CHAPTER 13-15 LEADERSHIP NOTES PDF

Page |1 Philippines designated the last week of October PERSONAL AND PERSONAL DEVELOPMENT every year beginning in 1958 as Nurses' Week....

Page |1 Philippines designated the last week of October PERSONAL AND PERSONAL DEVELOPMENT every year beginning in 1958 as Nurses' Week.  On June 18, 1966, Republic Act 4704 amended CHAPTER 13 certain portions of R.A. 877.  The following were included among the salient changes: THE LEGAL ASPECTS OF NURSING a. The scope of nursing practice was broadened to circumscribe the whole management of the care of The Philippine Nursing Law patients and the acts constituting professional practice of nursing were spelled out to include such  The word "law" may be defined as a rule of conduct services as reporting, recording and evaluation of a pronounced by controlling authority, which may be patient’s case, execution of nursing procedures and enforced. There are three essential characteristics of techniques, direction and education to secure physical every law. The first one is the authority or the right to and mental care and the application and execution declare the rule exists. The second is that such rule of physician’s orders concerning treatment and is pronounced or expressed and that its source can medication. be identified. Lastly, a right to enforce the same must b. The minimum age required of applicants for be provided. admission to the nurse’s examination was lowered from 21 to 18 years of age, but no candidate who Nursing Jurisprudence passed the examination was permitted to practice the  Department of law which comprises all legal rules profession until he or she reached the age of 21.Republic and principles effecting the practice of nursing Act 7164, introduced by Senator Emerson Alvarez, includes the study and interpretation of rules and codified and revised all the laws regulating the practice principles and their application in the regulation of the of nursing in the Philippines. It was known as the practice of nursing Philippine Nursing Act of 1991.In October 21, 2002, Republic Act No. 9173 otherwise known as “The Functions of Law in Nursing Philippine Nursing Act of 2002” replaced R.A. 7164.  There are laws governing the practice of Nursing, one of  Provides a framework for establishing what nursing which is House Bill No. 4955 AN ACT PUNISHING THE actions in the care of patients are legal delineates the MALPRACTICE OF ANY MEDICAL PRACTITIONER IN THE nurse’s responsibilities from those of other professionals PHILIPPINES AND FOR OTHER PURPOSES  Helps to establish the boundaries of independent nursing actions  Assists in maintaining a standard of nursing  Practice by making nurses accountable to the law Legal Liabilities in Nursing  As nurses begin their professional obligations, their legal responsibilities begin as well. Their license to practice Brief History of the Philippine Nursing Law attests that they are qualified under the law to practice their profession. The Philippine Nursing Act of  The first law that had to do with the practice of 1992 is the best guide the nursecan utilize as it defines nursing was contained in Act No.2493 in 1915, which the scope of nursing practice. regulated the practice of medicine. This act provided  There are also standards of care that may be used as for the examination and registration of nurses in the criteria in evaluating their work. The nurses are enjoined Philippine Islands. to be familiar with the Philippine Nursing Law, and the  During that time, the applicants need to be only standards of nursing care, other laws which affect twenty years old, of good physical health and good nursing practice and their code of ethics.Responsibility moral character. Graduates of intermediate courses and Accountability for the Practice of Professional of the public school could enter the school of nursing, NursingWhen nurses undertake to practice their which was then giving only two years, and a half of profession, they are held responsible and accountable instruction. These graduates were called first class for the quality-of performance of their duties. nurses. Those who desired to be second class nurses  Nurses employed in an agency, institution, or hospitals filed an application with the district health officer in are responsible directly to their immediate supervisors. the district where they resided. Private duty nurses, being independent practitioners,  In 1919 Act 2808 was passed- this is known as the First True are held to a standard of conduct that is expected of Nursing Law. It created among others a board of reasonably prudent nurses. The standard is clearly examiners for nurses. defined, legal expectation to which nurses are held  However, it was in 1920 that the first board examination accountable.A nurse assumes responsibility and in the Philippines was given. accountability for all nursing care delivered  On June 19, 1953, the Philippine Nursing Law or R.A. 877 was passed. This act regulated the practice of nursing in Responsibility the Philippines.  