CHAPTER Legal and Ethical Issues in Medical Practice, Including HIPAA © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-2 Learning Outcomes 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-3 Learning Outcomes (cont.) 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-4 Learning Outcomes (cont.) 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-5 Introduction • Reasons to study medical law and ethics – Function at the highest professional level – Avoid legal problems © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-6 Medical Law and Ethics • Knowledge of medical law and ethics provides insight into – The rights, responsibilities, and concerns of health-care consumers – The legal and ethical issues facing society, patients, and health-care professionals as the world changes – The impact of rising costs on the laws and ethics of health-care delivery © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-7 Medical Law and Ethics (cont.) A law is a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority Ethics 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-8 Medical Law and Ethics (cont.) • Criminal law – Crime against the state – Criminal acts are • Felonies or • Misdemeanors – Examples include: • • • • Murder Arson Sexual assault Burglary • Civil law – Crimes against the person – Includes a general category of laws known as torts – Torts are either: • Intentional (willful) or • Unintentional (accidental) © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-9 Intentional Torts Assault Open threat of bodily harm Battery An action that causes bodily harm to another, including touching without permission Fraud Depriving or attempting to deprive a person of his or her rights Invasion of privacy Interference with a person’s right to be left alone Defamation of character Damaging a person’s reputation by making false and malicious public statements False imprisonment Intentional, unlawful restraint or confinement of a person © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-10 Unintentional Torts 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 services  © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-56 Legal Contract Elements • An agreement between two or more competent people to something legal • Names and addresses of the people involved • Consideration (whatever is given in exchange, such as money, work, or property) • Starting and ending dates, as well as date(s) the contract was signed • Signature of the employer and employee © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-57 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! © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-58 Labor and Employment Laws • Title VII of the Civil Rights Act of 1964 – Law 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 1967 • Sexual harassment – The victim has the responsibility to let the harasser know that the conduct is offensive – The victim should also report any instance of sexual harassment to a supervisor or the personnel department – Prohibits discrimination in hiring or firing based on age for persons aged 40 or older © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-59 Labor and Employment Laws (cont.) • 1976 Pregnancy Discrimination Act – Makes it illegal to fire an employee based on pregnancy, childbirth, or related medical conditions • Civil Rights Act of 1991 – Provides monetary damages in cases of intentional employment discrimination © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-60 Labor and Employment Laws (cont.) • Titles I and V of the Americans with Disabilities Act of 1990 – Ban discrimination against disabled persons in the workplace – Mandate equal access for the disabled to certain public facilities – Require all commercial firms to make existing facilities and grounds more accessible to the disabled © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-61 Labor and Employment Laws (cont.) • 1938 Fair Labor Standards Act – Prohibits child labor and firing employees for exercising their rights under the act’s wage and hour standards – Provides for overtime pay and a minimum wage • Equal Pay Act of 1963 – Requires equal pay for men and women doing equal work • Family Leave Act of 1991 – Allows employees to take unpaid leave time for maternity, for adoption, or for caring for ill family members © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-62 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-63 Legal Medical Practice Models • Be aware of laws governing the practice model of your place of employment • Five types of practice models – Sole proprietorship • Single physician – Partnership • Two or more physicians practice together • Contract specifies rights, obligations, and responsibilities © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-64 Legal Medical Practice Models (cont.) – Group practice • Three or more licensed physicians • Physicians share the collective income, expenses, facilities, equipment, records, and personnel for the practice  Professional corporation  Corporation is a body formed and authorized by law to act as a single entity  Physicians who form corporations are shareholders and employees of the organization  Incorporators and owners have limited liability in case lawsuits are filed © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-65 Legal Medical Practice Models (cont.) – Clinics • Broad in their range of specialties and sub-specialties • Locations – In hospital – Freestanding – urgent care – In-store © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-66 Apply Your Knowledge What 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-67 In