Duty of Care PDF

Duty of care - The defendant is not guilty of negligence if they acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in a particular art - The law imposes a duty of care but the standard of care is a matter of medical ju...

Duty of care - The defendant is not guilty of negligence if they acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in a particular art - The law imposes a duty of care but the standard of care is a matter of medical judgement Standard of care owed - Once a duty has been established it needs to be determined if someone was in breach of that duty - If a professional acts in a way widely accepted by peers then they have not breached that duty - The civil liability act states that there is differing peer professional opinions widely accepted by a significant number of practitioners does not prevent any one or more of opinions being relied upon - It does not need to be universally accepted by peers - Paramedics obtain standards from places such as: o Statutory provisions o Professional codes of practice o Employer policies and procedural guidelines o Peer professional opinion - Claim of negligence could arise if reasonable action is not taken to: o Locate pt o Assess adequately o Treat patient o Transport patient o document Governance for good Samaritans in QLD and the civil liability act 2003 - Key principles for QLD in the civil liability act and the law reform act o Protection of persons performing duties to enhance public safety ▪ Civil liability does not attach to a person in relation to an act done or omitted in the course of rendering first aid or other aid to a person in distress if The first aid or other is given by the person while performing duties to enhance public safety The first aid or other is given in circumstances of emergency The act is done or omitted in good faith without reckless disregard for safety of the person o Liability at law shall not attach to a medical practitioner, nurse or other person prescribed under a regulation in respect of an act done or omitted in rendering medical care or aid ▪ At or near the scene of the incident ▪ While the injured person is being transported from the scene of incident to hospital ▪ If Act is done in good faith Services are performed without fee or reward Procedural law -> criminal law and civil law (names of parties etc.) - In procedural law, both civil law and criminal law apply to healthcare workers (HCWs), each with unique rules, standards of proof, and implications. Civil Law - Role of Healthcare Workers (HCWs): HCWs often encounter civil law, especially in tort law cases, which address claims of harm or injury. The most common area for HCWs in civil law is torts. - Tort Law: o Trespass to the Person: ▪ Battery: Unauthorized physical contact. ▪ Assault: Causing fear of imminent harm. ▪ False Imprisonment: Restricting a person's freedom without lawful authority. o Trespass to Land: Unlawful entry onto someone’s property. o Negligence: Failing to meet the standard of care, resulting in harm to a patient. - Standard of Proof: Civil cases are decided on the balance of probabilities (more likely than not), which is a lower standard than in criminal law. - Purpose: Civil law seeks to resolve disputes and often involves compensation rather than punishment. - Overlap with Criminal Law: Civil and criminal law are not mutually exclusive; actions by HCWs can have both civil and criminal implications. Criminal Law - Purpose: Criminal law involves laws of conduct set by society and is enforced by the state. Its aim is to maintain public order and deter wrongful conduct. - Role of HCWs: HCWs may face criminal liability if they violate laws during practice. However, they can sometimes claim lawful justification for actions that would otherwise be criminal if performed within the scope of their duties (e.g., using involuntary treatment under an Emergency Examination Authority (EEA), which may temporarily restrict a patient’s liberty). - Criminal Code: In Queensland, criminal offenses are defined under the Criminal Code Act 1899. - Burden of Proof: The prosecution must prove guilt beyond all reasonable doubt, a high standard aimed at protecting the accused’s rights. o The defense’s role is to show that the prosecution's case does not meet this standard. - Features of Criminal Law: o Parties: The case involves the state (prosecutor) against the accused (defendant). o Initiation: The state initiates the action. o Elements of a Crime: Each offense comprises specific elements (e.g., in theft—removing an object, belonging to another, with intent to permanently deprive the owner). o Presumption of Innocence: Every accused person is innocent until proven guilty. o Individual Liability: Responsibility for criminal acts cannot be transferred to another person. In both criminal and civil law contexts, HCWs must navigate legal standards carefully, as their actions can simultaneously raise civil liabilities and criminal questions. All components of what needs to be established to convict negligence Medical Negligence - Negligence is the act of causing harm to another because of a failure to exercise reasonable care - - The elements of negligence have been formed through common law - These principles are captured in all state and