One of the landmarks in the history of the nursing  Refers to the execution of duties associated with a profession in the Philippines is the Presidential nurse’s particular role. That is, the nurse is Proclamation of a Nurses' Week. Under Proclamation No. responsible for providing care within established 539dated October 17, 1958 the President of the standards of the profession. The responsible nurse M. CAMINARES BSN4 BLOCK B Page |2 demonstrates characteristics of reliability and legal orders of physicians concerning treatment dependability. and medications.  Only when these orders are legal in writing and bear the Accountability doctor’s signature does the nurse have the legal right to follow them.  Refers to the ability to answer for one’s own actions. The  Written orders are better understood and chances of nurse is accountable to herself most of all. He/she also error are minimized if they are clear, specific, complete balances accountability to the patient, the profession, and legible. the employing institution, and society.  Verbal orders can be minimized if the nurse seeks a Liability clear understanding from the physicians in establishing a policy concerning the importance of written orders.  An obligation one has incurred or might incur through  The general rule requiring a nurse to execute all any act or failure to act. When the nurse fails to meet lawful orders of a physician is tempered by common the legal expectations of care, the client can initiate sense. The nurse must not execute an order if she is action if harm or injury is incurred by the client. reasonably certain it will result in harm to the patient. In such case she must speak out and risk incurring the Professional Negligence physician’s resentment or ire rather than a lawsuit. It is preferable to raise the matter of carrying out the  The term negligence refers to the commission or omission procedure as a point of clarification in a tactful, of an act, pursuant to a duty, that a reasonably prudent acceptable manner. person in the same or similar circumstances would or  A nurse must see to it that she understands the action would not do, and acting or the non-acting is the of a drug, its minimum and maximum dosages, route proximate cause of injury to another person or his of administration, and untoward effects so that she may property. skillfully, safely, and effectively carry them out.  The elements of professional negligence are:  She should be able to report and record the effects on 1) Existence of a duty on the part of the person the patient so that the doctor can judge its charged to use due care under circumstances, therapeutic value and know when to discontinue its 2) Failure to meet the standard of due care, use. 3) The foreseeability of harm resulting from failure  Tests and treatments should be explained to the to meet the standard, and patient in accordance with the general plan of his 4) the fact that the breach of this standard care so that the patient can give full consent and resulted in an injury to the plaintiff. cooperate in its implementation. Malpractice  Any unfavorable psychologic or physical reaction should be likewise reported so that the proper action  Malpractice in the usual sense implies the idea of may be taken. Sometimes, however, refusal may be due improper or unskillful care of a patient by a nurse. It to inaccurate presentation of facts. would also see that malpractice also denotes stepping  Patients must receive special sympathetic attention beyond one's authority with serious consequences. from the nurses. Every effort should be made to correct inaccurate views and modify superficially-held beliefs. Medical Orders, Drugs, and Medications Telephone Orders  R.A. 6675 states that only validly registered medical, dental and veterinary practitioners, whether in private  There are legal risks by telephone orders. These may be institution/ corporation or in the government, are misunderstood or misinterpreted by the receiving nurse. authorized to prescribe drugs. Sometimes too, messages from telephones may sound  Prescriptions made by unauthorized persons constitute unclear or garbled because of some trouble in the illegal practice of medicine, dentistry or veterinary telephone lines. Most importantly, the signature of the medicine and is punishable under R.A. 2832 of the ordering physician is not present and this order may Medical Act of 1959, R.A. 4419 of the Dental Act, and later be denied incase errors exist or court litigations R.A. 382 or the Veterinary Act.In accordance with R.A. arise. 5921, or the Pharmacy Act as amended, Intravenous Therapy and Legal Implications All prescriptions must contain the following information:  Nurses now participate in complex intravenous  Name of the prescriber therapy procedures that were once performed only  Office address by doctors.  Professional registration number  Because of this change, nurses must remember that  Professional tax receipt number their legal right to give intravenous injections is based on  Patients/client’s name, age and sex, and date of the Philippine Nursing Act of 1991 Section 28 which state prescription. that "in the administration of intravenous injections, special training shall be required according to protocol R.A. 6675 requires that the drugs be written in their generic names. established.  "Therefore, nurses have to undertake a certified training  The dependent and coordinated function of the nurse course on intravenous therapy. In giving intravenous pertains to the application and execution of written injections, nurses should also follow the policies of their agencies. Even if nurses have formal training on M. CAMINARES BSN4 BLOCK B Page |3 IV therapy, if the hospital does not allow them to do 2) A fair explanation of the procedures to be done so, then they may not do the procedure. and used and the consequences;  Board of Nursing Resolution no. 8 states that any 3) A description of alternative treatments or procedures; registered nurse without such training and who 4) A description of the benefits to be expected; administers IV injections to patients, shall be held 5) Material rights if any; and liable, either criminally under Sec. 30 ( c) Art. VII of said 6) The prognosis, if the recommended care, procedure, is law or administratively under Sec. 21 Art. III or both refused. (whether causing or not injury or death to the patient). Proof of Consent  A written consent should be signed to show that Consent to Medical and Surgical Procedures the procedure was the one consented to and that the person understood the nature of the procedure, Consent the risks involved and the possible consequences.  A signed special consent is necessary before any  is defined as a “free and rational act that presupposes medical or surgical treatment is done such as x- knowledge of the thing to which consent is being rays, special laboratory tests, blood transfusions, given by a person who is legally capable to give operations, cobalt therapy, or chemotherapy consent.” and the like.  The consent signed by the patient or his authorized representative/legal guardian upon admission is for Who Must Consent. the initial diagnosis and treatment. Subsequent treatments/operations require individual, informed  Ordinarily, the patient is the one who gives the consent. consent in his own behalf. However, if he is  Before any medical or surgical procedure can be incompetent (such as in the case of minors or performed on a patient, consent must be obtained the mentally ill) or physically unable and is not an from the patient or his authorized representative who emergency case, consent must be taken from may be his parent or guardian. another who is authorized to give itin his behalf.  It is only in case of emergency where the consent requirement does not apply. The physician should give Consent of Minors as much information about a contemplated procedure  Parents, or someone standing in their behalf, and the patient should receive enough information give the consent to medical or surgical treatment to allow him to give an informed consent for such of a minor. Parental consent is not needed procedure or treatment. however, if the minor is married or otherwise  The intentional touching or unlawful beating of another emancipated. person without authorization to do so is a legal wrong called battery. Consent of Mentally ill Nature of Consent  A mentally incompetent person cannot legally consent to medical or surgical treatment. The  Consent is an authorization, by a patient or a consent must be taken from the parents or legal person authorized by law to give the consent on guardian. the patient's behalf that changes a touching from non-consensual to consensual. It is the nurse Emergency Situation who actually secures the consent of the patient upon admission.  When an emergency exists, no consent is  This consent is usually for diagnostic necessary because inaction at such time may procedures and initial treatment deemed cause greater injury. A mother who is on the necessary by the medical staff. To substantiate the advanced stage of labor or a patient who goes to patient’s consent, a written authorization is the emergency room gives an implied consent to needed as proof against any liability that may an immediate treatment or attendance. arise due to an alleged unlawful touching of a  However, if time is available and an informed patient. consent is possible, it is best that this be taken for the protection of all parties concerned. Informed consent  “It is established principle of law that every human being of adult years and sound mind has the right Refusal to Consent to determine what shall be done with his own body. He may choose whether to be treated or not  A patient who is mentally and legally competent (sane and to what extent, no matter how necessary the mind and of legal age) has the right to refuse to permit medical care, or how imminent the danger to his life touching of his body or to submit to a medical or surgical or health if he fails to submit to treatment.” procedure no matter how necessary, nor how imminent the danger to his life or health if he fails to submit The essential elements of informed consent include: to treatment.  