CLO3 Questions PDF

Sub-Outcome 01: Describe each of the following relationships: physician-patient, hospital-patient, hospital-physician 1.Physician- Patient Relationship: This relationship serves as the cornerstone of healthcare. It starts when the patient requests treatment and the physician agrees to provide...

Sub-Outcome 01: Describe each of the following relationships: physician-patient, hospital-patient, hospital-physician 1.Physician- Patient Relationship: This relationship serves as the cornerstone of healthcare. It starts when the patient requests treatment and the physician agrees to provide that treatment. This is a contractual relationship that involves an offer and an acceptance. It can either exist as an express contract or an implied contract. Once this relationship is established, it continues until its properly terminated or when the patient no longer needs treatment. Terminating the relationship can be accomplished through: the physician withdraws from the contract, the patient may dismiss the physician, or the physician and the patient may mutually agree to end the contract. 1 Sub-Outcome 01: Describe each of the following relationships: physician-patient, hospital-patient, hospital-physician 2. Hospital- patient relationship: The relationship begins when the patient in voluntarily admitted to the hospital. At the time of admission the patient sign certain forms agreeing to pay for the treatment. This act establishes an express contract to receive health care. This relationship ends when the patient is discharged or leaves the hospital against medical advice. 2 Sub-Outcome 01: Describe each of the following relationships: physician-patient, hospital-patient, hospital-physician 3.Hospital-Physician Relationship: This relationship is not based on direct health care. It is based on the contract between hospital and physician that allows the physician to bring his patients to the hospital to receive healthcare. In this relationship the hospital provides and coordinates patient care along with the physician. It begins with credentialing process. Being a licensed physician is not enough to become a member of the hospital medical staff. The credentialing process involves the examination by the hospital 's governing board of the physician 's background, experience and licensure against established criteria. Once admitted to the medical staff, the governing board determines the scope and limit- that is, medical staff privileges- of the physician 's practice in the hospital. Hospitals have a duty to assure that their medical staffs are competent. 3 Sub-Outcome 02: Define negligence, medical malpractice Medical Malpractice Professional medical "negligence or misconduct, such as failure to meet the prevailing standard of care for the profession that results in harm to another. Duty Breach Conduct has failed to conform to standard of care Must have some duty, e.g. physician to patient Malpractice (Health Information: Cause Harm Management of a Breach must be the "proximate Physical pain, suffering, emotional Strategic Resource, cause" of the harm distress, monetary loss page 793) 4 Sub-Outcome 02: Define negligence, medical malpractice Duty of Care A health professional who undertakes to care for a patient has a duty to exercise reasonable care and skill to avoid injuring the patient. It is an obligation, recognized by law, to avoid conduct which would pose unreasonable risk to others. 5 Sub-Outcome 02: Define negligence, medical malpractice Negligence "Once a health professional (Doctor, Nurse...etc) has responsibility for a patient a legal relationship comes into existence which obliges the health professional to exercise such a degree of skill and care leaves a health professional open to an action in negligence by an aggrieved patient. This is a civil action in which the aggrieved patient sues the health professional (Doctor, nurse...) for damages, for an alleged injury resulting from the treatment given or from an omission of treatment or advice." 6 Sub-Outcome 02: Define negligence, medical malpractice For an action in negligence to succeed the patient must establish his/her case on the following: 1. A duty of care was owed by the health professional (defendant) 2. The defendant's conduct fell below the required standard of care 3. The breach of the duty of care caused, or materially contributed to, the damage suffered can either be physical or mental. 4. The loss or damage suffered was reasonably foreseeable 5. The loss or damage is assessable monetarily 7 Sub-Outcome 02: Define negligence, medical malpractice Examples of Negligence: Failure to disclose risks (Patient Autonomy). Failure to diagnose. Many actions of negligence are commenced under this category and frequently related to allegations of delayed diagnosis of cancer. Failure to provide sufficient advice 8 Sub-Outcome 02: Define negligence, medical malpractice Assessment of Damages: Damages are assessed and awarded in regard to: General damages for pain, suffering and loss of amenity Specific damages for actual financial losses and expenses (loss of income, medical and hospital expenses). Future losses and expenses arising from the negligence 9 Sub-Outcome 02: Define negligence, medical malpractice Five Errors can be made with respect to the compilation and utilization of the patient record: 1. information which is required for the care and treatment of the patient is omitted. 2. incorrect information is placed in the record. 3. information which is required by a particular staff member or service for the patient's care or treatment is not transferred to them. 4. personnel fail to read recorded information. 5. personnel read the record incorrectly either through carelessness on the part of the reader or illegibility on the part of the recorder. 10 Sub-Outcome 02: Define negligence, medical malpractice An example of negligence in record keeping resulting in liability is seen in the British Columbia case of Wipfli v. Britten, where the doctor's record keeping was criticized: "...his failure to record the fundal height and other usual obstetric information on the running chart for the November 7 visit..., all contributed in some degree to Dr. Britten's failing to diagnose that Mrs. Wipfli was carrying twins. Under the circumstances of this case I am satisfied that his failure to diagnose twins was not in accord with the reasonable standard of care of a family physician practicing in Vancouver in 1975-76. I conclude that he was negligent". It must therefore be concluded that in any preventive liability, liability risk management or quality assurance program, special attention must be paid to the quality of record keeping. This applies not only to records maintained in a health institution but equally to those records maintained in private. Ro:covsky, L.E. &c Rozovsky, F.A. The Canadian Law of Patient Records. Toronto, Butterworths, 1984, p. 31. 