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192 Cards in this Set
- Front
- Back
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health care practitioners
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those who are trained to administer medical or health care to patients.
(Judson pg. 3) |
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litigious
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prone to engage in lawsuits
(Judson pg 3) |
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In what areas can knowledge of law and ethics help a nurse gain perspective?
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1. The rights, responsibility, and concerns of health care consumers.
2. The legal and ethical issues facing society, patients, and health care practitioners as the world changes. 3. The impact of rising costs on the laws and ethics of health care delivery (Judson pg. 3-4) |
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plaintiff
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the person bringing charges in a lawsuit
(Judson pg. 4) |
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defendant
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The person or party against whom criminal or civil charges are brought in a lawsuit (Judson pg. 4)
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liable
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Accountable under the law
(Judson pg. 4) |
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precedent
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Decisions made by judges in the various courts that become rule of law and apply to future causes, even though they were not enacted by a legislature; also knows as case law. (judson pg 5)
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summary judgment
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A decision made by a court in a lawsuit in response to a motion that pleads there is not basis for a trial. (Judson pg 5)
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fraud
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Dishonest or deceitful practices in depriving, or attempting to deprive, another of his or her rights. (Judson pg. 5)
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What can manufacturers of medical devices be held legally responsible for?
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1. breach of warranty
2. Statements made about device that are found to be untrue 3. Strict liability for devices that threaten ones safety 4. fraud or intentional deceit (Judson pg 5) |
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law
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Rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority
(Judson pg. 7) |
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ethics
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Standards of behavior, developed as a result of one's concept of right and wrong. (Judson pg. 9)
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moral values
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One's personal concept of right and wrong, formed through the influence of the family, culture, and society. (Judson
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what influences ones moral values?
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Through the influence of the family, culture, and society - serves as the basis for ethical conduct. (Judson pg. 9)
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code of ethics
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A list of principles intended to govern behavior- here, the behavior of those entrusted with providing care to the sick. (Judson pg. 9)
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what is needed to get the MD?
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1. graduation with a bachelors degree at 4 year college in premed.
2. graduation from 4 year medical school. then must pass USMLE (boards) taken in 1st & 4th year years of med school, and 1 or 2 yrs post grad. (pg 39) |
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What is the training emphasis for the MD?
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musculoskeletal system and correction of joint and tissue problems (pg 40)
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What is the training emphasis for the OD?
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emphasizes intervention in the form of drugs and or surgery. (pg 40)
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What is the ratio of gen care docs vs. specialists?
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37.4% vs. 62.6% respectively (pg. 40)
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allopathic
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different suffering- emphasizes intervention in the form of drugs and or surgery to alleviate suffering. (pg. 40)
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Who has the authority to give or revoke a medical license?
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falls to the state medical boards. The federal government has no authority except DEA permits which allows the doc to prescribe narcotics and non-narcotics. (pg 40)
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What are the requirements to get license from state to practice medicine?
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1. 21 yrs of age (age of majority)
2. must be of good moral character 3. must have completed education 4. completed residency 5. be US citizen or plan to be one 6. state resident |
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What happens to license of doc moves?
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1. reciprocity- out of state license is accepted due to state prior agreement to grant reciprocity between the states.
2. endorsement- license given based on credentials deemed to meet licensing in new state Pg. 41 |
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endorsement
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the process by which a license may be awarded based on individual credentials judged to meet licensing requirements in a new state. Pg 41
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In what case does a doc not need a license to practice in a state?
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1. emergency
2. while establishing residency 3. employed by us armed forces, public health, vets, or other federal facility 4. When engaged solely in research and not treating patients Pg 41 |
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What actions are considered unprofessional?
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falsifying records, using unprofessional methods to treat a disease, betrayal of patient confidentiality, fee splitting, fraud, and sexual misconduct. (pg. 41)
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What actions are considered felonies?
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murder, rape, larceny, manslaughter, robbery, arson, burglary, violations of narcotic laws, and tax evasion. (pg. 41)
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What is considered personal or professional capacity issues affecting a docs license?