territories law - A HCP has a duty to exercise reasonable care and skill in the performance of their professional duties - Duty extends to responding to an incident, assessment and examination, interpretation of findings and diagnosis, rx of pt, extrication, transport, documentation and handover - A wrongful act or omission committed by a paramedic can lead to civil or criminal proceedings Elements of Negligence - Four elements required for negligence to be found o Existence of a duty of care o A breach of the standard of care o Damage suffered which was reasonably foreseeable and: o The breach caused or materially contributed to the damage - Ambulance services and health providers are treated differently to other emergency services o Kent v Griffith ▪ The ambulance service has a specific duty of care to respond to a particular emergency call Negligence may be found where an inadequate response makes the situation worse o Hill v chief ▪ Does not confer generally immunity upon the police A duty of care would not arise without special circumstances - If all four elements are not found then negligence won't be found - There must be legal duty of care in existence, there is no common law duty to rescue another unless a duty of care exists to compel a person to rescue another Available defences to allegations of negligence including contributory negligence 1. Contributory Negligence - This defense asserts that the plaintiff’s own actions contributed to their injury or loss. If the defendant can prove the plaintiff was partially responsible, their liability may be reduced. In jurisdictions with comparative negligence, damages are reduced in proportion to the plaintiff’s degree of fault. For instance, if the plaintiff is found 20% responsible, the defendant’s liability may be reduced by that amount. - In some systems that recognize pure contributory negligence, the plaintiff’s recovery could be entirely barred if they’re found to be even minimally responsible for their injury. 2. Voluntary Assumption of Risk (Volenti Non Fit Injuria) - This defense applies when the plaintiff knowingly and voluntarily accepts the risks associated with an activity. For example, a spectator injured by a stray ball at a sports event might be deemed to have accepted the inherent risks of attending such events. 3. Inevitable Accident - An inevitable accident defense is used when harm occurs due to an event that could not have been foreseen or avoided, even with reasonable care. This defense argues that the incident was unavoidable, and the defendant exercised appropriate caution. 4. Act of God (Force Majeure) - Defendants can use this defense when the injury or loss results from a natural event outside human control, such as floods, earthquakes, or severe storms. The argument here is that the event was so unusual and powerful that it was impossible to foresee or prevent it. 5. Statutory Authority - Some actions may be protected if they are carried out under statutory authority. For example, a government authority’s lawful conduct—such as construction in a designated area—might limit its liability if authorized by law. 6. Illegality (Ex Turpi Causa Non Oritur Actio) - This defense applies if the plaintiff was involved in illegal activity that directly contributed to their injury or loss. For example, a plaintiff injured while committing a crime may have limited recovery rights due to their unlawful conduct. Defence Butfort test -> arsenic tea case study Doctrine of necessity What justifies acts that might be negligent In tort law, defenses like the But-for test, the doctrine of necessity, and various justifications can play critical roles in determining liability in cases involving potentially negligent acts. 1. But-for Test The But-for test is a common causation test in negligence cases to assess whether the defendant's actions were a necessary condition for the harm that occurred. In other words, but for the defendant’s actions, the harm would not have happened. For example, in the arsenic tea case (Barnett v Chelsea & Kensington Hospital), where a man died after drinking arsenic-laced tea, the hospital's failure to treat the patient was examined under the But-for test. The court found that, even if the hospital had treated him, he would still have died from the poisoning, thereby breaking the chain of causation and ruling the hospital not liable. 2. Doctrine of Necessity The doctrine of necessity justifies actions that would otherwise be considered wrongful when those actions are necessary to prevent a greater harm. This doctrine can apply in cases where an act is performed to protect life, property, or prevent serious harm, even if the action might be otherwise unlawful. The necessity defense considers: - Whether there was an imminent threat of harm. - Whether the defendant’s actions were proportionate to the threat. - Whether the action taken was the only viable option. This doctrine may justify actions that might otherwise seem negligent if they were performed under pressing circumstances to prevent a worse outcome. 