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LEGAL CONCERNS

SIR. EURICH ROI C. ARANETA, RRT


LAW
A rule of conduct or action prescribed or
formally recognized as binding or enforced
by a controlling authority
•Substantive Law – purpose of the law
•Procedural Law – method in which a
law is executed
Public Law and Private Law
• Public Law – from the latin phrase ius publicum which refers
to the relationship of the individual to the state or
government
• Private Law – laws that involves the relationship between
individuals like contract law and tort law
a. Contract Law - concerns the rights and duties that
arise from agreements
b. Tort Law – concerns the wrongdoings that are done
by one party against another (intentional or non-intentional)
Types of Law
1. Common
2. Criminal
3. Civil
4. Administrative
5. Public Law
Common Law
•is judge-made, not codified or enacted
through written legislation
•established through precedent and
customary traditions
•In contrast with statutory law (laws
derived from legislative enactments)
Criminal Law
• Aka Penal Law
• body of law that relates to crime that can be threatening
or harmful to the property, health, safety, and moral
welfare of people

• Crime - commission of an act that is forbidden


- omission of a duty that is commanded by a
public law
Level of Seriousness of a Crime
1. Felony – more serious crimes such as murder,
kidnapping, or robbery
- punishment: can be a year or more in a
prison and sometimes accompanied with paying of
damages done
2. Misdemeanor – less serious crimes such as shoplifting
- punishment: less than a year
Objectives of Criminal Law
1. Retribution
2. Deterrence
3. Incapacitation
4. Rehabilitation
5. Restoration
Retribution
•the most widely seen goal
•Criminals ought to Be Punished in some
way
Deterrence
•aim is to impose a sufficient penalty to
discourage the offender from criminal
behavior
•use of punishment as a threat to deter
people in doing crimes
Incapacitation
•Designed simply to keep criminals away from
society so that the public is protected from
their misconduct
•Through prison, or simply by putting the
criminal to jail
Rehabilitation

aims at transforming an
offender into a valuable
member of society
Restoration

is to repair, through state


authority, any injury inflicted
upon the victim by the offender
Aspect of Criminal Law Statutes
1. mens rea – a latin phrase which means “guilty mind”
- is the mental state that one must possess when committing a crime
2. actus reus – a latin phrase which means “guilty act”
- refers to the action taken by the perpetrator
3. mala in se - a latin phrase which means “bad itself”
- refers to acts that are bad all by themselves (violent crimes)
4. mala prohibita – a latin phrase which means “wrong because prohibited”
- acts that are illegal even though they may not be actually evil
(malum – singular)
Civil Law

the body of laws of a state


regulating ordinary private
matters
What is the difference between Civil and
Criminal Law
CIVIL LAW CRIMINAL LAW

DEFINITION Disputes within the individual Deals with crimes

PURPOSE Compensation is awarded to the Punishment for the suspect


victim

TYPE OF PUNISHMENT Compensation Imprisonment or death penalty

EXAMPLES Landlord-tenant / diversion / Theft, assault, murder


child custody
Administrative Law

rules and regulations enforced by


various government agencies
Example: LTO, CHED, POEA….
Patient`s Bill of Right
and Patient Care Partnership

