Week 9
- Look up physician assistant licensing laws for Florida
- Where is this located in the body (title/chapter, section/division/part number)?
- Under what circumstances do laws state that a PA’s license can be suspended or revoked?
- Provide citation
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Week 10
1.Look up "statutory consent to medically treat laws for florida – this assignment is related to the materials in this week's content. Do not research age of consent laws related to sex.
2. Where is the law located?
3. What does the law say about consent in emergency medical situations?
Cite your research and sources.
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Week 10 part 2
1. Research the following cases:
*Harold Glucksberg case (90s)
*Terri Schiavo case (90s to 2000s)
*Brittany Maynard case (2010s)
2. Summarize the facts of each case for the class
3. What laws and court cases are involved?
4. Summarize both sides of the argument
5. Besides the right to die, what are some related legal issues? (ex: disability rights, due process, advance directives)
Cite your research and sources.
Patient Records and Legal Reporting
Information Management
A process intended to facilitate the flow of information within and between departments and caregivers
Determine customer needs
Set goals and establish priorities
Improve accuracy of data collection
Provide uniformity in data collection definitions
Limit duplication of entries
Information Management
Deliver timely and accurate information
Provide easy access to information
Maintain security and confidentiality of information
Enhance patient care activities
Improve collaboration through information sharing
Information Management
Establish disaster plans for information recovery
Provide orientation and staff training
Annual review of information management plan
Scope
Organization
Objectives
Effectiveness
Medical Record: Means of Communication
Documentation of patient’s:
Illness
Symptoms
Diagnosis
Treatment
Medical Record: Means of Communication
Communication tool (e.g., progress notes)
Protect legal interests of patient and provider
Provide database for use in statistical reporting
Continuing education
Research
Provide information for billing
Medical Record Contents
Admission record
Age
Address
Reason for admission
Social security number
Marital status
Religion
Health insurance
Medical Record Contents
Consent authorization for treatment
Advance directives
History and physical exam
Diagnosis
Information that supports the diagnosis
Patient screenings and assessments
Medical Record Contents
Treatment plan
Physicians’ orders
Progress notes
Nursing notes
Integrated record includes physician progress and nursing notes along with the notes of other disciplines
Medical Record Contents
Diagnostic reports
For example, laboratory and imaging
Consultation reports
Vital signs
Fluid intake and output
Pain management records
Anesthesia assessment
Medical Record Contents
Operative reports
Medication administration records
Discharge planning
Patient education
Discharge summaries
Documentation of Care
Record accurate entries
Nurse’s charting
Documentation and reimbursement (DRGs)
Charting by exception
A system where nurses notes record concise and significant changes in a patient’s conditions
Failure to maintain records
Medical record battleground
Not to be used for complaining about others
Diagnosis-Related Groups (DRGs)
Patients classified into categories based on age, diagnosis and treatment required
Used by Medicare to reimburse providers
Based on preestablished average prices for each DRG
If hospitals can provide quality patient care at a lower cost, they keep the extra money
Incentive to keep costs under control
Privacy Act of 1974 5 U.S.C. 552
Enacted to safeguard individual privacy from misuse of federal records, to give individuals access to records concerning themselves that are maintained by federal agencies, and to establish a Privacy Protection Safety Commission.
Health Insurance Portability and Accountability Act (HIPAA)
Designed to protect the privacy, confidentiality, and security of patient information
Standards apply to all health information in all formats
HIPAA: Privacy Provision
Patients are able to access their records and request correction of errors.
Patients must be informed of how personal information will be used.
Patient consent for release of information for marketing purposes required.
Patients can ask insurers and providers to take reasonable steps to ensure their communications are confidential.
Patients can file privacy-related complaints.
HIPAA: Privacy Provision
Health insurers or providers document their privacy procedures.
Health insurers or providers designate a privacy officer and train their employees.
Providers may use patient information without patient consent for:
Purposes of providing treatment
Obtaining payment for services
Performing non-treatment operational tasks of the provider’s business
HIPAA: Security Provision
Policies and procedures are designed to show how the entity will comply with the act.
