1. Chapter 3Medical and LegalIssues

2. Introduction (1 of 2) A basic principle of emergency care is to dono further harm. A health care provider usually avoids legalexposure if he or she acts: In good faith According to an appropriate standard of care 3. Introduction (2 of 2) The EMT is often the first link in the chain ofprehospital care. Litigation against EMS will increase due towider availability and more complex care. 4. At the end of this module students will be able to: Describe the different types of consent Discuss forcible restraint Discuss refusal of care Discuss confidentiality (HIPPA) Discuss the EMTs Scope of Practice Define duty to act, negligence, and abandonment Define defamation of character Define the Good Samaritan law Discuss special mandatory reporting requirements Discuss ethical responsibilities 5. Reading Assignmentand Test Information Take a moment to read the following in yourtextbook AAOS Emergency Care and Transportation ofthe Sick and Injured Tenth Edition Pages 78-100 Remember your test will evaluate ALL material within this presentation, assignments, and textbook. 6. Consent (1 of 2) Consent is permission to render care. A person must give consent for treatment. If the patient is conscious and rational, he orshe has a legal right to refuse care. 7. Consent (2 of 2) Foundation of consent is decision-makingcapacity. Can understand information provided Can make informed choice regarding medicalcare Patient autonomy is right of patient to makedecisions about his or her health. 8. Expressed Consent Patient acknowledges he or she wants youto provide care or transport. To be valid, patient must provide informedconsent. You have explained treatment, risks, andbenefits to patient. 9. Implied Consent (1 of 2) Applies to patients who are Unconscious Otherwise incapable of making informeddecision Source: Dan Myers 10. Implied Consent (2 of 2) Should never be used unless there is athreat to life or limb. Principle of implied consent is known as theemergency doctrine. 11. Involuntary Consent Applies to patients who are: Mentally ill In behavioral crisis Developmentally delayed Obtain consent from guardian Not always possible, so understand localprovisions 12. Minors and Consent (1 of 2) Parent or legal guardian gives consent. In some states, a minor can give consent. Depending on age and maturity Emancipated minors (married, armed services,parents) Teachers and school officials may act inplace of parents. 13. Minors and Consent (2 of 2) If true emergencyexists, and noconsent isavailable: Treat the patient. Consent is implied. 14. Forcible Restraint (1 of 2) Sometimesnecessary withcombative patient 15. Forcible Restraint (2 of 2) Is legally permissible But generally you must consult medical control for authorization. In some states, only a law enforcement officer may forcibly restrain. 16. The Right to Refuse Treatment(1 of 2) Conscious, alert adults with decision-making capacity: Have the right to refuse treatment Can withdraw from treatment at any time Even if the result is death or serious injury Places burden on EMT to clarify need fortreatment 17. The Right to Refuse Treatment(2 of 2) Before you leave a scene where a patient,parent, or caregiver has refused care: Encourage them again to allow care. Ask them to sign a refusal of care form. Document all refusals. A witness is valuable in these situations. 18. Confidentiality (1 of 2) Information should remain confidential. Information generally cannot be disclosedexcept: If patient signs a release If legal subpoena is presented If it is needed by billing personnel 19. Confidentiality (2 of 2) HIPAA (Health Insurance Portability andAccountability Act of 1996) Contains a section on patient privacy Strengthens privacy laws Safeguards patient confidentiality Considers information to be protected healthinformation (PHI) 20. Advance Directives (1 of 3) Advance directive specifies treatmentshould the patient become unconscious orunable to make decisions. A do not resuscitate (DNR) order is anadvance directive that gives permission notto resuscitate. Do not resuscitate does not mean do nottreat.NC also has the MOST form.These forms can be located at the following:http://www.ncdhhs.gov/dhsr/EMS/pdf/DNR.pdfhttp://www.ncdhhs.gov/dhsr/EMS/pdf/ncmostform.pdfCopy and paste the links 21. Advance Directives (2 of 3) Advance directive is also called: Living will or sometimes referred to as a Healthcare directive 22. Advance Directives (3 of 3) Some patients may have named surrogatesto make decisions for them. Durable powers of attorney for health care Also known as health care proxies 23. Physical Signs of Death (1 of 4) A physician determines cause of