Questions and Answers of Legal Aspects

Nurses have a duty to question discharge.
Nurses have a duty to report physician negligence.
Healthcare professionals are required to adhere to the prevalent standards of care required within their professions. This includes proper assessment, reassessment, diagnosis, treatment, and
Describe the four common levels of EMS personnel: emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic.
Lawsuits arise in a wide variety of patient care settings (e.g., emergency transport services, emergency department, physical therapy, radiology)and office practices (e.g., chiropractic, dentistry).
EMS lawsuits involving paramedics include, for example, the wrong dosage of drugs administered, inability to diagnose a patient’s extent of injury, and failure to transport a patient.
Some of the more common issues involving emergency department lawsuits include failure to conduct an adequate physical examination, failure to admit a patient, insufficient or contradictory medical
When the skills of a specialist are required in an emergency department, hospitals are required to notify an on-call specialty physician for assistance.
Describe negligence-related risks when providing laboratory, nutritional, pharmacy, physical therapy, podiatry, radiology, respiratory, chiropractic, dentistry, and podiatric services.
Healthcare organizations are responsible for the quality and timeliness of the services provided by their clinical laboratories. When laboratory services are contracted, such as often occurs in
Discuss why a hospital has a duty to provide adequate security on its premises.
The nutritional needs of each patient must be met during his or her stay in an organization’s facility. Organizations are responsible for the provision of nourishing, palatable, well-balanced
Medication errors are common as a result of many factors, including the vast number of drugs available and their similar names and appearances. These errors constitute a leading cause of injury. In
In addition to their regular duties to manage the pharmacy and accurately dispense medications, pharmacists are required to maintain patient medication profiles and monitor these profiles for
Physical therapists evaluate patients’ disabilities and potential for rehabilitation for the purpose of preventing and treating neuromuscular or musculoskeletal disabilities.
Physician assistants are responsible for their own negligent actions; in addition, their employers also can be held responsible for their negligent acts based on respondeat superior.
Lawsuits in the practice of dentistry involve, for example, failure to refer, obtain patient consent, prescribe antibiotics, sterilize equipment, practice within one’s scope of competency, and
Hospitals have a duty to implement reasonable security measures to protect patients, visitors, and staff from the criminal acts of third parties.
Licensure of healthcare professionals is the process through which licensing boards, agencies, or departments grant to individuals who meet certain criteria the legal right to practice in a
Certification is an external verification of the competencies that an individual has achieved and typically involves an examination process.
Credentialing is a process by which an individual is permitted to perform a specific procedure in a designated setting (e.g., hospital).
Information management is the process of facilitating the flow of information within and among departments and caregivers.
The medical record is the principal means of communication among healthcare professionals in matters relating to patient care.
The contents of inpatient medical records provide evidence of a patient’s care from admission to discharge (e.g., admission record, authorization for treatment forms, advance directives, history
Patient care documentation must be complete and accurate. Federal funding can be denied for inaccurate record keeping.
The Privacy Act of 1974 was enacted in part to safeguard individual privacy from the misuse of federal records and to give individuals access to records concerning themselves that are maintained by
HIPAA requires the establishment of national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers. HIPAA provisions also
Medical records are maintained for the benefit of patients and are considered the property of the healthcare provider. Patients, providers of care, and third parties such as insurance carriers
The requirements for the length of time medical records must be retained are based on statutory requirements, advice from legal counsel, patient needs, future need for the records, and legal
Although electronic medical records improve the ease and efficiency with which data are compiled and shared, they also pose confidentiality risks.
Records can be used as important evidentiary tools. The integrity and completeness of a medical record can be crucial in reconstructing the events surrounding alleged negligence.
Falsification of medical or business records is grounds for both criminal indictment and civil liability.
Patient consent is an agreement by the patient to allow something proposed by another to be performed on his or her body.
Consent can be expressed verbally or in writing.It can be implied by statute or granted by the courts in cases where emergency care is needed to save the life of the patient.
Oral consent, although binding, is often difficult to corroborate, whereas written consent provides visible proof of a patient’s wishes.
Implied consent is generally presumed when immediate action is required to prevent death or permanent impairment of a patient’s health.In such cases, documentation justifying the need to treat
Statutory consent provides that when a patient is clinically unable to give consent to a lifesaving emergency treatment, the law implies consent on the presumption that a reasonable person would
Judicial consent may be necessary in those instances where there is concern as to the absence or legality of consent.
