpractice ClaimsLawsuitsAdd to cost of healthcareTake a psychological toll on all involvedRisk managementIdentify and trackDevelop improvement plansMonitorAssess Medical NegligenceMalpractice claimsMedical negligence Malfeasance Misfeasance NonfeasanceDDutyDerelictDirect CauseDamagesPatients must be able to prove all 4 Ds in order to move forward with a malpractice suit.Medical Negligence (cont.)Four Ds of NegligenceMedical Negligence (cont.)Malpractice lawsuits – civil lawTort Breach of contractSettling malpractice suitsTrialArbitrationSubpoena Medical Negligence (cont.)Law of AgencyEmployees – agents of the physicianRespondeat superior – “Let the master answer”Physicians are responsible for the negligence of employeesEmployees are legally responsible for their own actions, and they can be sued directly.Medical Negligence (cont.)Courtroom conductAttend proceedings Be on timeBring required documents Refresh your memory Speak professionallyAnswer all questionsAnswer only the question askedAppear well groomedMedical Negligence (cont.)Professional liability coverageProtects against financial lossesHigh cost to practiceReason Patients SueUnrealistic expectationsPoor rapport and poorcommunication Greed and our litigious societyPoor quality of carePreventing Malpractice Claims (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 courtPreventing Malpractice Claims (cont.)CCaringCommunicationCompetenceChartingThe 4 Cs of Malpractice PreventionPreventing Malpractice Claims (cont.)Effective CommunicationGood listening skills Return callsBe sure informed consent forms are signedAvoid admitting guiltUse tact, good judgment, and professional abilityReach an understanding about feesApply Your KnowledgeWhat are the 4 D of negligence needed to prove a malpractice and 4Cs of malpractice prevention?ANSWER: The 4 Ds are duty, derelict, direct cause, and damages. The 4 Cs are caring, communication, competence, and charting.Bravo!Administrative Procedures and the LawRisk managementMust meet legal standardsInsurance billingPatient consent formsOffice correspondenceDocumentation Appointment scheduling DocumentationReferralsMissed appointmentsDismissalsAll other patient contactDocumentation (cont.)Medical record correctionOwnership of the patient recordRetention and storage of the patient recordCredentialingEnsures healthcare providers are qualifiedMedicare requirementsCMS Websitewww.cms.gov/manuals/downloadsProvider Enrollment Chain and Ownership System (PECOS). Insurance carriers FDA Regulatory FunctionDrug manufacturingNonprescription or OTC drugsPrescription drugsPregnancy categoriesControlled substancesFDA Regulatory Function (cont.)Comprehensive Drug Abuse Prevention and Control ActDrug Enforcement AdministrationDoctor registrationOrdering controlled substancesLegal Documents and the PatientAdvance medical directiveDurable power of attorneyUniform donor cardApply Your Knowledge What are the legal implications of poor documentation?ANSWER: Poor or incomplete documentation can contribute to the loss of medical liability cases. It is important that documentation demonstrate that nothing was neglected and that care given met standards.Good Job!Federal Legislation Affecting Health CareHealth Care Quality Improvement Act (1986) Improve the quality of medical care Peer reviewLimitation of damagesProtection to those providing informationNational Practitioner Data BankFederal False Claims ActQui tamTo bring action for the king and one’s selfControl three types of illegal conductFalse billing claimsKickbacksSelf-referralsOccupational Safety and Health Administration (OSHA)Division of the U.S. Department of Labor Protection of workers from exposure to health hazards on the jobOSHA Blood-borne Pathogens Protection Standard –1991Health Insurance Portability and Accountability Act (HIPAA)Improve efficiency and effectiveness of health-care deliveryProtect and enhance the rights of patientsImprove the quality of health careHIPAA (cont.)Title I: Health Care Portability Title II: Prevention of Health Care Fraud and Abuse, Administrative Simplification and Medical Liability ReformThe HIPAA Privacy RuleHIPAA Security Rule. HIPAA (cont.)HIPAA Privacy Rule - PHIUseDisclosure Managing and storing of patient informationNotice of Privacy Practices (NPP)Sharing (TPO)HIPAA (cont.)HIPAA Security RuleA security officer Security awareness trainingAudit controls Limit physical access Conduct risk analyses Establish policies and proceduresHIPAA (cont.)HIPAA Security RuleChart securityReception area securityPatient care area securityFax securityCopier and printer securityHIPAA (cont.)HIPAA Security RuleViolations and penaltiesAdministrative simplificationStandardizing patient informationStandardized codes and formats – electronic transaction records2. While you are documenting on the computer, you are called to a patient room for an emergency. What should you do before leaving the computer?Apply Your KnowledgeANSWER: OSHA regulations describe precautions that must be taken to protect workers from exposure to health hazards on the job.1. What do OSHA regulations describe?ANSWER: You should close the patient record and log off the computer to protect the confidentiality of patient information.Good Answers!Confidentiality Issues and MandatoryDisclosureWhen in doubt, do not release information.It is the patient’s right to keep patient information confidential. Use the same degree of confidentiality for all patients.Confidentiality Issues and MandatoryDisclosure (cont.)Be aware of all applicable laws and of the regulations. If it is necessary to break confidentiality discuss situation with the patient.Obtain written approval from the patient before releasing information.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!EthicsPrinciples of right and wrong vs. requirements of lawBioethics: social issuesIssues that arise due to medical advances Hippocratic OathAMA: Code of Medical Ethics: Current Opinions with AnnotationsApply 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!Legal Medical Practice ModelsFive types of practice modelsSole proprietorship Partnership Group practice Professional Corporation ClinicsApply 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!In Summary5.1 A law is a rule of conduct or action. Ethics are  standards of behavior or concepts of right or  wrong.5.2 Physician and patient rights and  responsibilities.5.3 The four Ds of malpractice and the four Cs of  malpractice prevention.. In Summary (cont.)5.4 Credentialing is the approval process a healthcare provider must go through to be  allowed to bill Medicare and other insurance  carriers for providing medical services to  patients under their insurance plans. 5.5 Federal healthcare regulations: HCQIA,  Federal False Claims Act, OSHA, and HIPAA.In Summary (cont.)5.6 The six rules for preventing improper release.5.7 Ethics reflect the general principles of right  and wrong. A professional, particularly a  medical professional, is expected to follow  especially high ethical standards.5.8 There are five basic types of practice  management models.Let no one come to you without leaving better and happier.—Mother TheresaEnd of Chapter 5