death. Presumptive signs of death: Unresponsiveness to painful stimuli Lack of a carotid pulse or heartbeat Absence of breath sounds No deep tendon or corneal reflexes 24. Physical Signs of Death (2 of 4) Presumptive signs of death (contd): Absence of eye movement No systolic blood pressure Profound cyanosis Lowered or decreased body temperature Review table 3-1 Page 86 in your textbook 25. Physical Signs of Death (3 of 4) Definitive signs of death: A body in parts (decapitation) Dependent lividity (blood settling) 26. Physical Signs of Death (4 of 4) Definitive signs of death (contd): Rigor mortis (stiffening) Putrefaction (decomposition) 27. Medical Examiner Cases (1 of 2) Involvement depends on nature/scene ofdeath. Examiner notified in cases of: Dead on arrival (DOA)/dead on scene (DOS) Death without previous medical care Suicide Violent death 28. Medical Examiner Cases (2 of 2) Examiner notified in cases of (contd): Poisoning, known or suspected Death from accidents Suspicion of a criminal actSource: Corbis 29. Scope of Practice (1 of 3) Outlines the care you are able to provide 30. Scope of Practice (2 of 3) Medical director further defines bydeveloping: Protocols Standing orders 31. Scope of Practice (3 of 3) Carrying out procedures outside scope ofpractice may be considered: Negligence or in some states a Criminal offense 32. Standards of Care (1 of 3) Manner in which you must act or behave You must be concerned about safety andwelfare of others. 33. Standards of Care (2 of 3) Standards of care established by: Local custom Statutes Protocols Professional or institutional standards Example: AHA CPR guidelines Textbooks 34. Standards of Care (3 of 3) Standards of care established by (contd): Standards imposed by states Medical Practices Act Certification Licensure 35. Duty to Act Individuals responsibility to provide patientcare Duty to act applies: Once you respond to a call Treatment is begun 36. Negligence (1 of 2) Failure to provide same care that personwith similar training would provide in sameor similar situation. 37. Negligence (2 of 2) All four of the following elements must bepresent for negligence to apply: Duty Breach of duty Damages Causation 38. Abandonment Unilateral termination of care by EMTwithout: Patients consent Making provisions for continuing care Abandonment may take place: At scene In emergency department 39. Assault and Battery, and Kidnapping (1 of 2) Assault: Unlawfully placing person in fear ofimmediate bodily harm Example: restraint Battery: Unlawfully touching a person Example: providing care without consent 40. Assault and Battery, and Kidnapping (2 of 2) Kidnapping: Seizing, confining, abducting,or carrying away by force Example: transport against will A false imprisonment charge is more likely(defined as unauthorized confinement of aperson). 41. Defamation (1 of 2) Communication of false information thatdamages reputation of a person Defamation that is in writing is referred to aslibel Defamation that is spoken is known as slander 42. Defamation (2 of 2) Defamation could happen with: False statement on a run report Inappropriate comments made duringconversation Run report should be accurate, relevant,and factual. 43. Good Samaritan Laws and Immunity (1 of 2) If you reasonably help another person, youwill not be held liable for error/omission Good Samaritan actions to be met: Good faith Without expectation of compensation Within scope of training Did not act in grossly negligent manner 44. Good Samaritan Laws and Immunity (2 of 2) Gross negligence is conduct that constituteswillful or reckless disregard. 45. Special Mandatory ReportingRequirements (1 of 3) Most states have a reporting obligation: Abuse of children, older persons, and others Injury during commission of a felony Drug-related injuries Childbirth 46. Special Mandatory ReportingRequirements (2 of 3) Most states have a reporting obligation(contd): Attempted suicides Dog bites Communicable diseases Assaults Domestic violence 47. Special Mandatory ReportingRequirements (3 of 3) Most states have a reporting obligation(contd): Sexual assault Exposures to infectious disease Transport of patients in restraints Scene of a crime The deceased 48. Summary (1 of 8) Consent is generally required from aconscious adult before care can be started. Never withhold lifesaving care unless avalid DNR order is present. 49. Summary (2 of 8) A parent or legal guardian must giveconsent for treatment or transport of aminor. Conscious, alert adults have the right torefuse treatment or withdraw fromtreatment. 50. Summary (3 of 8) Patient communication is confidential. Advance directives, living wills, or healthcare directives are often used when apatient becomes comatose. There are both definitive and presumptivesigns of death. 