Informed consent is a legal concept that provides that a patient has a right to know the potential risks, benefits, and alternatives of a proposed procedure.
Validity of consent:■■ Subjective standard: Informed consent is determined by patient testimony.■■ Objective standard: Resolves the issue of informed consent in terms of what a reasonably
Liability for performing a medical or surgical procedure without consent is distinct from a question of negligence or malpractice in performing the procedure. A physician can be found liable for
Parental consent for a medical or surgical procedure on a minor is generally:■■ Required prior to the procedure.■■ Not required if the minor is married or otherwise emancipated.
Consent for incompetent patients, assuming there is no designated family member or surrogate decision maker, can be obtained through application to a court for an order designating a decision maker
Regardless of religious beliefs, patients have the right to refuse medical treatment. If a patient refuses treatment:■■ The refusal should be noted in the patient’s medical record.■■ A
Discrimination in the workplace is often based on age, disability, national origin, pay, pregnancy, race, religion, and sexual harassment.
An exculpatory agreement is an agreement that relieves one from liability when he or she has acted in good faith. However, these are generally considered invalid in the medical setting.
Defenses to claims that informed consent was lacking include:■■ Risk not disclosed is commonly known and does not warrant disclosure.
Each patient should be informed of his or her rights and responsibilities at the time of admission.If a patient does not understand his or her rights and responsibilities, they should be explained to
Patient rights include the right to admission, assessments, and reassessments and to participate in care decisions, informed consent, and treatment.Patients also have the right to refuse treatment
Patient responsibilities include maximizing healthy habits, such as exercising, not smoking, and eating healthy; being involved in healthcare decisions;working collaboratively with healthcare
Caregivers should consider themselves as patient advocates because of their position to help patients who are often helpless and unable to speak for themselves.
Ethics is the branch of philosophy that seeks to understand the nature, purposes, justifi cation, and founding principles of moral rules and the systems they comprise.■ Ethics involves making sound
Morality is a code of conduct and a guide to good behavior.■ Moral judgments are those judgments concerned with what an individual or group believes to be the right or proper behavior in a given
Principles of ethics are universal rules of conduct.■■ Autonomy is the right of a person to make his or her own decisions.■■ Beneficence is the principle of doing good, demonstrating
Values are standards of conduct. Values are used for judging the goodness or badness of some action.■■ Intrinsic value is something that has value in and of itself (e.g., compassion, honesty,
The pillars of moral strength that build moral character include: courage, wisdom, temperance, commitment, discernment, fairness, fidelity, freedom, honesty, integrity, kindness, respect,
Religious ethics serves a moral purpose by providing codes of conduct for appropriate behavior through revelations from a divine source.
Secular ethics is based on codes developed by societies that have relied on customs to formulate their codes of ethics.
Professional ethics is a set of standards or codes of conduct established by the membership of a specific profession.
Healthcare ethics committees:■■ Address legal-ethical issues that arise during the course of a patient’s care and treatment.■■ Serve as a hospital resource to patients, families, and staff,
Abortion is the premature termination of a pregnancy, either spontaneous or induced. Roe v.Wade is the Supreme Court’s ruling that, within certain guidelines, women are allowed to make decisions
States’ and women’s rights regarding reproductive decision have been further shaped and defined by a number of landmark rulings.■■ In 1992, in Planned Parenthood v. Casey, the Supreme Court
Individuals have a right to refuse to participate in abortions for reason of conscience or religious or moral conviction.
Several states have placed restrictions on abortions by reducing funding.
Sterilization is defined as the termination of the ability to produce offspring.■■ A vasectomy is a surgical procedure performed on men in which the vas deferens is severed and tied to prevent
Wrongful birth, wrongful life, and wrongful conception have led to a variety of lawsuits.■■ Wrongful birth actions claim that, but for breach of duty by the defendant, a child would not have been
Physicians can avoid liability in wrongful conception/ pregnancy actions by obtaining oral and written consent that indicates that the physician has disclosed the inherent risks of the sterilization
Artificial insemination most often takes the form of the injection of seminal fluid into a woman to induce pregnancy.■■ Homologous artificial insemination is when the husband’s semen is used in
Surrogacy is a method of reproduction whereby a woman agrees to give birth to a child she will not raise but will instead hand over to a contracted party.
