HEALTH SCIENCE INSTRUCTIONAL SUPPLEMENT. Foundation Standard 5:

Transcription

1 HEALTH SCIENCE INSTRUCTIONAL SUPPLEMENT Foundation Standard 5: Legal Responsibilities

2 Health Sciences Instructional Supplement Foundation Standard 5: Legal Responsibilities Copyright 2012, 3 rd edition, by the National Consortium for Health Science Education (NCHSE) The National Consortium on Health Science Education is a national partnership of individuals and organizations with a vested interest in health science education. The consortium was organized in 1991 to stimulate creative and innovative leadership for ensuring a well prepared health care workforce. The supplements are sold for use by a single teacher at a school/site. Multiple teachers at a site are required to purchase a site license OR multiple single supplement sets. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. The editor for this supplement was Kim Smith, CreativEd Services. Although this publication remains subject to copyright, permission is granted free of charge to make up to 100 copies per year of the pages that are required for student instruction. This permission does not apply to material reprinted in the supplement for which permission must be obtained from the original copyright holder. 2 National Consortium for Health Science Education

3 Table of Contents Content Outline Resources Lesson Plans Instructional Activities and Information Understanding Legal Responsibilities Thinking About Contracts Thinking About Contracts Answer Key Wrongful Death Lawsuit Writing Assignment Rating Scale Evaluating Medical Legal Drama Awarding Damages Written Documentation Questions Written Documentation Questions Answer Key PowerPoint Content Outline: 5.2 Legal Practices Bill of Rights Informed Consent Lawsuit Informed Consent Lawsuit Teacher Information Harassment, Employment and Scope of Practice Teacher Information Sexual Harassment News Article Rubric Healthcare Workers with Disabilities Health Science Library National Consortium for Health Science Education

4 Foundation Standard 5: Legal Responsibilities Healthcare professionals will understand the legal responsibilities, limitations, and implications of their actions within the healthcare delivery setting. They will perform their duties according to regulations, policies, laws and legislated rights of clients. 5.1 Legal Implications 5.11 Analyze legal responsibilities. A. Legal responsibilities 1. Criminal law 2. Civil law B. Torts 1. Malpractice 2. Negligence 3. Assault and battery 4. Invasion of privacy 5. False imprisonment 6. Abuse a. Physical abuse b. Verbal abuse c. Psychological abuse d. Sexual abuse 7. Defamation e. Slander f. Libel C. Contracts 1. Implied contracts 2. Expressed contracts 3. Legal disability 4. Agent 5.12 Apply procedures for accurate documentation and record keeping. A. Privileged communications 1. Most information must be kept confidential 2. Information exempt by law and must be reported: a. Births and deaths b. Injuries caused by violence that may involve police c. Drug abuse d. Communicable diseases e. Sexually transmitted diseases B. Health care records 1. Considered privileged communication 2. Belong to healthcare provider 3. Patient has right to obtain copies 4. Can be used in court of law 5. Erasures not allowed 6. Cross out errors with single line, insert correct information, date and initial 7. Retain as long as required by state law 8. Computerized records and confidentiality safeguards a. Limit access b. Use passwords c. Monitor and evaluate computer use 4 National Consortium for Health Science Education

5 5.2 Legal Practices 5.21 Apply standards for Health Insurance Portability and Accountability Act (HIPAA). A. Federal protection for privacy of health information in all states B. Patients must sign HIPAA consent form for health care provider C. Patient must sign authorization before provider can release information D. Exemptions = exempt information E. Patients can see and obtain copies of medical records F. Health care providers must keep communications confidential 5.22 Describe advance directives. A. Advance directives B. Durable power of attorney C. Living wills D. Patient Self Determination Act (PSDA) 5.23 Summarize the Patient s Bill of Rights. A. Patient s Bill of Rights 1. Considerate and respectful care 2. Obtain complete diagnosis, treatment and prognosis 3. Informed consent 4. Advance directives 5. Privacy and confidentiality 6. Reasonable response to request for services 7. Obtain information regarding facility relationships to other healthcare and educational institutions 8. Right to refuse to participate in research 9. Reasonable continuity of care 10. Review medical records, examine bills, get explanations of care and charges 11. Be informed of hospital rules and regulations, and available resources to resolve disputes or grievances B. Resident s Bill of Rights 5.24 Understand informed consent. A. Legal implications B. Right to withdraw consent 5.25 Explain the laws governing harassment, labor, and scope of practice. A. Labor and employment 1. Americans with Disabilities Act 2. Civil Rights Act of Occupational Safety and Health Act (OSHA) B. Sexual harassment C. Other forms of harassment D. Grievance E. Scope of practice 5 National Consortium for Health Science Education

