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Laws & legal responsibilities in every aspect of life
Goal – protect you & society (traffic laws)
 Health care workers have certain responsibilities as well
– Important to be aware of & follow
– Protects you, the employer, & the patient

 Based on law
 Civil law or criminal law
– Civil law - dealing with legal relationships between PEOPLE & protection of a person’s
RIGHTS
– Criminal law – dealing with WRONGS against a
PERSON, PROPERTY, or SOCIETY
 Health care mostly affected by CIVIL law
– Contracts
– Torts – wrongful act that does not involve a contract

 Criminal laws can apply
– Practicing without a license
– Misuse of narcotics
– Theft
– Murder
 Health care professionals are required to know & follow state laws regulating licensure or registration & set standards for their profession

 Occurs when a person is harmed or injured because a HCP doesn’t meet the expected standards of care
– Civil wrongs NOT crimes
– Can lead to legal action (lawsuits)
– Offenses may be complex & subject to interpretation
– Malpractice, negligence, assault & battery, invasion of privacy, false imprisonment, abuse, defamation

 “bad practice”, commonly called professional negligence
 Failure of a professional to use the degree of skill & learning commonly expected in a particular profession
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Results in injury, loss, or damage to person
Examples –
– Puncture wound & dr. doesn’t order tetanus shot
– Nurse performing minor surgery without training

 Failure to give care that is normally expected of a person in a particular position with resulting injury to another person
 Examples
– Falls due to side rails down
– Using or not reporting defective equipment
– Infections caused by non-sterile technique, equipment, or supplies
– Burns caused by improper heat or radiation

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Closely related & often used together
Assault – includes a threat or attempt to injure
Battery – unlawful touching of another person without consent
 Patients must give CONSENT & have the right to REFUSE
 Some procedures require written consent
– Surgery
– Diagnostic tests
– Treatment of minors
– Side rail releases

 Verbal consent is permitted at times
– Must be INFORMED CONSENT- permission given
• Voluntarily
• Person of sound mind
• After procedures & all risks involved have been explained in terms person can understand
 Can withdraw consent at any time
 Explain all procedures, DO NOT PERFORM if pt does not give consent
 Examples
– Performing procedure after pt has refused tx
– Improper handling & rough treatment

 Unnecessary exposure of a person OR revealing personal info without consent
 Examples
– Improper draping or covering leaving pt exposed to view
– Sending info to an insurance company without written permission
– Informing news media about condition without permission

 Restraining an individual or restricting another person’s freedom
 Examples
– Keeping pt hospitalized against his will
– Application of physical restraints without proper authorization or with no justification

 Any care that results in physical harm, pain, or mental anguish
– Physical – hitting, forcing persons against their will, depriving food/water, restraints, not providing personal care
– Verbal – shouting, swearing, harsh words, racism, abusive statements
– Psychological – threatening harm, denying rights, belittling, intimidating, ridiculing, threatening to reveal information
– Sexual – unwanted sexual touching or act, sexual gestures, suggesting sexual behavior

 Pts may experience abuse before entering your facility
– Domestic abuse –threatening, manipulative, aggressive, or violent behavior to maintain power & control
– Child abuse – directed toward a child
– Elder abuse – directed toward an older person

 Be alert to signs & symptoms indicating abuse
– Unexplained bruises, fractures, burns, injuries
– Signs of neglect – poor personal hygiene
– Irrational fears or change in personality
– Aggressive or withdrawn behavior
– Patient statements

 Presence of signs & symptoms indicate need for more investigation
 Health care workers are REQUIRED to report any signs of abuse –
MANDATED REPORTERS
 Laws in all states protect reporting of any type of abuse to authorities

 False statements that cause a person to be ridiculed or cause damage to his/her reputation
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Incorrect info given out in error
– Libel – written information
– Slander – information is spoken
Examples –
– Reporting pt with an infectious disease to an agency when lab results are inaccurate
– Stating person has a drug problem when another medical condition exists

 Agreement between two or more parties
 Three parts
– Offer – competent person enters into a relationship with HCP & offers to be a pt.
– Acceptance – HCP gives an appointment or examines or treats a pt.
– Consideration – payment made by pt for services provided

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Implied – cause obligations that are understood without verbally expressed terms
– Example – qualified HCP prepares meds & pt takes meds (implied that pt accepts the treatment)
Expressed – stated in distinct & clear language, oral or written
– Example – surgery permit
– Promises of care must be kept
– All risks associated with treatment must be completely explained to pt.

