Medical-Legal Issues 11/ 06/2011. when they don’t feel they have received treatment living up to...
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Transcript of Medical-Legal Issues 11/ 06/2011. when they don’t feel they have received treatment living up to...
when they don’t feel they have received treatment living up to that standard
they are becoming more willing to seek legal compensation -$$$
Public has increasing awareness of expected standards of care
Torts (Civil wrong)
Area of law dealing with violations of civil rights, rather than criminal acts
Court attempts to provide a remedy in form of an action for damages ($$$)
2 types-
– IntentionalAssaultBatteryFalse imprisonmentLibel and slanderInvasion of privacy
– Unintentional acts (negligence)
Assault:
Any act that creates apprehension in another of imminent, harmful, or offensive contact
Or an attempt of an act with intent to commit a batteryTo be guilty: injury doesn’t have to occur or nor does
attempt need to be successful - Throwing a rock and missing
- A punch that doesn’t connect
Assault could be telling Pt. you are going to do an exam they are not supposed to have!!
BatteryAccording to Calif. Penal Code 242
Any willful and unlawful use of force or violence upon the person of another
(even if no bodily harm, pain or physical marks result!)
Harmful or offensive touching of another
Grabbing someone by clothing, or touching them in angry, vengeful, rude or hostile manner
-even if its just that person’s perception
Spitting on someone
Kissing or hugging someone
Fondling or grabbing body parts
…could be construed as battery!
Examples of Battery
Battery cont’d
Must be willful- intent must be there- act was not accidental (bumping into someone, car accident- not willful)
Assault is the attempt, battery is the success
Battery implies assault- cannot be battery without assault
Parent Chastising Child is not guilty of Assault and Battery
If punishment is reasonable
But, if an instrument is used likely to cause serious injury,
- then parent could be prosecuted for criminal offense
Although battery implies willful act to harm or provoke –
A reassuring touch on Pt’s shoulder could be battery!
if Pt. has forbidden you to touch them
You might be guilty of battery if –
you have not explained properly everything you are about to do and Pt freaks out and jumps up and hits head on tube
It is OK to restrain a Pt who is a danger to themselves or others
You could also be guilty of battery-
If you take a radiograph against pt’s will
Or radiograph the wrong pt
Or radiograph the wrong body part
Or take Excessive repeat exposures
How To Prevent Accusations Of Assault And Battery when dealing with Pts
Make sure you are doing right Pt! Check identification prior to beginning exam
Read requisition carefully
-make sure you are doing right exam -on correct body part
Explain exam fully
Check if female pt. could be pregnant
Shield!
Injury Reporting
Tech must report any injury to supervisor immediately!
No matter how minor the incident, or how unlikely there is an injury, err on side of caution!
Be careful! Pt could get fingers caught in fluoroscopy unit as it moves, even if they do not mention it and show no signs of injury- you could still be liable!
Make sure to check condition of Pt at all times!
“Snitch Law”
According to Safe Medical Devices Act of 1991:
Techs who fail to report defects and failures in medical devices ..
Could be liable for Civil Penalties from $15,000 up to $1 million per case!
Even broken measuring ruler on tube could be grounds for suit!
Report any equipment breakdown immediately to supervisor!
False Imprisonment
Intentional confinement without authorization using force, threat of force, confining clothing or structures
(Becomes an issue when a pt wishes to leave and cannot do so)
Inappropriate restraints can constitute false imprisonment, i.e., brat board to restrain a child without first explaining to parents
Not immediately releasing child from pigg-o-stat if parent requests
It is OK to restrain a Pt who is a danger to themselves or others
Libel And Slander
Torts that effect person’s good name or reputation (information must be untrue)
Slander– Oral defamation of character
Libel– Written defamation of character
Examples: spreading untrue rumors about Pt, staff or studentsWriting evaluations that are unfair or using false informationWriting on request that Pt refused repeat, just to get out of doing it
Invasion of Privacy
Touching a Pt inappropriately (may only be their perception of it!)
Be careful when checking for landmarks or placing shielding on Pt
Always explain first what you are about to do!
Not protecting a Pt’s modesty:
Not dressing a Pt properly in gownNot covering with sheet or blanket
Gossiping about a Pt
Not protecting confidentiality of records
What is a “Breach”?A failure to live up to the requirements or standards set forth in an agreement, contract or promise….
What is the most common reason for pts suing hospital, doctor or other health care individual?