Entities must adopt a written set of privacy policies and procedures.
The privacy officer develops and implements policies and procedures.
Policies and procedures must reference management oversight & organization buy-in to comply with documented security controls.
Procedures identify employees who will have access to protected health information.
Access to protected health information (PHI) in all forms is restricted to employees who have a need for it to complete job function.
HIPAA: Security Provision
Procedures address access authorization, establishment, modification, and termination.
There is an ongoing training program.
Entities that outsource business processes to a third party ensure vendors have framework to comply with HIPAA.
Care is taken to determine if the vendor further outsources any data handling functions to other vendors, while monitoring whether appropriate contracts and controls are in place.
There is a contingency plan for responding to emergencies.
Covered entities are responsible for backing up their data and having disaster recovery procedures in place.
HIPAA: Security Provision
Recovery plan should document data priority and failure analysis, testing activities, and change control procedures.
Internal audits review operations with goal of identifying potential security violations.
Policies and procedures document scope, frequency, and procedures of audits.
Audits are routine and event based.
Procedures document instructions for addressing and responding to security breaches.
HIPAA: Physical Safeguards
Responsibility for security must be assigned to a specific person or department.
Controls must govern the introduction and removal of hardware and software from the network.
When equipment is retired, it must be disposed of properly to ensure that PHI is not compromised.
Access to equipment containing health information should be carefully controlled and monitored.
Access to hardware and software must be limited to properly authorized individuals.
HIPAA: Physical Safeguards
Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
Policies are required to address proper workstation use.
Workstations should be removed from high-traffic areas and monitor screens should not be in direct view of the public.
If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.
HIPAA: Technical Safeguards
Information systems housing PHI must be protected from intrusion.
When information flows over open networks, some form of encryption must be utilized.
If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.
Each covered entity is responsible for ensuring data within its systems has not been changed or erased in an unauthorized manner.
HIPAA: Technical Safeguards
Data corroboration, including use of check sum, double-keying, message authentication, and digital signature, may be used to ensure data integrity.
Covered entities must also authenticate entities with which they communicate.
Authentication consists of corroborating that an entity is who it claims to be.
Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.
HIPAA: Technical Safeguards
Information technology documentation should also include a written record of all configuration settings on components of the network because these components are complex, configurable, and always changing.
Documented risk analysis and risk management programs are required.
HITECH Act
Health Information Technology for Economic and Clinical Health (HITECH) Act
Provides that the Secretary of HHS must post a listing of breaches of unsecured protected health information affecting 500 or more individuals
https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
Medical Records: Ownership and Release
Ownership resides with the organization rendering treatment.
Right to privacy: the right to be kept out of the public spotlight
Organizations and physicians can withhold records if the info could be expected to cause substantial and identifiable harm to the patient
Medical Records: Ownership and Release
Request by patients
Failure to release records
Legal action
Requests by third parties
Insurance carriers processing claims
Medical researchers
Educators
Government agencies
Privacy exceptions
Criminal investigations
Medicaid fraud
Substance abuse records
Use Of Patient Data Gathered
Provider mistakes often occur because of unwieldy, unorganized, and voluminous amounts of information gathered on patients.
Caregivers who fail to use information collected when assessing patient needs may find themselves in a lawsuit.
Todd v. Sauls
Physician breached his duty of care for failure to read nursing notes
Retention of Records
Varies state to state
Failure to Preserve X-rays
Illinois Supreme Court held hospitals must retain X-rays and other such photographs or films as part of their regularly maintained records for a period of 5 years.
Rodgers v. St. Mary's Hosp. of Decatur
Electronic Medical Records: Advantages
Retrieves patient information
Improves productivity and quality
Reduces costs
Supports clinical research
Education
Computer-assisted diagnosis and treatment
Electronic Medical Records: Advantages
Allows for computer-generated prescriptions
Generates reminders for follow-up testing
Assists in decision-making process
Aids in standardizing treatment protocols
Assists in identification of drug–drug and food–drug interactions
Telecommunications
Electronic Medical Records: Disadvantages
Increased risk of lost confidentiality and unauthorized disclosure of information
Technology crime and related illegal activities
Increase in cyber crime
Costs to protect networks and critical infrastructures from cyber-based threats
One checkmark on a computer form can populate many fields and multiple pages, giving the impression that a thorough patient assessment was conducted.