The right of self-determination provides that every human being of adult years and sound mind has the right to determine what shall be done with his or her own body.
According to the Patient Self-Determination Act of 1990, healthcare organizations have a responsibility to explain to patients, staff, and families that patients have legal rights to direct their
When there is uncertainty regarding a patient’s wishes in an emergency situation, the dilemma should be resolved in a way that favors the preservation of life.
The Harvard Ad Hoc Committee on Brain Death published a report in 1968 describing the characteristics of a permanently nonfunctioning brain.
Futility of treatment occurs when a physician recognizes that the effect of continuing treatment will be of no benefit to the patient.■■ Morally, there is a duty to inform the patient when there
Cardiopulmonary resuscitation (CPR) is an emergency procedure performed on individuals who experience a cardiac arrest.
Do-not-resuscitate (DNR) orders are those prescribed by a physician indicating that, in the event of a cardiac or respiratory arrest, no resuscitative measures should be used to revive the patient.
Withholding and withdrawal of treatment:■■ Withholding of treatment is a decision not to initiate treatment or medical intervention for the patient.■■ Withdrawal of treatment is a decision to
Euthanasia is the mercy killing of the hopelessly ill, injured, or incapacitated. Euthanasia is complex, and the legal system must maintain a balance between ensuring that the patient’s
Physician-assisted suicide:■■ The right to allow a physician to assist patients in dying who are terminally ill and mentally competent to determine how they wish to spend the remaining days of
Advance directives for health care are instructions, preferably executed in writing, by individuals specifying what actions should be taken for their care in the event that they become unable to make
Autopsies are postmortem examinations conducted to ascertain the cause of death. Most states have enacted autopsy consent statutes that establish an order to obtain consent to autopsy based on the
Research, experimentation, and clinical trials are, in most states, subject to a combination of federal and state guidelines and regulations to ensure the proper supervision and control over research
An abused child is defined as one who has suffered intentional and serious mental, emotional, sexual, and/or physical injury inflicted by a parent or other person charged with the child’s care.
Organ donations and transplantations are guided by federal regulations and accreditation standards of accrediting bodies such as The Joint Commission. Hospitals are required to implement written
Human genetics describes the study of inheritance as it occurs in human beings. It includes such areas as stem cell research, clinical genetics(e.g., genetic disease markers), and molecular
Child abuse laws differ from state to state, but, in most states, persons required to report cases of child abuse are protected.■■ The person reporting abuse does not have to be absolutely
Senior abuse is less likely to be reported than child abuse, and proving senior abuse charges is often difficult. Types of senior abuse include abandonment, emotional or psychological abuse, physical
Describe the signs of spousal abuse and what steps nurses should follow in addressing the patient’s safety needs.
Timely reporting of drug interactions is necessary to help prevent harmful occurrences by those dispensing, prescribing, and taking the medication reported.
Hospitals, as part of their staff education and training programs, should educate staff as to how to recognize the signs of spousal abuse.As part of a patient’s discharge instructions, the patient
The prompt reporting of communicable diseases is necessary in order for states to protect citizens’ health by invoking the power to quarantine.
All births and deaths are reportable by statute.Unnatural deaths are to be referred to the medical examiner to determine the actual cause of death and provide related assistance for further criminal
The National Practitioner Data Bank (NPDB) is used to collect and release information on the professional competence and conduct of physicians, dentists, and other healthcare practitioners.
Incident reports include statements from employees and physicians regarding significant or noteworthy deviation from acceptable patient care. Some states require the reporting of specific incidents.
A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. The Joint Commission encourages self-reporting of sentinel events.
A job description is used to describe the duties and responsibilities of the employee in a particular job. It should include at a minimum education, experience, and licensure requirements.
Employment-at-will is a doctrine by which employment can be terminated at any time by either the employee or employer. Exceptions to this doctrine include employment contracts and issues involving
Public policy prohibits the termination of an employee based on factors such as disability, age, race, color, religion, sex, national origin, pregnancy, filing safety violation complaints with
Termination for cause can be due to provisions for termination in employment contracts, financial necessity, hostile attitude, improper billing practices, poor work performance, alcoholism, and
Unemployment compensation can be denied, for example, in cases of profanity, threatening coworkers, theft, poor work attendance, voluntary termination, and violation of no-smoking policies.

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