These bills delineate the rights


of the patient as a consumer
of healthcare
12 Patient`s Bill of Right
1. the right to considerate and respectful care
2. the right to obtain from his physician complete and current information
in terms the patient can reasonably expect to understand; also included
the right to know the identity of any physicians, nurses, and others that
involved in their care
3. the right to make decisions about the plan of care prior to and during
the treatment
4. the right to have an advance directive
5. the right for privacy
6. the right for confidentiality
7. the right to review the records pertaining to his/her medical care
8. the right to expect that a hospital will make reasonable response to the
request of a patient
9. the right to ask and be informed of the existence of business
relationships among the hospitals, schools, or any other health care
provider that may influence patient care and service
10. the right to consent or decline to participate in clinical research
11. the right to expect reasonable continuity of care
12. the right to be know the policies and practices that relate to patient
care, treatment, and practices
6 Patient`s Responsibility
(Grieco, 1996)
1. to provide an accurate and complete history
2. to keep appointments and to notify the responsible
practitioner if you can`t make it
3. to his/her actions when refusing treatment or not
following the practitioner`s instruction
4. to fulfill the financial obligations
5. to follow hospital rules and regulations
6. to be considerate of the rights and property of others
Incident Report
•AKA unusual occurrence report or
accident notification report
•It is a documented and formal written
report due to an injury or any error
caused to a patient or hospital properties
that is made by the medical staff
Filling an Incident Report
1. Write in simple terms what occurred
2. What time
3. What date
4. Which room or department
5. To whom
6. Who was present
7. Condition of the patient / equipment
8. What was done to alleviate the situation at the time
ETHICAL PRINCIPLES
•Ethics – a set of moral principles that govern
one`s course of action
•Principle – a set of standard that establish what
is right and wrong
Parts of Standard of Ethics
1.Code of Ethics – was developed, revised and adopted
by ASRT and ARRT in July 1998. It serves as a guide in
ethical aspect of radiologic science.
2.Rules of Ethics – added in 2001 that is considered to
be mandatory and enforced by ARRT. It is designed to
promote protection and comfort of the patient
Ethical principles
A set of ethical principles has been derived from the basic ethical philosophies:
1. Utilitarianism – aka consequentialism
- state that actions are morally correct when largest number of
persons are benefited by the decision made

2. Deontology – the study of the nature of duty and obligation


- comes from a Greek word which means “duty”
- right takes priority over good

3. Virtue – focuses on using wisdom rather than emotional and intellectual


problem solving.
Ethical Principles
1. Autonomy – right to make rational decision free from external pressures

2. Beneficence – all acts must be meant to attain a good result

3. Confidentiality – concept of privacy

4. Double effect – the facts of some actions may produce both a good and bad effect. There are
four criteria must be fulfilled before this type of action will be permissible:
a. the act is good or morally neutral
b. the intent is good, not evil, although a bad result may be foreseen
c. the good effect is not achieved by means of evil deed
d. the good effect must be more important than the evil effect
5. Fidelity – duty to fulfill one`s commitment and keeping
promises
6. Justice – all person must be treated equally
7. Nonmaleficence – duty to abstain from inflicting harm
and duty to do no harm
8. Paternalism – attitudes that sometimes prompts
healthcare worker to make decision regarding a person`s
care without consulting the person affected
9. Sanctity of life – life is the highest good
10. Veracity - honesty
11. Respect for Property - keeping patient`s belongings
safe
The Three Sections of Rules of Conduct or
Practice Standard
1.Professional Performance Standards – activities of the practitioner
in the areas of education, interpersonal relationship, personal and
professional self assessment, and ethical behavior

2. Clinical Performance Standards – activities of the practitioner in the


care of patients and the delivery of diagnostic or therapeutic
procedures and treatment.

3. Quality Performance Standards – activities of the practitioner in the


technical areas of performance
PHYSICIAN`S ORDER
AND CONSENT
Consent
• is a contract wherein the patient voluntarily gives
permission to someone to perform a procedure of
service.
• The legal aspect of obtaining consent deals with the
healthcare`s “duty to warn” and the ethic “to do no
harm”
• It will not be legal if the patient is not informed of all the
aspects of the procedure to be performed.
Consent

• Part of the consent, the patient must also be informed of


the consequences if the suggested procedure is not
completed
• The radiographer must make sure that the patient has
understand the procedures including the benefits and
risk of undergoing such
Consent Validity

1. Voluntary – the decision to either consent or not to consent to treatment must be


made by the person themselves, and must not be influenced by pressure
2.Informed - the person must be given all of the information in terms of what the
treatment involves, including the benefits and risks, whether there are reasonable
alternative treatments and what will happen if treatment doesn't go ahead
3.Capacity - the person must be capable of giving consent, which means they
understand the information given to them, and they can use it to make an informed
decision
Some Important Contents on a Consent
Form

• Patient`s • Duration of the  Other options for


identification procedure the treatment
• Name of the • Risks and benefits  Dignity and
examination of the procedure Privacy
• Purposes of the • Persons involved  Financial cost
examination  Patient Signature
• Nature of the
procedure
Sample of Consent
Types of Informed Consent