Legal Proceedings and the Medical Record
Complete, accurate, and timely records
Reconstructs events surrounding alleged negligence
Aid police in investigations
Provides information as to the cause of death
Aids in information recall for witnesses
Falsification of Medical Records
Falsifying Medical or Business Records
Alteration and Destruction of Medical Records
Tampering with Medical Records
Nurse Changes Record Entries
Illegible Handwriting
Poor penmanship can lead to patient injury.
The American Medical Association encourages physicians to print, type, or computerize their orders.
A Harvard study found that penmanship was among the causes of 220 prescription errors out of 30,000 cases.
Timely Completion: Medical Records
Caregivers must promptly complete records.
Failure to timely record patient information can lead to forgetfulness and documenting the wrong information on the wrong record.
Failure to complete records as required by policy can be the basis for suspension of privileges.
Confidential and Privileged: Communications
Health Care Quality Improvement Act of 1986
Insulates certain medical peer activities affecting medical staff privileges from antitrust liability
Reasonable belief that it is conducted in furtherance of health care
Remember, ordinary business documents are NOT privileged
Burden to establish privilege on party seeking to shield info from discovery
Confidential and Privileged: Communications
Attorney–client privilege
Preclude discovery of memoranda written to an organization’s risk management director
Physician–patient confidentiality
Info acquired by physicians will not be disclosed, unless the patient consents or the law requires disclosure
HIV confidentiality
Duty to disclose vs. rights of confidentiality
Confidential and Privileged: Communications
Privileging and credentialing
Committee’s action or its exchange of honest self-critical study (peer review) vs. factual accountings of otherwise discoverable facts (ex: committee minutes, general policies and procedures for staff monitoring)
Courts’ opinions are mixed, depends on state law, scope and legislative intent
Ex: application for staff privileges
Confidential and Privileged: Communications
Privileged information considerations
Extent to which the information may be available from other sources
Degree of harm that the litigant will suffer from its unavailability
Possible prejudice in the agency’s decision
Charting: Helpful Advice
Complete and pertinent entries
Timely entries
Legible entries
Clear and meaningful entries
Complete
Charting: Helpful Advice
Avoid
Defensive and derogatory notes
Erasures and correction fluids
Criticism
Complaints
Tampering with the chart
Secure records pending legal action
Charting: Helpful Advice
Obtain legal advice
Entries made by others must not be ignored
Patient care is a collaborative interdisciplinary team effort
Entries made by healthcare professionals provide valuable information in treating the patient
Charting: Helpful Advice
Reasoning for not following the advice of a consultant should be noted in the medical record, not so as to discredit the consultant, but to show the reasoning why a consultant’s advice was not followed.
Find and Research Laws
https://www.loc.gov/law/help/guide.php (Library of Congress legal research site)
https://uscode.house.gov/browse.xhtml (Federal Statutes)
https://www.law.cornell.edu/cfr/text
(Federal Regulations)
Find and Research Laws
State Laws
https://www.loc.gov/law/help/guide/states.php
Also use state legislature websites
Case Law/Court Opinions
Individual Exercise 1: Research Laws
Look up physician assistant licensing laws for the state you were assigned
Where is this located in the body (title/chapter, section/division/part number)?
Under what circumstances do laws state that a PA’s license can be suspended or revoked?
Provide citation
Legal Reporting Requirements
Abuse
Abuse in the healthcare setting often occurs to those who are most vulnerable and dependent on others for care.
Abuse can take many forms, such as physical, psychological, medical, and financial.
Abuse is not always easy to identify because injuries can often be attributed to other causes.