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senility, injury or illness, chronic alcoholism, drug abuse, or other conditions that impair the docs ability to perform tasks. (pg 41)
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which case set presidence that the board can revoke medical license permanently?
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Roy V. Medical board of Ohio 1995
pg. 32 |
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What is required for a physician to be considered guilty of fraud?
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Must prove "intent to deceive"
1. falsifying medical diploma, license, or credentials. 2. billing government agency for services not rendered. 3. falsifying a medical report 4. falsely advertising or misrepresenting patient "secret cures" or special powers to cure an ailment. Pg. 42 |
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respondeat superior
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literally, "let the master answer" is a doctrine under which an employer is legally liable for the acts of his or her employees, if such acts were performed within the scope of the employees' duty. (pg 43)
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managed care
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a system in which, financing administration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee. (pg. 46)
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indemnity
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A traditional form of health insurance that covers the insured against potential loss of money from medical expenses resulting from an illness or accident (pg. 46)
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health maintenance organization (HMO)
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A health plan that combines coverage of health care costs and delivery of health care for a prepaid premium. (pg. 46)
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Capitation
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set in advance payment made to providers based on calculated costs of medical care of a specific population of subscribers. (pg. 46)
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Third party indemnity health insurance
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the insurance company reimburses health care practitioners for medical care provided to policyholders. (pg. 46)
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formularies
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plan's list of approved prescriptions for which it will reimburse subscribers. (pg 46)
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utilization review
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method used by a health plan to measure for which it will reimburse subscribers. (pg. 46)
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individual practice association (IPA)
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A type of HMO that contracts with groups of physicians who practice in their own offices and receive a per member payment (capitation) from practices
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What are the primary objectives of HIPAA?
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1. Improve the efficiency and effectiveness of the health care industry
2. Help employees keep their health insurance coverage when transferring to another job. 3. Protect confidential medical information that identifies patients from unauthorized disclosure or use. (pg 49) |
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telemedicine
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remote consultation by patients with physicians or other health professionals via telephone, closed circuit television, or the internet. (pg. 51)
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cybermedicine
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a form of telemedicine that involves direct contact between patients and physicians over the internet, usually for a fee. (pg 52)
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e-health
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term for the use of the internet as a source of consume information about health and medicine. (pg 52)
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executive order
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a rule or regulation issued by the president of the united states that becomes law without the prior approval of Congress (pg. 62)
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constitutional law
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law that derives from federal and state constitutions. (pg. 63)
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case law
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law established through common law and legal precedent. Began as common law(pg 63)
This includes legal precedents (pg 64) |
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Sources of Law
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1. Constitutional law
2. case law (from common law) 3. Statutory law 4. administrative law |
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legal precedents
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decisions made by judges in various courts that become rule of law and apply to future cases, even thought they were not enacted by legislation. (pg. 64)
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statutory law
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law passes by the US Congress or state legislature. (city =municipal ordinances) (pg. 64)
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administrative law
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enabling statutes enacted to define powers and procedures when an agency is created. (pg. 64)
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substantive law
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the statutory or written law that defines and regulates legal rights and obligations. Defines the legal relationship between people and the state. (criminal, civil, military, and international law(pg. 65)
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procedural law
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law that defines the rules used to enforce substantive law.
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criminal law
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law that involves crimes against the state. (pg. 65) ex. New York v. John Doe
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felony
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an offense punishable by death or by imprisonment in a state or federal prison for more than 1 year. IE abuse, arson, burglary, conspiracy, embezzlement, fraud, illegal drug usage,grand larceny, manslaughter, mayhem, murder or attempted, robbery, sodomy, tax evasion, practicing w/o license. (pg. 65-66)
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misdemeanors
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a crime punishable by fine or by imprisonment in a facility other than a prison for less than one year. EX traffic violations, theft (under certain amount), attempted burglary, disturbing the peace. (pg. 66)
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Can knowledge of a crime make you guilty?