6 Resources TEXTBOOKS The purpose of the resource list is to help teachers know where they might find the content to support the information in the supplement. There may be books that clearly contain the content and are not on this list. All of the books on this list will not contain everything in the modules. HOWEVER, the list below reflects the resources used in the development of the Foundation Standard 5: Legal Responsibilities Health Science Instructional Supplement. Text Author(s) Publisher Edition/ Copyright Health Careers Today Gerdin, Judith Mosby Elsevier 5 th, 2011 Diversified Health Occupations Simmers, Louise, Karen Simmers-Nartker and Sharon Simmers-Kobelak Delmar Cengage Learning 7 th, 2009 Health Care Science Technology Booth, Kathryn A. Glencoe 1 st, 2003 Health Science Fundamentals Badasch, Shirley and Pearson Education Inc. 1 st, 2009 Doreen Chesebro Introduction to Health Care Mitchell, Joyce and Lee Haroun Delmar Cengage Learning 3 rd, 2011 Medical Law and Ethics Fremgen, Bonnie F. Pearson Education Inc 4 rd, 2010 Medical Law, Ethics and Bioethics Tamparo and Tatro FA Davis 7 th, 2012 POWERPOINT PRESENTATIONS A PowerPoint presentation has been aligned to Foundation Standard 5: Legal Responsibilities, and is included with this supplement. It is: 5.2 Legal Practices ASSESSMENT A forty-item multiple-choice test is provided for student assessment of Foundation Standard 5. Those test items can be used as a unit test, as part of a teacher-made test, or as a practice tool in preparation for students to take the National Health Care Foundation Skill Standards Assessment. 6 National Consortium for Health Science Education

7 Web resources provide a huge variety of instructional ideas for the classroom. A list of web suggestions are included in this supplement. In addition to the web resources listed, teachers are encouraged to search key words from the detailed content outline for additional resources. University of Tennessee: Legal Issues in Health Care This website addresses legal issues in five career areas: Medicine, Nursing, Pharmacy, Dentistry and Allied Health. It includes online instructional tutorials and fact sheets on a variety of legal topics, and includes StudyMate activities the help students learn the law while playing games and having fun! Topics include: Confidentiality Consent Medical Records Risk Management End-of-Life Legal Issues Legal Issues of Treating Communicable Diseases Legal Issues of Mental Health New York State HIPAA Statewide Agency Training Program This website has a detailed HIPAA training program and would be useful for a student to wants to learn more about HIPAA rules and standards. Select next on the intro page and then HIPAA Basics to get started. Putting on Mock Trials This website has detailed instructions in a PDF document published by the American Bar Association. It includes everything you need to run a mock trial in the classroom, including judging forms, appeal activities and sample trials. 7 National Consortium for Health Science Education

8 Malpractice Trial: Frankenstein This lesson plan from Discovery Education has everything needed to help students stage a mock trial, with Frankenstein suing his creator in civil court for negligence, malpractice, and emotional and physical distress. Counselors and Medical Malpractice This pdf is a 2-page example of a malpractice case involving a licensed mental health counselor. The charge is inappropriate behavior and sexual misconduct. The case is explained simply and clearly, and includes much of the terms and legal standards that students will learn in this unit. Also clear is how expensive legal fees can be ($11,780) and how important it is to maintain an ethical client-professional relationship. 8 National Consortium for Health Science Education

9 Lesson Plans Accountability Criteria Activity Comments Resources/Materials 5.11 Analyze legal responsibilities and limitations. Understanding Legal Responsibilities Page 16 This activity is designed to have students read, find and analyze information about legal responsibilities. Assign students to work in groups of two or three. Give each student a copy of the handout Understanding Legal Responsibilities. Assign each pair one of the torts on the page. (You may prefer NOT to assign sexual abuse as a role play.) Give teams overnight (homework) to research their specific tort, and plan a 2-3 minute role play to demonstrate and explain their tort to the rest of the class. During class, have teams perform their role play. Fill in any information gaps. They should do their own research in the classroom using classroom texts and resources to find the meaning of terms not demonstrated in a role play. Time: 45 minutes Handout: Understanding Legal Responsibilities 1 per student Thinking about Contracts Page 17 Students should be assigned to work in pairs. This activity is designed to encourage students to construct knowledge. They should be able to figure out reasonable responses to all but the bonus question. You can challenge students to find the answer to the bonus question as a homework assignment for bonus points. Time: 20 minutes Handout: Thinking about Contracts 1 copy per pair Answer key on page 18 9 National Consortium for Health Science Education

10 Accountability Criteria Activity Comments Resources/Materials 5.11 Analyze legal responsibilities and limitations. (Continued) Wrongful Death Lawsuit Pages This is a reading assignment, a writing assignment, and a thinking assignment, all rolled into one. Have students read the short legal case. Ask them to think about the facts of the case, and then write an opinion. Be sure students know they must choose only one outcome, A, B or C, and write an opinion on their choice. This assignment is not about right or wrong answers, but rather, the ability to articulate a point of view in writing. The written opinion page should be no longer than one page in length. Time: As homework or 45 minutes. Copy of the Wrongful Death Lawsuit 1 per student Writing Assignment Rubric 1 per student Evaluating Medical Legal Drama Page 21 Teacher information and recommendations for showing medical legal drama are provided on page 21. Be sure you do not violate any copyright laws. Take time to talk with your media coordinator about your options. This assignment works well as an optional assignment for advanced learning or credit. BONUS LEARNING OPPORTUNITIES: Teachers should look for ways to extend learning. If you can motivate students to learn more by providing bonus points or grades, you create a win-win situation. Some teachers provide advanced, optional learning assignments, grade the assignment, and then factor in the assignment as an additional test grade. Keep your standards high and look for ways to push your students towards higher learning. Time: varies 10 National Consortium for Health Science Education

