Curriculum to Accompany
Medical Assisting:
Administrative and Clinical Competencies,
6th Edition
Course:
Medical Ethics and Liability
Curriculum to Accompany Medical Assisting: Administrative and
Clinical Competencies, 6th Edition
Course: Medical Ethics and Liability
Contents
Part A: Ethics and Legal Responsibility
Part B: Professional Liability
Curriculum to Accompany Medical Assisting: Administrative and
Clinical Competencies, 6th Edition
Course: Medical Ethics and Liability
Course overview
Within the purview of medical assisting, many topics are vital to the success of the
professional medical assistant. Being aware of issues related to medical ethics, the
possibility of being sued, understanding what your limitations and responsibilities are,
and a grasp on federal and state health care legislation and regulation is essential. Every
medical assistant must know the scope of practice within the state and the level of
education to circumvent legal situations. By having a firm grasp on these things, the
medical assistant can help to assure that the bounds of practice are not overstepped – at
least intentionally. This part of the course will talk about the many ethical and legal
responsibilities encountered in the medical office or clinical setting as well as issues
concerned with professional liability.
Resource list
Textbook: Thomson Delmar Learning’s Medical Assistant: Administrative and Clinical
Competencies, Sixth Edition, by Lucille Keir, Barbara Wise, Connie Krebs, and Cathy
Kelley-Arney. © 2007, Thomson Delmar Learning, ISBN 1-4180-6633-8. Chapter 3.
Student CD-ROM: CD-ROM that accompanies Thomson Delmar Learning’s Medical
Assistant: Administrative and Clinical Competencies, Sixth Edition. This CD-ROM
contains StudyWARE, The Critical Thinking Challenge, and an Audio Library.
Workbook: Workbook to accompany Thomson Delmar Learning’s Medical Assistant:
Administrative and Clinical Competencies, Sixth Edition, by Lucille Keir, Barbara Wise,
Connie Krebs, and Cathy Kelley-Arney. © 2007, Thomson Delmar Learning, ISBN 14180-3267-0. Chapter 3.
Instructor’s Materials: Instructor’s Resource Manual to accompany Thomson Delmar
Learning’s Medical Assistant: Administrative and Clinical Competencies, Sixth Edition,
by Lucille Keir, Barbara Wise, Connie Krebs, and Cathy Kelley-Arney. © 2007,
Thomson Delmar Learning, ISBN 1-4180-3268-9.
Instructor’s CD-ROM: Electronic Classroom Manager to accompany Thomson Delmar
Learning’s Medical Assistant: Administrative and Clinical Competencies, Sixth Edition,
by Lucille Keir, Barbara Wise, Connie Krebs, and Cathy Kelley-Arney. © 2007,
Thomson Delmar Learning, ISBN 1-4180-3269-2.
DVD: Thomson Delmar Learning’s Critical Thinking for Medical Assistants DVD Series.
Program 3, Legal and Ethical Issues. Series ISBN 1-4018-3857-X.
The Internet: It is strongly recommended that faculty and learners alike have a working
knowledge of the Internet.
Equipment List
1. Multimedia projector
2. Computer with Internet access
3. Multimedia equipment
4. AAMA credentialing information
5. AMT credentialing information
6. DVD player
CAAHEP content
III.C.1.c (1)
Legal guidelines/requirements for health care
III.C.1.c (2)
Medical ethics and related issues
ABHES content
VI.B.1.a.4.(a)
Ethical decisions, medical jurisprudence, and confidentiality
VI.B.1.a.4.(b)
Legal terminology pertinent to office practice
VI.B.1.a.4.(c)
Medical/ethical issues in today’s society
CAAHEP competencies
III.C.3.c(2)(a)
Identify and respond to issues of confidentiality
III.C.3.c(2)(b)
Perform within legal and ethical boundaries
III.C.3.c(2)(c)
Establish and maintain the medical record
III.C.3.c(2)(3)
Document appropriately
III.C.3.c(2)(f)
Demonstrate knowledge of federal and state health care legislation
and regulations
ABHES competencies
VI.B.1.a.1.(b)
Maintain confidentiality at all times
VI.B.1.a.5.(a)
Determine the needs for documentation and reporting
VI.B.1.a.5.(b)
Document accurately
VI.B.1.a.5.(d)
Follow established policy in initiating or terminating medical
treatment
VI.B.1.a.5.(g)
Monitor legislation related to current healthcare issues and
practices
Learning Activities
(HW) Terminology Notebook. Assign chapter for reading and have students define key
terms and retain in a key term notebook for future reference.
