Medico-Legal Issues Trauma Care Rebekah Ley, LLB (Hons), MSc

17
Innovation and excellence in health and care Addenbrooke’s Hospital I Rosie Hospital Medico-Legal Issues Trauma Care Rebekah Ley, LLB (Hons), MSc

description

Medico-Legal Issues Trauma Care Rebekah Ley, LLB (Hons), MSc. Introduction. Challenges of trauma care and trauma units. The Law – but which ones? Scenarios. Ethics. Shields not swords. Challenges. What makes trauma care (the emergency department) different? - PowerPoint PPT Presentation

Transcript of Medico-Legal Issues Trauma Care Rebekah Ley, LLB (Hons), MSc

Page 1: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Innovation and excellence in health and care Addenbrooke’s Hospital I Rosie Hospital

Medico-Legal Issues

Trauma Care Rebekah Ley, LLB (Hons), MSc

Page 2: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Introduction

• Challenges of trauma care and trauma units.• The Law – but which ones?• Scenarios.• Ethics.• Shields not swords.

Innovation and excellence in health and care

Page 3: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Challenges

What makes trauma care (the emergency department) different?

• What do you know about your patient?• How many patients need to be seen?• How quickly must you make a decision?• Quality indicators.• Legal and ethical interface.

Innovation and excellence in health and care

Page 4: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

The Law – but which ones?

• Privacy and confidentiality.– Viewed as a basic human right.– If you don’t keep things secret patients won’t share

important information to enable diagnosis and treatment.

However: sometimes disclosure is compulsory and permissible

– Data Protection Act.– Public Health.– Professional codes of conduct.

Innovation and excellence in health and care

Page 5: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

The Law – but which ones?

• Capacity:– Mental Capacity Act.– Can’t simply explain the risks and then ask a patient

to agree.• Quick screen, ask the patient:

– What is wrong with you?– Do you know what your options are?– What’s likely to happen if you accept the treatment or

refuse it?– What is your choice?– Why have you made this choice?

Innovation and excellence in health and care

Page 6: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

The Law – but which ones?

• Advance Directives:– Basis is the concept of autonomy.– Mental Capacity Act.– Prior the Mental Capacity Act.

• The directive may:– Be a statement a competent individual has made

about desired future care.– Be more formal and rarely appoint a person to make

decisions for them.– Consider intention not just the specifics; consult.

Innovation and excellence in health and care

Page 7: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

The Law – but which ones?

• Criminal behaviour– Investigation and prevention of crime.– Road traffic offences.– Judicial or other statutory proceedings.– Safeguarding.

Innovation and excellence in health and care

Page 8: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios – Privacy and Confidentiality

15 year old girl admitted following RTA; her boyfriend was driving the car. She admits to being pregnant. She tells you that she does not want her parents to know. What should you do?

Innovation and excellence in health and care

Page 9: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios – Privacy and Confidentiality

Consider:• Normally only share with express consent.• Competence.• GMC Guidance.• Safeguarding issues?

Page 10: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios - Capacity

27 year old male brought to the Trauma Centre by friends after consuming an unspecified amount of cocaine. He is unkempt and shivering. His observations are: pulse 172 bpm; BP 196/30 mm Hg; RR 36 breaths/min; temp 37.8˚C; Sp02 100% on room air. He is connected to a cardiac monitor, given oxygen and an intravenous catheter inserted.

Innovation and excellence in health and care

Page 11: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios - Capacity

The doctor asks for the patient to be given 10mg of diazepam. The patient says he doesn’t want it. He says that he has been through this before and recovered. His friends say that “he doesn’t’ know what he’s saying” and ask the doctors to treat him.

What should you do?

Page 12: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios - Capacity

• The consequences of refusing emergency care may be serious and permanent.

• Sudden cardiac arrest?• Intoxicants, hypoxia, brain injury, mental illness and

dementia are common problems that can impair decision making but just because they are present doesn’t mean the patient lacks capacity.

• Be sure to assess carefully you can use the quick screen.

• Can you defer the decision while the patient improves?• Document the decision

Innovation and excellence in health and care

Page 13: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios – Advance Directives

A 75 year old male has been airlifted to hospital after falling 10ft from a roof. He was initially unconscious but when paramedics arrived he was awake but confused. His GCS was 14. He was immobilised with a C-collar and backboard. During transfer to the trauma centre his GCS dropped from 14 to 10. On assessment significant head injury was suspected and arrangements being made to transfer the patient to CT when the patient’s wife and son arrive.

Innovation and excellence in health and care

Page 14: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios – Advance Directives

The patient suddenly deteriorates dropping his GCS to 8. Clinicians prepare to intubate but the wife becomes very upset saying that her husband has a living will that says if he is critically ill he does not want any interventions including intubation.

Page 15: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Scenarios – Advance Directives

• Advance Directives/living wills can have limited application.

• Context.• Would the patient have wanted the directive to apply to

this particular circumstance e.g., did he write it contemplating something irreversible or this situation?

• What will you do?

Innovation and excellence in health and care

Page 16: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Ethics

• Understanding and acknowledging your own views.• Dissecting common problems and common themes.

Remember:• Ethics and the law are not the same: following the law

does not necessarily result in ethical behaviour and ethical behaviour might not be covered by the law.

• Difficult to disentangle these concepts in trauma care. • While legal and ethical conclusions may be similar,

ethical and legal analysis are often very different.

Innovation and excellence in health and care

Page 17: Medico-Legal Issues  Trauma Care  Rebekah Ley, LLB (Hons), MSc

Shields not swords

Having worked in the NHS for twenty years I have seen most things.

The best advice I can give anybody here today is simple (you should be doing it anyway) but just in case…

I call it 3Cs -

• Casenotes

• Communication

• Competence

Innovation and excellence in health and care