Lecture 2: How Law Affects Paramedics & PHIPA PDF

🚑 Lecture 2: How Law affect paramedics & PHIPA How Laws Affect Paramedic Practice Ethics: considers a ‘moral code’. Can be subjective; there are things that go against our moral code but we still have to do it and not include our opinion…...

🚑 Lecture 2: How Law affect paramedics & PHIPA How Laws Affect Paramedic Practice Ethics: considers a ‘moral code’. Can be subjective; there are things that go against our moral code but we still have to do it and not include our opinion… for instance. Should paramedics participate in MAID ( Medically Assisted In Dying). Paramedics & abortion. paramedics transporting pt from organ harvesting. Ethical consideration vs. Clinical Decisions Ethical Responsibilities: principles that identify conduct deemed morally desirable. Failing to perform the job appropriately can result in civil or criminal liability. protect yourself from anything by knowing the laws. Health care has conducts that are deemed morally ethical 4 principles of Ethics 1. Respect patient autonomy; respect the freedom of pt 2. Do no Harm; don’t do worse then whats already there 3. Do-good minimize harm; prevent further harm 4. Justice -do whats right or fair The legal System; each law arises from a different branch of government. Lecture 2: How Law affect paramedics & PHIPA 1. Legislative Law; laws that determine what is right and wrong. Administrative Law (The Acts); these are the acts like Paramedic acts, construction act, occupation health and safety etc. Common Law & Civil Law; common law is set to regard how people get along. Includes; English Common law, French cicl law - based on Roman civil law system. Common law is known as Civil Code.. Criminal Law; this is when the government, police come after you. Criminal law is to protect society by maintaining law and order, to be found guilty you have to be shown beyond reasonable doubt that the defendant committed the alleged crime and be punishment according to their crime.. Civil Law; to uphold rights of individual and to settle agreement. This is area of law dealing with private complaints. Enforced by bringing a civil lawsuit in which the plaintiff requests the court to award damages. Torts: The filing of a civil suits as a results of damages from wrongful acts is a Tort. A tort is a civil wrong committed by one person against another such as to cause that other some injury or damage, either to person or property. How laws affect the paramedics you are measured using the following. Scope of practice; defines what you as a paramedic can do. In the AMP (ambulance) Act it layers your practice, like ACP, PCP.. Medical Direction; delegating Physician, e.g. doctor of your hospital. ALS/BLS Standards of Care - MOH; What you do as a paramedic (done right) with the direction of delegated doctor your actions are covered by ALS. Licensure Vs Certification. Certification - grants recognition to an individual who has met predetermined qualifications Lecture 2: How Law affect paramedics & PHIPA 2. Licensure - a process of occupational regulation governmental agency granted Motor Vehicle Laws. Highway Traffic Act Mandatory Reporting requirements: things as a paramedic you should report. Child Abuse & Neglect: Important. Elder abuse, spousal abuse. sexual assault. Gunshot and stab wounds. Animal bites. Communicable Diseases. Traffic accidents causing death Protection for the paramedics. Infectious disease exposure notification. Immunity statutes like, Good Samaritan Laws - protect those trying to do the right thing on certain scope.. Base Hospital Physician, Medical malpractice insurance - Falls into the ALS. Service SOPs. Regulated Health Professions Act Immunity; in the ALS - 38. no actions or other proceeding for damages shall be instituted against… a member, employee, for an act done in good faith in the performance or intended performance of a duty or in the exercise or the intended exercise of a power under this Act, a health profession Act,… a regulation or a by-law under those Acts or for any neglect or default in the performance or exercise in good faith of the duty or power. legal Accountability of the Paramedic Lecture 2: How Law affect paramedics & PHIPA 3  The law will ask was the action…. Responsible to act in a reasonable and prudent manner. Responsible to provide a level of care and transportation consistent with education/training. Negligence could result in legal accountability and liability. Standards are considered Components of Negligence 1. Duty to act 2. Breach of Duty 3. Damage to patient 4. Proximate Cause 1. Duty to Act. Respond and render care. Obey laws and regulations. Operate emergency vehicle reasonably and prudently. Provide care and transportation to the expected standard. Provide care and transportation