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Perhaps, can be considered an accessory if contributes to or aids in the commission of a crime by direct or indirect act, by watching and not giving aid, or concealing a crime. IE if you know insurance fraud is happening, you have to report it or be an accessory(pg. 66)
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plaintiff
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the person bringing charges in a lawsuit. Need to show they have been wronged or injured in some way(pg. 66)
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prosecution
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the government as plaintiff in a criminal case. (pg 66)
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defendant
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the person or party against whom charges are brought in a criminal or civil lawsuit. (pg 66)
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civil law
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law that involves wrongful acts against persons, not crimes. Often around contract violation, slander, libel, trespassing, product liability, auto accidents, divorce, child support, and child custody. Generally results in paying of some amount to injured party (pg. 66)
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tort
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civil wrong committed against a person or property, excluding breach of contract. May be intentional or unintentional(pg. 67)
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tortfeasor
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the person guilty of committing the tort. If the action is deemed malicious, punitive damages may be awarded as well.(pg 67)
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what are some intentional torts
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assault, battery, defamation of character, false imprisonment, fraud, and invasion of privacy. (pg. 67)
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assault
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open threat of bodily harm or acting in a way as to put another in "reasonable apprehension of bodily harm" (pg. 67)
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battery
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actions that cause bodily harm to another. Bodily contact made without permission. Healthcare, unauthorized touching of patient such as suturing a wound, giving injection, or performing a physical examination. (pg. 67)
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Defamation of Character
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Damaging a person's reputation by making public statements that are both false and malicious. (Libel or slander)
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Libel
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expressing in published print, writing, pictures, or signed statements, reading aloud or broadcasting for the public content that injure the reputation of another. (pg 67)
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Slander
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speaking defamatory or damaging words intended to prejudice others against an individual in a manner that jeopardizes his or her reputation or means of livelihood. (pg. 67)
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False imprisonment
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intentional, unlawful restraint or confinement of one person by another. Ex. refusing to dismiss a patient upon request or preventing an employee or patient from leaving the facility. (pg. 67)
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Fraud
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deceitful practices in depriving or attempting to deprive another of his or her rights. ex promising miracle cures, or accepting fees from patients for using mystical or spiritual powers to heal. (pg 67)
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Invasion of privacy
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intrusion into a person's seclusion or private affairs, public disclosure or private facts about person, false publicity about a person, or use of person's name or likeness without permission. improper breach of confidentiality is invasion of privacy. (pg 67)
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What are the unintentional torts?
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Acts that are not intended to cause harm but are committed unreasonably or with disregard for the consequences. IE negligence. (67-9)
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negligence
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an unintentional tort alleged when one may have performed or failed to perform an act that a reasonable person would or would not have done in a similar circumstance. (pg. 69)
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jurisdiction
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the power and authority given to a court to hear a case and to make a judgment. Federal court hears federal crimes, suits against the US (pg. 69)
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What type of tort is most likely to concern health care practitioners?
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Negligence (pg. 69)
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contract
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a voluntary agreement between two parties in which specific promises are made for a consideration. (pg. 72)
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What 4 elements are required to be present in a contract to make it legally binding?
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1. Agreement
2. Consideration 3. Legal Subject Matter 4. Contractual capacity (pg. 72) |
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Agreement
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one party makes an offer, the other party accepts.
Certain conditions pertain to offer: 1. can be present or future 2. it must be communicated 3. made in good faith and not under duress or joke. 4. clear enough to be understood by both parties 5. define what both parties will do if offer is accepted. (pg. 72) |
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Consideration
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Something of value is bargained for as part of the agreement. Ex physician's consideration is providing his or her services, the patient's consideration is payment of physician's fee. (pg. 72)
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Legal Subject Matter
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made for legal purposes. Ex cant enforce contract entered into by patient to pay for services when doc is not licensed and can not complete his end of the bargain. (pg. 72)
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breach of contract
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when either party fails to comply with the terms of a legally valid contract. (pg. 72)
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contractual capacity
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both parties entering into a contract must be capable of fully understanding all of its terms and conditions. (pg 72)
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To avoid charges of battery or assault, what must a health care practitioner do when treating a minor?
