Discussion 7

Slide 1

Intro Slide

Slide 2

Scene 1

Professor Charles enters classroom and introduces the topics for today’s lesson and begins the lecture.

Prof Charles: Hello everyone….welcome back to class. Today, we are going to discuss patient consent and legal reporting requirements.

Consent, in the healthcare setting, is the voluntary agreement by a person who possesses sufficient mental capacity to make an intelligent choice to allow a medical procedure and/or treatment proposed by another to be performed on him or herself. Consent changes a touching that otherwise would be nonconsensual to one that is consensual. Consent can be expressed or implied.

Express consent can be in writing or verbal authorizing medical care.

Implied consent is determined by some act or silence, which raises a presumption that consent has been authorized.

There are a variety of legal requirements mandated by both federal and state regulatory agencies.

Most states have legislative reporting requirements for child abuse, Elder abuse, and diseases that pose a threat to public health and safety (e.g., anthrax, smallpox).

Let’s first discuss informed consent. What is informed consent?

Casey: Informed consent is the legal doctrine that provides that a patient has the right to know the potential risks, benefits, and alternatives of a proposed procedure.

Donald: I would agree, but would also add that where there are two or more medically acceptable treatments options, the competent patient has the absolute right to know and select from the available treatment options after being informed of the alternatives, risks, and benefits of each.

Casey: In addition to what has already been noted, I would say that the right to control one’s own body spawned the doctrine of informed consent.

Prof. Charles: Absolutely… what is the responsibility of the hospital?

Donald: The hospital employees who are not physicians do not have an independent duty to obtain informed consent of the patient. Or to warn patients of the risks of a procedure to be performed by a physician.

Prof. Charles: When is a patient considered competent to make medical decisions?

Casey: The clinical assessment of decision-making capacity should include the patient’s ability to:

Understand the risks and alternatives;

Evaluate the information provided by the physician;

Express his or her treatment preferences; and

Voluntarily make decisions regarding his or her treatment plan without undue influence.

Prof. Charles: Great job Casey! Now let’s take a closer look at how this affects the hospital nurse

Slide 3

Check Your Understanding

Which of the following is a responsibility of the hospital nurse and informed consent?

A. Nurse has a duty to advise a patient as to a particular procedure to be performed.

B. Generally speaking a hospital nurse has no duty to advise a patient on consenting to have a hospital procedure performed.

C. The hospital nurse has a duty to provide informed consent if she/he helps the patient sign the informed consent form.

Correct Feedback:

B. The nurse has no duty, generally, to advise the patient in considering signing an informed consent

Incorrect Feedback:

A. Nurse has a duty to advise a patient as to a particular procedure to be performed.

C.. The hospital nurse has a duty to provide informed consent if she/he helps the patient sign the informed consent form

Slide 4

Scene 2

Discussion between Prof Charles and students.

Prof. Charles: In general, a hospital nurse has no duty to advise a patient in considering an informed consent even if the nurse is to help obtain the patient’s signature.

Casey: So, Professor Charles…can you explain the physician’s duty in obtaining informed consent?

Prof. Charles: Absolutely! The physician is expected to disclose to their patients the benefits, risks, and alternatives of recommended procedures. Disclosure should include what a reasonable person would consider material to his or her decision of whether or not to undergo treatment.

Donald (interrupts): Just to be clear, is this necessary for diagnostic tests?

Prof. Charles: No, only if the procedure is medical treatment, surgery, or medical procedure.

Casey: I am still not quite clear on the hospital’s duty to the patient in regards to informed consent.

Prof. Charles: Sure….There are exceptions to the rule that the hospital has no duty to inform the patient in gaining informed consent. There is a case which is a good example of the hospital’s duty to obtain informed consent. In Keel v. St. Elizabeth Medical Center, the hospital failed to obtain an informed consent when the patient received a CT and injection of a diagnostic contrast dye. The patient developed a swelling of a vein caused by a blood clot at the site of the injection. The hospital offered no information on risks and complications related to the dye injection.

Slide 5

Check Your Understanding

When the allowance for the doubtful account appears on a company’s financial statements, its balance is considered a _____ balance.

A. Credit

B. Debit

Correct Feedback:

A. Credit is correct. The doubtful account allowance is considered a contra account…which is basically the equivalent of an offsetting account. In this instance, the doubtful allowance account offsets the asset account, thereby creating a credit balance.