11 Sub-Outcome 02: Define negligence, medical malpractice What Is Negligence? A Medical Practitioner may be liable for negligence if they have failed to exercise reasonable skill and care in any one or more of the following areas: 1. Treatment 2. Diagnosis 3. Provision of Information 4. Provision of Advice Negligence Is the omission to do something which a reasonable man, guided upon those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do - definition by Alderson B (1856) 12 Tort Law in the UAE What is the meaning of 'Tort' under the U.A.E. Law? A Tort is: a civil wrong resulting from an act or omission which has caused damage to other persons or property, regardless of whether or not the act or omission constitutes a crime or is precipitated by a contractual breach. Tort is recognized in U.A.E. law under Articles 124 and Articles 282 of the U.A.E. Civil Code which read as follows: Article 124 Article 282 " Personal obligations or rights shall arise out of dispositions, legal events and the law, and the sources of obligation shall be as follows; " Any harm done to another shall render the actor, 1. Contracts even though not a person of discretion, liable to 2. Unilateral acts make good the harm.“ 3. Acts causing harm (torts) 4. Acts conferring a benefit; and 5. The law " These articles are founded upon original Islamic Sharia principles, which hold that it is not acceptable for any person to cause damage to another persons physical or material well being. 14 14  Liability All competent adults are liable, or legally responsible, for their own acts both in their jobs and in their private lives. In the work place, employers carry liability insurance to cover situations in which employees or anyone else on the premises, maybe injured or harmed. As employers, physicians have general liability for: The practice s building and grounds. Automobiles. Employee safety. In addition to general liability, physicians and other health care providers have certain professional liability. Court case: A patient stepped on something protruding in a hospital parking lot. She fell, breaking her foot. She subsequently sued the hospital. A jury ordered the hospital to pay her $ 70,000, and the supreme court affirmed. 15 15  Hospital Liability: The hospital operates through a governing board in which its authority is invested. The existence of this authority creates certain duties and liabilities for governing boards and their individual members. Major responsibilities and legal risk: The hospital is responsible for failing to meet the standards of care required within the hospital. 16 16  Some of the duties of the hospital board are: 1. Maintain professional standards. 2. Provide adequate and competent medical staff. 3. Provide adequate facilities and equipment. 4. Grant medical staff privileges in the hospital, 1. by determining the scope and limit of the physician 's practice in the hospital. 5. Supervision of staff and management of hospital. 6. Disciplining procedures of health care professional. 47  Physician Liability: The wide range of authority in treating patients has brought with it a broad range of law suits. 18 Examples of situations where physicians tend to be most vulnerable to lawsuits are: 1. Abandonment. 2. Patient falls. 3. Wrongful death. 4. Delay in treatment. 5. Failure to follow- up. 6. Failure to disclose/ informed consent. 7. Failure to order diagnostic tests. 8. Failure to seek consultation or to refer to a medical specialist. 9. Infections. 10. Lack of documentation. 11. Misdiagnosis. 49 sub-Outcome 03: Define the meaning of standard of care and explain its role in medical malpractice cases It is the level and quality of care that a reasonably prudent professional would have rendered in the same or similar circumstances. A reasonably prudent professional is someone with average intelligence and comparable training and experience. Standard of care for the different health care professions are well established and can be obtained from: 1.State laws and regulations governing the pertinent profession. 2.professional associations and accrediting organizations. 3.Internal policies and procedures of the health care facilities. 4.Expert testimony. Procedures & Policy related to authorized & unauthorized practice. 20 20  Profession A profession is a particular area of employment that people enter following a program of study and the achievement of a formal qualification. The area of training is normally specialized and it is expected that no other person could perform that job, without having completed the study program. A profession must be legally approved. 21 21  The work & behavior of professionals is normally controlled by a professional association. A profession needs to be accepted as such, by the society. Once the professional association has been granted legal approval, its members have an exclusive right to work in this field. Believing that people outside of the profession are not well qualified to judge its members competence, the professional association sets standards of service, recruitment, education and training, and member discipline; it decides on an appropriate code of ethics and further regulates the member's behavior with a code of conduct. This contrasts with non-professions, where Ministries set work standards and define community interests. 53  There are a number of C H A R A C T E R I S T I C S of a profession. 1. Community benefit 2. The work undertaken by a professional is normally directed towards a general community benefit, rather than to individual self interest. 3. i Professional responsibility 4. There is recognition of responsibility towards clients, employers, and public. 5. Worker autonomy 6. There is an expectation of worker autonomy. This means that, given the training undertaken, you are capable of using your own judgment & you have freedom to control your work. 7. Controlled by a professional association 52  Competence: When we talk of working in a 'professional manner', we really mean that we are competent at what we do. This means that the worker uses their knowledge & is able to complete the required task(s) effectively & efficiently, as per their association's required method of work practice. It is expected that professionals undertake ongoing educational activities to maintain their knowledge & skills. The ability to do what is needed 24 24 Professional competence means working to the standards set by your governing association. Your work must be conducted at a level to which you are trained, be recorded accurately & be open to evaluation. In other words, you are accountable for the work you do. 55  Accountable To be responsible for your work & be able to demonstrate how the quality of your work was monitored & evaluated. Professional accountability means working to practice guidelines & requires that you apply methods of quality control to all your work activities. The quality of your work must be demonstrable to your clients (the public), the organization you work for and your professional association. 56  Code of practice A collection of laws &/or rules that guide professional work behavior. A code of practice can include guidelines &/or required standards for the following: 1.standards of behavior, 2.specific activities & work practices, 3.maintenance of records, 4.d scope (extent & limits) of responsibilities, 5.ethical code of practice, 6.governing laws & rules outlined in other codes to which the professional is also accountable, such as reasons for disciplinary action. 7.requirements for ongoing education. 27 27