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gain consent of a responsible parent or legal guardian, except in cases when minor suffers life threatening emergency or has been legally determined to be mature. (pg. 72-3)
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Who is considered a minor
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anyone under the age of 18 in most states, and 21 in some jurisdictions. (pg 73)
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Texas state law says minors must notify parents of abortions. What are the exceptions?
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1. She is mature and sufficiently well informed to make the decision without notifying parents
2. notifying parents would not be in her best interest 3. notifying parents may lead to physical, sexual, or emotional abuse. (pg. 73) |
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expressed contract
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a written or oral agreement in which all terms are explicitly stated. (pg 74)
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implied contract
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an unwritten and unspoken agreement whose terms result from the actions of the parties involved (pg. 74)
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statute of frauds
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state legislation governing written contracts. This states which contracts must be in writing to be enforced.
(pg. 74) |
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third party payor contract
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a written agreement signed by a party other than the patient who promises to pay the patient's bill. (pg. 74)
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What needs to be in the Regulation Z of the Consumer Protection Act?
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1. fees for service
2. amount of down payment 3. date payment is due 4. date of final payment 5. amount of each payment 6. interest charged to be made |
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Fair debt collection practices act
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the federal statute prohibiting certain unfair and illegal practices by debt collectors and creditors. It prohibits certain methods of debt collections including harassment, misrepresentation, threats, disseminating false info about debtor, and engaging in unfair or illegal practices in attempting to collect a debt. (pg. 76)
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Does a physician have to treat every patient seeking medical care?
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No with one exception. If they are hired to care for a population such as in a hospital, they must treat every patient that comes into that locale. (pg 79)
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Is a physician bound to know reactions patients have to anesthetics or drugs of any kind?
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No, they bound to note allergies or adverse reactions to medications reported by the patient before treatment is administered.
(pg. 79) |
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Patients' implied duties
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1. Follow instructions of doctor and cooperate as much as possible.
2. Give relevant information to doctor 3. Follow orders for treatments providing similar to what other doctors do. 4. Pay fees charged for services rendered. (pg. 81) |
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May a doctor stop treatment or end physician-patient relationship if patient fails to pay?
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Yes, providing the patient is given adequate notice. (pg 81)
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What should the doctor do for patients who fail to keep appointments?
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to protect from abandonment charges, all missed appointments should be noted on the patient's chart. (pg 81)
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What should a doctor do if they are going to terminate the physician-patient relationship?
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send the patient a formal written notice that they are withdrawing from the case. They need to provide time to seek out a new provider. Should be sent certified mail with return receipt requested. Managed care may restrict termination of patient care without approval. (pg 82)
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liable
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accountable under the law. All adults are responsible for their actions on the job and in their personal lives. (pg. 93)
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As employers, physicians have general liability for what?
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1. The practice's building and grounds
2. automobiles 3. employee safety (pg. 94) |
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standard of care
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the level of performance expected of a health care practitioner in carrying out his or her professional duties. (pg. 94)
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duty of care
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the legal obligation of health care workers to patients and sometimes nonpatients. Ex custodians of health care facility are owed duty of care as they dispose of needles and this should be done properly to show them the proper duty of care. (pg 94)
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confidentiality
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the act of holding information in confidence, not to be released to unauthorized individuals. we have an ethical and legal duty to safeguard patient privacy. (pg. 98)
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privileged communication
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Information held confidential within a protected relationship. ex attorney- client and physician- patient privilege (pg. 98)
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Is breach of confidence grounds for revocation of a physician's license?
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yes. many states have this as grounds for revocation. (pg 98)
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Can a doctor give information to third parties about a patient?
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Not without written consent. This includes insurance companies, attorneys, neighbors, even acknowledging if the patient is a client. (pg 98)
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What can the doctor do to provide confidentiality when speaking to a patient on the phone with others in the room?