1. Simple Consent – matter of obtaining a patient`s permission to perform a


procedure. Can be divided into:
a. Express Consent – aka Explicit Consent/ Direct Consent
– occurs when the patient does not stop the procedure and let it
continue
b. Implied Consent – occurs in emergency situations when it is not possible to
obtain consent from the patient itself, his family, or any legal representative then
the healthcare worker will decide for the patient
2. Inadequate consent – aka ignorant consent
- when the patient has not been informed adequately to make
a responsible decision
Form of Consent

Can in be in a form of orally/verbally, in writing, or through action:

Orally/verbally: when the patient says she`s happy to undergo X-Ray procedure

Writing: when the patient signed the consent form before undergoing examination
that involves administration of contrast media

Action: when the patient holding out an arm during blood extraction
Giving Consent to Children, Young People,
Intellectually Disabled, and Mentally Ill

“People aged 16 or over are entitled to consent to their own


treatment, and this can only be overruled in exceptional
circumstances”

• Gillick Competent – those who are under 16 years old that are
capable in giving out their consent because they`re believe to
have enough intelligence, competence and understanding to
fully appreciate what's involved in their treatment
Giving Consent to Children, Young People,
Intellectually Disabled, and Mentally Ill

OTHERWISE, SOMEONE WITH “PARENTAL RESPONSIBILITY”


CAN CONSENT FOR THEM, THIS COULD BE:
1.mother and/or father of the patient
2.patient`s legally appointed guardian
3.person with a residence order concerning the patient
4.local authority designated to care for the patient
5.person with an emergency protection order for the patient
When consent can be overruled

Mental Capacity Act (2005)

- If a person refuses treatment, which may lead to


their death or a severe permanent injury, their
decision can be overruled by the Court of Protection.
Consent during Emergencies and
Unconscious Cases

• Consent is not required in an emergency cases.


• If the family physician or specialists had thought the
situation an emergency, they could have treated the
child despite the parents’ objections
• provided the examination is limited to what is
immediately necessary to save life and avoid significant
deterioration in the patient’s health
Physician

• Physician – licensed person who are practicing medicine that is concerned with
promoting, maintaining, or restoring health through the study, diagnosis, and
treatment of disease, injury, and other physical and mental impairments
• Medical Doctor – these are medical students who graduated from a medical school but
doesn`t have a license
• General Practitioner (GP) or Generalist - provide routine health care (e.g., physical
examinations, immunizations) and assess and treat many different conditions,
including illnesses and injuries
• Specialist - physicians who undergo specialization and focuses more on a specific area
on medicine
Referring Physician, Ordering Physician,
and Attending Physician
• Referring physician - usually a physician who sends a
patient to a specialist for more information or treatment
• Attending Physician - one who attends a hospital at
stated times to visit the patients and give directions as to
their treatment
• Ordering Physician – physician who usually gives order
example a physician asking his patient to undergo
radiology services such as x-ray and ultrasound
Physician`s Order
• Communication or instruction from a physician directing
that a service be provided
• Could be through writing, telephone/cellphone, e-mail,
relayed by the medical staff
Why do Physician`s Order matter
• Communicating directives regarding the medical care of
the patient
• Demonstrating “under the care of a physician” and
active involvement of physician in the care of the patient
• Evidence of medical necessity
DEALING WITH
PATIENTS
Belongings X Valuables
• Belonging - any personal essential item that needs to be at the bedside.
• Valuable - any item that needs to be locked up for safety.

BELONGINGS VALUABLE
= =
BEDSIDE SAFE

Space to store patient valuables is limited. Staff should


encourage patients to send valuables home whenever
possible.
Remind Your Patients
The hospital will not accept responsibility for
items that are kept at the bedside.