11 Accountability Criteria Activity Comments Resources/Materials 5.11 Awarding Damages Analyze legal responsibilities and limitations. (Continued) Pages This is an applied math assignment with information about a malpractice suit. Have students work alone or in pairs. Students should read the instructions and answer the questions. A teacher key is on page 23. It includes information to include in a class discussion. This can be done as a homework assignment. Time: 45 minutes. Copy of the Awarding Damages 1 per student Calculators 5.12 Apply procedures for accurate documentation and record keeping. Written Documentation Questions Pages The activity is designed to help students understand the legal implications of written documentation and record keeping. Students can work by themselves or in pairs. This can be done as a classroom assignment or homework assignment. The goal of this activity is to have students think about the legal implications of written documentation. Give students the questions, and let them figure out the answers for themselves. With very few exceptions, students will be able to create reasonable accurate responses to the questions. Teachers will need to review the correct answers so that students can fill in any important points they might have missed. Handout: Written Documentation Questions 1 per student or pair Time: 30 minutes 11 National Consortium for Health Science Education

12 Accountability Criteria Activity Comments Resources/Materials 5.21 Apply standards for Health Insurance Portability and Accountability Act (HIPAA). Legal Practices PowerPoint On course flash drive HIPAA in the Community The PowerPoint covers important content information for HIPAA, advance directives, Patient s Bill of Rights, informed consent, and labor laws. Time: 30 minutes Have students visit a local medical office or healthcare facility, or talk to local healthcare providers, and ask what they know about HIPAA. Students should write up and turn a brief report of what they were told, or found out. If they were given a copy of a HIPAA consent form, they should bring it to share with the class. As a class, discuss the reaction of the local healthcare community to HIPAA legislation. Time: Homework and class discussion 20 minutes. A content outline of the PowerPoint is provided on pages of this supplement Describe advance directives. Advance Directives Discussion Class discussion: Ask any of the following questions. One example of an advance directive is an advance funeral directive. Are you aware of advance funeral directives of any of your family members? Do you feel like you know the wants and desires of your family members, should they ever become unable to make their own decisions? Time: 30 minutes 12 National Consortium for Health Science Education

13 Accountability Criteria Activity Comments Resources/Materials 5.23 Summarize the Patient s Bill of Rights. Bill of Rights Page 31 This activity is designed to give students a chance to think seriously about the Patient s Bill of Rights while thinking creatively about specific rights. This can be done as homework, in pairs, or in small groups. If small groups are assigned, allow students time to share and explain their rights with the class. Time: 30 minutes Handout Bill of Rights, 1 per student or group List of Patient s Bill of Rights from the American Hospital Association included on page112 in Diversified Health Occupations, 7 th ed Understand informed consent Explain the laws governing harassment, employment, and scope of practice. Informed Consent Lawsuit Page 32 Harassment, Employment and Scope of Practice Page Have students read the Informed Consent Lawsuit. Then, following the steps outlined on the teacher information page. Time: 30 minutes The teacher information page provides introductory information and website links. A fact sheet regarding sexual harassment can be found on the NCHSE Supplements flash drive. Sexual harassment can occur in the workplace, and on the high school campus. Have students read the fact sheet about sexual harassment, and then compose an editorial for the school newspaper titled Don t be a Victim. The article should clearly and tactfully tell teens, male and female, what to look out for and how to respond if they are victims of sexual harassment. With the student s permission, the best article should be submitted to the school or local paper for publication. Time: 30 minutes class time + Homework Copy of the Informed Consent lawsuit 1 per student Copy of the teacher instructions on page 33. Copy of fact sheet, 1 per student 13 National Consortium for Health Science Education

14 Accountability Criteria Activity Comments Resources/Materials 5.25 Explain the laws governing harassment, employment, and scope of practice. Healthcare Workers with Disabilities Pages This assignment includes selected information from the U.S. Equal Employment Opportunity Commission. Have students read the information in the handout. Have students answer the questions at the end of the reading, either in writing or as a class discussion. Handout: Healthcare Workers with Disabilities 1 per student (continued) Time: 30 minutes HOSA Knowledge Test: Medical Law and Ethics Students who show an aptitude or interest in legal responsibilities should be encouraged to participate in the Medical Law and Ethics event. The event consists of a 100-item multiple choice test and a tie-breaker essay. As with all HOSA events, students should push themselves to study independently and learn as much as they possibly can. In competition, the competitor who knows more than all the other competitors is the one who brings home the top prize. Encourage students to practice their essay skills as well. The tiebreaker question can make a difference, and an essay that uses correct grammar, spelling and punctuation can make a positive difference. Time: Varies done outside of class time. Guidelines with test plan at sites/default/files/kt1 2.pdf 14 National Consortium for Health Science Education

