Medical law and Ethics

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Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Medical Law and Ethics

Importance of the Legal

System for the Physician

and the Healthcare

Professional

Chapter 3

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Medical Practice Acts

• Establish examining boards • Provide baseline for practice of medicine • Determine prerequisites for licensure • Forbid practice of medicine without a

license

• Specify conditions for renewal, suspension, and revocation of licenses

• Vary from state to state

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Licensure of Physician

• Examination – National Board Medical Examination

(NBME)

– Federal Licensing Examination (FLEX)

– U.S. Medical Licensing Examination

(USMLE)

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Licensure of Physician

• Endorsement: an approval or sanction • Reciprocity: cooperation of one state in

granting license to practice medicine to a

physician already licensed in another

state

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Licensure of Physician

• Registration: • Occurs annually or biannually • Physicians must pay a fee • Physicians are required to complete

seventy five hours of CME in a three year

period

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

When Valid License Is Not Needed by a Physician

• When employed by federal medical facilities (but must be a licensed

physician to practice medicine in some

state)

• In an emergency • While establishing residency • When engaged solely in research

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Revocation and Suspension

• Unprofessional conduct: falsifying records, gross immorality

• Commission of a crime: Medicare/Medicaid fraud, rape, murder,

larceny, narcotics conviction

• Personal incapacity: physical or mental incapacity

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Licensure and Certification of Allied Health Professionals

• Licensure: graduate from accredited school and pass national exam of

competency

• Certification: meet standards set by accreditation body and pass national

exam of competency

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Accreditation

• Voluntary request of official review by accrediting agency

• Examine policy and procedures of agency

• Must demonstrate that the institution maintains high standards

• Examples: JCAHO and CAAHEP

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Standard of Care

• Ordinary skill and care that must be used by medical practitioners

• Must provide same knowledge, care, and skill that similarly trained physician and/or

medical professional would provide under

same circumstances

• Perform as “reasonable and prudent” person would perform

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Physicians Are…

• Not obligated to treat everyone in case of emergency

• Expected to use reasonable, ordinary skill and care (not extraordinary)

• Expected to exhaust all resources available to them for patient care

• Not to expose patients to undue risk

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Prudent Person Rule (also called the “reasonable person standard”)

• Must provide following information to patient:

– Diagnosis

– Risk and consequences of treatment

– Expected benefits of treatment or procedure

– Alternative treatments

– Prognosis if no treatment

– Cost and expected pain

– Follow acceptable standard of care

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Confidentiality

• Keeping private all information about patient

• No disclosure without written consent • Medical Patient Rights Act: a federal

law that gives all patients right to have

privacy respected and records held

confidential

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Statute of Limitations

• Period of time patient has to file lawsuit • Usually one to three years • Discovery Rule: begins when problem

discovered or when the patient should

have known of the injury

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Good Samaritan Laws

• State laws help protect health care professionals and ordinary citizens from

liability while giving care in emergency

• No one is required to provide aid – Except in Vermont

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Good Samaritan Laws

• Only required to act within limits of acquired skill and training

• Once you start you must continue until help arrives or you physically cannot

continue

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Respondeat Superior

• “Let the master answer” • Employer liable for acts of employee

within scope of employment

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Employee’s Duty to Carry Out Orders

• Duty to interpret and carry out orders • Duty to clarify ambiguous or erroneous

orders

• Duty to decline orders that appear dangerous for patient and to notify

physician

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Scope of Practice

• Must understand and work within scope of practice for discipline

• Must understand and practice within guidelines of profession

• Must understand and follow chain of command so no employee makes

decision he or she is unqualified to make

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Employer’s Duty to Employees

• Responsibility to provide safe environment for employees and staff

• Most have liability insurance to cover accidents and unforeseen incidents

• May bond employees who handle money • Some have liability insurance for auto if

used for work-related business

Medical Law and Ethics, Fourth Edition

Bonnie F. Fremgen

Upper Saddle River, New Jersey 07458

Risk Management

• A practice used to control or minimize incidence of problem behavior that might

result in injury to patients and employees

and liability for physician/employer

– Identify risk behaviors and practices

– Develop and follow plan of action to

eliminate problem behavior

– Address corrective actions in policy and

procedure books and employee handbooks