Paramedic Care: Principles & Practice PDF

Paramedic Care: Principles & Practice Sixth Edition Chapter 7 Medical–Legal Aspects of Out-of-Hospital Care Copyright © 2023, 2017, 2013...

Paramedic Care: Principles & Practice Sixth Edition Chapter 7 Medical–Legal Aspects of Out-of-Hospital Care Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Standard Preparatory (Medical–Legal and Ethics) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Competency Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical– legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction Paramedics must: – Be familiar with legal issues they encounter in field – Be prepared to make medical decisions and appropriate legal decisions Laws vary state to state; protocols vary county to county Specific legal question: rely on advice of attorney Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (1 of 14) You have specific legal duties to your – Patient – Crew – Medical director – The public Duties often set by state statues and regulations Failure to follow may result in “liability” Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (2 of 14) EMS providers also have ethical responsibilities – Respond promptly to both physical and emotional needs of every patient – Treat all patients and their families with courtesy and respect – Maintain skills and medical knowledge – Participate in continuing education programs, seminars, refresher training Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (3 of 14) EMS providers also have ethical responsibilities (cont ) inued – Critically review your performance; constantly seek improvement – Report honestly and with respect for patient confidentiality – Work cooperatively with and respect other emergency professionals – EMS practitioners also often encounter moral issues Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (4 of 14) The Legal System – Constitutional law: ▪ Based on Constitution of United States; protects people against governmental abuse – Common law ("case" or "judge-made"): ▪ Society's acceptance of customs and norms over time; changes and grows over years Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (5 of 14) The Legal System (cont ) inued – Statutory law (legislative): ▪ Does not come from court decisions; created by lawmaking or legislative bodies – Regulatory law (administrative): ▪ Enacted by administrative or governmental agency at either federal or state level Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (6 of 14) Categories of Law – Criminal law: ▪ Crime and punishment ▪ Crimes against society – Civil law: ▪ Noncriminal issues (personal injury, contract disputes, matrimonial issues) – Plaintiff: person initiating litigation – Defendant: person against whom complaint is made Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (7 of 14) Tort law: – Civil wrongs committed by one individual against another Trial courts: – Judge or jury determines outcome of individual cases Appellate courts: – Hear appeals of decisions by trial or appeals courts Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (8 of 14) Anatomy of a Civil Lawsuit – Incident – Investigation – Filing of complaint – Answering of complaint Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (9 of 14) Anatomy of a Civil Lawsuit (cont ) inued – Discovery ▪ Examination before trial (deposition) ▪ Interrogatory ▪ Requests for document production – Trial – Decision – Appeal – Settlement Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (10 of 14) Laws Affecting EMS and the Paramedic – Scope of Practice ▪ Range of duties and skills paramedics allowed and expected to perform ▪ Set by state law or regulation and/or by local medical direction ▪ Policy to guide paramedics in dealing with intervener physicians Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (11 of 14) Certification and Licensure – Certification: ▪ Recognition granted to individual who has met qualifications to participate in certain activity – Licensure: ▪ Used to regulate occupations, generally by governmental agency – Understand EMS laws and regulations in your state Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (12 of 14) Motor Vehicle Laws – Special motor vehicle laws govern operation of emergency vehicles and equipment; vary state to state Reporting Requirements – Each state has different laws to protect public ▪ Report spousal abuse, child abuse and neglect, abuse of elderly, sexual assault, gunshot and stab wounds, animal bite, communicable diseases Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (13 of 14) Disaster/Homeland Security Laws – Address responses to disasters – Give flexibility to government to adapt rapidly – Often allows the governor or local officials the ability to modify or waive laws or regulations during disaster Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Duties and Ethical Responsibilities (14 of 14) Legal Protection for the EMS Practitioner: – Immunity: ▪ Exemption from legal liability – Good Samaritan laws: ▪ Immunity for people who assist at medical emergency – Ryan White Comprehensive AIDS Resources Emergency Act (Ryan White Care Act): ▪ Exposure to blood-borne or airborne pathogens Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (1 of 13) Required to provide level of care to patients consistent with education and training; equal to other paramedics with equivalent training Expected to perform duties in reasonable and prudent manner – Intentional tort: civil wrong committed by one person against another based on willful act Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (2 of 13) Negligence and Medical Liability – Negligence: deviation from accepted standards of care recognized by law for protection of others against unreasonable risk of harm Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 7-1 EMS Liability Claims Summary of 275 Ems Liability Claims From a Large National Ems Insurer For a Two-Year Period Cause Percentage Patient handling 45% Emergency vehicle movement or 31% collision Medical management 11% EMS response or transport 8% Lack or failure of equipment 4% Other causes 9% Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (3 of 13) Components of a Negligence Claim – Duty to act: formal contractual or informal legal obligation to provide care ▪ Duty to respond to scene and render care to ill or injured patients ▪ Duty to obey federal, state, local laws and regulations ▪ Duty to operate emergency vehicle reasonably and prudently Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (4 of 13) Components of a Negligence Claim (cont ) inued 1. Duty to Act: formal contractual or informal legal obligation to provide care ▪ Duty to provide care & transportation to expected care standard ▪ Duty to provide care & transportation consistent with scope of practice and local medical protocols ▪ Duty to continue care and transportation through to appropriate conclusions Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (5 of 13) Components of a Negligence Claim (cont ) inued 2. Breach of Duty: breach of that duty ▪ Malfeasance: – Performance of wrongful or unlawful act by paramedic ▪ Misfeasance: – Performance of legal act in manner harmful or injurious ▪ Nonfeasance: – Failure to perform required act or duty Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (6 of 13) Components of a Negligence Claim (cont ) inued – Negligence so obvious no extensive proof required ▪ Res ipsa loquitur: – Complainant must prove damages would not have occurred in absence of somebody's negligence – Instruments causing damages were under defendant's control at all times – Patient did nothing to contribute to their own injury ▪ Negligence per se (automatic): – Paramedic violates statute and injury to plaintiff results Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (7 of 13) Components of a Negligence Claim (cont ) inued 3. Actual Damages: ▪ Plaintiff must prove that they were actually harmed in a way that can be compensated by award of damages – Plaintiff may seek punitive (punishing) damages Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (8 of 13) Components of a Negligence Claim (cont ) inued 4. Proximate Cause: ▪ Action or inaction of paramedic immediately caused or worsened damage suffered by plaintiff – Plaintiff needs to prove damage to patient was reasonably foreseeable Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (9 of 13) Defenses to Charges of Negligence – Good Samaritan laws – Governmental immunity – Statute of limitations – Contributory or comparative negligence Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (10 of 13) Ways to protect yourself against claims of negligence – Appropriate education, training, continuing education – Appropriate medical direction – Accurate, thorough documentation – Professional attitude and demeanor – Act in good faith – Use common sense – Covered by medical liability insurance Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (11 of 13) Special Liability Concerns – Medical Direction: ▪ May be liable to patient for negligent supervision of paramedic – Borrowed Servant Doctrine: ▪ If supervising other emergency care providers, you may be liable for any negligent act they commit Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (12 of 13) Special Liability Concerns (cont ) inued – Civil Rights: ▪ Patient may sue for violating their civil rights if you fail to render care for discriminatory reason – Off-Duty paramedic: ▪ Liability may arise in situation in which off-duty paramedic renders assistance at scene Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Legal Accountability of the Paramedic (13 of 13) Special Liability Concerns (cont ) inued – Airway Issues: ▪ Failure to secure airway or failure to recognize airway improperly placed can result in devastating or fatal injuries for patient – Placing an ET tube in the esophagus is not malpractice, but Not Recognizing that it is in the esophagus is Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (1 of 22) Special Liability Concerns (cont ) inued – Restraint Issues: ▪ Patient who must be physically or chemically restrained due to patient's behavior – Special Restraint Concerns: ▪ Excited delirium syndrome (ExDS) ▪ Restraint or positional asphyxia – Understand and practice safe restraint techniques ▪ Medical restraint is high-risk issue Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (2 of 22) Confidentiality – Medical or personal information will not be released to without express permission of patient/legal guardian – Specific circumstances for release ▪ Patient consents to release of their records ▪ Other medical care providers have need to know ▪ EMS is required by law to release a patient's medical records ▪ Third-party billing requirements Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (3 of 22) Confidentiality (cont ) inued – Health Insurance Portability and Accountability Act ▪ Changed methods EMS providers use to file for insurance and Medicare payments ▪ Added layers of privacy protection for patients ▪ All EMS employees trained in Health Insurance Portability and Accountability Act (HIPAA) compliance ▪ Patient’s rights regarding health records Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (4 of 22) Confidentiality (cont ) inued – Defamation ▪ Person makes intentional false communication that injures another person's reputation or good name – Libel False statements in writing – Slander Spoken false or malicious statements Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (5 of 22) Confidentiality (cont ) inued – Invasion of Privacy ▪ Release of confidential information, without legal justification, regarding patient's private life; exposes patient to ridicule, notoriety, embarrassment Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 7-2 The use of social media can pose risks if protected patient information or employment information is distributed. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (6 of 22) Consent – Consent is the granting of permission to treat ▪ By law, you must get patient's consent before you can provide medical care or transport ▪ Patient must be competent to give or withhold consent – “Competent” is one who is lucid and able to make an informed decision Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (7 of 22) Consent (cont )inued – Informed consent: based on full disclosure of information ▪ Nature of illness or injury; recommended treatments ▪ Risks, dangers, benefits of treatments ▪ Alternative treatment possibilities; risks, dangers, benefits of accepting each one ▪ Dangers of refusing treatment and/or transport Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (8 of 22) Consent (cont ) inued – Expressed consent: ▪ Most common; person directly grants permission to treat—verbally, nonverbally, in writing – Implied consent: ▪ Patient requires emergency intervention but is mentally, physically, or emotionally unable to grant consent Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (9 of 22) Consent (cont ) inued – Involuntary consent: ▪ Court orders patients to undergo treatment, even though they may not want it – Competent adult in police custody does not lose the right to make medical decisions for themselves. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved EMS Practitioner–Patient Relationship (10 of 22) Consent (cont ) inued – Special Consent Situations ▪ Minor (