Breach of confidentiality
Breach of Duty
Not performing to standards of profession, hospital, or dept.Examples:
Turning in x-rays which you know are not acceptable, and could be improved
(if Pt gets worse because diagnosis could not be made because of poor films-could be lawsuit!)
Not shielding
Attempting to do an exam you are not qualified to do
Not checking to see if Pt is pregnant
Negligence
Radiographer unintentionally causes injury to Pt
Between Tech and Pt there is implied contract to provide reasonable care
Neglect or omission of reasonable care or caution in this relationship is negligence
Can result in a malpractice lawsuit!
Negligence (cont’d)
Wantonly negligent or recklessness in exposing others to danger
Not shielding!
Over-exposing pt. to radiation when using CR or DR with use of intentionally high mAs in order to window and level after to make sure you don’t have to repeat image
Not guarding against Pt falling off table
(2 people walked Tania and I to car in wheel chair after dental surgery- waited until seatbelts on, engine started)
Respondeat Superior
Latin phrase meaning “ let the master answer”
Hospital must pay for torts committed by employees
Injured pt doesn’t have to prove hospital negligent, only technologist
Hospital automatically liable, but tech may still be sued
Res Ipsa Loquitor
Latin phrase meaning “thing speaks for itself”
Usuallly plantiff has to prove defendant negligent
In this case, defendant has to prove innocence
Example: pt has radiation burns that could only be caused by negligence on part of tech. Tech must prove they were not the responsible party
For a radiographer to be held negligent in court, 4 factors must be established:
1. Duty was expected of the radiographer (Standard of care)
2. Breach of duty by radiographer3. Injury to pt must actually have occurred4. Cause of injury due to radiographer’s negligence
(could a reasonably cautious Tech foreseen consequences?)
Doctrine of Reasonably Prudent Man(Radiologic Technologist)
When judging whether a Tech has been negligent in their duties:
How would a technologist who is:Reasonably prudent Has comparable education and skillProviding reasonable standard of care, skill and behavior
respond in this situation?
Court interviews experts in field to establish standards
Doctrine of Foreseeability
Principle of law that holds individual liable for injury that results from a negligent act that could or should have been foreseen
Examples: Not having enough assistance when moving Pt onto tableUsing table with broken foot rest
Wallboard holder that’s not secure
Outdated drugs
Understaffing- (A Pt dies or suffers damage from too long of a wait,or Tech rushing to keep up with back log of Pts)
Cause and effect relationship
Plaintiff (person initiating law suit) must must prove the connection between injury and Tech’s actions
What if Pt was radiated and later found to be pregnant, and gave birth to a child with birth defects?
Did Tech check if Pt was pregnant?
Did Tech exercise reasonable caution even if Pt thought she wasn’t pregnant?
Plaintiff would have to prove that birth defects were a result of x-rays
Doctrine of Personal Responsibility
Even though hospital may be sued and held legally liable for actions-
Law does not permit wrongdoer (YOU) from escaping legal liability!
You are still legally responsible and accountable!
Radiographer might want to consider getting personal medical malpractice insurance
(You are not responsible for anything hospital or Radiologist may do)
What if Pt falls getting off table to vomit in sink while you are checking images, after complaining to you they
felt nauseous?
You are negligent under Doctrine of Personal Responsibility!
Never leave Pt unattended in X-ray room!
If there is an injury- who is liable?
IF : Supervisor knowingly assigns you to do a task you are not qualified to do, and you do it anyway?
Both of you!
IF: Student decides on their own to attempt an exam they have not been signed off on?
If Supervisor did not assign or know student was going to do exam- student alone is liable
(but hospital has deeper pockets and no doubt has insurance)
Sharing the blame
Contributory negligence– Pt contributed to injury
Comparative negligence– Fault of Pt and radiographer are equal
Assumption of risk– Pt knew the dangers ahead of time
• Had given informed consent
Informed Consent
Pt has right to know and participate in his/her own health care
Pt must be informed of:– Nature of treatment/procedure
– Any risk, complications, expected benefits or effects of such treatment
– Any alternatives to procedure and their risks and benefits
3 Types Of Consent:
Written consentExpressed consent– Verbal
Implied consent– By action– What if pt. is unconscious when they arrive at ER?
All are binding in court!All are binding in court!
If you perform exam without consent- you just committed battery!
Who May Give Consent for a Procedure?
Any person over 18 who is declared conscious and competent
Spouses have no authority to consent for each other
Can a minor give consent for themselves?– -No! only parents and legal guardians can consent unless…
• Minor is emancipated If pregnant- automatically emancipated
• Life threatening situation occurs during regular school hours- State can consent for minor