Summary 3.1 Ethics deals with general principles of right and wrong Allied health professionals are expected to the right thing in all aspects Bioethics arise from issues that deal with medical advances 3.2 The four Cs of malpractice prevention are caring, communicating, competency, and charting properly 3.3 Medical documentation is essential © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-68 In Summary (cont.) 3.4 Federal legislation affects health care 3.5 OSHA regulations state that the medical assistant must – – – – – – – Have protective gear Know how to properly decontaminate Know how to dispose properly of sharp equipment Notify officials of exposure incidents Have a post-exposure evaluation and follow-up procedures Know how to handle potentially infectious laundry Be informed about hazardous materials © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-69 In Summary (cont.) 3.6 When an exposure incident occurs, the medical assistant must immediately notify the physician/employer or supervisor 3.7 Quality controls have regulated set standards that seek quality in the work performed and accuracy of test results after the work is performed 3.8 HIPAA (Health Insurance Portability and Accountability Act) regulations have a great impact in the medical office today because they address issues such as health-care fraud and abuse, medical liability reform, and standardizing patient information throughout the health-care system © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3-70 End of Chapter Let no one come to you without leaving better and happier —Mother Theresa © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed [...]... reserv ed 3- 35 Documentation • Clear and complete – Referrals – Missed appointments – Dismissals – Patient contact – Medical record correction • Medical records – Property of facility or physician – Doctrine of Professional Discretion – Retention and storage • Based on state law © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 36 Controlled Substances and the Law Be familiar with correct... 3- 33 Standard of Care (cont.) • Apply legal concepts to practice by – Following legal guidelines and maintaining awareness of health-care legislation and regulations – Maintaining and disposing of regulated substances appropriately – Following risk-management and safety procedures – Recognizing professional credentialing criteria © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 34... patient record reasons for terminating care and actions taken to inform the patient © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 32 Standard of Care • Apply legal concepts to practice by – Maintaining confidentiality – Practicing within the scope of training and capabilities – Preparing and maintaining medical records – Documenting accurately – Using proper guidelines when releasing... patient – Refusal to follow physician instructions – Patient family member complaints – Personality conflicts – Failure to pay for services rendered – Repeated failure to keep appointments • When withdrawing from care, a physician must – Provide written notification • Reasons for withdrawing • Recommend that the patient find another physician – Send by certified mail with return receipt requested – Document... – Legal responsibility for actions • Understand scope of practice • Understand standard of care and duty of care – Medical assistants are all held to the “reasonable person standard” • Consent – Implied – actions imply permission – Informed • Patient receives all information necessary to make a decision regarding treatment • Doctrine of informed consent – legal basis for informed consent © 2011 T he... forward with a malpractice suit © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 25 Malpractice (cont.) • Civil law – Concerned with an individual’s private rights • Settling malpractice suits – Arbitration • People with special knowledge in the field listen to the case and decide the dispute – Torts • Negligence • Breach of contract – Failure to adhere to a contract’s terms – Court... ll rights reserv ed 3- 28 Malpractice (cont.) • Reasons patients sue – Unrealistic expectations • Professional Liability Coverage – protects the physician and staff against financial losses from lawsuits filed against them – Poor rapport and poor communication – Greed and our litigious society – Poor quality of care © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 29 Malpractice (cont.)... are: – Follow physician’s instructions and cooperate with plan of care – Provide relevant information to the physician – Follow the physician’s orders for treatment – Pay the fees charged for services provided © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 21 Preventing Lawsuits • Lawsuits – Add to cost of health care – Take a psychological toll on all involved • Prevention – Use... reserv ed 3- 17 Patient Rights/Responsibilities • Patient responsibilities – Follow physician’s instructions and cooperate with care – Provide relevant information to the physician – Follow the physician’s orders for treatment – Pay the fees charged for services provided © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 18 Patient-Physician Contract (cont.) • Liability – Legal responsibility... ommunication ompetence harting Develop trust and respect with patients by communicating professionally and confirming that you have been understood Maintain competence and update knowledge and skills frequently Documentation is proof of competence Chart every conversation and interaction you have with a patient © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 3- 31 Terminating Care of a Patient