51. Summary (4 of 8) A donor card or drivers license indicatesconsent to organ donation. Standard of care is established in manyways. When your ambulance responds to a call ortreatment is begun, you have a legal duty toact. 52. Summary (5 of 8) Negligence is based on duty, breach ofduty, damages, and causation. Abandonment is termination of care withoutthe patients consent or provisions fortransfer of care. Assault is unlawfully placing a person infear of immediate bodily harm. 53. Summary (6 of 8) Battery is unlawfully touching a person,which includes providing emergency carewithout consent. Good Samaritan laws protect persons whostop to render aid. 54. Summary (7 of 8) Records and reports are important,particularly if a case goes to court. You should know the special reportingrequirements for abuse of children, theelderly, and others; injuries related tocrimes; drug-related injuries; and childbirth. 55. Summary (8 of 8) You must meet legal and ethicalresponsibilities while caring for the patientsphysical and emotional needs. As an EMT, a number of situations mightcause you to end up in court. 56. Review1. You arrive at the scene of an elderly lady complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This is an example of: A. implied consent. B. informed consent. C. expressed consent. D. emergency consent. 57. ReviewAnswer: CRationale: Expressed consent (also calledactual consent) is when the patient authorizesyou to provide treatment and transport, eitherverbally or nonverbally. For example, a patientwho holds out his or her arm to allow you takea blood pressure is nonverbally giving youexpressed consent. 58. Review (1 of 2)1. You arrive at the scene of an elderly lady complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This is an example of:A. implied consent. Rationale: Implied consent is limited to life- threatening emergencies and is appropriate when a person is unconscious and/or delusional.B. informed consent. Rationale: Informed consent is when the patient has been told of the specific risks, benefits, and alternative treatments. 59. Review (2 of 2)1. You arrive at the scene of an elderly lady complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This is an example of:C. expressed consent. Rationale: Correct answer. It is also known as actual consent.D. emergency consent. Rationale: This does not exist as a form of consent. 60. Review2. Which of the following is an example of abandonment? A. An EMT leaves the scene after a competentadult has refused care. B. An EMT transfers care of a patient to anemergency department nurse. C. An AEMT transfers care of a patient to aParamedic. D. An EMR is transferred patient care from anAEMT. 61. ReviewAnswer: DRationale: Abandonment occurs when patientcare is terminated without the patients consentor when care is transferred to a provider oflesser training and level of certification. 62. Review (1 of 2)2. Which of the following is an example of abandonment?A. An EMT leaves the scene after a competent adult has refused care. Rationale: Mentally competent adults have the right to refuse treatment or withdraw from treatment at any time.B. An EMT transfers care of a patient to an emergency department nurse. Rationale: An EMT can transfer care to someone of equal or higher medical authority. 63. Review (2 of 2)2. Which of the following is an example of abandonment?C. An AEMT transfers care of a patient to a Paramedic. Rationale: An AEMT can transfer care to someone of equal or higher medical authority.D. An EMR is transferred patient care from an AEMT. Rationale: Correct answer 64. Review3. The unauthorized confinement of a person is called: A. assault. B. battery. C. false imprisonment. D. slander. 65. ReviewAnswer: CRationale: False imprisonment is defined asthe confinement of a person without legalauthority or the persons consent. 66. Review (1 of 2)3. The unauthorized confinement of a person is called: A. assault. Rationale: Assault is unlawfully placing a person infear of bodily harm. B. battery. Rationale: Battery is touching a person or providingcare without consent. 67. Review (2 of 2)3. The unauthorized confinement of a person is called: C. false imprisonment. Rationale: Correct answer. D. slander. Rationale: Slander is false and damaging informationabout a person that is communicated by the spokenword. 