Medical/Legal Issues & Medical/Legal Issues & Professional EthicsProfessional Ethics

Rad Tech ARad Tech A

SP 2010SP 2010

HIPPAHIPPA

The Health Insurance Portability and The Health Insurance Portability and Accountability Act of 1996 mandates that Accountability Act of 1996 mandates that federal laws or regulations ensure the federal laws or regulations ensure the confidentiality of medical records. confidentiality of medical records.

Patients or representatives should have Patients or representatives should have access to all records except in the event the access to all records except in the event the provider feels that it is not in the best provider feels that it is not in the best interest of the patient’s health to have interest of the patient’s health to have access or if the knowledge of the health access or if the knowledge of the health care information could cause danger to the care information could cause danger to the life or safety of any person.life or safety of any person.

HIPAAHIPAA Health Insurance Portability and Health Insurance Portability and

Accountability ActAccountability Act Privacy of records and confidentialityPrivacy of records and confidentiality Confidentiality standards establish Confidentiality standards establish

guidelines for the storage, access, guidelines for the storage, access, and transmission of individual health and transmission of individual health information.information.

Patients must authorize the release Patients must authorize the release of health information.of health information.

HIPPAHIPPA

Within radiology:Within radiology:

Technologists are sometimes asked Technologists are sometimes asked by patients if they can examine their by patients if they can examine their records while in transit, waiting for a records while in transit, waiting for a procedure or undergoing an procedure or undergoing an examination. The record information examination. The record information should not be shared with the patient should not be shared with the patient in this fashion as this may lead to in this fashion as this may lead to misinterpretation of information.misinterpretation of information.

HIPAA Video- Will be shown on HIPAA Video- Will be shown on Last day of class. (SAT students)Last day of class. (SAT students)

Be careful ….. the walls sometimes Be careful ….. the walls sometimes have earshave ears

The Importance of a The Importance of a Professional EthicProfessional Ethic

Ethics: the systematic study Ethics: the systematic study of rightness and wrongness of of rightness and wrongness of human conduct and character human conduct and character as know by natural reasonas know by natural reason

Professional Ethic: the ethical Professional Ethic: the ethical conduct of a professionconduct of a profession

DefinitionsDefinitions

EthicsEthics – The systematic study of rightness – The systematic study of rightness and wrongness of human conduct and and wrongness of human conduct and character as known by natural reason.character as known by natural reason.

MoralsMorals – Generally accepted customs, – Generally accepted customs, principles, or habits of right living and principles, or habits of right living and conduct in a society and the individual’s conduct in a society and the individual’s practice in relation to these.practice in relation to these.

ValuesValues – Ideals & customs of a society – Ideals & customs of a society toward which the members of a group have toward which the members of a group have an affective regard; a value may be a quality an affective regard; a value may be a quality desirable as an end in itself.desirable as an end in itself.

Professional EthicsProfessional Ethics

Internal controls of a profession based Internal controls of a profession based on human values or moral principles.on human values or moral principles.

Standards of conduct beyond mere Standards of conduct beyond mere conformity to law.conformity to law.

Professionals may encounter Professionals may encounter conflicting values or belief systems conflicting values or belief systems that can compromise patient care.that can compromise patient care.

ARRT Code of EthicsARRT Code of Ethics

A guide by which RT’s and A guide by which RT’s and Candidates may evaluate their Candidates may evaluate their professional conduct as it relates to professional conduct as it relates to patients, health care consumers, patients, health care consumers, employers, colleagues, & other employers, colleagues, & other members of the health care team.members of the health care team.