(ICA) Show a DVD clip—“Licensing and scope of practice” from Program 3: Legal and
Ethical Issues (Critical Thinking series).
(ICA) Show a DVD clip—“Ethical practice” from Program 3: Legal and Ethical Issues
(Critical Thinking series).
(ICA) Show a DVD clip—“HIPAA and the right to privacy” from Program 3: Legal and
Ethical Issues (Critical Thinking series).
(ICA) Differentiate between law and ethics
(ICD) AAMA Code of Ethics discussion by points of the code and have each student
provide their interpretation or correlation to the AAMA Code of Ethics.
(ICA) Divide the class into two groups to discuss pro-life and pro-choice as it pertains to
the life of a fetus
(ICD) Medical transplants and their ethical impact
(ICD) Living will vs. durable power of attorney vs. do not resuscitate
(ICD) Emancipated minor discussion – do you know anyone who is an emancipated
minor? What do you think?
(ICA) Preparation of consent forms for a simulated medical office
(HW) Define privileged communications plus the implications associated with such
communication; when are they exempt, if ever?
(HW) Chapter 3, Unit 1 Workbook Assignment Sheet.
(ICA) Use the Internet to research federal and your state’s legally required disclosures
(ICA) Make up four different scenarios involving defamation of character, libel, and
slander. Have students identify the tort involved in each scenario.
(ICD) Discuss the differences in revoking and/or suspending a medical license and what
the difference between the two adverse actions are
(ICA) Have the students prepare a physician Bill of Rights, patient Bill of Rights, and
sample form for terminating the physician-patient contract
(ICA) Provide examples for the students to identify the difference between abandonment
and professional negligence as well as discussing their feelings on each.
(ICA) Provide an example of an implied agreement and when it might be used.
(ICA) Show a DVD clip—“HIPAA and the release of medical records” from Program 3:
Legal and Ethical Issues (Critical Thinking series).
(ICA) Why is the retention of medical records so important? Have the students to
research how long your state requires that a health care provider maintain medical
records on patients.
(ICA) Split the class into two or three groups to discuss why caution is essential when
preparing written brochures with instructions for patients.
(HW) The Critical Thinking Challenge, page 65 in the text.
(HW) Chapter 3, Unit 2 Workbook Assignment Sheet.
(HW) The StudyWare Challenge, Chapter 3. Have students take the Quiz in “Quiz
Mode” and either email their scores to the instructor, or print the scores to turn in.
(ICA) Following review of the chapter and homework assignments, use the Electronic
Classroom Manager’s Test Bank to give a quiz on this chapter that includes the content
and competencies listed for CAAHEP and ABHES as well as items from the Certification
Connection.
Part A: Ethics and Legal Responsibility
Learning Objectives
Cognitive
1. Define the words to know in the two sections of the chapter.
2. Identify each of the following as related to licensure: requirements for physicians,
methods of licensure, and exceptions to the need for licensure
3. Define public law and private law.
4. Understand and delineate the difference between ethics and law, and apply ethical
considerations to medical assisting.
5. Discuss the five primary elements of the American Association of Medical
Assistants Code of Ethics.
6. Identify ethical dilemmas associated with Diagnosis Related Groups (DRG),
societal groups denied insurance coverage, and the life and rights of a fetus.
7. Define three categories of medical transplants plus identifying the most common
type of transplant.
8. Describe a living will and its implications.
9. Name four examples of tort low.
10. Define an emancipated minor and provide examples of such an individual.
11. List the three parts of a contract.
12. Differentiate between implied and express consent; prepare a common consent
form typically found in an ambulatory health care setting.
13. Define privileged communication.
14. List instances when disclosure of information is legally required.
15. Define defamation of character, libel and slander; discuss the differences between
the three.
16. Explain why a medical license might be revoked or suspended.
Affective (behavior)
17. Describe a precaution in providing a patient with written instructions and why
caution is involved in writing such instructions.
