Medical/Legal Issues &
Professional Ethics
Rad Tech A
SPRING 2012
HIPPA
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The Health Insurance Portability and
Accountability Act of 1996 mandates that federal
laws or regulations ensure the confidentiality of
medical records.
Patients or representatives should have access
to all records except in the event the provider
feels that it is not in the best interest of the
patient’s health to have access or if the
knowledge of the health care information could
cause danger to the life or safety of any person.
HIPAA
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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.
HIPPA
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Within radiology:
Technologists are sometimes asked by
patients if they can examine their records
while in transit, waiting for a procedure or
undergoing an examination. The record
information should not be shared with the
patient in this fashion as this may lead to
misinterpretation of information.
HIPAA Video- Will be shown on
Last day of class. (SAT students)
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Be careful ….. the walls sometimes have
ears
The Importance of a
Professional Ethic
Ethics: the systematic study of
rightness and wrongness of
human conduct and character as
know by natural reason
Professional Ethic: the ethical
conduct of a profession
Definitions
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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 individual’s 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.
Professional Ethics
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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.
ARRT Code of Ethics
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A guide by which RT’s 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
ARRT Code of Ethics
Appendix D
1. Professional manner, respond to pt needs,
support colleagues
2. Provide services to humanity w/ full respect for
mankind
3. Delivers pt care without discrimination
4. Practices & uses equipment appropriately
5. Acts in the best interest of the pt.
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.
Ethical Dilemma
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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
Group Activity # 1
I Think Dr. Jones
Misread the Film”
You have just finished a routine radiologic procedure on Mrs.
Green. As you develop the film, it becomes clear that Mrs.
Green is probably suffering from a rare form of bone disease.
Dr. Jones, a young resident, glances at the film and smiles. “I
didn’t think Mrs. Green had anything to worry about,” he says.
“That joint pain she was complaining about must be all in her
head.” Later, you see Dr. Jones talking to Mrs. Green’s family.
He is smiling and joking with them as he signs Mrs. Green’s
discharge papers. Shaken, you mutter to yourself, “I think Dr.
Jones misread the film.” What should you do”
Ethical Theories
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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.
Moral Principles
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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
Medical/Legal Issues
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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.
Causes of Legal Action
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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.
Schloendorf v.
Society of New York Hospital
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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 patient’s
consent commits an assault, for which he is
liable in damages.
Doctrine Serves 6 Functions
1.
2.
3.
4.
5.
6.
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
Standard of Care
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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.
Practice Standards for
Radiography Appendix A pg. 411
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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
Patient Fall in Radiology Dept
~NEGLIGENCE~
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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 fx’d her neck & femur – requiring surgery.
Surgery caused a pulmonary embolism
Radiologist was negligent for not securing
medical hx prior to exam, pt won lawsuit.
Four Elements to Prove
Negligence
1.
2.
3.
4.
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.
Cause of Legal Action
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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.
Cause of Legal Action
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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.
Patient Rights &
Responsibilities
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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.
Res Ipsa Loquitur
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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
Res Ipsa Loquitur
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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 defendant’s sole
care custody & control.
Respondeat Superior
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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.
Corporate Liability
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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.
Informed Consent
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A person’s 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.
Documentation
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In court, if you testify that you properly
assessed the patients medical risk and
obtained consent from the patient verbally
prior to the examination; will that serve as
meeting the Technologist Standard of
Practice?
Group Activity #2Case Study
Life or Death, the right to choose
Pt. Vega & her husband (Jehovah’s 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 D&C 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.