68. Review4. Failure of the EMT to provide the same care as another EMT with the same training is called: A. libel B. slander C. negligence D. abandonment 69. ReviewAnswer: CRationale: An EMT could be held liable fornegligence if he or she fails to provide thesame care as another EMT with the sametraining would provide in the same situation.For example, if an EMT fails to give oxygen toa patient with shortness of breath (anintervention that is clearly indicated), he or shemay be held liable for negligence. 70. Review4. Failure of the EMT to provide the same care as another EMT with the same training is called:A. Libel Rationale: Libel is making a false statement in a written form that injures a good persons name.B. Slander Rationale: Slander is verbally making a false statement that injures a good persons name.C. Negligence Rationale: Correct answerD. Abandonment Rationale: Abandonment is the abrupt termination of contact with a patient. 71. Review5. An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to contact the childs parents. You should: A. continue to treat the child and transport as soon aspossible. B. cease all treatment until the childs parents can becontacted. C. continue with treatment only if authorized bymedical control. D. only provide airway management until the parentsare contacted. 72. ReviewAnswer: ARationale: The child in this scenario iscritically-injured and requires immediatetreatment and transport; waiting until hisparents are contacted wastes time andincreases his chance of a negative outcome. Ifyou are unable to contact a minors parents orlegal guardian, you should proceed with carebased on the law of implied consent. 73. Review (1 of 2)5. An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to contact the childs parents. You should:A. continue to treat the child and transport as soon as possible. Rationale: Correct answerB. cease all treatment until the childs parents can be contacted. Rationale: If a true emergency exists, then consent is implied. 74. Review (2 of 2)5. An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to contact the childs parents. You should:C. continue with treatment only if authorized by medical control. Rationale: If a true emergency exists, then consent is implied.D. only provide airway management until the parents are contacted. Rationale: If a true emergency exists, then consent is implied. 75. Review6. An advance directive is: A. a set of specific guidelines that clearly definesthe different types of consent. B. a formal list that defines by state law whether apatient has decision-making capacity. C. a written document that specifies the care youshould provide if the patient is unable to makedecisions. D. a verbal order given to you by a dying patientsfamily regarding whether treatment should beprovided. 76. ReviewAnswer: CRationale: An advance directive is a writtendocument signed by the patient and a witnessthat specifies the medical care that should beprovided if the patient loses decision-makingcapacity (ie, he or she is no longer deemedcompetent). 77. Review (1 of 2)6. An advance directive is:A. a set of specific guidelines that clearly defines the different types of consent. Rationale: An Advance Directive specifies the specific care a patient will receive and does not address any type of consent.B. a formal list that defines by state law whether a patient has decision-making capacity. Rationale: An Advance Directive document has already determined that a patient was competent to make decisions when the document was created and signed. 78. Review (2 of 2)6. An advance directive is:C. a written document that specifies the care you should provide if the patient is unable to make decisions. Rationale: Correct answerD. a verbal order given to you by a dying patients family regarding whether treatment should be provided. Rationale: An Advance Directive is a written order that defines the patients medical decisions. 79. Review7. Which of the following patients is competent and can legally refuse EMS care? A. A confused young female who states that sheis the president B. A man who is staggering and states that heonly drank three beers C. A conscious and alert woman who is in severepain from a broken leg D. A diabetic patient who has slurred speech andis not aware of the date 80. ReviewAnswer: CRationale: A patient who is of legal age (18 inmost states), is conscious, and is alert toperson, place, time, and event, likely hasdecision-making capacity and can legallyrefuse EMS care. However, patients who areconfused, possibly intoxicated, or delusionalare not capable of making a rationale decision;therefore, you should provide care based onthe law of implied consent. 81. Review (1 of 2)7. Which of the following patients is competent and can legally refuse EMS care?A. A confused young female who states that she is the president Rationale: You must assess whether this patients mental condition is impaired.B. A man who is staggering and states that he only drank three beers Rationale: You must assess whether this patients mental condition is impaired. 