Initial Questions and Activities
 Differentiate between law and ethics.
 Initiate an AAMA Code of Ethics discussion by points of the code and have each
student provide their interpretation or correlation to the AAMA Code of Ethics.
 Discuss medical transplants and their ethical impact.
 Discuss the differences between the concepts of living will, durable power of
attorney, and do not resuscitate.
 Emancipated minor discussion – do you know anyone who is an emancipated
minor? What do you think?
Key Concepts
References & Activities
Slides
Licensure requirements
Page 53
4-9
Ethical considerations
Page 53
State and federal laws
Page 54
10-19
Legal and ethical considerations including
Anatomical Gift Act
Page 55
20-31
Legal matters that affect practices
Page 56
(ICA) In-Class Activities
1. Show a DVD clip—“Licensing and scope of practice” from Program 3: Legal and
Ethical Issues (Critical Thinking series).
2. Show a DVD clip—“Ethical practice” from Program 3: Legal and Ethical Issues
(Critical Thinking series).
3. Show a DVD clip—“HIPAA and the right to privacy” from Program 3: Legal and
Ethical Issues (Critical Thinking series).
4. Divide the class into two groups to discuss pro-life and pro-choice as it pertains to
the life of a fetus.
5. Preparation of consent forms for a simulated medical office.
6. Use the Internet to research federal and your state’s legally required disclosures.
7. Have the students to prepare a physician Bill of Rights, patient Bill of Rights, and
sample form for terminating the physician-patient contract
8. Have students provide an example of an implied agreement and when it might be
used.
9. Split the class into two or three groups to discuss why caution is essential when
preparing written brochures with instructions for patients.
(ICD) In-Class Discussion
1. Is there a difference between law and ethics? If so, can you provide an
explanation of the differences and how it pertains to you as a medical assistant?
Students should understand that laws pertain to matters that are regulated through
federal and/or state legislation for the purpose of protecting the public. Ethics deal with
moral issues, such as the difference in the basic concepts of right and wrong, differences
in truth and fiction, and behavioral actions for providing medical care. A medical
assistant may breach ethical considerations and not be punished while if a law is
violated, punishment through imprisonment and/or fines may be assessed.
2. Why are there codes of ethics of medical professionals, particularly medical
assistants?
Codes of ethics for various medical professionals emphasize the concept of ethical
behavior in the profession. Reinforcement of these considerations by vowing to act in
accordance with the recognize ethical guidelines for medical assistants assists in
ensuring the students’ commitment to such behavior.
3. Do you think that a fetus has rights? Do you think that the mother has rights?
These will vary according to the individual belief of the students; this may be a lively
discussion.
4. Do you have an opinion of medical transplants? How much do you know about
the process? Are you or would you be willing to designate yourself or a loved
one as an organ donor?
Each student is entitled to their opinion regarding medical transplants. Discussing the
process of how to appropriately designate yourself or a loved one as an organ donor by
talking about the Uniform Anatomical Gift Act will help to enlighten the students
regarding the process. Willingness to be an organ donor will be based on personal
preference.
5. Do you think that living wills should always be observed?
Each student is entitled to their opinion; however, discuss the considerations that involve
living wills.
6. Do you know anyone that is classified as an emancipated minor?
Whether the students know any that fits this designation will be anyone’s guess. In the
event that they don’t know any emancipated minors, discuss the points that categorize
these individuals such as: under the legal age but no longer living with their parents,
self-supporting, serving in the military, or married.
7. How much do you know about contractual law? Why is it important in health
care?
Contractual law deals with three basic issues: offer, acceptance, and consideration In
health care, you need to understand that when a patient calls for an appointment, accepts
the provision of health care by the provider, and either has their insurance company to
pay for the services or pay for it themselves, a contract between the two parties has been
formed. Usually when we think of contracts, we think of more formal, written contracts,
so applying contract law to the health care setting can be abstract for some individuals.
8. Isn’t consent simply consent? How will you know the differences?
There are two types of consent: express and implied. Express consent in the health care
field is a more formal type of consent in that the patient is provided the terms of the
consent (usually) in a written document. For instance, prior to having surgery, a patient
will be provided with a description of the procedure, complications associated with the
procedure, contraindications of such a procedure, and the like; after being informed
verbally and in writing, the patient signs the consent form. Implied consent is more
informal and can be as simple as a patient coming to the office for care, and by allowing
the medical assistant to take their vital signs or take their blood, the patient is consenting
to the procedure.
