MedicalLegal Issues

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Medical/Legal Issues Professional Ethics

• Rad Tech A Week 14

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Definitions

• Ethics The systematic study of rightness and
  wrongness of human conduct and character as known
  by natural reason.
  
• Morals Generally accepted customs, principles,
  or habits of right living and conduct in a
  society and the individuals practice in relation
  to these.
• Values Ideals customs of a society toward
  which the members of a group have an affective
  regard a value may be a quality desirable as an
  end in itself.

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Professional Ethics

• Internal controls of a profession based on human
  values or moral principles.
  
• Standards of conduct beyond mere conformity to
  law.
  
• Professionals may encounter conflicting values or
  belief systems that can compromise patient care.
  

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ARRT Code of Ethics

• A guide by which RTs and Candidates may evaluate
  their professional conduct as it relates to
  patients, health care consumers, employers,
  colleagues, other members of the health care
  team.
• Comprised of 10 principles

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ARRT Code of EthicsAppendix D pg. 435

• Professional manner, respond to pt needs, support
  colleagues
  
• Provide services to humanity w/ full respect for
  mankind
  
• Delivers pt care without discrimination
• Practices uses equipment appropriately
• Acts in the best interest of the pt.

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ARRT Code of Ethics

• 6. Obtains pertinent info for physician
• 7. Practices in accordance with accepted
  standards, minimizes radiation exposure
  
• 8. Practices ethical conduct
• 9. Respects confidences and pt right to privacy
• 10. Strives to improve knowledge skills by
  participating in C.E.
  

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Ethical Dilemma

• Situation requiring moral judgment between two or
  more equally right alternatives. There are two
  or more competing norms.
  
• Four components to solve an ethical dilemma
• 1. Identify the problem
• 2. Develop alternative solutions
• 3. Select the best solution
• 4. Defend your selection

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Ethical Theories

• Consequentialism Evaluates the rightness or
  wrongness of ethical decisions by assessing the
  consequences on the pt.
  
• Nonconsequentialism Belief that actions
  themselves, rather than consequences, determine
  the worth of actions actions are right or wrong
  according to the morality of the acts. Ex Lying
  to a pt if the lie might ultimately benefit the pt

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Moral Principles

• Beneficence Bringing about good
• Nonmaleficence Preventing harm, to do no harm
• Autonomy Self-reliance, independence, liberty
  rights, individual choice, freedom of will
  
• Veracity Telling the truth
• Fidelity Being faithful
• Justice Acting with fairness or equity

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Medical/Legal Issues

• The liability of the technologist is not the same
  as the radiologist involved, but the liability is
  potentially real.
  
• Although the law is often a mirror image of the
  failures of medicine, it is also a book of
  lessons from which we can learn.
  

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Headliners

• If the Institute of Medicine is right, then, at
  the very least, 100 patients will die in
  hospitals in the U.S. today because of injuries
  from their care, not from their diseases. How
  many will die tomorrow?
• Although it cant be proven that they caught
  their infections in the hospital, these women are
  convinced they did. Each year in this country,
  an astounding 2 million people contract an
  infection this way. And 90,000 of those die as a
  result according to the Centers for Disease
  Control and Prevention.

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Schloendorf v. Society of New York Hospital

• Basic principle of law and lays a foundation for
  the relation between patients and health care
  practitioners.
  
• Every human being of adult years and sound mind
  has a right to determine what shall be done with
  his own body, and a surgeon who performs an
  operation without his patients consent commits
  an assault, for which he is liable in damages.

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Doctrine Serves 6 Functions

• Protects individual autonomy
• Protects pt status as a human being
• Avoids fraud and duress
• Encourages health care practitioners to consider
  their decisions carefully
  
• Fosters rational decision making by the pt
• Involves the public in medicine

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Standard of Care

• Degree of skill (proficiency), knowledge, and
  care ordinarily possessed employed by members
  in good standing within a profession.
  
• To test whether the standard of care has been
  met, one must determine what a reasonable,
  prudent practitioner would have done under
  similar circumstances.

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Practice Standards for Radiography Appendix A pg.
411

• Developed by a group of medical imaging
  professionals adopted by ASRT
  
• Outline the practice of medical imaging in three
  areas of Performance Standards
  
• 1. Clinical Performance Standards
• 2. Quality Performance Standards
• 3. Professional Performance Standards

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Causes of Legal Action

• Approx 10 of all medical negligence claims are
  somehow related to diagnostic imaging.
  
• Medical Negligence failure to use such care as
  a reasonably prudent health care professional
  would use in similar circumstances.

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Patient Fall in Radiology DeptNEGLIGENCE

• Favalora v. Aetna Casualty Surety Co.
• Pt. admitted to hospital for general checkup GI
  series.
  
• Pt complaint Stomach pains, general fatigue,
  and fainting.
  
• While undergoing x-ray exam, pt fainted, fell,
  and fxd her neck femur requiring surgery.
  
• Surgery caused a pulmonary embolism
• Radiologist was negligent for not securing
  medical hx prior to exam, pt won lawsuit.