Child Abuse
Intentional serious mental, emotional, sexual, and/or physical injury inflicted by family or other person responsible for care
Child Abuse Prevention and Treatment Act (CAPTA)
Minimum standards states must incorporate in their statutory definitions of child abuse and neglect
Child Abuse: Who Should Report
Healthcare setting
Administrators, physicians, interns, registered nurses, chiropractors, social service workers, psychologists, dentists, osteopaths, optometrists, podiatrists, mental health professionals, & volunteers in residential facilities
Penalties for failure to report
States vary on penalties
Good faith reporting immune to liability
Child Abuse: How to Detect
Indicators of abuse and maltreatment that appear to be part of a pattern
Physical indicators
Bruises
Sprains
Fractures
Cigarette burns
Child Abuse: How to Detect
Behavioral indicators
Diminished psychological or intellectual functioning
Failure to thrive
No control of aggression
Self-destructive impulses
Decreased ability to think and reason
Acting out and misbehavior, or habitual truancy
Senior Abuse
Mistreatment: Results in harm or loss
It can involve:
Physical and sexual abuse
Domestic and psychological abuse
Financial abuse
Neglect
Failure to provide needed care
Senate Select Committee on Aging
Less likely to be reported than child abuse
Most instances of senior abuse
Repeated events
Not one-time occurrences
Senate Select Committee on Aging
Victims are often 75 years of age or older, & women more likely to be abused than men.
Seniors often ashamed to admit their loved ones abuse them.
May fear reprisals if they complain
Family members are resentful of a frail & dependent senior parent.
Majority of abusers are relatives or caregivers
National Center on Elder Abuse
The National Center on Elder Abuse (NCEA), directed by the U.S. Administration on Aging, is committed to helping national, state, and local partners in the field be fully prepared to ensure that older Americans will live with dignity, integrity, and independence, and without abuse, neglect, and exploitation.
Preventing Abuse: Policies and Procedures
Prohibition of mistreatment
Description of reporting procedures regarding alleged abuse
Maintenance of evidence of alleged abuse
Investigation of alleged abuse
Prevention of further potential abuse while investigation is in progress
Abuse: Documentation
Suspected abuse should be defined clearly and objectively.
Witnesses: Reporters of abuse must describe statements made by others as accurately as possible.
What actions were taken, by whom, when, where, etc.
Information should be included about how witnesses may be contacted.
Photographs: It may be necessary to photograph wounds or injuries.
Hospital emergency room or the police department can be asked to photograph in emergency situations.
Communicable Diseases
Reported to protect citizens from infectious diseases
Reporting required by statutes
AIDS
State HIV required reporting
Mandatory testing
Births and Deaths
Reportable by statute (all births and deaths)
Physician that pronounces death must sign death certificate
Necessary to maintain accurate census
Medical examiner
Suspicious deaths
Determines cause of death
Adverse Drug Reactions
Harmful drug reactions that occur as a result of administration of a drug or combination of drugs
Medwatch
FDA program for reporting harmful reactions
Physician Competency
Health Care Quality Improvement Act
Encourage physicians to participate in peer review
Restricts ability of incompetent physicians to move from state to state without disclosure/discovery of their previous substandard care or unprofessional conduct
Authorizes National Practitioner Data Bank to collect & release information on professional competence & conduct of healthcare practitioners
National Practitioner Data Bank
Created by Congress as national repository of information with primary purpose of facilitating a comprehensive review of healthcare practitioners’ professional credentials
Operates under authority of the Secretary of DHHS
Applies to healthcare entities and healthcare practitioners
Hospitals must report adverse actions within 30 days
Confidential information
Incident Reporting
States’ reportable incidents
Serious injury or death
Hospital-acquired infections
Fires
Loss of power
Employment strikes
Incident Reporting
Are incident reports discoverable?
Conflicting case law
Report prepared in anticipation of litigation
Prepared in ordinary course of business
Factual narratives
Sentinel Events
Unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof
“Or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.