consistent with the scope of practice/ protocols. Continue care and transportation through to its appropriate conclusion 2. Breach of Duty. Standard of care; Established by court testimony, reference to published codes, standards, criteria and guidelines Breach of Duty occurs by. Malfeasance - wrongful or unlawful act; what you did resulted in something bad ( you did something that wasn’t authorized for you to do) Lecture 2: How Law affect paramedics & PHIPA 4. Misfeasance - legal act which is harmful or injurious ( you did something you were authorized but did it wrong). Nonfeasance - failure to perform required act or duty ( you didn’t do your duty) 3. Damage to the Patient. Did the pt suffer compensable physical or psychological damages? Damages like _ Medical expenses; their damages resulted in paying medical bills _ Lost earnings _ Conscious pain and suffering _ Wrongful death. Punitive damages could be awarded for gross negligence or willful misconduct 4. Proximate Cause ⦁ Was the action or inaction of the paramedic the cause of, or worsened the damage ⦁ The act or lack of must have been foreseeable by the paramedic ⦁ Usually established by expert testimony Legal Accountability of the Paramedic Defenses to Negligence ⦁ Good Samaritan Law ⦁ Governmental Immunity ⦁ Statue of limitation ⦁ Contributory Negligence Special Liability Concerns ⦁ Liability insurance - primary or umbrella policies Lecture 2: How Law affect paramedics & PHIPA 5  ⦁ Liability pf paramedic Medical Director ⦁ Liability for “borrowed servants” (students, volunteers, etc, EMT-B with paramedic) ⦁ Civil rights ⦁ Off-duty paramedic Protect Yourself ⦁ Appropriate education, training & continuing education ⦁ Appropriate medical direction ⦁ Accurate & thorough documentation ( if it’s not written its not done) ⦁ Professional attitude & demeanors Paramedic - Patient Relationships Confidentiality: ⦁ Confidentiality information (PHIPA) keep info secret; Release of information - release only to certain people Consent ⦁ Expressed (”I need help”) ⦁ Informed ( you tell them information & they say yes) ⦁ Implied ( you have to do it, knowing they would want you to) ⦁ Involuntary (involves police, use of restriction) Special Consent Issues Legal age = 16 Unless Emancipated (Free from legal) ⦁ Minors who are married, parents, in armed service ⦁ Independent living & self- supporting ⦁ Un-emancipated minors are not able to give or withhold consent Lecture 2: How Law affect paramedics & PHIPA 6  ⦁ Emergency doctrine applies to minors when parents or guardian is not present ⦁ Mentally incompetent adults ( if there is a guardian consent may be given or withheld; Emergency doctrine applies if no one available) ⦁ Prisoners or Arrestees (court or police may be authorized emergency treatment) (usually limited to care needed to save life or limb) Refusal of care or Transport ⦁ pt must be conscious & able to make reasonable decisions ⦁ Make multiple attempts to convince pt to accept care ⦁ Enlist the help of others ⦁ Ensure the pt is informed ⦁ Consult medical direction ⦁ Have pt sign & disinterested party witness & sign ACR (Ambulance Caller Report) ⦁ Advise pt that he/she may call back ⦁ Get family or friends to stay with pt ⦁ DOCUMENT EVERYTHING!!!!!! VIRCA ⦁ V = Valued - refusal of care must be valued ⦁ I = Informed - provide consul to pt on why pt should go to the hospital; informed them of risk ⦁ R = Relevant - Refusal has to be relevant to the care being given ⦁ C = Capacity - pt has to be in full & conscious capacity to refuse ⦁ A = advice - tell them how to monitor themselves & tell them to call back Legal Complications Related to consent Abandonment Lecture 2: How Law affect paramedics & PHIPA 7  ⦁ Terminating care when it is needed & desired by pt, & without assuring that appropriate care continues to be provided by another qualified provider False Imprisonment ⦁ Transported without consent or who is restrained without proper cause or authority Assault ⦁ Threatening, attempting or causing fear of offensive physical Battery ⦁ Unlawful touching without consent Personal Health Information Protection Act; 2004: An overview Underlying Principles ⦁ PHIPA is informed by the 10 principles set out in the Canadian Standards Association Model Code for the Protection of Personal Information 1. Accountability 2. Identifying Purposes 3. Consent 4. Limiting Collection 5. Limiting Use, Disclosure & Retention 6. Accuracy 7. Safeguards 8. Openness 9. Access Lecture 2: How Law affect paramedics & PHIPA 8  10. Challenging Compliance Organization of PHIPA Part l = Interpretation & Application Part ll = Practice to Protect Personal Health Information Part lll = Consent, Capacity & Substitute Decision making Part lV = Collection, Use & Disclosure Part V = Access & Correction Part Vl = Administration & Enforcement Part Vll = General (Immunity, Offences, Regulations) Part Vlll = Complementary Amendments Part lX = Commencement & Short Title PHIPA Terms ⦁ Health information Custodian(HIC): ⦁ A person who operates a: → hospital or independent health facility → approved charitable home for the aged, home for the aged, nursing home → Pharmacy → Laboratory → Ambulance Service: (ie chief of the deportment) → home for special care → a centre, program or service for community health or mental health whose primary purpose is the provision of health care → Community care access centre → Any other prescribed person or class pf persons Lecture 2: How Law affect paramedics & PHIPA 9  Health Care practitioners Include: → a member defined under Regulated health Profession Act → a drugless practitioners under Drugless Practitioners Act → a member of Ontario College of Social Workers & Social Service workers who provides health care → a person whose primary function is to provide health care for payment ⦁ a service provider within the meaning of the Long-Term Care act ⦁ Minister (together with ministry) of Health and Long-Term Care ⦁ Medical officers of health or boards of health ⦁ Agent: (ie, Paramedic), in relation to HIC, means a person that, with the authorization of the HIC, acts for or on behalf of the HIC, & not the agent’s own purpose, whether or not the agent has authority to bind the HIC, whether or not the agent is being remunerated. ▷ The Act also applies to the use & disclosure of personal health information by those persons who receive personal health information from health information custodians ▷ e.g. recipients may include insurance companies, employers, researchers, etc; those who perform services on behalf of a health information custodian are defines as agents. ⦁ Healthcare: means any observation, examination, assessment, care, service or procedure that is done for a health-related purpose that is done to provide ▷ treatment or maintain an individual’s physical or mental condition ▷ prevent diseases or injury or to promote health as part of palliative care & includes ▷ the compounding, dispensing or selling of a drug, a device or equipment ▷ a community service that is described in the Long-term Care Act Lecture 2: How Law affect paramedics & PHIPA 10  ▷ everything that happens throughout the performance of ‘health care’ must stay confidential ⦁ Consent ⦁ Capacity ⦁ SDM What is Personal Health Information (PHI) PHI is identifying information about individual in oral or recorded form that: ▷ relates to his/ her personal or mental health ▷ relates to providing health care or identifying health care provider ▷ plan of service within the meaning of the Long-term Care Act ▷ relates to the donation of body part or bodily substance ▷ payments or eligibility for health care in respect of the individual ▷ is a health number ▷ identifies a substitute decision-maker (SDM) of that individual ▷ is in a record held by HIC where the record contains any of the above information PHI doesn’t include a record of information about employee/ agent of HIC Interplay Between PHIPA and FIPPA/ MFIPPA HICs covered under PHIPA include some FIPPA/ MFIPPA instituations, such as ▷ MOHLTC (under FIPPA) ▷ Boards of health (under MFIPPA) ▷ Municipal Homes for the aged (under MIFPPA) ▷ Municipal ambulance services (under MIFPPA) These institutions are subject to Lecture 2: How Law affect paramedics & PHIPA 11  ▷ PHIPA with respect to PHI ▷ FIPPA/ MIFPPA w/ respect to Personal Information(PI) that is not PHI ▷ Selected provisions of FIPPA/ MFIPPA with respect to all PI Practices To Protect Information Accountability & Openness ▷ Must have a contact person to ensure compliance with Act, respond to access request, inquires & complaints from public ▷ Must make available to the public a written statement describing the HIC’s information practices, how to make a complaint ▷ Must be responsible for its PHI & for actions of agents Definitions - Collect, Use, & Disclose ▷ Collect: means to gather, acquire, receive or obtain PHI by any means any source ▷ Use: related to PHI, in custody or under the control of HIC or person. Use means to handle or deal with the information, but doesn’t include disclosing the information. Transferring PHI between an agent of the HIC & the HIC is USE not DISCLOSURE. ▷ Disclose: Related to PHI in the custody or under the control of a HIC or a person; it means to make the information available or to release it to another HIC or to another person, but doesn’t include to use the information. Consent ▷ Consent is required for the collections, use, & disclosure pf PHI subject to specific exceptions. * Consent must ▷ Be a consent of the individual ▷ be knowledgeable Lecture 2: How Law affect paramedics & PHIPA 12  ▷ relate to the