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Four Elements to Prove Negligence

• Must establish a duty to the patient by the
  health care provider
  
• Breach of this duty by an act or by failing to
  perform some act.
  
• A compensable injury
• A causal relation between the injury and the
  breach of duty.

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Cause of Legal Action

• Tort Civil wrong committed by one individual
  against another. May be classified as either
  intentional or unintentional. This type of claim
  arises from a breach of duty.
• Assault Any willful attempt or threat to
  inflict injury on the person and any intentional
  display of force that would give the victim
  reason to fear or expect immediate bodily harm.

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Cause of Legal Action

• Battery An unlawful touching of another that is
  without justification or excuse.
  
• False Imprisonment Conscious restraint of
  another without proper authorization, privilege,
  or consent.
  
• Defamation Holding up a person to ridicule,
  scorn, or contempt in a respectable
  considerable part of the community.

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HIPAA

• Health Insurance Portability and Accountability
  Act
  
• Privacy of records and confidentiality
• Confidentiality standards establish guidelines
  for the storage, access, and transmission of
  individual health information.
  
• Patients must authorize the release of health
  information.

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Patient Rights Responsibilities

• Patient rights informs the pt of the right to be
  well informed, to participate in treatment
  decisions, and to communicate openly with the
  physicians.
• Patient also has the responsibility to provide
  accurate medical history, to ask questions, and
  inform if pt is unable to follow treatment.
  
• Hospitals may (and do) list other very specific
  responsibilities.

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Res Ipsa Loquitur

• The thing speaks for itself
• Burden of proof shifts from the plaintiff to the
  defendant.
  
• Must have 3 elements
• 1. Type of injury did not occur except for
  negligence.
  
• 2. Activity was under complete control of
  defendant.
  
• 3. Plaintiff did not contribute to his own
  injury

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Res Ipsa Loquitur

• Franklin v. Collins Chapel Correctional Hospital
• 82 yr. senile female wrongful death after
  sustaining 3rd degree water burns while bathing
  
• Res Ipsa Loquitur - Injuries suffered by the
  resident do not occur in a nursing facility in
  the absence of negligence, and the deceased was
  in the defendants sole care custody control.

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Respondeat Superior

• The master speaks for the servant the master is
  liable in certain cases for the wrongful acts of
  his or her servants. Deep Pockets approach.
  
• If a radiographer is sued, the hospital and
  physician would also be named as defendants.
  Well established theory that the physician or
  health care facility is responsible for the
  negligent acts of its employees.

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Corporate Liability

• Requires the hospital or health care entity to be
  responsible for the quality of care delivered to
  consumers.
  
• Health care corp. must assess evaluate the
  quality of care delivered must be prepared to
  make changes as needed.
  
• The corp. may be required to intervene if
  suboptimal care is being provided by one of its
  independent contractors.

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Informed Consent

• A persons agreement to allow something to happen
  (i.e surgery) that is based on full disclosure of
  the facts knowledge of benefits, risks, and
  alternatives to the procedure.
• Required when a patient is subjected to any type
  of invasive procedure.
  
• If the pt consents to a procedure then revokes
  the consent, the doctor must stop the procedure.
  

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Case Study Life or Death, the right to choose

• Pt. Vega her husband (Jehovas Witnesses)
  signed a release requesting that no blood or
  blood products be administered to her during her
  hospital stay to deliver a baby. Following her
  delivery, she began to bleed heavily. Her doctor
  ordered a DC which she agreed to but refused a
  blood transfusion. She continued to bleed and
  was eventually transferred to the ICU. Her
  doctors told her that she would die if she did
  not receive the blood transfusion. Both her and
  her husband continued to refuse the blood
  transfusion. Because her doctor and the hospital
  felt that it was essential for her to receive the
  blood, they filed a complaint requesting that the
  court issue an injunction that would permit the
  hospital to administer the blood transfusion.

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Case Study Spouses Right as Guardian
Questioned by Relatives

• Mr. Martin sustained debilitating injuries as the
  result of a car accident. His injuries left him
  totally paralyzed on the left side. He could
  communicate to a very minimal degree through head
  nods. The court determined that he would never
  have the capacity to make decisions regarding the
  withdrawal of life-support equipment. His wife
  petitioned the court to withdraw life support
  while his mother sister counterpetitioned to
  have Mrs. Martin removed as the pts guardian and
  to keep him on life support.

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Case Study Mothers Rights vs. Hospitals Values

• Mrs. Jones had a high risk pregnancy and chose
  St. Johns hospital to deliver at because of
  their impeccable reputation. She went into
  preterm labor and arrived at the hospital where
  they tried to stop the labor. Unable to do this,
  Mrs. Jones continued to labor. During the
  process, she began developing complications but
  her fetus was still alive. The hospital was a
  Catholic facility and would not take the baby by
  C-section because it would be considered
  abortion, however, if they allowed the labor to
  continue there was a high possibility that the
  mother could die. Whos rights/values were right?