(HW) Homework Assignments
1. Terminology Notebook. Assign Unit for reading and have students define key
terms and retain in a key term notebook for future reference.
2. Define privileged communications plus the implications associated with such
communication; when are they exempt, if ever?
3. Chapter 3, Unit 1 Workbook Assignment Sheet.
Presentation Tools
Note to Instructors: If you change Objectives or Assignments, don’t forget to change the
slides accordingly.
Chapter 3,
Slides 1-2
Introduce the course and unit.
Slide 3
The differences between liability and ethics.
Slides 4-7
Licensure requirements for physicians.
Discuss requirements associated with military physicians and residence
requirements as well as which states allow for reciprocity
Slides 8-9
The concepts of revocation and suspension.
Introduce the concept of HIPAA associated with betrayal of patient
confidence
Slide 10
Civil law (also called private law).
Slides 1112
Consent.
Slides 1314
Civil law terms.
Slide 15
The difference between libel and slander.
Slide 16
Privileged communications.
Be sure learner understands difference in implied and expressed
consents
Negligence needs to be discussed from the standpoint of another person
in the same position – for instance, a medical assistant is judged against
what another medical assistant would do, not a nurse or a physician
Remind learners about HIPAA.
Slide 17
The concept of emancipated minor.
Slide 18
Insert comments about why such disclosures are not considered a breach
of patient confidentiality.
Slide 19
Criminal law (also called public law).
Slides 20-
Principles of medical ethics.
22
Slide 23
Ethical concerns—diagnosis-related groups.
Talk about why insurance carriers may deny coverage to HIV positive
or AIDS patients; include in discussion “pre-existing conditions” and
denial of health care coverage
Slide 24
Ethical concerns—health insurance.
Slide 25
Ethical concerns—relating to a fetus.
Slides 2627
Ethical concerns—relating to transplants.
Slide 28
Responding to ethical concerns.
Slide 29
Precautions to take when giving written instructions to patients.
Emphasize that many patients will not inform you if they do not
understand what is being provided to them
Slide 30
The concept of living will.
Slide 31
The AAMA Creed and AAMA Code of Ethics.
Refer students to Figures 3-1 and 3-2 on page 54.
Slide 32
Have students answer the checkpoint questions on the slide to review
the content in the unit.
Part B: Professional Liability
Learning Objectives
Cognitive
1. Define the words to know in the two sections of the chapter.
2. List the rights of the physician in providing health care.
3. List the rights of the patient in receiving health care.
4. Identify the correct procedure for terminating the physician-patient contract.
5. Define and provide examples of abandonment.
6. Define and provide examples of professional negligence.
7. Provide an example of an implied agreement.
8. Give reasons for retaining medical records.
Initial Questions and Activities
 Discuss the differences in revoking and/or suspending a medical license and what
the difference between the two adverse actions are
 Provide examples for the students to identify the difference between abandonment
and professional negligence as well as discussing their feelings on each.
Key Concepts
References & Activities
Slides
Physician and patient rights
Page 60
30-42
Employee rights
Page 61
43-44
Medical records
Page 63
45-54
HIPAA
Page 65
(ICA) In-Class Activities
1. Show a DVD clip—“HIPAA and the release of medical records” from Program 3:
Legal and Ethical Issues (Critical Thinking series).
2. Why is the retention of medical records so important? Have the students to
research how long your state requires that a health care provider maintain medical
records on patients.
3. Make up four different scenarios involving defamation of character, libel, and
slander. Have students identify the tort involved in each scenario.
4. Following review of the chapter and homework assignments, use the Electronic
Classroom Manager’s Test Bank to give a quiz on this chapter that includes the
content and competencies listed for CAAHEP and ABHES as well as items from
the Certification Connection.
(ICD) In-Class Discussion
1. Are you aware of the differences between defamation of character, libel, and
slander? How might these impact your career as a medical assistant?
Defamation of character includes libel and slander; libel is malicious, verbal comments
about an individual while slander involves written comments. As a medical assistant, you
must be very cautious not to make untoward remarks about any patient in addition to
being careful not to breach patient confidentiality.
