Chapter 3 Medicolegal and Ethical Issues Copyright © 2013 by Jones & Bartlett Learning, LLC, an...
-
Upload
brett-sims -
Category
Documents
-
view
223 -
download
1
description
Transcript of Chapter 3 Medicolegal and Ethical Issues Copyright © 2013 by Jones & Bartlett Learning, LLC, an...
Chapter 3Chapter 3
Medicolegal and Ethical IssuesMedicolegal and Ethical Issues
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company2
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Learning ObjectivesLearning Objectives
Explain the importance, necessity, legality of Explain the importance, necessity, legality of patient confidentialitypatient confidentiality
State conditions that require EMT to notify State conditions that require EMT to notify local law enforcement officialslocal law enforcement officials
Define EMT Define EMT scope of practicescope of practice
State conditions necessary for EMT to have State conditions necessary for EMT to have duty to actduty to act
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company3
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Learning ObjectivesLearning Objectives
Discuss issues of abandonment, negligence, Discuss issues of abandonment, negligence, battery, and their implications to EMTbattery, and their implications to EMT
Define Define consent;consent; discuss methods of obtaining discuss methods of obtaining consentconsent
Differentiate between expressed (informed) Differentiate between expressed (informed) and implied consentand implied consent
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company4
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Learning ObjectivesLearning Objectives
Explain role of consent by minors in issues of Explain role of consent by minors in issues of carecare
Discuss implications for EMT in patient Discuss implications for EMT in patient refusal of transportrefusal of transport
Discuss importance of Do Not Resuscitate Discuss importance of Do Not Resuscitate (DNR) orders, advance directives, and local (DNR) orders, advance directives, and local or state provisions regarding EMS applicationor state provisions regarding EMS application
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company5
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Learning ObjectivesLearning Objectives
Discuss considerations of EMT regarding Discuss considerations of EMT regarding issues of organ retrievalissues of organ retrieval
Delineate actions that an EMT should take to Delineate actions that an EMT should take to assist in preserving crime scenesassist in preserving crime scenes
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company6
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Ethical ResponsibilitiesEthical Responsibilities
The Golden RuleThe Golden Rule ““Do unto others as you would have them do unto Do unto others as you would have them do unto
you”you” Act in best interest of patientAct in best interest of patient
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company7
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Ethical ResponsibilitiesEthical Responsibilities
Ethics & competenceEthics & competence Quality careQuality care
• Caring, competentCaring, competent• Responsible to maintain competenceResponsible to maintain competence• Strive for level of masteryStrive for level of mastery• Requires diligence, self-evaluationRequires diligence, self-evaluation• Keep knowledge, skills currentKeep knowledge, skills current• Participate in quality improvement processParticipate in quality improvement process• I CAREI CARE
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company8
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Ethical ResponsibilitiesEthical Responsibilities
ConfidentialityConfidentiality Patients have right to know information Patients have right to know information
given will be kept confidentialgiven will be kept confidential Information release must be writtenInformation release must be written
• ExceptionsExceptions Information to press/mediaInformation to press/media
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company9
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Ethical ResponsibilitiesEthical Responsibilities
Health Insurance Portability & Accountability Health Insurance Portability & Accountability Act (HIPAA)Act (HIPAA) Widespread –use of electronic recordsWidespread –use of electronic records Potential of patient information transmitted without Potential of patient information transmitted without
knowledge/consentknowledge/consent Outlines how private information used, disclosedOutlines how private information used, disclosed
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company10
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Ethical ResponsibilitiesEthical Responsibilities Reporting requirementsReporting requirements
Reportable circumstancesReportable circumstances• Child abuseChild abuse• Geriatric abuseGeriatric abuse• Family violence, abuseFamily violence, abuse• Violent crimesViolent crimes• Certain infectious diseasesCertain infectious diseases• Patients transported against their willPatients transported against their will• Mentally incompetentMentally incompetent• Animal bitesAnimal bites• Wounds from guns/knivesWounds from guns/knives• DeathsDeaths
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company11
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Scope of PracticeScope of Practice
Range of activities, limitations of medical Range of activities, limitations of medical providerprovider State EMS laws address:State EMS laws address:
• Minimum training standardsMinimum training standards• Medical controlMedical control• Vehicle/equipment specificationsVehicle/equipment specifications• Licensure/certification requirementsLicensure/certification requirements• May specify formation, duties of EMS councils/medical May specify formation, duties of EMS councils/medical
advisory committeesadvisory committees
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company12
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Scope of PracticeScope of Practice
Establishes what EMT legally can, cannot do Establishes what EMT legally can, cannot do in emergency medical evaluation, treatmentin emergency medical evaluation, treatment
National EMS Scope of Practice ModelNational EMS Scope of Practice Model