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don't use their name. Ask the customer to call back if doctor gets a voicemail as can not be sure others are not going to hear it. (pg 98)
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liable
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accountable under the law. All adults are responsible for their actions on the job and in their personal lives. (pg. 93)
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As employers, physicians have general liability for what?
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1. The practice's building and grounds
2. automobiles 3. employee safety (pg. 94) |
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standard of care
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the level of performance expected of a health care practitioner in carrying out his or her professional duties. (pg. 94)
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duty of care
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the legal obligation of health care workers to patients and sometimes nonpatients. Ex custodians of health care facility are owed duty of care as they dispose of needles and this should be done properly to show them the proper duty of care. (pg 94)
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confidentiality
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the act of holding information in confidence, not to be released to unauthorized individuals. we have an ethical and legal duty to safeguard patient privacy. (pg. 98)
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privileged communication
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Information held confidential within a protected relationship. ex attorney- client and physician- patient privilege (pg. 98)
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Is breach of confidence grounds for revocation of a physician's license?
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yes. many states have this as grounds for revocation. (pg 98)
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Can a doctor give information to third parties about a patient?
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Not without written consent. This includes insurance companies, attorneys, neighbors, even acknowledging if the patient is a client. (pg 98)
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What can the doctor do to provide confidentiality when speaking to a patient on the phone with others in the room?
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don't use their name. Ask the customer to call back if doctor gets a voicemail as can not be sure others are not going to hear it. (pg 98)
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when can a doctor waive confidentiality?
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1. subpoena (malpractice suit)
2. if a danger to public health or welfare 3. if danger to self or others 4. if other party pays for appt. 5. if the patient signs a waiver. (pg 99) |
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What is the Earnhardt Family Protection Act
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allows autopsy photographs or rcecordings of the autopsy to be examined only by a surviving spouce, parent, or child. Anyone else must obtain a court order and examine the materials under the "direct supervision of the custodian". Provisions were made for those seeing the photographs in the normal course of their position. (pg. 99)
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misfeasance
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the performance of a lawful act in an illegal or improper manner. Ex doc asks nurse to change burn patient dressing. Nurse does not use sterile technique and the patient gets infection. this is normal task not done with proper procedure. (pg. 101)
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nonfeasance
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the failure to act when one should. EMT gets to scene of accident and patient goes into cardiac arrest and dies. EMT freezes..he could be guilty of malfeasance. (pg 101)
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malfeasance
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the performance of a totally wrongful and unlawful act. ex. Doc is out, medical assistant dispenses drugs from doc supply. this could be wrong drug. Wrong of medical assistant to take this action. (pg101)
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How are all medical professional liability claims classified?
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1. Malfeasance
2. misfeasance 3. nonfeasance (pg. 101) |
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what are the 4 elements that must be present to prove that a health care professional is guilty of negligence?
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1. Duty- duty of care is owed
2. Dereliction - provide breached duty of care to injured 3. Direct Cause- breach was direct cause of the injury 4. Damages- there is legally recognized injury to the patient (pg 101) |
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When a patient sues a doctor, who has the burden of proof?
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the plaintiff, the patient suing. their attorney must prove the 4 Ds. Some states have review boards to examine facts and made finding of "malpractice" or " no malpractice" (pg 101-2)
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What are the 7 JCAHO requirements from 01/01/2004 to address patient safety?
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1. Improve accuracy of patient identification
2. Improve effectiveness of communication of care givers 3. Improve safety of high alert meds 4. eliminate wrong patient, site or procedure surgery 5. Improve safety of infusion pumps 6. improve effectiveness of clinical alarm systems 7. Reduce the risk of HAI (pg 103-104) |
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How does a hospital meet JCAHO requirements for Improving the accuracy of patient identification?
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1. use 2 patient identifiers when taking blood or giving meds, NOT patient room
2. Prior to start of surgery or invasive procedure confirm right patient, site, and procedure using active communication, not passive. (pg 103) |
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How does a hospital meet JCAHO requirements for improving the effectiveness of communication among caregivers?