15 INSTRUCTIONAL ACTIVITIES AND INFORMATION 5.11 Understanding Legal Responsibilities Role Play Page Thinking about Contracts Student Activity Page Thinking about Contracts Answer Key Page Wrongful Death Lawsuit Student Information Page Writing Assignment Rubric Rubric Page Evaluating Medical Legal Drama Teacher Information Page Awarding Damages Applied Math Activity Page Awarding Damages Answer Key Page Written Documentation Questions Student Activity Page Written Documentation Questions Answer Key Page Legal Practices PowerPoint Content Outline Pages Bill of Rights Student Information Page Informed Consent Lawsuit Student Information Page Informed Consent Lawsuit Teacher Information Page Harassment, Employment and Scope of Practice Teacher Information Page Sexual Harassment News Article Rubric Page Healthcare Workers with Disabilities Reading Assignment Pages Health Science Library Page National Consortium for Health Science Education

16 Understanding Legal Responsibilities 5.11 In this activity, you will learn specific terms related to the legal responsibilities of health care workers, and have an opportunity to write and demonstrate a role play scenario. Your specific role play will be to enact an assigned common tort. In addition to the role play, you should be able to explain your tort to your classmates. You will also have an opportunity to view other role plays and tort descriptions. A chart is provided below for your notes. Legal Term Criminal law Description Civil law Tort Malpractice Negligence Assault Battery Invasion of privacy False imprisonment Physical abuse Verbal abuse Psychological abuse Sexual abuse Defamation Slander Libel Implied contract Expressed contract Legal disability Agent 16 National Consortium for Health Science Education

17 Name Date Thinking about Contracts A contract is a legal agreement between two or more parties. What comes to mind when you think of a contract? 2. In health care, some contracts are classified as implied contracts. An example of an implied contract could be: Thalea goes to the dentist, sits in the dental chair when asked, and follows instructions from the dental assistant. What is the implied contract? 3. This form is an example of an expressed contract. How would you define and describe an expressed contract? 4. A person who has a legal disability does not have the legal capacity to form a contract. Can you think if some examples of conditions or situations that might give someone a legal disability? 5. In health care, the principal is responsible for the actions of the agent. What do you think that means? Bonus: What Latin phrase is the legal term to describe this relationship? 17 National Consortium for Health Science Education

18 Thinking about Contracts Answer Key A contract is a legal agreement between two or more parties. What comes to mind when you think of a contract? Students should think of examples such as a recording contract (musical artist), a prenuptial agreement, a teaching contract, a contract to purchase a house, etc. They may also suggest that a contract states the terms of an agreement. 2. In health care, some contracts are classified as implied contracts. An example of an implied contract could be: Thalea goes to the dentist, sits in the dental chair when asked, and follows instructions from the dental assistant. What is the implied contract? The agreement is understood without putting the agreement in writing. 3. This form is an example of an expressed contract. How would you define and describe an expressed contract? Orally or in writing in clear and distinct language. Includes details of the agreement. 4. A person who has a legal disability does not have the legal capacity to form a contract. Can you think if some examples of conditions or situations that might give someone a legal disability? Minors (under 18), mentally incompetent persons, individuals under the influence of drugs or altered mental state (semiconscious or unconscious). 5. In health care, the principal is responsible for the actions of the agent. What do you think that means? The principal is the employer and the agent is the person working for the employer. For example, in a medical office practice, the physician (owner) is the principal and the medical assistant employed at the office is the agent. Bonus: What Latin phrase is the legal term to describe this relationship? Respondeat superior 18 National Consortium for Health Science Education

19 Wrongful Death Lawsuit 5.11 Myrtle Otis, wife of Harry Otis, deceased, Petitioner v. University Hospital, Respondent In this case, you are to consider the following legal standard: In a wrongful death lawsuit, the plaintiff must prove more likely than not that the death was caused by the defendant s negligence. On the afternoon of October 10, 1996, at 10:00 A.M., Harry Otis suffered lower abdominal pain and fainted at home. His wife called the office of his gastroenterologist, Dr. Land, to inform Dr. Land of these symptoms. Dr. Land told Mrs. Otis to call an ambulance and have Mr. Otis transported to the University Hospital emergency room. Mr. Otis was transported to the emergency room and arrived at 10:25 A.M. The emergency room staff was informed by Mrs. Otis that Dr. Land said he would meet them in the emergency room. The emergency room staff did not take a history or examine Mr. Otis in the belief that Dr. Land was coming to the emergency room and would arrive shortly. Dr. Land did not respond to being paged by the emergency room staff at 10:30 A.M. and 10:40 A.M. because he was performing a procedure on another patient in the hospital s outpatient clinic. Mr. Otis complained of increasing abdominal pain and asked to use a bedpan at 10:50 A.M. Soon after straining on the bedpan, Mr. Otis could not catch his breath. Dr. Land arrived in the emergency room at 10:55 A.M. and had just entered Mr. Otis room when Mr. Otis went into cardiac arrest. Mr. Otis died 35 minutes after arriving at the hospital. The autopsy revealed that he died from a ruptured abdominal aneurysm which caused massive internal bleeding. Mrs. Otis brought a wrongful death action against the hospital alleging negligence by the emergency room staff in not taking a history and in failing to physically examine Mr. Otis. Mrs. Otis expert witness, Dr. John Baily, a cardiologist, testified that the inaction by the emergency room staff violated acceptable medical standards. The hospital s expert witness, Dr. Candel, a thoracic surgeon, testified that someone in Mr. Otis condition had a no better than even chance to survive, even had there been an immediate diagnosis of the aneurysm and emergency surgery. Writing assignment: Based on the facts presented in this case, you are to write a one page opinion. A. Is Dr. Land at fault? B. Is the hospital at fault? C. Is there insufficient evidence to prove the wrongful death of Mr. Otis? You must take a stand and defend your opinion, and be sure you use good writing composition skills. 19 National Consortium for Health Science Education

