medical law

Medical Law

• Medical law encompasses the rules, regulations, and guidelines that govern conduct in society to protect citizens' health, safety, and welfare

Characteristics of Law

• Laws should reflect societal values
• The law exists to protect individual and group rights from encroachment
• Laws should remain dynamic to reflect society
• The law must be applied equally without discrimination
• Laws are based on what a reasonable person would do in similar circumstances
• All individuals possess basic rights and responsibilities

Relation between Patients & Health Care Practitioners

• In 1914 a precedent-setting case Schloendorf v. Society of New York Hospital estabilished that every adult of sound mind has the right to determine what shall be done with their body
• A surgeon performing an opertation without patient consent commits assault and is liable for damages

Functions Served by Principles of Law

• Protect individual autonomy
• Protect patient status as a human being
• Avoid fraud and duress/threat
• Encourage health care professionals to carefully consider decisions
• Foster rational decision making by the patient
• Involve the public in medicine

Types of Law

• Constitutional Law
• Statutory Law (Legislative Law)
  • Administrative rules
  • Regulations
  • Ordinances
• Case Law

Constitutional Law

• It is the supreme law of the land in the U.S.
• It separates the three branches of the government:
  • Executive (president)
  • Legislative (senate and house)
  • Judiciary (courts)

Statutory Law

• It is the 2nd area of law
• In the U.S., laws are enacted by legislative bodies or administrative agencies at the local, state, or federal level
• Statutory laws define and regulate many areas of health care, such as the use of ionizing radiation

Common Law or Case Law

• It is the 3rd area of law
• It is derived from the Common Law of England, many cases are decided on a case-by-case basis
• Case law dictates outcomes for sued health care professionals, especially in cases of negligence or standard of care violations
• Res judicata: the thing is decided (principle of common law)
• Stare decisis: let the decision stand (principle of common law)

Causes of Legal Action

• Torts
• Assault
• Battery
• False imprisonment
• Defamation
  • Slander involves spoken words
  • Libel involves written words
• Fraud

Torts

• A tort is a patient's claim of having been wronged or injured, excluding breach of contract, with cause for action for damages
• Torts arise from violations of duties imposed by general law on all persons involved in a transaction or situation
• A breach of duty must occur to warrant a tort action

Types of Torts

• Unintentional tort
  • Malpractice
  • Negligence
• Intentional tort
  • Assault/battery
  • False imprisonment
  • Intentional infliction of emotional distress

Tort of Outrage

• The perpetrator knew or should have known that the conduct would cause emotional distress
• The conduct was extreme and outrageous
• The perpetrator's action was the cause of the distress
• The distress was severe, and no reasonable person should have to endure it

Assault

• An assault claim may arise when a patient believes he or she has been threatened such that fear or bodily harm exists
• Assault does not require physical contact
• Assault may only be verbal
• Comments towards a patient may be perceived as possible harm
  • Example: “Hold still or we'll have to start all over!”
  • Example: “If you don't swallow these pills, the radiologist won't come in to do the study"

Battery

• Battery may occur even if unwarranted patient contact causes no injury
• Any unlawful touching constitutes battery if the patient believes the imaging professional touched them offensively
• Permission should be acquired and professional palpation techniques used when positioning patients and using palpation
• Battery charges may be warranted from improper positioning methods and rough handling

False Imprisonment

• False imprisonment occurs when a person is restrained or believes they're restrained against their will
• The individual must be aware of the confinement and lack reasonable means of escape
• Consent from an authorized individual is important when restraining or immobilizing senile, pediatric, or incompetent patients

Defamation

• Slander
• Libel
• Disclosure of confidential patient information on social media sites is viewed as harmful to patient
• Maintain high standards for privacy of a patient's medical information

Fraud

• It is the willful and intentional misrepresentation of facts that causes harm or loss of rights or property
• Fraudulent cases require:
  • An untrue statement known to be so, made to mislead
  • Reliance on the statement by the injured party
  • Damages incurred as a result of reliance

Health Information Privacy

• The Patient Care Bill of Rights holds health records as private and confidential
• Health records are the property of the provider; health information in those records is the property of the patient
• Digital images must be accurate, secure, and confidential

Negligence

• Negligence is the failure to do what a reasonable person would do under ordinary circumstances; it includes neglectful actions causing injury or unprofessional treatment, where:
  • A duty was owed
  • There as a breach of that duty
  • An injury occurred
  • Damage resulted from the injury

Cause of Action

• 10% of medical negligence claims are related to diagnostic imaging
• Claims may include improper diagnosis or injuries during diagnostic procedures
• As a radiographer, testimony may be required

Standard of Care

• Defines the degree of skill, knowledge, and care expected of professionals in good standing within the medical field
• It evolves as technology improves
• It is judged against reasonable actions under similar circumstances
• The standard of care is outlined by the profession and used by courts for guidance

ASRT

• Practice Standards for Medical Imaging and Radiation Therapy
• Practice Standards outline performance for medical imaging professions
• Imaging professionals must be competent in the knowledge and application of these standards

Patient Bill of Rights

• The American Hospital Association (AHA)'s Patient's Bill of Rights ensures 15 guarantees for anyone seeking medical care in a U.S. hospital
• The Patient Bill of Rights promotes respect for patients and providers, open communication, and effective patient care

Legal Doctrines

• Respondeat superior: "The master speaks for the servant."
• Res ipsa loquitur: "The thing speaks for itself," shifting the burden of proof to the healthcare practitioner