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1. have a process for verbal or telephone orders, read them back
2. standardize abbreviations, acronyms, and symbols uses in organization including terms NOT to be used. (pg 103) |
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What does a facility need to do to meet the JCAHO requirements for improving the safety of using high- alert medications?
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1. remove concentrated electrolytes ( Potassium Chloride, Potassium phosphate, and sodium chloride) from patient care units.
2. Standardize and limit the # of drug concentrations available in the organization. (pg. 104) |
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What does a facility need to do to meet JCAHO requirements for eliminating wrong site, patient, and procedure surgery?
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1. Create and use preop verification like check lists, confirm appropriate documents, (med records, x rays)
2. Use procedures to mark the surgical site, and involve patient in the marking process. (pg. 104) |
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What does a facility do to meet JCAHO requirements for improving the safety of using infusion pumps?
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Ensure free flow protections on all general use and patient controlled analgesia intravenous infusion pumps.
(pg. 104) |
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What does a facility do to meet JCAHO requirements to improve the effectiveness of clinical alarms?
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1. Use regular preventive maintenance and testing.
2. Be sure activated with appropriate settings and can be heard in the unit. (pg. 104) |
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What does a facility do to meet JCAHO requirements to reduce the risk of health care acquired infections?
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1. Comply with CDC hand hygiene
2. manage sentinel events of unanticipated deaths or major permanent loss of function associated with HAI. (pg. 104) |
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res ipsa loquitur
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"The thing speaks for itself". Also known as doctrine of common knowledge. A situation that is so obviously negligent that no expert witness need be called. ex. leaving a sponge in a patient. (pg. 105)
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What are the 3 conditions of res ipsa loquitur?
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1. the act of negligence must be obviously under the defendant's control
2.patient must not have contributed to the act. 3. It must be apparent the patient would not be injured if reasonable care had been taken. (pg. 105) |
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what cases fall under res ipsa loquitur?
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1. leaving foreign bodies inside a patient during surgery.
2. accidentally burning or otherwise injuring patient while anesthetized. 3. Damaging healthy tissue during operation. 4. Causing infection by use of nonsterile instruments. (pg. 105) |
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damages
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monetary awards sought by plaintiffs in lawsuits. Compensation bases upon the extent of the injuries, loss of income, damage to reputation, or other harm proved. (pg. 105)
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wrongful death statutes
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state statutes that allows a person's beneficiaries to collect for loss to the estate of the deceased for future earning when a death is judged to have been due to negligence. Some states have a cap for the total award (pg. 107)
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summons
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a written notification issued by the clerk of the court and delivered with a copy of the complaint to the defendant in a lawsuit, directing him or her to respond to the charges brought in a court of law. (pg 109)
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subpoena
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a legal document requiring the recipient to appear as a witness in court or to give a deposition. (pg. 109)
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deposition
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sworn testimony given and recorded outside the courtroom during the pretrial phase of a case. (pg. 109)
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interrogatory
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a written set of questions requiring written answers from a plaintiff or defendant under oath. (pg. 109)
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subpoena duces tecum
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A legal document requiring the recipient to bring certain written records to court to be used as evidence in a lawsuit. failure to comply may result in contempt of court charge that has fines and possible imprisonment. (pg. 109-10)
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What are the phases of a lawsuit
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1. Pleading Phase
2. Interrogatory or Pretrial Discovery Phase 3. Trial Phase 4. Appeals Phase (pg. 110) |
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What happens in the Pleading Phase of a lawsuit?
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1. plaintiff attorney files complaint with clerk of court stating situation, money sought
2. Summons issue to defendant. If they do not response, they can lose case by default 3. Defendant attorney files response, their side of situation, may counterclaim or cross complain. 4. Cross complaint, plaintiff files a reply. (pg. 109) |
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What happens in the Interrogatory or Pretrial Discovery Phase of a lawsuit?
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1. Trial date set
2. pretrial motions 3. discovery of facts, subpoena, interrogatory, depositions, subpoena duces tecum. 4. pretrial conference may be called by judge to hear the case (pg. 109) |
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What happens in the Trial Phase of a lawsuit?