20 Name Date Writing Assignment 5.11 Items Evaluated Points Possible Superior Excellent Good Fair Poor Points Allocated Organization 1. No longer than one page in length Introduction Body Conclusion Composition 5. All words spelling correctly Used proper grammar Used proper punctuation Neat and legible (spacing, font, margins) Topic and Clarity 9. Chose one outcome and supported decision by explaining why Information clear and concise TOTAL POINTS Comments: 20 National Consortium for Health Science Education

21 Teacher Information Evaluating Medical Legal Drama 5.11 Watching good movies can be a powerful learning tool, especially for today s young person who has grown up with multimedia at his/her fingertips. Before searching for something appropriate, we recommend you understand and follow your school policies for showing media (movies, TV shows) in the classroom. Your next strategy should involve your media coordinator. He/she will have tools to find appropriate media for use in your classroom. Next, be sure to preview anything you plan to show in class. Two reasons. First, so that you know what you are showing is appropriate for your students, and so that you can prepare viewing instructions. Viewing Instructions When you show any media in the classroom, viewing should be purposeful. Students should know why they are watching the media, what content they should be looking for, and what they should learn from the experience. Try writing a viewing guide that asks students to evaluate different points in the movie or video. By having students turn in a writing assignment after viewing something in the classroom, you can guide their learning. Movie Suggestions The Verdict (1982) starring Paul Newman. THIS MOVIE IS RATED R, however, it has a powerful representation of medical malpractice and errors that involve both a physician and a nurse. Screen it carefully and show only those parts that illustrate the legal aspects of healthcare without profanity. Sicko (2007) a Michael Moore documentary about the American health care industry and HMOs. Metacafe website - This website has a number of short, online videos. We particularly like students having a chance to listen to a malpractice lawyer talk about malpractice cases. TV Shows Health Science students can be loyal fans of current medical television shows. Ask your class if they have seen any TV shows or movies that involved medical legal issues, and facilitate a class discussion on what they saw and learned. 21 National Consortium for Health Science Education

22 Name Date Awarding Damages 5.11 Instructions: Read the following legal opinion and use a calculator to answer the questions at the end of this page. Terminology Non-settling defendant The hospital (or person) being sued that went to trial. (Did not settle out of court.) Damages The amount of money awarded by the jury. Reduction in judgment A decrease in the amount of money awarded by the jury at a trial. In 2009, Joyce Gibson filed suit against Valley Hospital, Dr. Donald Ray, MD, and Anesthesiology Associates and its employees Kay James and Dr. Bruce Bell, M.D., for the wrongful death of her husband. Prior to trial, Gibson settled with Dr. Ray for $250,000, $50,000 of which was allocated to economic and $200,000 to non-economic damages. Gibson also settled with Anesthesiology Associates and its employees for $50,000. Valley Hospital was the sole defendant at trial. However, the jury was instructed to find fault, if any, among all the defendants that were named in the original suit. The jury returned a verdict in favor of Gibson, finding Valley Hospital 90% at fault, Dr. Ray 5% at fault, and Anesthesiology Associates 5% at fault. The jury assessed damages at $573,853 - $202,853 in economic damages and $371,000 in non-economic damages. Gibson was awarded 90% of $573,853, plus $9,000 in costs, less 3 ½ % Social Security. 1. What was her total trial award? Valley Hospital moved for a reduction in judgment, arguing that the judgment should be reduced by the total amount paid by the settling defendants. 2. If the motion for reduction of judgment is approved, Gibson s trial award will be. 3. If the motion for reduction is NOT approved, how much money will Gibson get? 4. Do you think the reduction in judgment should be approved? Why or why not? 5. Should Dr. Ray and Anesthesiology Associates have settled out of court? Why or why not? 6. Who actually writes the check for the money awarded to Gibson? 7. What do you think is meant by economic and non-economic damages? 22 National Consortium for Health Science Education

