Constitutional and Civil Law Overview

Paramedic Care: Medical-Legal Aspects

• This chapter covers the medical-legal aspects of out-of-hospital care, including standards for paramedics.
• The preparatory standard (Medical-Legal and Ethics) is a key component
• Paramedics must be familiar with legal issues encountered in the field.
• They need to be prepared to make medical and appropriate legal decisions.
• Laws vary by state and county, so paramedics need to rely on legal counsel when needed.
• Paramedics have specific legal duties to patients, their crew, medical director, and the public.
• Duties often involve state statutes and regulations; failure to follow these can lead to liability.

EMS Provider's Responsibilities

• EMS providers also have ethical responsibilities.
• Responding promptly to patients' physical and emotional needs is expected.
• Treating patients and their families with courtesy and respect is part of the ethical and legal duties.
• Maintaining medical skills and knowledge is necessary.
• Continuing education programs, seminars, and refresher training are important.
• It is crucial to seek constant improvement in performance.
• Reporting honestly about patient confidentiality is vital.
• Working cooperatively and respecting other emergency professionals is also required.
• Paramedics may encounter moral issues.

The Legal System

• Constitutional law: Protects individuals from government abuse.
• Common Law: Based on societal customs and norms, evolving over time.
• Statutory Law (legislative): Created by lawmaking bodies, not court decisions.
• Regulatory Law (administrative): Established by government agencies (federal and state).

Categories of Law

• Criminal law: Deals with crime and punishment against society.
• Civil law: Governs non-criminal issues like personal injury, contracts, and family matters.
  • Plaintiff: individual who initiates litigation.
  • Defendant: individual against whom a complaint is filed.
• Tort law: Civil wrongs committed by one individual against another.
• Trial courts: Determine outcomes of individual cases through a judge or jury.
• Appellate courts: Hear appeals from decisions made by trial courts.

Anatomy of a Civil Lawsuit

• Incident, investigation, filing of complaint, and answering of complaint are key parts of a civil lawsuit.
• Discovery, examination, interrogatories, requests, and documents are parts of the discovery phase.

Laws Affecting EMS and the Paramedic's Scope of Practice

• Scope of practice is set by state and local medical direction.
• Policy guidelines for paramedics interacting with intervener physicians exist.

Paramedic Certification and Licensure

• Certifications and licensure are recognitions for qualifications meeting standards for certain activities.
• Paramedics follow governmental agencies' regulations.
• Paramedics are obligated to follow all EMS laws and regulations relevant in their state.

Motor Vehicle Laws and Reporting Requirements

• State laws govern emergency vehicles and equipment.
• Reporting requirements for various incidents like spousal abuse, child abuse, neglect, elder abuse, and others vary by state.

Disaster/Homeland Security Laws

• Disaster laws provide flexibility for governments to quickly adapt to emergencies.
• Such laws allow modifying or waiving regulations during disasters.

Legal Protection for EMS Practitioners

• Immunity is an exemption from legal liability.
• Good Samaritan laws protect individuals who aid during medical emergencies.
• The Ryan White Comprehensive AIDS Resources Emergency Act (Ryan White Care Act) addresses and covers exposure to pathogens.

Legal Accountability of the Paramedic

• Paramedics are obligated to provide care according to their training level, equal to other paramedics.
• Duty to perform their duties reasonably and prudently is crucial.
• Intentional Tort is when a person causes harm.
• Negligence is the deviation from accepted care standards.
• EMS liability claims can be related to several instances, including patient handling, emergency vehicle movement or collisions, medical management, EMS response or transport, lack of or failure of equipment, and other causes.

Components of a Negligence Claim

• Components of a negligence claim include duty, breach, causation, and damages.
• Duty to Act means the legal obligation to provide care.
• Breach of Duty is when the duty is not met.
• Proximate Cause is when the breach of duty directly causes damage to the patient.
• Damages are the harms sustained resulting in the need for compensation.
• "Res ipsa loquitur" means the negligence is obvious without further documentation.
• Negligence per se is automatic negligence related to a violation of the law/statute.

Defenses to Charges of Negligence

• Good Samaritan laws, governmental immunity, statutes of limitations, and contributory/comparative negligence.

Protecting Yourself Against Negligence Claims

• Education, training, continuing education, medical direction, proper documentation, professional behaviour, acting with good faith, and common sense (using critical thinking) are all vital.
• Liability insurance coverage protecting the paramedic.

Special Liability Concerns

• Medical directions, borrowed servant doctrine, civil rights violation, and airway issues.

EMS Practitioner-Patient Relationship

• Maintaining patient confidentiality is important.
• Obtaining consent, expressed and implied; informed consent; understanding consent withdrawal; special situations (minors, emancipated minors, etc).
• Reporting and documenting refusals of service.
• Being aware of potential issues, like violent or problem patients, particularly those involving drugs.

Boundary Issues

• Following ethical and societal limits.
• Avoiding danger zones, like being tired, seduced, or unprepared.

Legal Complications Related to Consent

• Abandonment, assault and battery, false imprisonment.
• Understanding reasonable force.

Crime and Accident Scenes

• Immediate actions if crime is suspected.
• Protecting oneself and other personnel, securing the scene, and patient contact and medical care.
• Documentation is key.

Duty to Report

• When abuse or neglect is suspected, the duty to report balances the need to protect patient confidentiality.
• Many states have regulations requiring EMS personnel to report such incidents.
• Avoiding confrontation and proper documentation is crucial.

Documentation

• Written documentation (patient care reports) is necessary for legal protection.
• Maintaining well-written, accurate, comprehensive care reports is important.
• Amendments to reports are needed if errors or missing information becomes apparent.
• State laws mandate record retention periods.

Employment Laws

• Employee-employer relationships, volunteer agency jurisdiction, consulting attorneys for legal issues; specifics: ADA, Title VII, amendments to Title VII, Equal Employment Opportunity Act of 1972, Age Discrimination and Employment Act of 1967/1975, Family Medical Leave Act of 1993, Fair Labor Standards Act of 1938, and Occupational Safety and Health Act and Ryan White Care Act.

Resuscitation Issues

• Obligated to begin efforts for unresponsive patients, but not when there are legal contraindications.
• DNR orders, obvious death, hazardous scenes
• Following advance directives (living wills, durable powers, POLST orders, and organ donor cards.
• Dealing with potential organ donation and complying with legal protocols.
• Correctly documenting death in the field.

Summary

• Legal issues impact daily EMS operations.
• Following state and local laws, standards, and protocols.
• Keeping current with continuing education, industry resources, and recertification is important.
• obtaining consent, maintaining confidentiality, and dealing with emergencies appropriately.