information ▷ not be obtained through deception or coercion ▷ Consent may be express or implied except where it must be express ▷ Consent is knowledgeable if its reasonable in the circumstances to believe that the individual knows the purposes of the collection, use or disclosure & that the individual may give or withhold consent. Collection By EMS ▷ Name, Address, & date of birth ▷ Health card number ▷ Facts about the situation being attended to, including health history & the type of health care provided ▷ Use of information by EMS Disclosure Consent is required for disclosure of PHI subject to specific exceptions such as where the disclosure is ▷ reasonably necessary for the provision of health care to the individual & it is not possible to get consent in a timely manner, unless the individual has expressly instructed otherwise. ▷ in order for the Minister or another HIC to determine or provide funding or payment to the HIC for the provision of health care. ▷ determining or verifying statutory eligibility for health care or related benefits or services ▷ upon the request of the minister, a disclosure to the minster for the purpose of monitoring or verifying claims for payments for health care funded by the ministry (direct disclosure) ▷ to a person carrying out an inspection, investigation or smiliar procedure that is authorized by a warrant or under an act Lecture 2: How Law affect paramedics & PHIPA 13  Exceptions to consent for disclosure continued : ▷ A HIC may disclose PHI about an individual, a. to the chief medical officer of health or a medical officer of health within the meaning of the Health protection & Promotion Act if the disclosure is made for a purpose of that Act b. to a public health authority that is similar to the persons described in clause (a) & that is established under the laws of Canada, another province or territory of Canada or other jurisdiction, if the disclosure is made for a purpose that is substantially similar to a purpose of the Health Protection & Promotion Act c. for contacting a relative, friend or substitute decision of an individual who is incapacitated, injured, or ill & unable to consent d. to a prescribed person who complies & maintains a PHI registry e. necessary to eliminate or reduce a significant risk of serious bodily harm to a person or group f. permitted or required by law, subject to prescribed requirements & restrictions ▷ Disclosure of PHI for research requires approval of researcher’s research plan by a research ethics board (REB) Disclosure For Planning & Management Of Health System ▷ HIC may disclose to a prescribed entity PHI for the purpose of analysis or compiling statistical information with respect to the management of, evaluation or monitoring of, the allocation of resources to or planning for all or part of the health system, including the delivery of services ▷ The prescribed entity must have in place practice & procedures to protect the privacy of individuals whose PHI it receives & maintain the confidentiality of the information Lecture 2: How Law affect paramedics & PHIPA 14  ▷ The information & privacy Commissioner must approve those practices & procedures ▷ Where a HIC may disclose PHI to a prescribed entity, that entity is authorized to collect it. A Person Who May Consent A Capable individual, regardless of age, can consent to collection, use or disclosure of own PHI. Capacity is presumed ▷ The following may consent on that individual’s behalf (”substitue decision makers”) → if the individual is capable & 16 or over, anyone who is 16 or over who the individual has authorized to act on his/ her behalf → if the individual is less than 16, a parent of the child, with some exceptions → if the individual is incapable of consenting, a person authorized to consent on behalf of the individual under this Act → if the individual is deceased, the deceased’s estates trustee or person who has assumed responsibility for the administration of the estate → a person whom an Act of Ontario or Canada authorizes or requires to act on behalf of the individual ▷ Where this act permits or requires an individual to make a request, express an instruction or take a step, a SDM may make the request, express an instruction or take the step Implied Consent ▷ Consent that is not expressed by an individual, but can be inferred from the surrounding circumstances ▷ HIC’s often rely on implied consent for the collection, use or disclosure of PHI, although only certain HIC’s may assume implied consent ▷ HIC’s cannot rely on implied consent when disclosing PHI to someone that is not a HIC or when disclosure is to another HIC but for a purpose not related to Lecture 2: How Law affect paramedics & PHIPA 15  health care Capacity ▷ Capacity is the ability to understand the information that