 All parties in contract must be free of legal disability
 Person with a legal disability does not have the legal capacity to form a contract
 Examples
– Minors – under legal age, differs by state
– Mentally incompetent persons
– Persons under influence of drugs or alcohol
– Semiconscious or unconscious persons
 Parents, guardians, or those permitted by law must form contract for these people

 Contract requires certain standards of care by competent, qualified people
 If contract not performed according to agreement, contract is BREACHED
 Examples
– Failure to provide care or giving improper care
– Failure to pay according to consideration
 Can lead to legal action

 Must be used when contract is explained to a non-English speaking person
 Many states require translator for deaf or hard of hearing
 Most agencies have a list of translators
 English-speaking relative or friend can serve as translator

 Person who works under direction or control of another person
 Employer is principal
– Responsible for actions of agent & can be required to compensate people who have been injured by the agent
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Employee is agent
Example – dental assistant tells pt “your dentures will look better than your real teeth”
– dentist may have to compensate if statement is false
 HCP must be aware that they are agents & work to protect employer’s interests

 ALL information given to HCP by pt
 BY LAW, all info must be kept confidential & shared only with other HCP that have the need to know
 Cannot give any info to others unless the pt gives you written consent
 Consent should give what info can be released, to whom the info can be given, & any time limits

 Some info is exempt by law and MUST be reported
– Births & deaths
– Injuries caused by violence – assault & battery, abuse, stabbings) that may require police involvement
– Drug abuse
– Communicable diseases & STDs

 Contain info about care that has been provided to pt
 Belong to HCP, but pt has right to obtain a copy of any info on record
 LEGAL RECORD in court of law
 No erasures allowed
– Cross out errors with a single line
– Insert correct info, initial & date

 Must be properly maintained, kept confidential, & retained for amount of time required by law
 To destroy, must shred or burn
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Use black ink to write in
Signature – BMcGrory, RN
– First initial, last name, title
Computer records – to safeguard
– Limit access & use codes to prevent access
– Require passwords to access specific info
– Monitor & evaluate computer use

 Set of principles dealing with what is morally right or wrong
 Provide a standard of conduct or code of behavior
 Allow a HCP to analyze info & make decisions based on what people believe is right & good conduct
 Modern health dilemmas?
– Euthanasia
– HCP has AIDS, should pt know?
– Aborted fetuses used for research?
– When should life support be discontinued?

 Can parents refuse blood transfusions for their children?
 Can a facility refuse expensive treatment to a person who cannot pay?
 Who gets the kidney? What age?
 Can a person sell an organ for transplant?
 Animals in medical research?
 Cloning?
 Selection of specific genes for transplanting
 Stem cell research?

 Saving life & promoting health #1 goal
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Keep pt. comfortable & preserve life when possible
Respect pt’s choice to die peacefully & with dignity when all options have been discussed
&/or predetermined by advance directives
 Treat all pts equally
 Avoid bias, prejudice, discrimination
 Provide care to the best of your ability
 Maintain competent skills, CEUs

 Maintain confidentiality
 Refrain from immoral, unethical, & illegal practices
 Show loyalty to pts, co-workers, & employer
 Be sincere, honest, caring

 Factors of care that pts can expect to receive
 Federal & state legislation requires agencies to have written policies about rights
 All personnel must respect & honor these rights