3. Justifications for Potentially Negligent Acts Acts that appear negligent may be justified if performed under certain conditions, such as: Reasonable precautions: If a defendant took reasonable precautions that align with industry standards or an accepted level of risk, their actions may not be seen as negligent. Standard of care: In negligence cases, the courts assess if the defendant met the appropriate standard of care for their profession or situation. Justifications are sometimes upheld if the defendant acted within this standard. Consent: In some cases, the victim’s consent can justify the defendant’s actions, particularly if the victim was informed of the risks. Together, these defenses, doctrines, and justifications address situations where the defendant’s actions may not be deemed negligent if they were conducted out of necessity, with reasonable care, or without actual causation of the harm. Employment and industrial law particularly liability In Australia, employment and industrial law liability is governed by federal and state legislation, primarily under the Fair Work Act 2009 (Cth), Work Health and Safety (WHS) laws, and anti-discrimination laws. Here’s how liability applies specifically in the Australian context: 1. Employer Liability Australian employers have legal obligations to provide a safe workplace, prevent discrimination and harassment, and ensure fair treatment. Key areas of liability include: Vicarious Liability: Employers can be held vicariously liable for wrongful acts or omissions of employees if those acts occur “in the course of employment.” This includes harassment, discrimination, and sometimes acts of negligence. For example, if an employee harasses another employee at a work event, the employer could be vicariously liable unless they can demonstrate they took all reasonable steps to prevent such conduct. Duty of Care and Negligence: Under Australian WHS laws, particularly the Work Health and Safety Act 2011 (Cth) (or similar state legislation), employers owe a duty of care to employees to eliminate or minimize risks as far as reasonably practicable. Employers must provide safe work systems, training, supervision, and ensure that equipment is safe. Failure to meet these standards can lead to negligence claims, and employers may be liable for workplace injuries or illnesses resulting from unsafe conditions. Discrimination and Harassment: Employers in Australia are liable under the Sex Discrimination Act 1984 (Cth), Racial Discrimination Act 1975 (Cth), Disability Discrimination Act 1992 (Cth), and Age Discrimination Act 2004 (Cth), which prohibit discrimination and harassment based on protected characteristics. Employers are expected to take reasonable measures to prevent discrimination and harassment and can face liability for failing to do so. 2. Employee Liability While employer liability is primary, employees in Australia can be individually liable in cases of serious misconduct: Personal Misconduct: Employees may be liable for actions outside their professional duties or breaches of workplace policy, especially if their behavior harms others or the business. This can include cases of theft, fraud, or intentional harm toward other employees. WHS Compliance: Employees have a duty to take reasonable care for their own safety and that of others under WHS laws. If an employee’s actions breach WHS laws and create risk, they may be individually liable, facing disciplinary action or even prosecution for gross negligence. 3. Union and Industrial Action Liability Australia’s Fair Work Act 2009 (Cth) governs lawful industrial actions. However, unions and employees can face liability in cases of unlawful action: Union Liability: Unions may be liable if they encourage or organize unlawful industrial actions, such as strikes that violate enterprise agreements or fail to meet notice requirements. For instance, if a union advises workers to stop work without following proper procedures, they could be held liable for losses incurred by the employer or damages caused during the strike. Inducing Breach of Contract: Unions or third parties that incite employees to breach their employment contracts may be liable under the tort of inducing breach of contract. The Fair Work Commission (FWC) and courts can order penalties, injunctions, or damages in cases where this tort applies. 4. Statutory and Regulatory Compliance Australia enforces strict regulations to ensure workplace compliance, with potential liability for breaches including fines and other penalties: Work Health and Safety Penalties: WHS laws are enforceable at both federal and state levels. Regulators, such as Safe Work Australia, can issue fines, improvement notices, and even criminal charges for breaches that lead to workplace accidents or unsafe conditions. Unfair Dismissal and Adverse Action Claims: Under the Fair Work Act, employees can bring claims for unfair dismissal or adverse action if they feel they were dismissed or treated unfavorably for reasons prohibited by law (e.g., discrimination, union activity). Employers may face compensation or reinstatement orders and are often liable for any damages awarded. Anti-Discrimination Penalties: Liability under anti-discrimination laws includes orders for compensation, corrective actions, and potential fines, overseen by bodies like the Australian Human Rights Commission (AHRC) and state anti-discrimination commissions. In Australia, these liability principles ensure that employers, employees, and