23 Awarding Damages - KEY What was her total trial award? 90% of $573,853 = $516,468 + $9,000 (costs) = $525,468. Subtract 3 ½% for Social Security 3.5% of $525,468 = $18,391. Therefore.$525,468 - $18,391 = $507,077 Valley Hospital moved for a reduction in judgment, arguing that the judgment should be reduced by the total amount paid by the settling defendants. 2. If the motion for reduction of judgment is approved, Gibson s trial award will be $207, If the motion for reduction is NOT approved, how much money will Gibson get? $507,077 + $300,000 or $807, Do you think the reduction in judgment should be approved? Why or why not? Answers will vary and are an opinion. In this case, the court denied the reduction in judgment citing legal statute. Students may say that it depends on the facts of the case, but remind them that this is a question of law, and the law itself should not be based on emotion, but rather, on legal statutes. 5. Should Dr. Ray and Anesthesiology Associates have settled out of court? Why or why not? This a good question to press student thinking. Is money the only consideration? What about time? What about stress? Who do students think makes the decision about settling out of court? Is it the physicians? OR the insurance company? 6. Who actually writes the check for the money awarded to Gibson? Most likely the insurance provider. A good follow up question might be If a nursing assistant was involved in the case, would she/he have been named in the suit? Why or why not? Students may determine that the CNA would not be named in the suit if she/he has no insurance, or money, and therefore, would not be able to pay damages. It depends on the individuals involved and the merits of the case. 7. What do you think is meant by economic and non-economic damages? Economic damages are the loss of income and the additional expenses that she will have now that she no longer has her husband. Non-economic damages are pain and suffering. Explain to students that this is an actual court case. Summarize by explaining that the sued are not always guilty, and the innocent are not always found not guilty. Medical malpractice is a tricky business, and there are many factors involved in who gets sued, what goes to trial, and how a jury will respond. Students should not shy away from the healthcare professions because of the legal ramifications, but they should always be as informed as possible about the legal and ethical issues that are a part of their chosen profession. 23 National Consortium for Health Science Education

24 Written Documentation Questions Most information a patient tells a doctor is privileged communication. What does that mean? 2. The information a patient tells his/her physician is privileged. Is the information a doctor tells a patient also privileged? Why? 3. Not all information in a health care setting is confidential. In fact, some things are required by law to be reported. What do you think they are? 4. Is a health care record or chart considered privileged communication? Why? 5. When you are in the hospital, a chart is kept that contains all of your medical information. Who do you think owns that chart, and what rights should the patient have regarding information in the chart? 6. Can information a health care worker writes in a patient s chart be admissible in a court of law? Why? 7. Do you think healthcare workers are permitted to erase entries in a patient s chart? Why? 8. If you accidently write something wrong in a patient s chart, what should you do to correct the error? Why? 9. Can you suggest three things that can be done to safeguard confidentiality in computerized records? 24 National Consortium for Health Science Education

25 Written Documentation Questions Answer Key Most information a patient tells a doctor is privileged communication. What does that mean? Information about the patient, and information the patient tells the doctor, must be kept confidential. 2. The information a patient tells his/her physician is privileged. Is the information a doctor tells a patient also privileged? Why? The things a doctor tells a patient is NOT confidential because student answers will vary, and should be very interesting. 3. Not all information in a health care setting is confidential. In fact, some things are required by law to be reported. What do you think they are? Births and deaths, injuries caused by violence that may involve police, drug abuse, communicable diseases, sexually transmitted diseases. 4. Is a health care record or chart considered privileged communication? Why? Yes. Contains confidential patient information. 5. When you are in the hospital, a chart is kept that contains all of your medical information. Who do you think owns that chart, and what rights should the patient have regarding information in the chart? The hospital owns the chart but the patient has a right to see what is in the chart and to have copies. 6. Can information a health care worker writes in a patient s chart be admissible in a court of law? Why? The chart is a legal record of medical care and can be admissible in a court of law. 7. Do you think healthcare workers are permitted to erase entries in a patient s chart? Why? No erasing because the chart is a legal document. 8. If you accidently write something wrong in a patient s chart, what should you do to correct the error? Why? Many students will reasonably figure this one out, although some responses will be interesting. An honest mistake needs to be apparent and easy to distinguish from an attempt to cover something up, therefore, an accepted method of correction is to cross out the error with one line, insert the correct information, date and initial. Agency policies will vary. 9. Can you suggest three things that can be done to safeguard confidentiality in computerized records? Limit computer access to only those who need it, use passwords, and monitor and evaluate computer use. 25 National Consortium for Health Science Education

26 PowerPoint Content Outline: 5.2 Legal Practices This PowerPoint is available on the course CD, and includes teacher information in the notes section of the PowerPoint. The content points from the PowerPoint are provided here in outline format Legal Practices In a healthcare setting Objectives 5.21 Apply standards for HIPAA Describe advance directives Summarize the Patient s Bill of Rights Understand informed consent Explain laws governing harassment, employment and scope of practice. HIPAA Health Insurance Portability and Accountability Act Federal protection for privacy of health information in all states. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule HIPAA Patients must sign HIPAA consent form for health care provider. HIPAA Only exception to confidentiality rules is information that must be reported by law to protect the safety and welfare of the public. Births and deaths Injuries caused by violence that require police involvement Communicable diseases Sexually transmitted diseases HIPAA Quiz 1. What federal department regulates HIPAA? 2. Must a patient sign a HIPAA authorization form before his/her physician s office files an insurance claim for the patient? 3. Can a physician give a son confidential information about his father s condition without the father s written consent? 4. Karen wants a copy of her dental x-rays. Can the dental office charge her $10 to provide her with a copy? 5. Brenda has a baby but does NOT want the information made public. Can she refuse to have the birth registered? 26 National Consortium for Health Science Education