 Considerate & respectful care
 Current info about diagnosis, treatment, & prognosis
 Informed consent
 Advanced directives & able to refuse
 Privacy
 Confidential treatment of records
 Reasonable response to requests
 Info about hospital & relation to other facilities
 Refuse research projects
 Review medical records & examine bill
 Informed of hospital rules, regs, policies

 Established by OBRA in 1987
 Must inform resident or caregiver & post a copy in facility
 Free choice of dr, care, research
 Freedom from abuse & chemical or physical restraints
 Privacy & confidentiality
 Accommodation of needs & choice
 Voice grievances without retaliation
 Organize & participate in groups, social, religious, & community activities

 Info about medical benefits, records, state survey results, advocacy, OMBUDSMAN
 Manage own funds, use own things
 Unlimited access to immediate family
 Share a room with spouse if both residents
 Remain in facility & not be transferred for any reason except medical, welfare of resident or others, failure to pay, or if facility can no longer meet the resident’s needs

 All states have adopted the federal rights & have added their own
 Failure to follow & grant rights can lead to job loss, fines, & imprisonment

 Legal documents that allow people to state what medical treatment they want or do not want in event that they become incapacitated & unable to express their wishes
 Living Wills
– Documents that allow people to state what measures should or should not be taken to prolong life when they are terminal

 Living wills (cont)
– Must be signed when person is competent
& witnessed by 2 adults that will not benefit from that person’s death
– Most states now honor these
– Frequently results in DNR order
• No CPR
• Die with peace & dignity
• Can be hard for HCP to honor this

 Durable Power of Attorney
– Document that permits an individual (known as a principal) to appoint another person (known as an agent) to make any decisions about health care if the principal is unable to make decisions
– Includes providing or withholding procedures, hiring or firing HCP, spending for health care, access to medical records
– Usually given to spouses or adult children, but can be anyone
– Needs to be signed by principal, agent, & 1 or 2 witnesses

 Patient Self-Determination Act (PSDA)
– 1990 law that required all facilities receiving federal dollars to
• Inform every adult, orally & in writing, of their right to make decisions, including right to refuse treatment
• Provide info & assistance with advance directives
• Document advance directives on med records
• Have written statements to implement pt’s rights in making decisions
• No discrimination or affect on care due to advance directives
• Educate staff on medical & legal issues of advance directives

 Perform only procedures for which you have been trained & can legally perform
– Never perform unless qualified
– Obtain training
– If asked to do something you are not qualified to do, state you have not been trained & refuse to do it
– If you are not legally permitted to perform procedures or sign documents, refuse due to legal limitations

 Use approved, correct methods while performing procedures
– Follow procedure manual
 Obtain correct authorization before performing any procedures
– Dr’s order, verbal or written
 Identify pt & obtain consent before performing procedures
– Check name band
– State pt’s name clearly & repeat if necessary
– Explain procedure briefly – make positive statements

 I.D. pt (cont)
– Obtain consent by lack of objection
– If pt refuses, check with supervisor
– Some procedures require written consent
– Never witness a signature unless authorized to do so

 Observe all safety precautions
– Handle equipment carefully
– Protect pts
– Be alert to safety hazards & correct ASAP
– Know & follow safety rules & regs
 Think before you speak, watch everything you say
– Don’t tell pt information unless instructed
– Revealing info could cause problems

 Keep all info confidential
– Written & oral
– Don’t leave records open & out
– Don’t reveal info without pt authorization & consent
– Make sure conversations can’t be overheard
– Avoid discussing pts at home, in social situations, public places, or outside agency

 Treat all pts equally
 Accept no tips or bribes for care you provide
– You receive salary
– Care should not change based on amount of money pt can give you
– Polite refusal necessary

 If error occurs, report it to your supervisor immediately
– Never try to hide or ignore
– Make every effort to correct ASAP
– Take responsibility for actions
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Behave professionally in dress, language, manners, & actions
Liability insurance – protects you