Patients need to be informed of this upon


admission to the unit. This discussion takes place
at the patient’s bedside with the unit staff.
Care of Patient`s Valuables
• A patient who comes to radiology department as an outpatient is frequently
required to remove some items such as clothes, accessories, and jewelries
and to put on patient gown before the procedure (diagnostic/therapeutic).
• RTs should be able to determine which items are only to be remove to
decrease the chances of patient discomfort and embarrassment.
Valuable Envelope
• When it is not possible for a patient to send their valuables home,
a “valuables envelope” will be provided. This indicates that the
valuables were surrendered to Hospital Staff, sealed in an
envelope, labeled with the patient’s ID, and secured in a safe area
in the department.
• If there are items that is too large to fit into the envelope, lockers
can be use instead.
• It is important to note that valuables are not itemized.Rather,
items are placed in the envelope, in the presence of the patient,
and sealed. The patient signs the seal of the envelope. If the
patient is unable to sign, two (2) staff members will sign the seal.
Dressing and Undressing of Patient
• The patient should be taken to the specific place
(dressing/changing room/cubicle) where patient is
expected to disrobe.
• RT should explain how to wear properly the hospital
gown (because some gown opens at the back).
• Patient should be supplied with hangers for his clothing.
• Purses, jewelry, and other valuables should be treated
with special care.
Tips on Dressing and Undressing
• Always preserve the person modesty by not undressing him unnecessarily.
• Close the door and draw the curtains when undressing the person.
• Encourage the person to do as much as possible himself to boost his
independence and morale.
• Talk to the person to alley anxieties and embarrassment during the process.
• Do not rush through the procedure.
• Be gentle in your movements and pull the clothes not the person.
• The most disabled limb should be dressed first and undressed last.
Step-wise Procedure for Assisting a
Dependent Patient in Dressing and
Undressing
Step 1- Perform initial tasks:

Wash hands and wear gloves. Introduce yourself. Explain him that you are
going to assist him in dressing.

Step 2- Teach the correct way to change clothes:

In order to trim down the risk of injuries and falls, guide your patient the
right procedure to change clothes. It will also help in increasing his level of
independence.
Step 3- Assist in undressing:

Start undressing the patient on his weaker side. Allow him to


remove his clothes at his own. Support him when he asks for your
assistance or when you feel the requirement. Put the dirty clothes to
the side. Put the clean clothes in such a way that the client can reach
them easily.

Step 4- Monitor carefully:

You need to keep a watch on your client minutely in order to prevent


him from falling. Ensure that he is able to dress safely. In case, he
feels dizzy or fatigued, be prepared to help him/her either to lie or
sit down instantly.
Step 5- Assist in dressing:

Guide the patient to begin dressing with the weakest side


first. Say if, the patient is weaker on the right portion of
the body; ask him to put his right arm in the right sleeve,
first. Let the client to perform maximum of the task
without your help.

Step 6- Perform final task:

Put dirty clothes at proper place. Dispose the gloves and


rinse your hands.
Assisting patient with disability of the
lower extremities
1.Place a long examining gown on the patient.
2.Instruct him to loosen belt buckles, buttons, or hooks around the waist and
slip the trousers over the hips.
3.If the patient cannot perform step # 2, reach under the gown and pull the
trousers down over the hips.
4.Have the patient sit down.
5.Squat down in front of the patient and gently pull the clothing over the legs
and feet to remove. You can call assistant preferable relatives of the patient.
Assisting Injured Patient

> Can most easily be accomplished in supine position


1. Cover the patient with a draw sheet and have an examining gown ready. Explain
what is to be done and ask for patient help.
2.Remove clothing from the less affected side first and then remove the clothing
from the more affected side.
3.Wear the clean gown starting on the affected side.

4.To remove trousers, loosen buckles and buttons and have the patient raise his
buttocks as the trousers are slipped over his hips. If the patient cannot raise his
buttocks, ask for an assistance then turn the patient toward the assistant and then
slide the trousers off on one hip. After, turn the patient toward your side then ask
the assistant to slide the trousers off on the hip.
Patient with an Intravenous Infusion

1.Slip the clothing off the unaffected side first.


2.Slide the sleeve of the unaffected side over the IV tubing and
catheter, then over the container of fluid.
3.Wear the clean gown by placing the sleeve on the affected side over
the container of fluid, then over the tubing and onto the arm where
there is the venous catheter in place.