Examples are patients who, because of their religious 1) The diagnosis and explanation of the condition; beliefs, may refuse blood transfusion. A patient may M. CAMINARES BSN4 BLOCK B Page |4 refuse to consent due to inadequate information  Under the Philippine Nursing Act of 2002 R.A. regarding the procedure to be done. If after the 9173,nursing students do not perform professional explanation, he still refuses to sign the consent form, he nursing. They are to be supervised by their Clinical should be made to fill out the release form to protect the Instructors.In order that the errors committed by hospital and/or agency and its personnel from any nursing students will be avoided/minimized, the liability that may result from his refusal. following measures should betaken:  If he refuses to sign the release form, this should be noted 1) Nursing students should always be under the in his chart. The competent person has a legal and supervision of their Clinical Instructors. ethical right to refuse treatment, and this right is formally 2) They should be given assignments that are in level established. of their training, experience and competency. 3) They should be advised to seek guidance specially Consent for Sterilization if they are performing a procedure for the first time. 4) They should be oriented to the policies of the nursing  Sterilization is the termination of the ability to produce unit where they are assigned. offspring. The husband and the wife must consent to the 5) Their performance should be assessed frequently to procedure if the operation is primarily to accomplish determine their strengths and their weaknesses. sterilization. When the sterilization is medically 6) Frequent conferences with the students will reveal necessary, the sterilization is an incidental result such their problems, which they may want to bring to the as in cases of abruptioplacenta, ectopic pregnancies attention of their instructors or vice-versa. Discussions or ruptured uterus, the patient's consent alone is of these problems will iron out doubts and possible sufficient. solutions may be provided Medical Records Charting Done by Nursing Students  The value of medical records is both scientific and  When a nurse or a clinical instructor countersigns the legal. As a record of illness and treatment, it saves charting of a nursing student, she attests that she has duplication in future cases and aids in prompt personal knowledge of information and that such is treatment. accurate and authentic. Anyone who countersigns  The record supplies rich material for medical and without verification commits herself to possible legal nursing research. It serves as a legal protection for the risk. hospital, doctor and nurse by reflecting the disease or condition of the patient and his management. Incident Reports  Nurses must remember the rule. "If it was not charted, It was not observed or done. “In the performance of their  The primary purpose of an incident report is to duties, nurses are expected to record fully, accurately, document and prevent possible consequent injuries. legibly, and promptly their observations from Classifying an event, as an incident does not imply admission to the time of the patient’s discharge. that someone made a mistake, it only means that  Daily notes should include not only medications and something unusual happened. treatments given or rendered but also the physical and emotional symptoms exhibited by the patient. The nurses’ notes are aids to medical diagnosis and in I. NONMALEFICENCE understanding the patient’s behavior.  One should not do and not risk harm  Since patients have the right to confidentiality of these  “Primum non nocere”… is a Latin records, nurses are legally and ethically bound to phrase that means "First, do no harm". protect the patient’s chart from unauthorized persons. The phrase is sometimes recorded as Permission has to be taken from the hospital authorities primum nil nocere.. for authorization to secure any information from the  Includes: physical, mental, patient’s chart. psychological, social, financial,  Nurses are responsible for safeguarding the patient’s spiritual, and symbolic. record from loss or destruction or from access by  It is a negative action. persons who are not legally authorized to read such. HIPPOCRATES Legal Responsibilities of Students  STATED THAT:  Nursing students are responsible for acquiring the Healthcare giver should not do harm. knowledge and skills necessary to become a safe  Examples : incompetent care, disrespecting practitioner. Included in this knowledge and skill dignity, breaching privacy, hopelessness, development is the awareness of ethical principles destroying reputation, misleading a younger and the process of ethical decision making. colleague,  Nursing students must act as reasonably prudent persons, equivalently with education and experience, when performing nursing duties. They must perform only those tasks that they are competent to perform. Liability for the Work of Nursing Students M. CAMINARES BSN4 BLOCK B Page |5 HOWEVER….  There are occasions when some The Ethical Duties of A Doctor harm may be allowed in order to avoid greater harm. Cause no harm Non-maleficence  PRINCIPLE OF DOUBLE EFFECT Effect a cure or Beneficence  When a more fundamental principle provide palliative treatment overrides nonmalficence Respect a patient’s Autonomy  IN SUCH CASE; asking for free and right informed consent of the one harmed is always Treat patient’s fairly Justice encouraged.  