LEGAL IMPLICATIONS IN HEALTH

CARE
By Wambua Florence

COURSE OBJECTIVES

By the end of this presentation, the student should be able to:

Define the major terminology used in legal implications in health care. Describe the legal responsibilities and obligations of health care workers. List the elements needed to prove negligence. Give examples of legal issues that arise in health care.

SOURCES OF LAW
Civil law. Criminal law.

TORT
A tort is a civil wrong made against a person or property. It may be intentional or unintentional. Intentional torts are willful acts that violate anothers rights. E.g assault, invasion of privacy and false imprisonment. An example of unintentional torts is negligence.

INTENTIONAL TORTS
Assault: physical or verbal that creates in another person apprehension or fear of imminent harm or offensive contact. E.g, a nurse threatening to give a client injection. Or a radiographer threatening to restrain a client for an x-ray procedure that he has refused to give consent for.

2. BATTERY
Battery: is any intentional physical contact with a person without consent. It may cause injury to a client or may be merely offensive. E.g if the nurse gives the injection, it is battery. Some times the battery could be life saving e.g in blood transfusion.

3. INVASION OF PRIVACY
Invasion of privacy tort protects the clients right to be free from unwanted intrusion into his or her private affairs. This includes confidentiality too. E.g release of clients medical records or information to an unauthorized person like the press or the clients employer or even family members.

4. MEDICAL INFORMATION
Computers and confidentiality: the medical records are protected by passwords and magnetic strip cards. These devices should not be shared with others and used only to retrieve files only when warranted. Improper use of the card to seek confidential information could lead to legal repercussions.

FALSE IMPRISONMENT
This tort serves to protect a persons individual liberty and basic rights. Preventing a client from leaving a health care facility voluntarily may constitute the tort of false imprisonment. The use of restrains physical or chemical, are viewed as false imprisonment.

UNINTENTIONAL TORTS.
Negligence: a lawsuit against negligence is termed malpractice. It also conduct that falls below a standard of care established by the law. It is characterized by thoughtlessness, carelessness or inattention. E.g case study of fall off the examining table; Downey v. Rothwell (1974).

PREVENTION OF NEGLIGENCE
Follow standards of care of your profession. Give competent health care. Insist on appropriate orientation, continued education, adequate staffing and communication with other members of staff. Develop a caring rapport with client. Document care given to client fully.

2.DOCUMENTATION
Medical records are a permanent legal document of the client or hospital. If a client dies and no documentation of care is found, legally, there was negligence. Other care providers may harm the patient in their care due to lack of up to date information. physiotherapy.

3.
Truthful documentation is also essential. Correction in case of a mistake should follow the policies and procedures of the institution. Example Medication given signature of the one who has erased.

CRIMINAL LIABILITY
The difference between a tort and criminal liability is the degree to which the act deviates from the standard of a reasonably competent practitioner. The law must prove that there was extreme carelessness on the part of the health care provider and wanton or reckless disregard for the lives or safety of other persons.

2. CONSENT
A signed consent form is required for treatment, treatment programs involving chemotherapy, procedures and research. If a client is deaf, illiterate or speaks a foreign language, an official interpreter must be available to explain the terms of the consent. Family members should not be used except in as a last resort.

3. INFORMED CONSENT
This is a persons agreement to allow something to happen, such as surgery or an invasive procedure, based on a full disclosure of the likely risks, benefits, alternatives and consequences of refusal. Informed consent creates a legal duty to health care providers to disclose the facts in terms the client can understand.

4.
The explanation should describe treatment alternatives, risk involved in all treatment options. In emergencies however, informed consent that is not obtained may not result in a lawsuit.

5.

Factors required for informed consent:

Brief complete explanation of the procedure or treatment. Names and qualifications of people performing and assisting in the procedure. A description of any possible harm, including damage or death that may occur as a result of the procedure. An explanation of alternative therapies to the proposed as well as the risks of doing nothing.

6. STUDENTS AND LEGAL LIABILITY

Students are liable if their actions cause harm to clients. The liability is generally shared by the student, instructor, hospital or health care facility and university or educational facility. If a student is employed as an aide, they should not perform procedures beyond the scope of an assistant which will be their job description.

PROFESSIONAL LIABILITY PROTECTION

Health care professionals who practice under hospitals are covered by legally by the legal advisor of the hospital. If one should operate independently like in a private clinic, they are liable for their own care.

SHORT STAFFING
During shortages, or staff down sizing, if the health care provider finds that they are working more than their required workload, they should report to their supervisors and if possible put it in writing and a copy kept off. No walk out should be staged in times of shortages as it raises the issue of abandonment.

PHYSICIANS ORDER.
All orders should be assessed and if found to erroneous or harmful further clarification should be sought. A pharmacist may be sought to clarify the order. Physicians should write all orders including DNR. Verbal orders are not encouraged as they increase the room for error.

LEGAL ISSUES IN HEALTH CARE

Abortion: in Rwanda its illegal, so those health care providers found to be performing abortions are liable for prosecution. Drug regulation: Federal acts control manufacture, distribution and sale of drugs, cosmetics and therapeutic devices. The food and drugs act and the controlled drugs and substances acts.

2.
Communicable diseases: HIV, SARS has legal implications for health care providers. Death and dying: definitions of death. brain death, emergence of artificial life support devices, organ transplants and euthanasia. Advance directive: is a mechanism enabling a mentally competent person to plan for a time when he or she may lack mental capacity to make medical decisions.

3.
A living will: is a document in which the person makes an anticipatory refusal of llife prolonging measures during a future state of mental incompetence. Psychiatric advance directive: is a new type of advance directive. Individuals with mental health problems complete it during periods of mental stability and competence outlining how they wihs to be treated in future should their underlying mental illness causes them to loose decision making capacity.

4.
Organ donation: legally competent people are free to donate their bodies or organs for medical use. Mental health issues: mental health act, suicidal patients. Public health issues: reporting suspected abuse and neglect, communicable diseases and other health related issues enacted to protect the publics health.

RISK MANAGEMENT
It is a system of ensuring appropriate health care by identifying potential hazards and eliminating them before harm occurs. Tools used in risk management is the incidence report or adverse occurrence report. These reports are analyzed to see how future problems can be avoided.

QUALITY ASSURANCE
The underlying rationale for quality assurance in risk management programs is the highest possible quality of care. Quality assurance is the responsibility of both the employer and the individual care provider. Good documentation is essential as proof that the health care provider acted ethically, reasonably and safely.

SUMMARY
With increased emphasis on clients rights, care providers should understand their legal obligations. The civil law system protects a persons private rights and the criminal law system with the rights of an individual and society. Clients are entitled to confidential health care and freedom from unauthorized release of information.

2.
A health care provider can be found negligent if the duty to the client is not well carried out, not carried out, the client was injured and the failure for care to be given caused injury. Informed consent document should be consulted and obtained always. Know all the laws that apply to your practice. Incident reports should be filed in all situations when someone could or did get hurt.

The end!