Comprised of 10 principlesComprised of 10 principles

ARRT Code of EthicsARRT Code of EthicsAppendix D Appendix D

1. Professional manner, respond to pt needs, 1. Professional manner, respond to pt needs, support colleaguessupport colleagues

2. Provide services to humanity w/ full 2. Provide services to humanity w/ full respect for mankindrespect for mankind

3. Delivers pt care without discrimination3. Delivers pt care without discrimination

4. Practices & uses equipment appropriately4. Practices & uses equipment appropriately

5. Acts in the best interest of the pt.5. Acts in the best interest of the pt.

ARRT Code of EthicsARRT Code of Ethics

6. Obtains pertinent info for physician6. Obtains pertinent info for physician

7. Practices in accordance with accepted 7. Practices in accordance with accepted standards, minimizes radiation standards, minimizes radiation exposureexposure

8. Practices ethical conduct8. Practices ethical conduct

9. Respects confidences and pt right to 9. Respects confidences and pt right to privacyprivacy

10. Strives to improve knowledge & 10. Strives to improve knowledge & skills by participating in C.E.skills by participating in C.E.

Ethical DilemmaEthical Dilemma Situation requiring moral judgment Situation requiring moral judgment

between two or more equally “right” between two or more equally “right” alternatives. There are two or more alternatives. There are two or more competing norms.competing norms.

Four components to solve an ethical Four components to solve an ethical dilemma:dilemma:

1. Identify the problem1. Identify the problem2. Develop alternative solutions2. Develop alternative solutions3. Select the best solution3. Select the best solution4. Defend your selection 4. Defend your selection

Group Activity # 1Group Activity # 1

““I Think Dr. JonesI Think Dr. Jones

Misread the Film”Misread the Film”

Ethical TheoriesEthical Theories

Consequentialism – Evaluates the Consequentialism – Evaluates the rightness or wrongness of ethical rightness or wrongness of ethical decisions by assessing the decisions by assessing the consequences on the pt.consequences on the pt.

Nonconsequentialism – Belief that Nonconsequentialism – Belief that actions themselves, rather than actions themselves, rather than consequences, determine the worth of consequences, determine the worth of actions; actions are right or wrong actions; actions are right or wrong according to the morality of the acts. according to the morality of the acts.

Moral PrinciplesMoral Principles

BeneficenceBeneficence – Bringing about good – Bringing about good NonmaleficenceNonmaleficence – Preventing harm, – Preventing harm,

to do no harmto do no harm AutonomyAutonomy – Self-reliance, – Self-reliance,

independence, liberty rights, independence, liberty rights, individual choice, freedom of willindividual choice, freedom of will

VeracityVeracity – Telling the truth – Telling the truth FidelityFidelity – Being faithful – Being faithful JusticeJustice – Acting with fairness or equity – Acting with fairness or equity

Medical/Legal IssuesMedical/Legal Issues

The liability of the technologist is not The liability of the technologist is not the same as the radiologist involved, the same as the radiologist involved, but the liability is potentially real.but the liability is potentially real.

Although the law is often a mirror Although the law is often a mirror image of the failures of medicine, it image of the failures of medicine, it is also a book of lessons from which is also a book of lessons from which we can learn.we can learn.

Causes of Legal ActionCauses of Legal Action

Approx 10% of all medical Approx 10% of all medical negligencenegligence claims are somehow related to claims are somehow related to diagnostic imaging.diagnostic imaging.

Medical NegligenceMedical Negligence – failure to use – failure to use such care as a reasonably prudent such care as a reasonably prudent health care professional would use in health care professional would use in similar circumstances.similar circumstances.

Schloendorf v.Schloendorf v. Society of New York Hospital Society of New York Hospital

Basic principle of law and lays a Basic principle of law and lays a foundation for the relation between foundation for the relation between patients and health care practitioners.patients and health care practitioners.

Every human being of adult years and Every human being of adult years and sound mind has a right to determine what sound mind has a right to determine what shall be done with his own body, and a shall be done with his own body, and a surgeon who performs an operation surgeon who performs an operation without his patient’s consent commits an without his patient’s consent commits an assault, for which he is liable in damages.assault, for which he is liable in damages.