Non-maleficence and Beneficence are mainly utilitarian  Autonomy and Justice are mainly deontological II. BENEFICENCE  Non-maleficence and Beneficence are... two aspects of  Means that one should well-being prevent or remove harm or risk of harm, do good, or provide a benefit. 4 Ethical rules  In health; it involves benevolence, compassion  Veracity – truth telling, informed consent, respect for (pity), charity. autonomy  Take positive steps to help others  Privacy – a person’s right to remain private, not to  It’s an extraordinary act. disclose information  Its urgency is in proportion to the relationship of the  Confidentiality – only sharing private information on a doer to the person at risk. ‘need to know basis’  Example: free medical services, exposing oneself to  Fidelity – loyalty, maintaining the duty to care for all no danger when caring for another, spending extra matter who they are or what they may have done time to guide a younger colleague, extra effort to be a role model. TWO METHODOLOGIES FOR THE MORAL EVALUATION OF ACTION:  It is a positive action  Weighing of Goods CONDITIONS THAT REQUIRE ONE TO PERFORM A BENEFICENT ACT ARE:  Principle of Double Effects  The person aided is at significant risk  The action is needed and likely to succeed  There is no significant risk for the doer Principle of Double Effect  The benefit for the recipient  An action that is good in itself that has two effects--an outweighs the harm to the doer intended and otherwise not reasonably attainable good Beneficent acts are sometimes PATERNALISTIC, restrict liberty for effect, and an unintended yet foreseen evil effect--is ones own good and may conflict with AUTONOMY and other licit, provided there is a due proportion between the interests intended good and the permitted evil.  Source: Mangan, Joseph. (1949). “An Historical Analysis of the Principle of Double Effect”. Theological Studies 10, 41-61; Quoted in Alison McIntyre, “Doctrine of the III. JUSTICE Double Effect,” Stanford Encyclopedia of Philosophy  This principle aims to provide specific guidelines for  Both a principle and a virtue relating to the rightness on determining when it is morally permissible to perform an people`s interactions and relationships. Benefits and risk action in pursuit of a good end with full knowledge that should be fairly distributed the action will also bring about bad results.  As a principle, one should give another what is one`s  In cases where a contemplated action has both good due. effects and bad effects, the action is permissible only if  As a virtue, it is the constant will to render what is right. it is not wrong in itself and if it does not require that one  Justice is related to: truthfulness, autonomy, stewardship, has direct intention of an evil result. solidarity, non maleficence.  In health: it is expressed in the individual and society`s obligation to deliver competent, affordable, and accessible healthcare. M. CAMINARES BSN4 BLOCK B Page |6 The doctrine consists of four conditions that must be satisfied  If there is a way of accomplishing the same end that before an act is morally permissible: does not cause the bad effect, then that way must be used.  The nature-of-the-act condition. The action must be  For example, if the pain can be eliminated through other either morally good or unbiased means than morphine without running the risk of death,  The means-end condition. The bad effect must not be then the other means must be used the means by which one achieves the good effect.  The right-intention condition. The intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect. 10 Moral Principles  The proportionality condition. The good effect must be 1. Golden Rule at least equivalent in importance to the bad effect. 2. The Principle of Totality- the whole is greater than its parts  The second of these four conditions is an application of 3. Epikia- there is always exception to the rule the more general principle that “good ends do not justify 4. One who acts through as agent herself responsible evil means…” 5. No one is obliged to betray herself  This doctrine says that “if doing something morally good 6. The end does not justify the means has a morally bad side-effect, it's ethically allowed to do 7. Defects of nature maybe corrected it provided the bad side-effect wasn't intended”. 8. If one is willing to cooperate in the act, no justice is done  This is true even if you foresaw that the bad effect would to him probably happen. 9. A little more or a less does not change the substance of Dilemma…. an act 10. No one is held to impossible  When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises as to whether the obligation to avoid evil requires one to abstain from a good action in order to prevent a foreseen but merely permitted concomitant evil effect.  The answer is… one need not always abstain from a good action that has foreseen bad effects, depending on certain moral criteria. The 5 moral Criteria that bring in the Principle of Double Effects… 1. The action in itself from its very strong objective be good or at least indifferent  The action cannot be something that is evil in itself.  