Remember to keep the bottle of fluid above the infusion site to prevent
backflow of the blood
Assisting the Patient in the Lavatory

• Patient may stay hours in the diagnostic imaging department and there were times patient is not
able to postpone urination or defecation.
1. If possible, help the patient to reach the lavatory near the examination room. But do not allow the
patient to go without assistance.
2. If the patient can help him/herself in the lavatory, just close the door and assure the patient that
there is an assistance waiting outside. (each lavatory should have an emergency button call but if
there`s none then it is the radiographer duty to frequently check the patient.
3. After the patient has finished tell him to wash his/her hands (assist if needed), then accompany the
patient back to the examination room.
4. Go back to lavatory and make certain that it is clean.

5. Don`t forget to wash your hands.


Bedpan/Urinal
• For patient who is unable to get to
the lavatory
• There are two types of bedpan:
a. Standard/Conventional bedpan –
made of plastic or metal with
approximately 4 inches high.
b. Fracture bedpan – for patient with
fracture or another disability
• Male urinal – a bottle-like
appearance made of plastic and
shaped which is desirable to any of
position
Assisting Patient with the Bedpan
1. Make sure there is a tissue, towel, disposable gloves, and alcohol
available.
2.Wear gloves then close the examination room door for patient
privacy.
3.Always place a sheet over the patient while helping her onto the
bedpan.
4.Place the bedpan at the end of table.

5.If the patient can move, ask him/her to place his one hand under
the lower back and rotate away from the radiographer. Then ask
the patient to raise the hips then place the pan under the hips.
6.If the patient cannot move, ask for an assistance then turn the
patient to a side-lying position. Then place the bedpan under the
hips then ask the patient to lay down in supine position.
REPUBLIC ACT 7877
Anti-sexual harassment act of 1995

AN ACT DECLARING SEXUAL


HARASSMENT UNLAWFUL IN
THE EMPLOYMENT, EDUCATION
OR TRAINING ENVIRONMENT,
AND FOR OTHER PURPOSES
Sexual Harassment could be in a form of:
1. verbal
2. written
3. environment
4. visual
5. physical
Two types and forms of sexual
harassment
1. sexual coercion - quid pro qul
- is the act of using pressure, manipulation, drugs, alcohol or physical
force to initiate sexual contact with someone against their will.
- a type of harassment which has direct results in some consequence to
the victim's employment. (ex: supervisor will use his power to invite someone to have sex
with him in exchange of promotion or job benefits)
2. sexual annoyance - aka hostile environment
- is a demeaning and unwelcome sexually related behavior that is
offensive, hostile or intimidating to the victim, but has no direct connection to any job
benefits.
Categories of sexual Harassment
1. Quid Pro Quo - something given in
exchange for something else
2. Hostile environment - an environment that
can be offensive or hostile so as to interfere
with a person`s ability to work.
3. Sexual Favoritism
R.A 7877
Approved by:
• Edgardo J. Angara (Senate President)
• Jose De Venecia, Jr. (Speaker House of Representatives)
• Edgardo E. Tumangan (Senate Secretary)
• Camilo L. Sabio (Secretary General of House of Representatives)
• Fidel V. Ramos (President of Philippines)
• Approved on February 8, 1995 (Wednesday)
Be it enacted by the Senate and House of Representatives
of the Philippines in Congress assembled
• SECTION 1. Title
• SECTION 2. Declaration of Policy
• SECTION 3. Work, Education or Training -Related, Sexual Harassment
Defined
a. Work - sexual favor is made as a condition in the hiring
b. Education or Training Environment - sexual favor is made a
condition to the giving of a passing grade
• SECTION 4. Duty of the Employer or Head of Office in a Work-related,
Education or Training Environment
• SECTION 5. Liability of the Employer, Head of Office, Educational or Training Institution
• SECTION 6. Independent Action for Damages
• SECTION 7. Penalties
a. imprisonment of 1 – 6 months
b. fine ranges from 10,000 to 20,000 PHP
• SECTION 8. Separability Clause
• SECTION 9. Repealing Clause
• SECTION 10. Effectivity Clause
a. this act shall take effect in 15 days after its complete publication in at least 2 national
newspapers in general circulation