Unanticipated death
Major permanent loss of function
Sentinel Events Examples
Suicide
Unanticipated death of a full-term infant
Infant abduction
Rape
Hemolytic transfusion reaction
Surgery on the wrong patient or wrong body part
Root Cause Analysis
Process for identifying basic or causal factors that underlie the variation in performance including the occurrence or possible occurrence of a sentinel event
Focuses on systems and processes
Goal is to improve organizational performance outcomes
Root Cause Analysis
Thorough
Credible
Investigation involves general and special causes
Researching literature
Search for best practices
Implementing and monitoring change
,
Patient Consent, Rights, and Responsibilities
Patient Consent
[N]o right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his own person.
—Union Pacific Ry. Co. v. Botsford
Consent
Voluntary agreement by a person who possesses sufficient mental capacity to make an intelligent choice to allow something proposed by another to be performed on himself or herself
Forms of Consent
Express consent can take the form of:
Verbal agreement
Written document authorizing medical care
Implied consent
Determined by some act or silence, which raises a presumption consent has been authorized
Generally applicable to emergency situations
Informed Consent
Legal doctrine where a patient has a right to know potential risks, benefits, and alternatives of a proposed procedure
Patient has absolute right to know about and select from available treatment options.
Predicated on duty of physician to disclose sufficient information to enable a patient to evaluate proposed medical or surgical procedures before submitting to them
Informed Consent
Verbal consent
Binding as written consent
More difficult to prove
Written consent
Visible proof of a patient’s wishes
When a proposed treatment may some unusual risk to the patient
Elements of Informed Consent
Nature of patient’s illness or injury
Procedure or treatment consented to
Purpose of proposed treatment
Risks and probable consequences of the proposed treatment
Probability proposed treatment will be successful
Elements of Informed Consent
6. Alternative methods of treatment, plus their risks and benefits
7. Risks and prognosis if no treatment is rendered
8. Patient understands nature of proposed treatment, alternatives, risks, and probable consequences of treatment
9. Signatures of patient, physician, and witnesses
10. Date the consent is signed
Implied Consent
Unconscious patients are presumed under law to approve treatment
Generally presumed when immediate action is required to prevent death or permanent impairment
Voluntarily submit to a procedure thereby implying consent (through actions not words)
Statutory Consent
Legislation allows emergency care
Eliminating need for written consent
Presumption:
A reasonable person would consent to lifesaving medical intervention.
Document need for immediate care
Attempt to contact family
Consider court order if necessary
Second opinion when in doubt
Judicial Consent
May be necessary in those instances where there is concern as to the absence or legality of consent.
Judge should be contacted only after alternative methods have been exhausted.
Some courts may require an attorney to initiate the call.
Physicians: Informed Consent
Physicians are expected to disclose to patients risks, benefits, and alternatives of recommended procedures
Disclosure should include what a reasonable person would consider material to his or her decision of whether or not to undergo treatment
Doctrine of informed consent is firmly rooted in the notions of liberty and individual autonomy
Informed consent is not merely a tool to avoid lawsuits
Physicians: Informed Consent
Physicians reveal to their patients information that skilled physicians of good standing would provide under the same or similar circumstance
NOT under duty to elucidate every little detail or all possible risk
Must adequately present material facts (ex: risks of a serious nature)
Consent is not valid if the patient does not understand
Course of Treatment Case: Patient’s Decision
Elderly woman living alone fell and fractured her hip
Orthopedic surgeon ordered bed rest
Plaintiff maintained independent style of living
Expert testimony
Bed rest inappropriate treatment
Patient successful in proving that she was not informed of alternative treatment
Course of Treatment Case: Patient’s Decision
Court held “necessary to advise a patient when considering alternative courses of treatment”
Physician should have explained alternatives
Risks & likely outcomes of alternatives
Matthies v. Mastromonaco
Lack of Consent: Riser v. American Medical Intern, Inc.
Patient had multiple medical diagnoses.
Physician ordered bilateral arteriograms to determine cause of patient’s impaired circulation.
Hospital could not accommodate physician’s request & patient was transferred to a radiologist at St. Jude Hospital.
He performed a femoral arteriogram, not the bilateral brachial arteriogram ordered by the ordering physician.
Patient was prepared for transfer back to De La Ronde Hospital.
