Medical/Legal and Ethical Issues

Confidentiality

• Confidential information• Pt. history• Assessment findings• Treatment rendered

• Releasing confidential information• Written release signed from pt/legal guardian

• Written release not needed…• Receiving facility,Transporting agencies • Continuation of care • 3rd party billing info• Continuing education (remove pt ID)• Sate law (rape, abuse, GSW)• Subpoena

12VAC5-31-950. Disclosure of patient information.

Reporting Requirements

• Vary from state to state • Abuse

• Child• Elderly• Spouse/family

• Crime• Wounds form violent crime• Sexual assault

• Infectious disease exposure• Pt. restraint laws• Mentally incompetent

• Intoxicated with injuries

Scope of PracticeWhat You Do…

• “Range of activities & limitations of a given medical provider”

• Defined by state legislation• References national curricula • May be enhanced by

• Medical direction• Protocols• Standing orders

• Va OEMS Scope of Practce

Standard of CareWhat You Know…

• “Body of knowledge, laws, policies, common practices, standards, and guidelines that provide the basis for prehospital care”

• Defined by protocols and

sate certification

Negligence

• “Deviation from standard of care that results in HARM to the pt.”

• 4 Elements of Negligence• Duty to act• Breach of duty• Damage• Causal connection

• ALL 4 must be proven

Components of Negligence

• Duty to Act• “Legal requirement to assess and treat a pt”• Est. pt-provider relationship• Implied

• Pt calls for ambulance and one is sent• Treatment is started

• Formal• Contracts

• Off duty EMT has NONE

Components of Negligence

• Breach of Duty• “Negligent action/omission that

has violated the standards of care expected for an EMT under the circumstances”

• Ex. Perform a procedure incorrectly

• Failing to act in a timely/appropriate manner

• Failing to act in the circumstances required

• Performing other skills deemed negligent

Components of Negligence

• Damage• Physical • Psychological

• No damage= No case

Components of Negligence

• Causal Connection• Clear connection from injury to EMT actions

Abandonment

• “Termination of pt care without assuring the continuation of care at the same level or higher”

Good Samaritan Laws

• Protects volunteers from litigation• Raises bar

• Negligence• Gross negligence

• “Willful & wanton recklessness that would be so careless as to be dangerous”

• Va Good Samaritan Law

Consent

• MUST be obtained before treatment • Types

• Expressed• Implied

Expressed Consent

• Verbal or other gesture• Characteristics

• Informed of risks/benefits • Legal age• Rational decisions• Conscious• Mentally competent

Implied Consent

• “Consent assumed from the unconscious pt requiring aid”

• Assumes a reasonable person would expect emergency care in the situation

ConsentSpecial Cases

• Children/Mentally incompetent people

• Consent from legal guardian/parent

• Treat as implied if none found• Emancipation

• 16 years old and:• Married• In armed forces • Lives independently of parents

• Financially self supporting• Is/was a parent • Code of Va § 16.1-331 - 334

Refusals

• Pt has right to• Refuse Care• Withdraw consent at any time

• Pt must be• Mentally competent• Informed of risks/consequences • Sing “release of liability” form

• Get a witness

• Complete PPCR • Narrative • Advice given• Planned treatments

Complications of Refusals

• False imprisonment • Transport pt against will

• Assault• Creating fear of injury

• Battery• Touching someone

without their permission

Do No Resuscitate (DNR)

• DNR• Legal order signed by doctor• Withholds lifesaving measures in event of

resp/cardiac arrest• HAVE TO SEE ORIGINAL

• OTHERWISE• Treat the pt• MUST TRANSPORT WITH PT

• Types• DNR Form• DNR jewelry • “Other DRN”

• Written order by doctor• Providers

• Cannot recognize DNR from other states• Va Durable DNR Fact Sheet

Advanced Directives

• Advance Directive• Withhold certain care but not others• Specific to the pt.

• Healthcare Proxy/POA• Legally empowered person other than pt• Makes medical decisions for pt• Mentally incompetent pt.

Special Situations

• Donor/Organ Harvesting• EMT role

• ID pt as possible donor• Est. communication with

medical direction• Provide care to maintain

viable organs

• Documentation• Donor card• Back of drivers license

Special Situations

• Medical ID insignia • Bracelets• Earrings • Charms/Pendants• Cufflinks • Ring

• ID pt with medical problems • Allergies• Epilepsy• Diabetes• DNR status• Etc…

Special Situations

• Crime Scenes • Ensure

personal/personnel/pt safety

• Notify police via dispatch if 1st responding

• Don’t disturb items • Don’t cut through

holes/stabs in clothing• Preserve chain of evidence• DOCUMENT!!!!!!

Risk Management

• SAFETY • Act according to Standard of Care• DOCUMENT!• Act in interest of the pt.

Take a beak!