Incorrect Feedback:

B. The allowance account must be zero or credit balance when reported on the balance sheet.

Slide 6

Check Your Understanding

When the patient is either physically or mentally unable to consent and no emergency exists, consent must be obtained from a person who is empowered to consent on the patient’s behalf. This person must have:

A. Medical training

B. Be an immediate family member

C. Be sufficiently informed to make an intelligent decision

D. Be a spouse

Correct Feedback:

C. Be sufficiently informed to make an intelligent decision

Incorrect Feedback:

A. Incorrect. Please try again

B. Be an immediate family member

D. Incorrect. Please try again. Remember the person does not have to be a family member

Slide 7

Scene 3

Discussion of legal reporting requirements.

Prof. Charles: Now let’s discuss legal reporting requirements mandated by both federal and state regulatory agencies.

Can anyone give examples of legal reporting requirements?

Casey: I think I can name a few. Abuse is not always easy to identify as it sometimes can be attributed to other causes. Some abuses are:

child abuse; and

elder abuse.

Donald: Prof. Charles….what are examples of child and elder abuse?

Prof. Charles: Donald, that is a great question…An example of child abuse is a child suffering from starvation. An example of elder abuse is assault, battery, and inappropriate restraint.

Casey: So is it safe to say that one of the hallmarks of abuse is harm or loss to the patient?

Prof. Charles: Yes, Casey….I think that is a pretty good distinction.

Casey: I think that the discussion on abuse has really clarified some questions for me. Now, a little more clarification on documentation of abuse would really help.

Prof. Charles: Well, that is a great lead-in to the next topic, which is legal reporting of abuse.

Slide 8

Scene 4

Discussion on increase in assets and decrease in liabilities.

Prof. Charles: Caregivers who suspect abuse are expected to report their findings. Symptoms and conditions of suspected abuse should be defined clearly and objectively.

In regards to witnesses, reporters of abuse must describe statements made by others as accurately as possible and what actions were taken, by whom, when, where, and so forth. Information should be included about how witnesses may be contacted.

In regards to photographs, it may be necessary to photograph wounds or injuries. A hospital emergency department or the police department can be asked to take photographs in emergency situations.

What are other examples apart from abuses that must be reported according to state or federal laws?

Casey: I would say that the caregiver should report actual or suspected cases of communicable diseases and all births and deaths.

Prof. Charles: Exactly…It is so important to remember that the state is more interested in suspicious or unusual deaths or births that may account for some form of criminal activity. The medical examiner may perform an autopsy and may make an investigation of all such cases. The medical examiner can also issue an autopsy report on the cause of death. A criminal indictment may be issued by the court if necessary.

Donald: Professor, in our discussion, you have provided us with a significant amount of information since we are discussing instances of abuse, communicable diseases and legal reporting, I would like to learn more about the Health Care Quality Improvement Act of 1986 (HCQIA) which gives limited immunity to those reporting and reviewing instances which may affect a physician’s medical staff privileges.

Prof. Charles: The problem of providing a safe patient environment, particularly in a hospital, and the legal reporting of such violations resulted in the passage of HCQIA in 1986.

This Act allowed health entities to improve the quality of medical care through effective professional review and disclosure of incompetent physicians to the state and federal government without fear of reprisals. Also, this reporting helped prevent an incompetent physician from moving state to state without disclosure of the physician’s damaging or incompetent performance.

Casey: So, how did the National Practitioner Data Bank (NPDB) figure into this reporting requirement?

Prof. Charles: The NPDB was established by law to protect the public and patient safety by restricting the ability of unethical or incompetent practitioners to move state to state without disclosure or discovery of previously damaging or incompetent performance.

The NPDB allows hospitals a snapshot physician’s history before credentialing. The sad fact is, though, many hospitals do not report all cases to the NPDB and thus it is not a catch-all for reporting and protection of the public.

Slide 9

Scene 5

Summary

Picture of Casey and Donald as they speak.

Prof Charles: We are just about out of time. Let’s go over what we learned in this lesson.

Today, our discussion focused on the patient consent and legal reporting and the related legal issues. Liability for performing a medical or surgical procedure without consent is distinct from a question of negligence or malpractice in performing the procedure. Generally, senior abuse is less likely to be reported than child abuse, and proving senior abuse charges is often difficult. The NPDB may be queried by state licensing boards, hospitals, other healthcare organizations and professional societies that have entered into employment or affiliation relationships with physicians, dentists, or other healthcare practitioners who have applied for clinical privileges or appointment to a medical staff.

Before we adjourn, are there any questions?

Donald: I have no questions; I think that the information was clearly presented, Professor.

Casey: No questions for me. Thank again Professor.

Professor Charles: Well, if there are no further questions, I will say good evening and I will see you next time.