2. Which is the most severe – revoking or suspending a medical license?
Revocation of a license is a permanent punishment; suspension of a license is temporary.
3. Do health care providers have any rights in providing health care?
Health care providers do actually have rights associated with the provision of health
care; they may select their hours of operation, their location, their individual practices
for seeing patients, billing insurance carriers, participation with insurance carriers, etc.
4. Do patients have any rights in receiving health care?
There is a patient bill of rights that many providers and hospitals use to assure that
patients are aware that they have rights associated with the receipt of health care.
5. How would a provider terminate the relationship with the patient without
repercussions?
The provider should prepare a letter sent to the patient as certified mail with return
receipt requested; a copy of the letter as well as the return receipt from the patient must
be maintained in the patient’s file (medical record). If a certified letter is not sent, there
will be no way to ascertain if the patient received the letter informing them of the health
care provider’s withdrawal from their care.
6. Is it possible for a health care provider to abandon a patient? If so, how?
Yes, it is quite possible that a health care provider can abandon a patient. Failure to see
a patient after admitting one to the hospital is one example of abandonment; another
example is if a provider withdraws from a patient’s care without notifying the patient
properly of their intentions, not offering to send medical records to the new provider,
and/or not giving the patient ample time to find a new provider.
7. What problems could occur as a result of providing a patient with written
materials from an office?
(1) Providing written materials to a patient that cannot read can be construed as
professional negligence. (2) The provision of written materials to patients that have
English as a second language can also be seen as professional negligence. (3) Written
instructions that are not clear will not help the patient’s care. (4) Written documents that
promise a cure that does not work can be interpreted as a breach of contract.
8. What’s the purpose in maintaining medical records? Do you consider them legal
documents? If so, why?
Maintenance of medical records helps to assure that patients will receive prompt and
effective medical care. They are definitely legal documents that are often used in court.
Remember that if something is not documented in the patient’s chart, it was not done, and
if it is documented incorrectly, the burden of proof will fall on the health care provider.
Be cognizant of proper charting to prevent questions in case of a law suit.
(HW) Homework Assignments
1. Terminology Notebook. Assign Unit for reading and have students define key
terms and retain in a key term notebook for future reference.
2. The Critical Thinking Challenge, page 65 in the text.
3. Chapter 3, Unit 2 Workbook Assignment Sheet.
4. The StudyWare Challenge, Chapter 3. Have students take the Quiz in “Quiz
Mode” and either email their scores to the instructor, or print the scores to turn in.
Presentation Tools
Note to Instructors: If you change Objectives or Assignments, don’t forget to change the
slides accordingly.
Chapter 3,
Slide 33
Introduce the unit.
Slide 34
Definition of professional liabilities.
Slides 3536
Physician rights.
Slide 37
Physician rights—right to vacation.
Slide 38
Physician rights—right to terminate a physician-patient contract.
Why do physicians have the right to determine who they will accept as
patients? Talk about various issues such as specialty areas, facilities,
etc. for better understanding
Talk about abandonment if proper procedure is not following for
termination of physician-patient contract
Slides 3940
Guidelines for withdrawing care to a patient.
Slides 4142
Patient rights.
Slides 4344
Medical assistant rights.
Slides 4547
Medical records.
Slides 48-
Preventing unauthorized release of information.
Discuss the difference between discrimination, harassment, and hostile
work environment; many learners do not understand there is a
difference in the three
Emphasize the point that medical records are legal documents – either
the physician’s best friend or worst enemy
49
Keep emphasizing HIPAA since it is such an important element of
health care today
Slides 5051
Making notes in a medical record.
Slide 52
Correcting medical records.
Remind learners that documentation must be written in blue or black ink
in a legible fashion; also remind them that they are not to make entries
into a medical record without the provider’s permission
Provide some poor examples of correcting a patient’s medical record as
well as the correct way to do so
Slide 53
Medical records—ownership of the medical record.
Slide 54
Medical records—who has access to the medical record.
Talk about why it would be important for the provider to be present
during the review of records
Slide 55
Have students answer the checkpoint questions on the slide to review
the content in the unit.
Slides 5658
The Keys to Career Success slides emphasize the relationship of the
material learned in the classroom to on-the-job success.