Shortly after ambulance departed, the patient suffered a seizure in the ambulance and was returned to St. Jude.
Lack of Consent: Riser v. American Medical Intern, Inc.
Patient’s condition deteriorated, and the patient died 11 days later
Plaintiffs claimed patient was a poor risk for procedure
District court ruled for plaintiffs.
The defendant appealed.
What did the appeals court determine?
Lack of Consent: Riser v. American Medical Intern, Inc.
The Court of Appeals held that there was a breach in the standard of care by subjecting the patient to a procedure that would have no practical benefit to the patient.
The physician had failed to obtain informed consent from the patient.
Hospitals: Informed Consent
Hospitals generally do not have an independent duty to obtain informed consent.
Hospitals will be held liable if physician is an employee, but not an agent/independent contractor
Hospitals: Life or Death: Right to Choose
Jehovah’s Witness, in Stamford Hospital v. Nelly E. Vega, executed a release requesting that no blood or its derivatives be administered during her hospitalization.
Hospital filed a complaint requesting the court issue an injunction.
Connecticut Supreme Court determined hospital had no common law right or obligation to thrust unwanted medical care on a patient.
Nurses: Informed Consent
A nurse generally has no duty to:
Advise a patient as to a procedure to be employed
A nurse may confirm with the patient that the physician has explained the procedure.
Obtain a patient’s informed consent
Policy and procedures may provide that the nurse may witness that the risks, benefits, and alternatives have been explained.
Validity of Consent
Physicians should provide as much information about treatment options as is necessary.
Based on a patient’s personal understanding of the physician’s explanation of risks and the probable consequences of treatment.
Needs of each patient can vary depending on age, maturity, and mental status.
Individual responsible for obtaining consent must weigh importance of giving full disclosure to the patient against the likelihood that such disclosure will adversely affect the patient’s decision.
Validity of Consent
Courts generally utilize an “objective” or “subjective” test to determine whether a patient would have refused treatment if the physician had provided adequate information as to the risks, benefits, and alternatives of the procedure.
Validity of Consent
Subjective test
Must determine if the individual patient would have chosen the procedure if fully informed
Relies on patient testimony
Objective test
Must show that a reasonable person would not have undergone a procedure if properly informed
Objective test preferred
Assessing Decision-Making Capacity
Includes patient’s ability to:
Understand risks, benefits, and alternatives of a proposed test or procedure
Evaluate information provided by the physician
Express his or her treatment preferences
Voluntarily make decisions regarding his or her treatment plan
Without undue influence by family, friends, or medical personnel
Admission Consent Forms: Limited POA
Signed at the time of admission
For routine services
Unwarranted reliance for specific and potentially high-risk procedures/treatments
Limited power of attorney
Written authorization to represent or act on another's behalf in some legal matter
School officials or others acting on parents or guardians’ behalf in case of emergency care
Consent for Specific Procedures
Variety of consent forms
Specifically describe the risks, benefits, and alternatives of particular procedures
Anesthesia
Cardiac catheterization
Surgery
Radiation & chemotherapy therapy
Blood and blood by-products, etc.
Who May Consent
Competent patients
Guardianship
Guardian is an individual who, by law, is vested with the power and charged with the duty of taking care of a patient
Parental consent
Usually required, though in some circumstances courts have held consent of minors to be valid
Emancipated minor
Parental consent not required
Who May Consent
Many states recognize that treatment of certain conditions will not require parental consent
Pregnancy, venereal disease, drug dependency
Matter of public policy: minor may not seek treatment if parental consent is needed
Incompetent Patients
When there is doubt as to a patient’s capacity to consent, the consent of the legal guardian or next of kin should be obtained
Ability to consent is a question of fact
Physicians are in the best position to make that determination
Right to Refuse Treatment and Religious Beliefs
Patients have a right to refuse treatment.
