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Medical, Legal, & Ethical Issues Criminal Law

• Deals with wrongs against society or it’s members

• Crime & Punishment

Civil Law• Deals with non-criminal issues and

conflicts between two parties• Tort Law-Civil wrongs between two parties• Litigation-Process of carrying on a lawsuit• No cap on what private industry could pay

Good Samaritan Laws• Protect people who assist at the scene

of emergency.• Protect against civil liability• Makes a person immune if the act in

good faith, is not negligent, acts within the scope of his/her training, and does not accept payment for their services.

Scope of Practice• Outlines the care you are able to

provide for your patient.• Refined by your Medical Director• Refined by State & Local Rules• Defined by DOT Standards

Delegation of Authority• The granting of privileges by a physician

to a non-physician to perform skills and procedures.

• Medical Practice Act

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Standard of Care• How a reasonably prudent person with

similar training & experience would act under similar circumstances, with similar equipment in the same place.

• Factors taken into consideration:– General confusion at the scene– The needs of other patients.– The type of equipment available

Factors Considered for the Standard

• Locally Accepted Protocols• Standards Imposed by Law• Professional or Institutional Standards

Duty to Act• Individual’s responsibility to provide

patient care• Comes from either statue or function

A legal or contractualrequirement to provide care

Formal Duty:

Implied Duty:Call to 911, beginning care for patient

Duty to Act

Contractual obligation between agency and municipality

Off dutyOut of your EMS system, but

in an ambulance

Duty to Act: Ethical/ Moral Abandonment• Unilateral termination of patient care

without patient consent and without making provisions for continuing care at the same level of skills or higher

• Maybe both criminal &/or civil

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MalpracticeIndicates a failure to conform

to a standard of care.

Negligence• Failure to provide the same care that a

person of similar training would provide.• Deviation from an accepted standard of

care that results in further injury to the patient.

Four Things to Prove for Negligence:

• A duty to act• A breech of that duty• Injury • Causation

Vicarious LiabilityMakes you liable for the wrong doings of

another as long as you have a relationship to the wrongdoer

Defamation

• Communication of false information that damages reputation of a person– Libel if written– Slander if spoken

Defamation

• Defamation could happen with:– False statement on a run report– Inappropriate comments made during

conversation

• Run report should be accurate, relevant, and factual.

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Consent• The act of granting permission to treat• Types of consent:

– Informed Consent– Expressed Consent– Implied Consent– Involuntary Consent

Informed ConsentOnly after patient has had all benefits and

risks explained in a way they can understand

Expressed Consent• Verbal, non-verbal, or written

communication by a patient that he or she wants medical care

• Most common form of consent

Implied Consent• Situation involving an unconscious

patient where care is initiated under the premise that if the patient were conscious he or she would want medical care

• Commonly used in pediatric patients

Involuntary Consent• Consent based upon a court order that

go against a patient’s wishes• Commonly used in overdoses and

mentally disturbed patients

Problem Patients• Pediatrics• Patient’s under the influence• Mentally disturbed patients

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Can a patient withdraw consent at any time?

• A mentally competent patient may withdraw consent at any time

• Must be informed refusal• Must be documented carefully

What if I don’t get proper consent?

Assault & Battery• Assault:

– Placing a person in apprehension of immediate bodily injury without their consent

• Battery:– Unlawful touching of an individual without

their consent• Maybe both criminal &/or civil

False Imprisonment• Intentional and unjustifiable detention• Can be avoided by obtaining proper

consent

Kidnapping Confidentiality• Any type of information that pertains to

a patient is confidential• This includes oral and written

information• This information is only passed to other

healthcare professionals in direct contact with the patient

• HIPAA Mandates

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What if we break patient confidentiality?

• Found guilty of Libel or Slander– Libel=false or malicious writings– Slander=false or malicious words

• Decertification, Suspension, or Probation of your certification

• Civil liability• Criminal Liability

HIPAA• Safeguards patient confidentiality.• Limits EMS providers from obtaining

follow-up information.• Releases health information only with

patient’s permission.

What type of patient makes E.M.S. lose the most lawsuits?

RefusalsWhy?

Refusals• Biggest liability• Most successfully litigated• Protection is accurate and complete

documentation

Patient Refusals• Must do a Head to Toe Assessment• Vital Signs Obtained• Must be an Informed Refusal

– Risks/Benefits– Explanation of Signature Page– What the pt should do if the problem gets

worse– Explanations and forms were understood

• Signature of Patient or Guardian• Must be Witnessed• Remember People Under the Influence

Can’t Refuse!

Things we must report:• Suspected Child Abuse/Neglect• Suspected Elderly Abuse/Neglect• Domestic Violence• Deceased Individuals• Childbirth• Attempted Suicides• Any Type of Suspected Crime

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Obvious Death• Rigor Mortis• Lividity• Decomposition• Mortal Injuries

Special Situations• Organ donors

• Medical identification insignia

• OOHDNR

Advance Directives

• Advance directive specifies treatment should the patient become unconscious or unable to make decisions.

• A do not resuscitate (DNR) order is an advance directive that gives permission not to resuscitate.– “Do not resuscitate” does not mean “do not

treat.”

Advance Directives

• Advance directive is also called:– Living will– Health care directive

Advance Directives

• Some patients may have named surrogates to make decisions for them.– Durable powers of attorney for health care– Also known as health care proxies

Forcible Restraint

• Sometimes necessary with combative patient

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Forcible Restraint

• Is legally permissible– But generally you must consult medical

control for authorization.– In some states, only a law enforcement

officer may forcibly restrain.

Medical Examiner Cases• DOA• Unknown cause of death• Suicide• Violent death• Poisoning• Accidents• Suspicion of criminal action

Crime Scenes

• Move as little as possible• Patient maybe considered evidence• Preserve, Preserve, Preserve• If you move or destroy something, tell

someone• Report anything you see, hear, or smell• Document, Document, Document• You maybe called to court as a witness

Emergency Driving• Emergency vehicles MUST follow the

same traffic laws as other motorists.• Emergency vehicles must be operated

in a safe manner.• Failure to operate safely could be found

as negligent• Maybe both criminal &/or civil

Ethical ResponsibilitiesMake patient's needs a priority.Maintain skills, knowledge.

Critically review performance.

Prepare honest reports.(Seek ways to improve)

Records and Reports

• Compile record for all incidents involving sick or injured patients

• Important safeguard against legal complications

• Courts consider:– An action not recorded was not performed– Incomplete or untidy reports is evidence of

poor emergency medical care

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The EMT in Court

• You can end up in court as a:– Witness– Defendant

• Case can be civil or criminal.

Source: © Photodisc

The EMT in Court

• Whenever called to testify, notify:– Your service director– Legal counsel

• As witness:– Remain neutral– Review run report before court

The EMT in Court

• As a defendant, an attorney is required.• Defenses may include:

– Statute of limitations – Governmental immunity– Contributory negligence

The EMT in Court

• Discovery allows both sides to obtain more information through:– Interrogatories

• Written requests or questions

– Depositions• Oral requests or questions

The EMT in Court

• Most cases are settled following the discovery phase during the settlement phase.

• If not settled, the case goes to trial• Damages that may be awarded:

– Compensatory damages– Punitive damages

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How do we protect ourselves against legal problems?

• Provide correct and efficient prehospital care ALL of the time

• Document, Document, Document• Error on the side of the patient

Questions?