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1. jury selected
2. opening statements 3. witnesses called testify and cross examined. 4. closing arguments 5. judge gives instructions to jury 6. jury reaches verdict 7. final judgment handed down by the court. (pg. 110) |
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What happens in the Appeals Phase of a lawsuit?
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1. posttrial motions filed
2. appeal can be made to have case heard by higher court if evidence errors were made (pg. 110) |
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What are the two types of depositions?
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1. Discovery depositions-cover material that will be examined when witness testifies in court.
2. Deposition in lieu of trial- used in lieu of witnessing in person in trial. Often more detailed questions asked(pg. 111) |
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If you are providing fact testimony, should you provide your opinion as well?
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no, you are not allowed to give your opinion, only the facts of what was observed. (pg. 111)
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testimony
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Statements sworn to under oath by witnesses testifying in court and giving depositions. (pg. 111)
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Alternative dispute resolution (ADR)
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Settlement of civil disputes between parties using neutral mediators or arbitrators without going to court. (pg. 112)
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Arbitration
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method of settling disputes in which the opposing parties agree to abide by the decision of an arbitrator. (pg. 114)
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how are arbitrators chosen?
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1. under the terms of written contract , an arbitrator is chosen by the court or by the American Arbitration Assoc.
2. If no contract, each party chooses an arbitrator and the 2 pick a 3rd. (pg. 114) |
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What are the 4 Cs of medical Malpractice prevention?
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1. Caring
2. Communication 3. Competence 4. Charting (pg. 123-5) |
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what are the key points of showing caring as one of the 4Cs?
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1. improves their medical condition
2. decreased likelihood they sue if they feel your concern. 3. avoid speaking poorly of other care providers 4. Listen to patients and give feedback to doctors (pg. 123) |
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what are the key points of communication as one of the 4Cs?
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1. If clear and ask for confirmation, patients and peers will trust and respect
2. offer to make appointments (pg. 124) |
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what are the key points of competence as one of the 4Cs?
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1. know yourself and limitations, follow standards of care, avoid actions not trained for.
2. maintain and update skills and knowledge 3. check drugs 3 times 4. use good medical practice 5. stay up to date on progress by reading professional journals. (pg. 124) |
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what are the key points of charting as one of the 4Cs?
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1. documentation is proof. If not there, not done.
2. Document as though the patient would read it. Never write anything the patient should not see. (pg. 125) |
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Why do patients sue?
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1. unrealistic expectations
2. poor rapport / communication 3. Greed 4. Lawyers/litigious society 5. Poor quality of care 6. Poor outcome 7. Failure to understand patient and family perspective / devaluing their point of view. (pg. 126-7) |
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What should be documented when a referral is made?
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1. who is making the appointment
2. that the patient has been referred 3. follow up that appt was made and kept 4. note reports of consultation and document all recommendations from referring physicians concerning further care. (pg. 128) |
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What should be documented when a patient has missed appointments?
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1. at end of day records should be updated with no show or canceled no reschedule
2. May need to follow up, this should be noted. (pg. 128) |
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What should be documented about the dismissal of a patient?
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must formally withdraw from a case or formally dismiss patient. A letter of withdrawal or dismissal has to be filed in the patient records and sent to patient. (pg. 129)
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What should be documented when a patient refuses treatment?
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1. this should be documented in patient record "informed refusal".
2. Best to obtain written refusal from patient. |
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What is the rule of thumb for documentation?
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"If it isn't documented, it wasn't done". (pg. 129)
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denial
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a defense that claims innocence of the charges or that one or more of the four D's of negligence are lacking. (pg. 130)
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affirmative defenses
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defenses used by defendants in medical professional liability suits that allow the accused to present factual evidence that the patient's condition was caused by some factor other than the defendant's negligence. (pg. 130)
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contributory negligence
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An affirmative defense that alleges that the plaintiff, through lack of care, caused or contributed to his or her own injury. ex. prisoner who signed himself out (pg131)
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comparative negligence
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an affirmative claimed by the defendant, alleging that the plaintiff contributed to the injury by a certain degree. (pg. 131)
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assumption of risk
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a legal defense that holds that the defendant is not guilty of a negligent act because the plaintiff knew of and accepted beforehand any risk involved. Ex. patient wanted to change herself denying assistance. She fell and was responsible(pg. 131)
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emergency
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a type of affirmative defense in which the person who comes to the aid of a victim in an emergency is not held liable under certain circumstances. (pg. 132)
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what are the circumstances by which a health care practitioner would not be held liable under common law in emergency?