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company13
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Scope of PracticeScope of Practice
Standard of careStandard of care ““Did you do the right thing & did you do it Did you do the right thing & did you do it
properly?”properly?” Describes body of knowledge, laws, policies, Describes body of knowledge, laws, policies,
common practices, standards, guidelinescommon practices, standards, guidelines Laws, rules, regulations govern EMT practiceLaws, rules, regulations govern EMT practice ProtocolsProtocols
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company14
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Scope of PracticeScope of Practice
Standard of careStandard of care EquipmentEquipment
• MedicationsMedications• Medical devicesMedical devices• Check equipment, document equipment failure, reportCheck equipment, document equipment failure, report
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company15
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
NegligenceNegligence
Deviation from accepted standard of care, Deviation from accepted standard of care, results in injury to patientresults in injury to patient
To prove negligence, must show:To prove negligence, must show:• Duty to actDuty to act• Breach of dutyBreach of duty• DamageDamage• Causal connectionCausal connection
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company16
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
NegligenceNegligence
““Good Samaritan” legislationGood Samaritan” legislation Protects private citizenProtects private citizen Provides aid without undue fear of Provides aid without undue fear of
litigationlitigation Protects EMT from civil chargesProtects EMT from civil charges Does not protect from gross negligenceDoes not protect from gross negligence
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company17
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
ConsentConsent
Before treating a patient, must obtain consent Before treating a patient, must obtain consent from patient, parent, guardianfrom patient, parent, guardian Principle of autonomy, self-determinationPrinciple of autonomy, self-determination
• Right to be self-directingRight to be self-directing
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company18
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
ConsentConsent
Consent not always possibleConsent not always possible DisorientedDisoriented Minors with no parent/guardian availableMinors with no parent/guardian available Mentally handicappedMentally handicapped
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company19
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
ConsentConsent
Expressed (informed) consentExpressed (informed) consent Must be obtained from every conscious, Must be obtained from every conscious,
competent adultcompetent adult Document when patient withholds consentDocument when patient withholds consent
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company20
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
ConsentConsent
Prehospital researchPrehospital research Research studies evaluate effectiveness of Research studies evaluate effectiveness of
procedures/treatmentsprocedures/treatments Research studies must be approved by IRBsResearch studies must be approved by IRBs
• Acquire patient consentAcquire patient consent• Purpose: Respect of patient autonomyPurpose: Respect of patient autonomy
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company21
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
ConsentConsent
Implied consentImplied consent Verbal/written consent not possibleVerbal/written consent not possible Reasonable person would want emergency Reasonable person would want emergency
treatmenttreatment
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company22
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
ConsentConsent
Other types of consentOther types of consent Children, mentally incompetent individuals not Children, mentally incompetent individuals not
legally able to give expressed consent legally able to give expressed consent • Must obtain consent from parent/guardianMust obtain consent from parent/guardian
Unless implied consent more appropriateUnless implied consent more appropriate Emancipated minorEmancipated minor
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company23
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Refusal of Treatment & TransportRefusal of Treatment & Transport
Person has right to refuse carePerson has right to refuse care Must be competent, able to make clear judgmentMust be competent, able to make clear judgment
Patient has right to withdraw from treatmentPatient has right to withdraw from treatment
““False imprisonment” if transferred against False imprisonment” if transferred against willwill
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company24
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Refusal of Treatment & TransportRefusal of Treatment & Transport
Assault/battery if you touch, provide care to Assault/battery if you touch, provide care to patient without consentpatient without consent
Try to convince patient to go to hospital Try to convince patient to go to hospital
Ensure patient understands consequences of Ensure patient understands consequences of not seeking medical attentionnot seeking medical attention
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company25
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Refusal of Treatment & TransportRefusal of Treatment & Transport
Sign “refusal of treatment” release formSign “refusal of treatment” release form
Use best judgment with mental incompetenceUse best judgment with mental incompetence
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company26
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Refusal of Treatment & TransportRefusal of Treatment & Transport
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company27
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
AbandonmentAbandonment
EMT discontinues patient-provider EMT discontinues patient-provider relationship without giving patient opportunity relationship without giving patient opportunity to obtain continued care at the same level or to obtain continued care at the same level or higherhigher