Legal Doctrines

• Doctrine of Informed Consent
  • Requires healthcare professionals to provide adequate information about the procedure, risks, benefits, and alternatives
  • Requires patient agreement to proceed
  • Radiologic technologists must ensure patient's understanding of the imaging procedure, risks, and benefits
• Doctrine of Negligence
  • Occurs when a healthcare professional fails to provide the standard of care, resulting in patient harm
  • Negligence is the basis for malpractice claims
  • Radiologic examples of negligence include improper positioning, inadequate image quality, or failure to recognize abnormalities
• Doctrine of Malpractice
  • Refers to professional misconduct or lack of skill resulting in harm
  • It is negligence specific to healthcare providers
  • Radiologists/technologists can be held liable if failure to meet standards causes patient harm
• Doctrine of Vicarious Liability
  • Like respondeat superior, employer accountability for employee/agent actions
  • Healthcare entities can be vicariously liable for errors by radiologic technologists or radiologists within their duties
• Doctrine of Implied Consent
  • Assumes consent in emergencies or for unconscious patients
  • Allows technologists/radiologists to proceed with imaging in emergency situations (trauma)
• Doctrine of Patient Autonomy
  • Emphasizes the patient's right to make decisions, including refusing treatment
  • Patients can say no to imaging like X-rays, CT scans, or MRIs
• Doctrine of Confidentiality
  • Requires healthcare providers to keep patient information private
  • Radiologic technologists and radiologists ensure patient information/imaging results are shared only with authorized individuals
• Doctrine of Mandatory Reporting
  • Requires healthcare professionals to report specific situations, like suspected abuse or communicable diseases
  • Radiologists and technologists may be legally obligated to report suspected abuse observed in imaging
• Doctrine of Direct Causation
  • Requires a direct link between healthcare actions and patient harm
  • An error by a radiologic professional that leads to delayed diagnosis/treatment, must be shown to have directly caused harm

Consents

• Rely on TRUST
• Required for interventional procedures
• Assume the provider acts in the patient's best interest, consistent with care standards
• Patients can make their own decisions about their care

Types of Consent

• Implied consent- agreement inferred from someone's actions
• Informed consent- based on full disclosure of the risks, alternatives, and benefits (and other relevant info)

Informed Consent

• Needed when a procedure is invasive, involves significant risks, the purpose of the procedure needs to be known

Features of Consent

• Information in lay language
• Information in the patient's primary language
• Respect for patient autonomy
• Signed consent form witnessed by disinterested third party
• Not the same as implied consent

Requirements for Informed Consent

• Shared decision-making between the patient and physician
• Patient is of legal age and mentally sound
• Patient offers consent voluntarily
• Patient receives adequate information

Informed Consent Form

• The informed consent form should contain:
  • Authorization clause to permit the procedure by a health professional
  • Disclosures explaining risks and benefits and possible alterntives to the procedure
  • Anesthesia clause
  • No-guarantee clause for therapeutic procedures
  • Authorization for disposal of tissues if needed
  • Acknowledgment that the information was explained to the patient
  • Signature of the patient and a witness

Consent Categories

• Express consent -Non-verbal e.g. nodding of head -Oral/verbal -Determined by an act or by silence

Emergency Situations

• In an emergency, implied consent requires signing an authorization form containing attempts to contact next of kin, signatures of 2 licensed MDs from 2 separate disciplines

Informed Consent and Medical Records

• If filing an informed consent within the medical record is not possible, then indicating where informed consent was obtained will be sufficient.
• Indicate in the medical record where to locate documentation of a treatment or procedure.

Advanced Directives

• These are legal papers specifying health care preferences if comunicating those descisions is not possible

Types of Advanced Derectives

• Living will
• Durable power of attorney for healthcare (healthcare proxy)
• Do not resuscitate (DNR)
• Do not intubate (DNI)

Living Will

• Written healthcare preferences regarding life-sustaining treatments.
• It dictates preferences like life support, or organ donation.
• It only goes into effect if the one making it is terminally ill/permanently unconscious.
• Helps doctors and loved ones make decisions on the one making it.

Do Not Resuscitate

• Instructions to healthcare providers not to perform cardiopulmonary resuscitation (CPR)
• Only applies to those with serious/terminal illness
• Written by doctor in consultation with patient and their family.
• Does not stop other medical treatments

Do Not Intubate

• Stops insertion of a breathing tube
• Often goes with DNR
• Protects against mechanical ventilation while allowing other support

Healthcare Proxy

• Where someone is able to make healthcare decisions (in a legal document) on behalf of someone who cannot do so/unresponsive.
• Must act in the best interest of the person, and follow their known wishes
• Can make decisions about treatments, surgeries, and end-of-life care.
• Does not grant any financial rights

Having Advanced Derictives in Place is Important, as

• Your wishes are respected
• It helps family members make otherwise difficult descisions
• Prevents unwanted/unneseccary procedures
• Easier discussions/preparation for treatment

Who Can Provide Conset

• Patient must be mentally and physically well/able to consent

Patients Must be

• An adult age.
• Representative of an incompetent adult.
• EMancipated minor.

Order of Contact for Care

• Contact/reach out to incapacitated patients in the following order: -Courts -Atrorney -Spouse -Sons/daughters -Parents

Precautions

• Patient can take back conscent at any time.
• Can take back in verbal conscent.
• Only competent/concious people can provide constent.
• Intoxicated / drugged/ ill persons cannot provide conscent.

Autonomy

• It is respectful to provide / maintain the principle of autonomy

Autonomy Includes

• Right to know information
• Consented and/or free healthcare
• Respect and dignity maintained

Conclusion

• Radiologic professionals are legally liable for daily actions
• There is a responsability to understand/practice the standard of care for the related profession
• Health information should be confidential