82. Review (2 of 2)7. Which of the following patients is competent and can legally refuse EMS care?C. A conscious and alert woman who is in severe pain from a broken leg Rationale: Correct answerD. A diabetic patient who has slurred speech and is not aware of the date Rationale: You must assess whether this patients mental condition is impaired. 83. Review8. You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him restrained if he does not give you consent. Your actions in this case are an example of: A. assault. B. battery. C. negligence. D. abandonment. 84. ReviewAnswer: ARationale: Unlawfully placing a person in fearof immediate bodily harm (ie, having himrestrained) without his consent constitutesassault. Unlawfully touching a person withouthis or her consent constitutes battery. 85. Review (1 of 2)8. You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him restrained if he does not give you consent. Your actions in this case are an example of: A. assault.Rationale: Correct answer B. battery.Rationale: Battery is unlawfully touching aperson. This includes care without consent. 86. Review (2 of 2)8. You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him restrained if he does not give you consent. Your actions in this case are an example of:C. negligence. Rationale: Negligence is failure to provide the same care that a person with similar training would provide.D. abandonment. Rationale: Abandonment is the unilateral termination of care without the patients consent. 87. Review9. The EMT has a legal duty to act if he or she is: A. off duty and witnesses a major car accident. B. a volunteer, is on duty, and is dispatched on acall. C. paid for his or her services, but is not on duty. D. out of his or her jurisdiction and sees a manchoking. 88. ReviewAnswer: BRationale: The EMTpaid or volunteerhasa legal duty to act if he or she is on duty and isdispatched on a call, regardless of the natureof the call. If the EMT is off duty and/or out ofhis or her jurisdiction, he or she has a moralobligation to act, but not necessarily a legalone. 89. Review9. The EMT has a legal duty to act if he or she is:A. off duty and witnesses a major car accident. Rationale: This is a moral obligation to act and not a legal one.B. a volunteer, is on duty, and is dispatched on a call. Rationale: Correct answerC. paid for his or her services, but is not on duty. Rationale: Whether paid or volunteer, the EMT must be on duty.D. out of his or her jurisdiction and sees a man choking. Rationale: This is a moral obligation to act, and not a legal one. 90. Review10. Which of the following statements aboutrecords and reports is FALSE?A. Legally, if it wasnt documented, it was not performedB. A complete, accurate report is an important safeguard against legal problemsC. An incomplete or untidy patient care report is evidence of incomplete or inexpert emergency medical careD. Your patient care report does not become a part of the patients hospital record because your treatment was provided outside the hospital 91. ReviewAnswer: DRationale: One of your most important safeguardsagainst legal problems is a complete, accuratereport; if it wasnt documented, it wasnt done!Furthermore, an incomplete or untidy patient carereport (PCR) suggests incomplete or inexpertmedical care. The PCR becomes a part of thepatients hospital medical record; even thoughyour treatment was provided outside the hospital,the PCR ensures continuity of care in the hospital. 92. Review (1 of 2)10. Which of the following statements about recordsand reports is FALSE?A. Legally, if it wasnt documented, it was not performed Rationale: True. If it was not written, then it was not performed.B. A complete, accurate report is an important safeguard against legal problems Rationale: True. The most important safeguard against legal problems is a complete, accurate report. 93. Review (2 of 2)10. Which of the following statements about recordsand reports is FALSE?C. An incomplete or untidy patient care report is evidence of incomplete or inexpert emergency medical care Rationale: True. An incomplete or untidy report equals incomplete or inexpert emergency care.D. Your patient care report does not become a part of the patients hospital record because your treatment was provided outside the hospital Rationale: Correct answer 94. Credits Chapter Opener: Steve Hamblin/AlamyImages Background slide image (ambulance): Galina Barskaya/ShutterStock, Inc. Background slide images (non-ambulance): Jones & Bartlett Learning. Courtesy ofMIEMSS.