Must be conscious and mentally competent
Hospitals must honor a patient’s decisions when treatment is refused
Religious beliefs
Blood or blood products
Exculpatory Agreements
An agreement that relieves one from liability when he or she has acted in good faith
Exculpatory agreements in the medical setting are generally considered invalid because it is against public policy
Experimental treatments may be an exception to this
Release Form
A patient’s refusal to consent to treatment, for any reason, religious or otherwise, should be noted in the medical record, and a release form should be executed
A completed release provides documented evidence of a patient’s refusal to consent to a recommended treatment
Proving Lack of Consent
Reasonably prudent person in patient’s position would not have undergone treatment if fully informed
Lack of informed consent is proximate cause of injury for which recovery is sought
Informed Consent: Claims and Defenses
Risk not disclosed is commonly known.
Patient assured the practitioner that he or she would undergo treatment regardless of the risk.
For example: Patient did not want to know about the risks.
Consent was not reasonably possible.
Practitioner reasonably believed manner and extent of disclosure could reasonably be expected to adversely and substantially affect patient’s condition.
Assignment 2
Due 4/28/22 by end of day -submit via BB
Explain what HIPPA is and what the federal law's position on patient privacy is.
Look up and list two laws (statutes) in the Act.
Research and list 3 state laws on patient privacy using the state you were assigned in a previous announcement
Do NOT copy and paste
summarize the gist of EACH law in 2-3 sentences
provide the citation for the 3 laws
specify whether this a statute or regulation
Assignment 2
Read the court case Tarasoff v. Regents of University of California
Do you agree with the court's decision? Why or why not?
Provide a discussion in light of HIPPA and the state laws that you found for Q2. Make sure you explain your reasoning
Please follow writing tips, comments and feedback from Paper 1
In-text citations and bibliography required
Text should be double-spaced; tables and bibliography single-spaced
Individual Exercise 1: Research Laws
Look up statutory consent laws for your assigned state
Where is the law located?
What does the law say about consent in emergency situations?
Patient Rights
Know one’s rights
HC orgs should educate patients about their rights
Patient’s bill of rights
42 CFR §483
Explanation of rights
Know caregivers
Ask questions
Patient Rights
Admission
Discrimination prohibited by federal law
Government facilities: no right of admission if not within statutory class (ex: veterans).
Hospital still has duty to extend reasonable care to those who need immediate assistance
Assessments and reassessments
Participate in care decisions
Informed consent
Patient Rights
Right to treatment
discrimination prohibited
Refuse treatment
Patient Self Determination Act of 1990
In some cases, courts will perform a balancing test to determine whether override a competent adult’s decision to refuse medical treatment
State interests (ex: protection of third parties) vs. patient rights
Patient Rights
Pain management
Process whereby caregivers work with the patient to develop a pain control plan
“The facility must ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person- centered care plan, and the residents’ goals and preferences.”
Quality care
Patient Rights
Appoint a surrogate decision maker
Joint Commission: “When a patient is unable to make decisions about his or her care, treatment, and services, the hospital involves a surrogate decision maker in making these decisions.”
Have special needs addressed
Execute advance directives
Advance directives are legal documents where a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity
Patient Rights
Compassionate care
Confidentiality
“The patient has right to the confidentiality of his or her clinical records.”
Exception: making the necessary info available to others involved in the patient’s care
Privacy and HIPAA
HIPPA: Patients have a right to receive a “Notice of Privacy Standards”
Patient Rights
Privacy and HIPAA
Disclosures permitted without patient authorization
To other providers who may be caring for the patient in order to provide safe treatment
To third-party payers to obtain payment of services
For healthcare operations
If required by law enforcement agency
When required to avert a serious threat to public health or safety
Required by military command authorities for their medical records
Patient Rights
Privacy and HIPAA
Disclosures permitted without patient authorization
To worker’s compensation or similar programs for processing of claims
In response to a subpoena for a legal proceeding
To a coroner or medical examiner for purposes of identification
Patient Rights
Privacy and HIPAA
Limitations on disclosures
Right to request restrictions regarding information used or disclosed about treatment or care
Right to request a list of the disclosure made of information released regarding his/her care
Right to amend: if a patient believes medical info is incorrect, right to request that it be corrected
Right to inspect and copy medical information that may be used to make care decisions
Patient Rights
Privacy and HIPAA
Limitations on disclosures
Right to file a complaint with the provider or DHHS if privacy rights are violated
Right to a paper copy of a notice pertaining to the patient
Right to know restriction on rights
Patient Rights
Patient advocate
Long-term care ombudsmen programs
Investigate reports of resident abuse in nursing homes
Established by the Older Americans Act in 1978
Ethics consultation
When faced with challenging treatment decisions that involve ethical dilemmas
However, not binding
Chaplaincy services
Patient Rights
Discharge orders and instructions for follow-up care must be provided to the patient prior to discharge from the hospital
Detainment – which intentional tort?