27 Advance Directives Also known as legal directives A legal document They allow individuals to state what medical treatment they want and do not want if they become incapacitated. Two main directives: Living will Durable power of attorney (POA) Living Will Document that states measures that should not be taken to prolong life when the patient is terminal. Must be signed when individual is competent and witnessed by two adults who would not benefit from the death. Most states have laws that honor living wills. Living wills often have a Do Not Resuscitate (DNR) request. If so, a doctor may write a Do Not Resuscitate order. Durable power of attorney Also Designation of Health Care Surrogate or Medical Power of Attorney Permits an individual (known as a principal) to appoint another person (known as an agent) to make healthcare decisions if the principal becomes unable to make decisions. Usually given to spouse or adult children. May be given to any qualified adult. POA must be signed by the principal, the agent, and two adult witnesses. Patient self determination act Abbreviated PSDA Federal law in 1990 Facilities receiving federal aid must: Inform patients of their right to make decisions concerning their medical care, including right-to-die. Provide assistance in preparing advance directives. Document advance directives in patient record. Provide written statements to implement the patient s requests. Affirm no discrimination because of advance directives. Educate staff on legal issues regarding advance directives. Advance Directives Quiz 1. If a patient legally signs a living will, can a physician refuse to cooperate? 2. What is the intent of the PSDA? 3. Robert has never been married and has no children. Can he give durable power of attorney to his cat? 4. Barney is very ill. His daughter puts a pen in his hand and bullies him into signing a Living Will. Is that legal? 5. Joe has signed a living will and the doctor writes a DNR order. What should the nurse caring for him do if he experiences cardiac arrest? 27 National Consortium for Health Science Education

28 Patient s Bill of Rights Many different forms American Hospital Association Patient s Bill of Rights Mental Health Patient s Bill of Rights Patient s Bill of Rights for Medicare and Medicaid Resident s Bill of Rights (OBRA) Managed Care Bill of Rights Complementary and Alternative Care Client Bill of Rights Etc. Patients have a right to: Considerate and respectful care. Obtain complete, current information concerning diagnosis, treatment and prognosis. Patients have a right to: Receive information necessary to give informed consent prior to the start of any procedure. Have advance directives for health care and/or refuse treatment to the extent permitted under law. Patients have a right to: Privacy concerning a medical care program. Confidential treatment of all communications and records. Reasonable response to a request for services. Patients have a right to: Obtain information regarding facility relationships to other healthcare and educational institutions. Right to refuse to participate in research. Reasonable continuity of care. Patients have a right to: Review medical records, examine bills, get explanations of care and charges. Be informed of hospital rules and regulations, and available resources to resolve disputes or grievances. Resident s rights include: Freedom from abuse and chemical/physical restraints. Participate in family/resident groups and in social, religious and community activities. Manage personal funds and use personal possessions. To share a room with his/her spouse if both are residents. 28 National Consortium for Health Science Education

29 Patient s Rights Quiz 1. A physician walks into a patient s room with three medical students. Does the patient have the right to ask the medical students to leave? 2. Does a patient have the right to challenge charges on his/her hospital bill? 3. A nurse anesthetist visits a patient before surgery, but the patient is not comfortable with the anesthetist. What should he/she do? 4. Do you think nursing homes ever violate any residents rights? Which ones? Informed Consent Informed consent is permission granted voluntarily by a person who is of sound mind after the procedure and all risks have been explained in terms the person can understand. Can be verbal, but for most procedures, should be in writing. Person can withdraw consent at any time. Procedures should not be performed if the patient does not give consent. Informed Consent Quiz 1. If a patient gives permission for a procedure but is heavily drugged at the time, is that legal? 2. If a patient signs a consent form without reading the form, have the rules for informed consent been legally met? 3. If a patient signs a consent form and, while of sound mind, changes his mind about having the procedure, can the physician still perform the procedure? Labor and employment Americans with Disabilities Act Prevents employment discrimination against disabled workers who are qualified to perform the job with reasonable accommodations. Civil Rights Act of 1964 Prevents hiring discrimination on the basis of race, color, religion, sex, age or national origin. Occupational Safety and Health Act (OSHA) Prevents unsafe working conditions. Sexual harassment Unwelcome actions that are sexual in nature. Victim and harasser may be man or woman, and may not be of the opposite sex. Harasser can be a supervisor, coworker, or nonemployee. Victim can be anyone affected by offensive conduct. Sexual harassment Victims should first speak directly to the harasser. Clearly identify the unwelcome behavior and that it must stop. If the harassment continues, follow the facility s sexual harassment policy. 29 National Consortium for Health Science Education