Doctrine Serves 6 FunctionsDoctrine Serves 6 Functions

1.1. Protects individual autonomyProtects individual autonomy

2.2. Protects pt status as a human beingProtects pt status as a human being

3.3. Avoids fraud and duressAvoids fraud and duress

4.4. Encourages health care practitioners Encourages health care practitioners to consider their decisions carefullyto consider their decisions carefully

5.5. Fosters rational decision making by Fosters rational decision making by the ptthe pt

6.6. Involves the public in medicineInvolves the public in medicine

Standard of CareStandard of Care

Degree of skill (proficiency), Degree of skill (proficiency), knowledge, and care ordinarily knowledge, and care ordinarily possessed & employed by members possessed & employed by members in good standing within a profession.in good standing within a profession.

To test whether the standard of care To test whether the standard of care has been met, one must determine has been met, one must determine what a reasonable, prudent what a reasonable, prudent practitioner would have done under practitioner would have done under similar circumstances.similar circumstances.

Practice Standards for Radiography Practice Standards for Radiography Appendix A pg. 411Appendix A pg. 411

Developed by a group of medical imaging Developed by a group of medical imaging professionals & adopted by ASRTprofessionals & adopted by ASRT

Outline the practice of medical imaging Outline the practice of medical imaging in three areas of Performance Standards:in three areas of Performance Standards:

1. Clinical Performance Standards1. Clinical Performance Standards

2. Quality Performance Standards2. Quality Performance Standards

3. Professional Performance 3. Professional Performance StandardsStandards

Patient Fall in Radiology DeptPatient Fall in Radiology Dept~NEGLIGENCE~~NEGLIGENCE~

Favalora v. Aetna Casualty & Surety Co.Favalora v. Aetna Casualty & Surety Co. Pt. admitted to hospital for general checkup Pt. admitted to hospital for general checkup

& GI series.& GI series. Pt complaint: Stomach pains, general Pt complaint: Stomach pains, general

fatigue, and fatigue, and fainting.fainting. While undergoing x-ray exam, pt fainted, While undergoing x-ray exam, pt fainted,

fell, and fx’d her neck & femur – requiring fell, and fx’d her neck & femur – requiring surgery.surgery.

Surgery caused a pulmonary embolismSurgery caused a pulmonary embolism Radiologist was negligent for not securing Radiologist was negligent for not securing

medical hx prior to exam, pt won lawsuit.medical hx prior to exam, pt won lawsuit.

Four Elements to Prove Four Elements to Prove NegligenceNegligence

1.1. Must establish a duty to the patient by Must establish a duty to the patient by the health care providerthe health care provider

2.2. Breach of this duty by an act or by failing Breach of this duty by an act or by failing to perform some act.to perform some act.

3.3. A compensable injuryA compensable injury

4.4. A causal relation between the injury and A causal relation between the injury and the breach of duty.the breach of duty.

Cause of Legal ActionCause of Legal Action

TortTort – Civil wrong committed by one – Civil wrong committed by one individual against another. May be individual against another. May be classified as either intentional or classified as either intentional or unintentional. This type of claim arises unintentional. This type of claim arises from a breach of duty.from a breach of duty.

AssaultAssault – Any willful attempt or threat to – Any willful attempt or threat to inflict injury on the person and any inflict injury on the person and any intentional display of force that would intentional display of force that would give the victim reason to fear or expect give the victim reason to fear or expect immediate bodily harm.immediate bodily harm.

Cause of Legal ActionCause of Legal Action

BatteryBattery – An unlawful touching of another – An unlawful touching of another that is without justification or excuse.that is without justification or excuse.

False ImprisonmentFalse Imprisonment – Conscious restraint – Conscious restraint of another without proper authorization, of another without proper authorization, privilege, or consent.privilege, or consent.

DefamationDefamation – Holding up a person to – Holding up a person to ridicule, scorn, or contempt in a ridicule, scorn, or contempt in a respectable & considerable part of the respectable & considerable part of the community.community.