Performing surgery to remove a life-threatening uterine cancer from a pregnant woman may be permitted, since the action is not evil in itself, even though it may incidentally cause an abortion. 2. The good effect and not the evil effect is to be intended;  The intention of the action must always be to bring about the good effect.  Example: Giving increasingly high doses of morphine to relieve suffering, even though this might bring about an end to life. 3. The good effect be not produced by means of the evil effect;  The evil effect (e.g., abortion) can only be an incidental by-product of the act, not the means to the good effect. 4. There be a proportionately grave reason for permitting the evil effect  Cannot be used in trivial cases.  Example: one can justify bringing about an abortion in the case of a patient with life-threatening cancer, but not in the case of someone who simply needs minor surgery. 5. There must be no other way to accomplish the end… M. CAMINARES BSN4 BLOCK B Page |7 TORT LAW IN HEALTHCARE CHAPTER 14 Overview  What is Right or Wrong  Is it Legal  Is it fair  Is it practical  What is guilt Basis of Legal Liability  A legal wrong is a violation of a person’s legal rights, or a failure to perform a legal duty owed to a certain person or to society as a whole. Legal wrongs include:  Crime  Breach of contract  Tort What Is Common Law?  Common Law is judge- made law.  The basic requirement is that courts follow precedent. This is how:  Judges derive legal principles by looking back at how other cases were decided, deducing a general principle, and applying it to the facts of this case. What is Tort Law? A formal definition.  “The body of rules that determine when… an injured party can recover compensation for an injury from another party through a civil action.” Why do we need tort law?  To provide compensation for people who have been injured  To achieve corrective justice by restoring the status quo when someone’s rights have been violated  For deterrence Classification of Law Basic Purposes of Tort Law Criminal Public Substantive  Preservation of peace between individuals by providing Wrongs a substitute for vengeance. Civil Private Procedural Wrongs  Culpability – to find fault for wrongdoing  Deterrence – to discourage the wrongdoer from committing future tort.  Compensation – to indemnify the injured person of wrongdoing M. CAMINARES BSN4 BLOCK B Page |8 Remember this…. Because an adverse medical outcome generally results in some financial damage, the effect of finding faults by the court is to… determine who shall bear the cost of an unfavorable outcome. Provider Recipient A Tort to be considered…..  Intentional:  Not only must the act be committed ARTICLE 2180 intentionally, but also the wrongdoer must realize that harm would result from  The obligation imposed by article 2176 is demandable that act. not only for one own`s act or omissions, but also for those  Always involved a willful act that of persons for whom one is responsible. violates another interest.  “diligence of a good father in the family” to prevent HOWEVER; damage.  Negligent wrong… may not involve  In short, the mistake of a doctor, is the mistake of the committing an act at all, it may be hospital – “vicarious liability”… of the employer. simply a failure to act when there is a duty to act. Quasi-Delict Definition:  Civil law: a delict (wrong) caused by negligence….. Seemingly, apparently, supposedly  A quasi-delict is a negligent act or omission which causes harm or damage to the person or property of another. ( Phil. Version of Tort )  Simplified:  An act whereby a person, without malice, but by fault, negligence or imprudence not legally excusable, causes injury to another.  Prima Facie: evidence proved to be true unless there is substantial contra evidences. ARTICLE 2176  The basic provision on quasi-delict,, is article 2176 of the Civil Code which provides: NEGLIGENCE  “Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to  Is a tort… a civil or personal wrongdoing… distinguished pay for the damage done. Such fault or negligence, if from criminal conduct. there is no pre-existing contractual relation between the  It is unintentional omission or commission of an act that parties, is called a quasi-delict”. It is a residuary category a reasonably prudent person would or would not do of private wrongs, characterized by either vicarious or under given circumstances. strict liability.  It is a form of conduct caused by heedlessness or carelessness.  Constitute a departure from the standard of care  Failure to use ordinary or reasonable care Law of Negligence  Negligence is the failure to exercise the standard of care required by law to protect others from an unreasonable risk of harm. M. CAMINARES BSN4 BLOCK B Page |9 Negligence can occur…  Actual damages must be established.  Where one has considered the consequences Causation: of an act and has exercised the “best possible” judgment.  The departure from standard of care must be the cause  Where one has failed to guard against a risk of the plaintiff`s injury. that should be appreciated.  