is relevant to deciding whether to consent to the collection, use, or disclosure & ability to appreciate the reasonably foreseeable consequences of giving, not giving, or withhold or withdrawing consent. Capacity & the SDM ▷ Substitute decision maker authorized to consent on behalf of an incapable individual in PHIPA, in order of priority → Guardian of the person or guardian of the property (with authority) → attorney for personal care or attorney for property (w/ authority) → the representative appointed by the Consent & Capacity Board → the spouse or partner → a child’s parent → a parent w/ only a right of access → a brother or sister → any other relative → Public Guardian & Trustee (as last resort) ▷ A SDM who makes decisions for an incapable person under the Health Care Consent Act has priority over the persons in the list above, with respect to information decisions necessary for, or ancillary to, a decision about treatment, a ling term care admission or a personal assistance service in a LTC facility, as the case may be Offences & Penalties ▷ Creates offences for conversations of the legislation, including: → wilfully collecting, using, or disclosing PHI in contravention of the Act Lecture 2: How Law affect paramedics & PHIPA 16  → Once access request made, disposing of a record of personal information in an attempt to evade the request → wilfully failing to comply with an order made by the IPC ▷ Maximum penalty of $50,000 for an individual & $25,000 for a corporation ▷ A person who complains to the IPC about a contravention of the Act is protected from retaliation Complementary Amendments ▷ PHIPA makes complementary amendments to other Acts, including: → Mental Health Act → Public Hospitals → Health Protection & Promotion Act → Long-Term Care Act → Occupational Health & Safety Act → Child & Family Services Act ▷ The Health Cards & Number Control Act, 1991 is repealed Policies & Practices Acts → Ambulance Act → Criminal Code of Canada → Victim’s Bill of Rights → Controlled Drugs & Substances Act → Regulated Health Professions Act → Child & Youth Family Services Act → Coroners Act → Good Samaritan Act → Powers of Attorney Act Lecture 2: How Law affect paramedics & PHIPA 17  → Long-Term Care Act → Healthcare Consent Act → HTA → MHA → OHSA → Human Rights Code → Accessibility for Ontarians with Disabilities Act → PHIPPA → MFIPPA PHIPA: Professional & Legal Issues What types of Health Care providers are required to comply PHIPA? ▷ Organizations & persons that are required to comply with PHIPA are referred to as Health Information Custodians (HICs) & are specifically listed in the legislation ▷ Examples of HICs Include → a Medical officer of Health within the meaning of the Health Protection & Promotion Act → an ambulance service → Hospitals → regulated health care practitioners such as physicians, nurses, dentists, chiropractor, etc What types of information does PHIPA apply to? ▷ Personally identifiable information about the health or health care of an individual ▷ Examples Include: Lecture 2: How Law affect paramedics & PHIPA 18  → Information about one’s physical or mental health, including family health history → Payment made for health care or eligibility for health care → An individual’s health card number → The identity of an individual’s health care provider, SDM → The donation of body parts or bodily substances or is derived from the testing or examination of such parts or substances Who is entitled to act on another person’s behalf for the collection, use & disclosure of personal health information? ▷ SDM, such as: → A parent/ legal guardian of a child under 16 years of age , with some exceptions → Any person given written authorization by individual that is least 16 years or the individual’s SDM to consent → An estate trustee or person who has assumed responsibility for administration of a deceased’s estate → A person that has legal authority under PHIPA to consent for an incapable individual → A person that is entitled or required to act as a substitute decisions-maker under legislation Use of Info ▷ to provide treatment, assessment & intervention ▷ to provide consumer health information & advice ▷ to plan & deliver appropriate services ▷ to maintain a record of treatment, & to mange & administer cases ▷ to investigate & mange incidents ▷ to aid in research & statistical programs Lecture 2: How Law affect paramedics & PHIPA 19  Does the Act apply to you? ▷ The Act applies to the use & disclosure of PHI by those who receive PHI from HIC ▷ Are you a custodian? A custodian as defined in the act, includes the ‘ambulance service’ as it set out in the ambulance Act ▷ Paramedic are agents - you perform activities for the purpose of a custodian rather than your own purpose Lecture 2: How Law affect paramedics & PHIPA 20