Patients have a right to be transferred to an appropriate facility when the admitting facility is unable to meet a patient’s needs
Use of transfer agreements
Right to choose receiving facility (pretransfer hearing)
Review of decision to discharge: clear and convincing evidence
Patient Rights
Access medical records
Know hospital’s adverse events
“Patients have a right to have access to any records made or received in the course of business by a health care facility or provider relating to any adverse medical incident.”
Know third-party relationships that may influence care
Ex: educational institutions, insurers, other HC providers
Patient Rights
Patient education
Ex: Medication safety, nutrition, access to community resources, equipment use
Transparency and hospital charges
Failure to disclose insurance applicants’ HIV status
North Carolina Health Care Cost Reduction and Transparency Act
Patient Responsibilities: Contemporary Perspective
Practice a healthy lifestyle
Maintain current medical records
Keep appointments
Provide full disclosure of medical history
Accurately describe symptoms
Patient Responsibilities: Contemporary Perspective
Responsibility to disclose information
Communicate care preferences
Stay informed
Report unexpected changes in health status
Adhere to agreed upon treatment plan
Patient Responsibilities: Contemporary Perspective
Avoid self-administration of medications
Actively participate in care
Comply with hospital policy
Respect
Understand medicine has limits
Patient Responsibilities: Contemporary Perspective
Ask questions
“What is this medication for?”
“What diet am I on?”
“Since you are going to change my dressing, did you wash your hands?”
Tips for Patients: Help Prevent Medical Errors
Medications
Inform your doctors about medicine you are taking.
Bring your medicines and supplements to doctor visits.
Inform your doctor about any allergies and adverse reactions you have had to medicines.
Make sure you can read your doctor’s prescription order.
Tips for Patients: Help Prevent Medical Errors
Ask for information about your medicines in terms you understand—both when your medicines are prescribed and when you pick them up.
When you pick up your medicine from the pharmacy, ask: “Is this the medicine that my doctor prescribed?”
Make queries about any questions and directions on your medicine labels; don’t be afraid to ask.
Tips for Patients: Help Prevent Medical Errors
Ask your pharmacist for the best device to measure your liquid medicine.
Ask for written information about the side effects your medicine could cause.
Tips for Patients: Help Prevent Medical Errors
Hospital stays
If you are in a hospital, consider asking all healthcare workers who will touch you whether they have washed their hands.
When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow at home.
Tips for Patients: Help Prevent Medical Errors
Surgery
If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done.
If you have a choice, choose a hospital where many patients have had the procedure or surgery you need.
Tips for Patients: Help Prevent Medical Errors
Other steps
Speak up if you have questions or concerns.
Make sure that someone, such as your primary care doctor, coordinates your care.
Make sure doctors have your health information.
Tips for Patients: Help Prevent Medical Errors
Ask a family member or friend to go to appointments with you.
Know that “more” is not always better.
If you have a test, do not assume that no news is good news—be sure to follow up.
Learn about your condition and treatments by asking your doctor, nurses, and other reliable sources.
Individual Exercise 2: Right to Die
Research the following cases
Harold Glucksberg case (90s)
Terri Schiavo case (90s to 2000s)
Brittany Maynard case (2010s)
Summarize the facts of each case for the class
What laws and court cases are involved?
Summarize both sides of the argument
Besides the right to die, what are some related legal issues? (ex: disability rights, due process, advance directives)