Plaintiff must prove patient was owed duty Plaintiff must prove patient was owed duty and duty was breachedand duty was breached
Charges possible if patient who refused care Charges possible if patient who refused care is incompetentis incompetent
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company28
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Intoxicated, Irrational, and Intoxicated, Irrational, and Emotionally Disturbed PatientsEmotionally Disturbed Patients
High legal riskHigh legal risk Held against wishes, charges can resultHeld against wishes, charges can result
““Protective custody”Protective custody” Violent/suicidal patientsViolent/suicidal patients
Forcible removalForcible removal ““Soft” restraintsSoft” restraints Precise documentationPrecise documentation
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company29
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Resuscitation IssuesResuscitation Issues
ProxiesProxies DNR ordersDNR orders Advance directivesAdvance directives Healthcare proxyHealthcare proxy
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company30
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Resuscitation IssuesResuscitation Issues
Extended transportExtended transport EMTs must have original DNR orderEMTs must have original DNR order If patient dies during transport:If patient dies during transport:
• Ambulance must stop where patient died• Coroner must be notified
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company31
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Donor & Organ HarvestingDonor & Organ Harvesting
Individuals may decide in advance to donate Individuals may decide in advance to donate organsorgans Driver’s license/separate donor cardDriver’s license/separate donor card Treat donor same as any other patientTreat donor same as any other patient Communicate information to hospital/medical Communicate information to hospital/medical
directiondirection
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company32
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Medical Identification InsigniaMedical Identification Insignia
Advance directive by medical identification Advance directive by medical identification insigniainsignia Bracelet/necklacesBracelet/necklaces
• Also for other medical conditionsAlso for other medical conditions
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company33
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Crime ScenesCrime Scenes
Emergency careEmergency care Ensure safety for self, fellow respondersEnsure safety for self, fellow responders Notify police through dispatchNotify police through dispatch Try not to disturb any item at sceneTry not to disturb any item at scene Do not cut through holes in clothing, if possibleDo not cut through holes in clothing, if possible Chain of evidence/custodyChain of evidence/custody
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company34
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Risk ManagementRisk Management
Practices by healthcare providers that reduce Practices by healthcare providers that reduce possibility of lawsuit/other legal/professional possibility of lawsuit/other legal/professional actions taken against EMT/medical actions taken against EMT/medical director/agencydirector/agency
Act according to standard of careAct according to standard of care
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company35
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Risk ManagementRisk Management
Document actions carefullyDocument actions carefully Prehospital care record is backbone of defensePrehospital care record is backbone of defense
Act in patient’s best interestAct in patient’s best interest
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company36
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
SummarySummary
Practice Golden Rule Practice Golden Rule
EMTs have ethical, professional duty to EMTs have ethical, professional duty to remain competentremain competent
EMTs are responsible for confidentialityEMTs are responsible for confidentiality
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company37
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
SummarySummary
May be required by law to report certain May be required by law to report certain conditionsconditions
Must function with scope of practiceMust function with scope of practice
Follow standard of careFollow standard of care
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company38
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
SummarySummary
Negligence is deviation from accepted Negligence is deviation from accepted standards of care resulting in injury to patientstandards of care resulting in injury to patient
Federal, state, Good Samaritan laws provide Federal, state, Good Samaritan laws provide degree of protection from lawsuitsdegree of protection from lawsuits
Must obtain consent before treating patient Must obtain consent before treating patient (implied or expressed)(implied or expressed)
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company39
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
SummarySummary
Patient may refuse care if mentally competent Patient may refuse care if mentally competent adultadult Make every attempt to convince patient otherwiseMake every attempt to convince patient otherwise Patient must sign releasePatient must sign release
Prematurely discontinuing care is abandonmentPrematurely discontinuing care is abandonment
Terminal patients may have DNR, advance Terminal patients may have DNR, advance directive, healthcare proxiesdirective, healthcare proxies
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company40
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
SummarySummary
If organ donation indicated on driver’s license, If organ donation indicated on driver’s license, donor card, communicate with hospitaldonor card, communicate with hospital
Do not disturb crime scene unless required for Do not disturb crime scene unless required for patient care; maintain & document chain of patient care; maintain & document chain of evidenceevidence
Prevent lawsuits - act according to standard of Prevent lawsuits - act according to standard of carecare
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company41
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Questions?