Where one engages in certain behavior expected to involve unreasonable dangers to others. Commission of an act includes:  Administering a wrong medication  Administering medication to a wrong patient  Performing operation without consent  Performing a surgical procedure on the wrong patient  Performing wrong surgical procedure Omission of an Act:  Failing to conduct a thorough history and physical examination  Failure to assess and reassess a patient`s nutritional status  Failure to administer medication  Failure to order diagnostic test  Failure to follow up on abnormal test results Forms of Negligence: Malfeasance  Performance of an unlawful or improper act. Misfeasance  Improper performance of an act causing injury Nonfeasance  Failure to act, when there is failure to act. Elements of Negligence  Duty to care  Breach of duty  Injury ( harm )  Factual causation  Proximate cause Duty of care:  There must be an obligation to conform to a recognized standard of care. Breach of Duty:  There must be a deviation from the recognized standard of care.  There must be failure to adhere to an obligation. Injury: M. CAMINARES BSN4 BLOCK B P a g e | 10 Elements of Negligence  Purpose of compensatory damages….  Put the injured party in the same financial situation he or she was in, before he or she suffered harm. Imputed Negligence  “To relate to a particular cause or source”  Under certain conditions, the negligence of one person can be attributed to another… Example:  The negligent act of an employee can be imputed to the employer. Negligence:  Negligence or carelessness of a professional person - MALPRACTICE  Reckless disregard for the safety of another is… - CRIMINAL NEGLIGENCE M. CAMINARES BSN4 BLOCK B P a g e | 11  Malpractice suits may allege various mistakes made by  Means, “the thing speaks for itself” e.g., a retained doctors or other medical professionals including surgical instrument misdiagnosis, mistreatment, delayed diagnosis, failure to diagnose, surgical errors, medical errors.  Not all errors in medical diagnosis and treatment are necessarily a malpractice, because there certain risk and margins for errors that arise inherently in the practice of medicine! Types of Damages Awards The law allows for the following types of damages:  Compensatory damages compensate the victim for losses actually incurred. They include:  Special damages, e.g., medical expenses  General damages, e.g., pain and suffering  Punitive damages are designed to punish people and organizations (hospital) so that others are deterred from committing the same wrongful and egregious act. ( also called exemplary damages ). Doctrine of Respondeat Superior  “let the master respond”  Is a legal doctrine holding employers liable, in certain cases, for the wrongful acts of their employees.  This also been referred as “vicarious liability” meaning: Res Ipsa Loquitur  Employer is answerable for the torts committed by employees.  Under this doctrine, the very fact that the injury or damage occurs establishes a presumption of negligence on behalf of the defendant M. CAMINARES BSN4 BLOCK B P a g e | 12  In the health care setting, an organization is liable for the negligent acts of its employees, even though there has been no wrongful conduction on the part of the institution.  Employees act within the scope of employment if their acts are so: 1) Closely connected with the job 2) Fairly and reasonably incidental to it that they may be regarded as methods, even though quite improper ones, of carrying out the objectives of employment  For liability to be imputed to the employer:  A master-servant relationship must exist between the employer and the employee.  The wrongful act of the employee must have occurred within the scope of his or her employment. Reason behind this Doctrine  The employer derives a benefit from the work of his employees and therefore he should also accept associated risk.  The question of liability frequently rest on…  Whether persons treating a patient are independent agents. Meaning…(responsible for their own acts)  Employees of the institution  Basic rationale!!!  Imposing liability on an employer developed because the employer possesses the right to control the physical acts of its employees.  Generally, the plaintiff`s attorney will file suit against both the employer and the employee.  Important reminders…  Employer is not without remedy if liability has been imposed against it for an employee`s negligent act.  The law holds negligent persons responsible for their act, employees are not absolved from liability when a health care facility is held liable through application Respondeat superior.  Not only may the injured party sue the employee directly, but also the employer, if sued, may seek indemnification from the employee.  The plaintiff has the burden for establishing an employee-employer relationship.  This is difficult especially in the case of independent physicians.  Remember this….  An officer or Director of a hospital is not, merely as a result of his or her position, personally liable for the torts of the employee.  To incur liability….  