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1. A true emergency situation existed and was not caused by the defendant
2. the appropriate standard of care was met, given the emergency situation. (health care providers can be covered by good samaritan acts) pg. 132 |
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What are the affirmative defenses?
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1. Contributory Negligence
2. Comparative Negligence 3. Assumption of Risk 4.Emergency (pg. 130-1320 |
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what are the types of defenses for negligence?
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1. denial
2. affirmative defenses 3. Technical defenses |
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What are the technical defenses?
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1. Release of Tortfeasor
2. Res Judicata 3. Statute of Limitations (pg 132- 134) |
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technical defense
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defenses used in a law suit that are based on legal technicalities. (pg. 132)
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release of tortfeasor
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a technical defense that prohibits a lawsuit against the person who caused the injury (the tortfeasor) if he or she was expressly released from further liability in the settlement of a suit. Ex 3rd party causes accident. they are responsible and usually settlement with them prevents further action against doc(pg. 133)
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Res Judicata
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"The thing has been decided". Legal principle that a claim cannot be retried between the same parties if it has already been legally resolved. Its all claims at one time, not one thing at a time. (pg 133)
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statute of limitations
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That period of time established by state law during which a lawsuit may be filed. (pg. 134)
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What are the common dates for marking the beginning of the statutory period?
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1. the day the alleged negligent act was committed.
2. when the injury was identified by patient or should have been by reasonable patient. 3. the day the physician-patient relationship ended or the day of the last medical treatment in a series. (pg. 134) |
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risk management
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the taking of steps to minimize danger, hazard, and liability (pg. 135)
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What are some risk management activities?
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1. written job descriptions for health care employees.
2. provide office procedure manuals 3. provide employee handbooks (pg. 135) |
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quality improvement (QI)
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a program of measures taken by health care providers and practitioners to uphold the quality of patient care. (pg. 135)
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What does credentialing consist of?
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1. application, license, malpractice insurance proof.
2. listed sources verified 3. medicare and medicaid sanctions and malpractice history checked vial data bank 4. findings presented to committee 5. peer review completes (pg. 136) |
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liability insurance
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contract coverage for potential damages incurred as a result of a negligent act. (pg. 136)
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what are the two types of malpractice insurance?
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1. Claims made insurance
2. Occurrence insurance (pg. 136) |
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tail coverage
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an insurance coverage option abailable for health care practitioners; when a claims-made policy is discontinued, it extends coverage for malpractice claims alleged to have occurred during those dates that claims-made coverage was in effect. (pg. 137)
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prior acts insurance coverage
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a supplement to a claims-made insurance policy that can be purchased from a new carrier when health care practitioners change carriers. (pg. 137)
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self-insurance coverage
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An insurance coverage option whereby insured subscribers contribute to a trust fund to be used in paying potential damage awards. (pg. 138)
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What are the 5 Cs of making medical records
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1. Concise
2. Complete (and objective) 3. Clear (and legibly written) 4. Correct 5. Chronologically ordered (pg. 147) |
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who owns the medical records?
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records are the property f the owners of the facility. (pg. 150)
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Who owns the information in the medical records?
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the patient. they can sign a release and obtain access and copies of record. (pg. 150)
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how long should records be kept?
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until the statute of limitations has passed. (pg. 150) However good too have them longer to best treat patient.
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health information technology (HIT)
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the application of information processing, involving both computer hardware and software, that deals with storage, retrieval, sharing , and usage of health care information, data, and knowledge for communication and decision making. (pg. 151)
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