Patient Rights & Patient Rights & ResponsibilitiesResponsibilities

Patient rights informs the pt of the right to be Patient rights informs the pt of the right to be well informed, to participate in treatment well informed, to participate in treatment decisions, and to communicate openly with decisions, and to communicate openly with the physicians.the physicians.

Patient also has the responsibility to provide Patient also has the responsibility to provide accurate medical history, to ask questions, accurate medical history, to ask questions, and inform if pt is unable to follow treatment.and inform if pt is unable to follow treatment.

Hospitals may (and do) list other very Hospitals may (and do) list other very specific responsibilities.specific responsibilities.

Res Ipsa LoquiturRes Ipsa Loquitur

The thing speaks for itselfThe thing speaks for itself Burden of proof shifts from the plaintiff to Burden of proof shifts from the plaintiff to

the defendant.the defendant. Must have 3 elements:Must have 3 elements:

1. Type of injury did not occur except 1. Type of injury did not occur except for for negligence.negligence.

2. Activity was under complete control 2. Activity was under complete control of of defendant.defendant.

3. Plaintiff did not contribute to his own 3. Plaintiff did not contribute to his own injuryinjury

Res Ipsa LoquiturRes Ipsa Loquitur

Franklin v. Collins Chapel Correctional Franklin v. Collins Chapel Correctional HospitalHospital

82 yr. senile female – wrongful death 82 yr. senile female – wrongful death after sustaining 3after sustaining 3rdrd degree water burns degree water burns while bathingwhile bathing

Res Ipsa Loquitur - Injuries suffered by the Res Ipsa Loquitur - Injuries suffered by the resident do not occur in a nursing facility resident do not occur in a nursing facility in the absence of negligence, and the in the absence of negligence, and the deceased was in the defendant’s sole deceased was in the defendant’s sole care custody & control.care custody & control.

Respondeat SuperiorRespondeat Superior

The master speaks for the servant; the The master speaks for the servant; the master is liable in certain cases for the master is liable in certain cases for the wrongful acts of his or her servants. wrongful acts of his or her servants. “Deep Pockets” approach.“Deep Pockets” approach.

If a radiographer is sued, the hospital If a radiographer is sued, the hospital and physician would also be named as and physician would also be named as defendants. Well established theory defendants. Well established theory that the physician or health care facility that the physician or health care facility is responsible for the negligent acts of is responsible for the negligent acts of its employees.its employees.

Corporate LiabilityCorporate Liability

Requires the hospital or health care entity Requires the hospital or health care entity to be responsible for the quality of care to be responsible for the quality of care delivered to consumers.delivered to consumers.

Health care corp. must assess & evaluate Health care corp. must assess & evaluate the quality of care delivered & must be the quality of care delivered & must be prepared to make changes as needed.prepared to make changes as needed.

The corp. may be required to intervene if The corp. may be required to intervene if suboptimal care is being provided by one suboptimal care is being provided by one of its independent contractors.of its independent contractors.

Informed ConsentInformed Consent

A person’s agreement to allow something A person’s agreement to allow something to happen (i.e surgery) that is based on to happen (i.e surgery) that is based on full disclosure of the facts: knowledge of full disclosure of the facts: knowledge of benefits, risks, and alternatives to the benefits, risks, and alternatives to the procedure.procedure.

RequiredRequired when a patient is subjected to when a patient is subjected to any type of invasive procedure.any type of invasive procedure.

If the pt consents to a procedure & then If the pt consents to a procedure & then revokes the consent, the doctor must revokes the consent, the doctor must stop the procedure.stop the procedure.

DocumentationDocumentation

In court, if you testify that you In court, if you testify that you properly assessed the patients properly assessed the patients medical risk and obtained consent medical risk and obtained consent from the patient from the patient verballyverbally prior to the prior to the examination; will that serve as examination; will that serve as meeting the Technologist Standard meeting the Technologist Standard of Practice? of Practice?

Group Activity #2Group Activity #2

Case Study Case Study

Life or Death, the right to chooseLife or Death, the right to choose