The Director ordinarily must be shown to have in some way or another participated in or directed the tortous act. M. CAMINARES BSN4 BLOCK B P a g e | 13 * #187 SERIES 1991 – RENEWAL OF PROFESSIONAL LICENSE PROFESSIONAL AND PERSONAL DEVELOPMENT  * #217 SERIES 1992 – DELISTING OF DELINQUENT PROFESSIONALS CHAPTER 15 LAWS AFFECTING THE PRACTICES OF NURSING IN PROCLAMATION/ PRONOUNCEMENTS & LETTERS OF INSTRUCTIONS THE PHILIPPINES  PROC #6 – UNITED NATIONS GOAL ON UNIVERSAL CHILD IMMUNIZATION BY 1990 PRESIDENTIAL DECREES  – PROC #118 – PROFESSIONAL REGULATION WEEK – JUNE 16-22  *PD 48 – FOUR (4) CHILDREN WITH PAID MATERNITY LEAVE  – PROC #539 – NURSES WEEK – EVERY LAST WEEK OF PRIVILEGE OCTOBER  *PD 69 – FOUR (4) CHILDREN FOR PERSONAL TAX  – LOI #949 – LEGAL BASIS OF PRIMARY HEALTH CARE EXEMPTION  – LOI #100 – MEMBERS OF ACCREDITED PROFESSIONAL  *PD 442 – NEW LABOR CODE ORGANIZATIONS GIVEN PREFERENCE IN HIRING OR  *PD 491 – NUTRITION PROGRAM ATTENDANCE TO SEMINAR  *PD 541 – PRACTICE OF FORMER FILIPINO PROFESSIONALS  – ILO CONVENTION #149 – IMPROVEMENT OF LIFE AND IN THE PHILIPPINES WORK CONDITIONS OF NURSING PERSONNEL (ILO  *PD 603 – CHILD AND YOUTH WELFARE CODE RECOMMENDATION #157)  *PD 626 – EMPLOYEE COMPENSATION AND STATE INSURANCE FUND  *PD 651 – BIRTH REGISTRATION FOLLOWING DELIVERY REPUBLIC ACTS  *PD 625 – ANTI IMPROPER GARBAGE DISPOSAL  *PD 851 – 13TH MONTH PAY  RA 1054 – FREE EMERGENCY MEDICAL AND DENTAL  *PD 856 – CODE OF SANITATION ATTENDANCE TO EMPLOYEES/ LABORERS OF ANY  *PD 965 – FAMILY PLANNING AND RESPONSIBLE COMMERCIAL, INDUSTRIAL OR AGRICULTURAL PARENTHOOD INSTRUCTIONS PRIOR TO ISSUANCE OF ESTABLISHMENTS MARRIAGE LICENSE  RA 1080 – CIVIL SERVICE ELIGIBILITY  *PD 996 – COMPULSORY IMMUNIZATION FOR CHILDREN  RA 1082 – CREATION OF RURAL HEALTH UNITS ALL OVER BELOW EIGHT (8) YEARS OLD AGAINST IMMUNIZABLE THE PHILIPPINES DISEASES  RA 1612 – PRIVILEGE TAX/ PROFESSIONAL TAX  *PD 1083 – MUSLIM HOLIDAYS  RA 2382 – PHILIPPINE MEDICAL ACT  *PD 143 – WOMAN AND CHILD LABOR LAW (NO CHILD  RA 3573 – REPORTING COMMUNICABLE DISEASES BELOW 14 SHALL BE EMPLOYED)  RA 4073 – TREATMENT OF LEPROSY IN GOVERNMENT  *PD 1519 – MEDICARE BENEFITS FOR ALL GOVERNMENT SKIN CLINIC, RURAL HEALTH UNIT OR BY DULY LICENSED EMPLOYEES PHYSICIAN  *PD 1636 – COMPULSORY MEMBERSHIP TO SSS OF SELF-  RA 4226 – HOSPITAL LICENSURE EMPLOYED PERSONS  RA 5181 – PERMANENT RESIDENCE AND RECIPROCITY QUALIFICATIONS FOR EXAMINATIONS/ REGISTRATION EXECUTIVE ORDERS  RA 5901 – WORKING HOURS AND COMPENSATION AND  * EO 51 – MILK CODE AGENCIES WITH 100 BED CAPACITY  * EO 180 – GUIDELINES ON THE RIGHT TO ORGANIZE OF  RA 6675 – GENERICS ACT OF 1988 GOVERNMENT EMPLOYEES  RA 6713 – CODE OF CONDUCT AND ETHICAL  * EO 203 – LIST OF REGULAR HOLIDAYS AND SPECIAL DAY STANDARDS FOR PUBLIC OFFICIALS AND EMPLOYEES  * EO 209 – FAMILY CODE OF THE PHILIPPINES (AMENDED  RA 6725 – PROHIBITION ON DISCRIMINATION VS. BY RA 6809) WOMEN  * EO 226 – COMMAND RESPONSIBILITY  RA 6727 – WAGE RATIONALIZATION  *EO 174 – NATIONAL DRUG POLICY (AVAILABILITY,  RA 6758 – SALARY STANDARDIZATION OF GOVERNMENT AFFORDABILITY OR SAFE, EFFECTIVE, QUALITY DRUGS) EMPLOYEES  * EO 857 – COMPULSORY DOLLAR REMITTANCE LAW  RA 6972 – DAY CARE IN EVERY BARANGAY  RA 7160 – LOCAL AUTONOMY CODE  RA 7170 – LEGACY OF DONATION OF ALL OR PART OF A HUMAN BODY AFTER DEATH BOARD OF NURSING RESOLUTION  RA 7192 – WOMEN IN DEVELOPMENT AND NATIONAL BUILDING  * #100 SERIES 1983 – IMPLEMENTING RULES AND  RA 7277 – MAGNA CARTA FOR DISABLED PERSONS REGULATIONS OF RA 7392  RA 7305 – MAGNA CARTA FOR PUBLIC HEALTH  * #633 SERIES 1984 – ICN CODE OF ETHICS WORKERS  * #1955 SERIES 1989 – PNA CODE OF ETHICS  RA 7432 – SENIOR CITIZENS BENEFITS AND PRIVILEGES  * #08 SERIES 1994 – SPECIAL TRAINING ON INTRAVENOUS  RA 7600 – ROOMING IN AND BREAST FEEDING ACT OF INJECTIONS FOR THE RNS 1992  * #1930 SERIES 1985 – CPE FOR NURSES M. CAMINARES BSN4 BLOCK B P a g e | 14  RA 7610 – SPECIAL PROTECTION OF CHILDREN AGAINST CHILD ABUSE, EXPLOITATION AND DISCRIMINATION  RA 7641 – NEW RETIREMENT LAW FOR EMPLOYEES IN THE PRIVATE SECTOR  RA 7719 – NATIONAL BLOOD SERVICES ACT OF 1994  RA 7875 – NATIONAL HEALTH INSURANCE ACT OF 1995  RA 7876 – SENIOR CITIZEN CENTER FOR EVERY BARANGAY  RA 7877 – ANTI SEXUAL HARASSMENT ACT OF 1995  RA 7883 – BARANGAY HEALTH WORKERS BENEFITS AND INCENTIVES ACT OF 1992  RA 8042 – MIGRANT WORKERS AND OVERSEAS FILIPINOS ACT 1995  RA 8187 – PATERNITY LEAVE ACT OF 1995  RA 8282 – SOCIAL SECURITY LAW OF 1997 (AMENDED RA 1161)  RA 8291 – GOVERNMENT SERVICE INSURANCE SYSTEM ACT OF 1997 (AMENDED PD 1146)  RA 8344 – HOSPITALS/ DOCTORS TO TREAT EMERGENCY CASES REFERRED FOR TREATMENT  RA 8424 – PERSONAL TAX EXEMPTIONS  RA 8749 – CLEAN AIR ACT  RA 7164 – PHILIPPINE NURSING ACT OF 1991  RA 9173 – PHILIPPINE NURSING ACT OF 2002  RA 6111 – MEDICARE ACT  RA 7624 – DRUG EDUCATION LAW  RA 349 – LEGALIZED USE OF HUMAN ORGANS FOR SCIENTIFIC PURPOSES  RA 6809 – AMENDED ARTICLE 34 OF FAMILY CODE, 18 YEARS IS MAJORITY AGE  RA 8344 – AN ACT PENALIZING THE REFUSAL OF HOSPITAL AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIALS MEDICAL TREATMENT AND SUPPORT IN EMERGENCY SERIOUS CASES  RA 9165 – COMPREHENSIVE DANGEROUS DRUG ACT OF 2002  RA 953 – NARCOTIC DRUG ACT  RA 2372 – PRACTICE OF MEDICINE BY A NURSE  RA 8423 – ESTABLISHED THE TRADITIONAL AND ALTERNATIVE HEALTH CARE  RA 8172 – SALT IODIZATION LAW  RA 9262 – ANTI VIOLENCE AGAINST WOMEN AND CHILDREN M. 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