30 Avoid sexual harassment Avoid discussing sexual matters not related to the job. Do NOT tell dirty jokes. Avoid sharing intimate details of your personal life at work. Do NOT joke about sexual matters. Avoid touching coworkers and patients in suggestive ways. Grievance A complaint about a circumstance considered to be unfair or potentially harmful. Learn facility grievance policy. Usually best to resolve workplace issues at the lowest level possible. Start with your immediate supervisor. Only file a grievance after working up the chain of command. Scope of practice What one is legally allowed to do in one s profession. You MUST understand and practice within the guidelines of your profession. A supervisor should only ask you to perform activities within your scope of practice. In most instances, you should refuse to perform skills outside your scope of practice. Harassment, Labor, and Scope of Practice Quiz 1. A healthcare worker tells dirty jokes to coworkers who encourage the jokes. Is this sexual harassment? 2. A male pharmacist makes crude comments about women to nobody in particular. A pharmacy assistant who hears his remarks finds the remarks offensive. Is this sexual harassment? 3. Are workplace romances considered sexual harassment? 4. What should you do if someone at work makes sexual comments that make you uncomfortable? Harassment, Labor, and Scope of Practice Quiz 5. What role does OSHA play in protecting the worker? 6. Roxy applies for a job as a medical receptionist. She is well qualified for the job, but is a double-amputee and uses a wheelchair. Can she be denied the job because her wheelchair use might require the office to make some renovations? 7. When should you file a grievance? 8. Do nursing assistants have a scope of practice? Conclusion Healthcare workers must know and follow the law in the practice of his/her profession in order to safeguard the rights of the patient and the integrity of the profession. Spend your career here.... not here. 30 National Consortium for Health Science Education

31 Bill of Rights 5.23 In this assignment, you are to write your own Bill of Rights. Choose one of the following topics or suggest one to your teacher for approval. You may use the Patient s Bill of Rights from the American Hospital Association to help give you ideas. Doggie Bill of Rights Animal rights for canine clients at a Veterinary practice. Teenager s Bill of Rights Rights specific to youth patients in a physician s office, ages Athlete s Bill of Rights Rights specific to high school and college athletes who are treated by an athletic trainer. Exceptionally Tall Person s Bill of Rights Rights in any health care setting for patients or clients who are taller than 6 7. An Exceptionally Busy Person s Bill of Rights Rights in any healthcare office setting for people who are very, very busy. A Future Healthcare Worker s Bill of Rights Rights of any health science student who must be on the receiving end of a health science education. You must come up with at least eight (8) rights that are specific to the group you chose. Be creative but thoughtful. Be sure to use complete sentences, and correct grammar, spelling and punctuation. My Unique and Personal Bill of Rights 31 National Consortium for Health Science Education

32 Informed Consent Lawsuit 5.24 Danny Duke, as survivor and personal representative of the estate of Darcy Duke, deceased, v. Carlos Rodriguez, M.D. and University Hospital Points of law to consider about informed consent: A competent individual has the categorical authority to refuse even lifesaving treatment. A physician who treats a patient despite the patient s refusal is civilly and criminally liable for assault and battery. A person is presumed to be competent unless the evidence shows otherwise. Mrs. Duke died of respiratory failure on July 24, Her breathing tube became dislodged that day and she and Mr. Duke refused, for more than four hours, to allow the medical personnel to reinsert it. After she finally consented to the re-intubation, an emergency room physician performed the procedure. Several minutes later however, Mrs. Duke coded and she was pronounced dead at 6:30 a.m. The plaintiff argues that Dr. Rodriquez should have gone to the hospital and re-intubated Mrs. Duke despite her wishes. During the trial, Dr. Rodriguez established that he would not have performed the re-intubation without the patient s consent, even if he had gone to the hospital that morning. Nurse McKay, one of the ICU nurses who cared for Mrs. Duke throughout the morning, testified that patients breathing tubes frequently become dislodged and the emergency room physician would have been called to perform the re-intubation the moment Mrs. Duke signed the consent form. Dr. Bone was the medical expert for the Dukes. He stated that Dr. Rodriquez s conduct fell below the standard of care because: (1) Mrs. Duke was not competent to refuse intubation, (2) the situation was an emergency and Mrs. Duke s consent was therefore implied, (3) Dr. Rodriquez had a duty to reintubate Mrs. Duke, (4) Dr. Rodriguez should have gone to Mrs. Duke s bedside to assess her competency instead of relying on the nurses to make that determination; and (5) a timely intubation would have saved Mrs. Duke s life. According to Dr. Bone, Mrs. Duke was in no position to judge appropriate therapy for herself and to make a rational decision. Nurse McKay, three other ICU nurses, and Dr. Franks, the emergency room physician who eventually reintubated Mrs. Duke, testified that the entire period of Mrs. Duke s extubation, she was awake, alert, oriented, and asking appropriate questions. In nurse McKay s chart notes at 4:00 a.m. it was written that Mrs. Duke was informed of and understood the risk of death if the tube is not timely reinserted. Based on what you have learned about informed consent, how would you rule in this case? 32 National Consortium for Health Science Education