unions follow fair, safe, and lawful practices in the workplace. The Fair Work Commission, WHS regulators, and federal courts play crucial roles in enforcing these standards, ensuring accountability and protection for all workplace participants The coroner: Role as a witness and documentation, Subpoenas that may occur to paramedics In Australia, coroners play a critical role in investigating unexpected or unexplained deaths, deaths occurring in suspicious circumstances, or deaths that occur in custody or during certain medical procedures. The coroner's role includes determining the cause and circumstances of the death and, if necessary, making recommendations to prevent similar incidents in the future. Paramedics, as first responders, may have direct involvement in these cases, both in their roles as witnesses and in providing required documentation. 1. Role of Paramedics as Witnesses Paramedics may be called as witnesses in a coroner’s inquest to provide testimony on their observations, actions, and the condition of the deceased when they arrived at the scene. Paramedics' evidence is critical, as they often hold first-hand knowledge of the circumstances surrounding the person’s death. Their testimony can contribute to understanding: The initial condition and position of the body.  Medical interventions or procedures they performed. Observations about the scene that may be relevant to determining the cause or manner of death. As witnesses, paramedics are expected to present factual accounts without forming subjective opinions about causation or fault unless specifically asked, as their role is to provide objective information from their perspective as first responders. 2. Documentation for the Coroner Documentation by paramedics is essential in coroner’s cases. Paramedic records, including patient care reports (PCRs), scene notes, and any additional observations, are critical for accurately capturing the patient’s status, interventions performed, and overall scene conditions. Accurate and thorough documentation is crucial because: Evidence of Interventions: The report serves as evidence of what treatments or procedures were attempted, including CPR, defibrillation, medication administration, and airway management. Chronology of Events: Documentation often includes timestamps for each intervention, providing a detailed timeline of the paramedic’s actions and the patient’s responses. Observational Data: Notes on environmental factors (such as hazardous conditions or unusual substances) may assist in reconstructing the incident, as coroners use this information to identify potential causes or contributing factors in the death. Poor or incomplete documentation can hinder the coroner's investigation, making it difficult to determine the exact sequence of events or contributing factors. 3. Subpoenas and Paramedics In cases that proceed to an inquest, paramedics may receive subpoenas for their involvement in the case. A subpoena is a legal document that compels the recipient to provide evidence or documents or appear as a witness. For paramedics, subpoenas may require them to: Provide Testimony: Paramedics might be summoned to testify in person regarding their actions, observations, and treatment provided. Supply Documentation: They may also be required to submit all relevant records, such as patient care reports, incident notes, or other internal documentation related to the case. Provide Expert Insight: In some instances, particularly in complex cases, paramedics might be asked to explain specific medical interventions or provide insight into standard practices relevant to the death under investigation. Failure to comply with a subpoena can have legal consequences, including potential penalties. When preparing to respond to a subpoena, paramedics may work with their organization’s legal team or seek guidance from professional bodies to ensure their testimony is both accurate and legally compliant. Key Considerations for Paramedics in Coroner's Cases Paramedics involved in coroner’s investigations must approach their role with professionalism and accuracy, as their documentation and testimony can significantly impact the investigation. This includes ensuring that all reports are complete, accurate, and written objectively, as these documents may be reviewed in court and form a basis for the coroner’s findings and recommendations. Criminal law: Murder v manslaughter, Burden of proof In Australian criminal law, both murder and manslaughter are serious offenses involving the unlawful killing of another person. The main difference lies in the level of intent and circumstances surrounding the act. 1. Murder Murder is defined as the unlawful killing of another person with malice aforethought. In Australia, a person is guilty of murder if: Intent to Kill: The accused intended to kill the victim. Intent to Cause Serious Harm: The accused intended to cause serious harm that resulted in death. Reckless Indifference to Human Life: The accused acted with reckless disregard for the possibility of causing death. Felony Murder Doctrine: In some jurisdictions, if someone dies as a result of a dangerous or violent crime (e.g., armed robbery), the person committing the crime may be charged with murder, even if death wasn’t intended. In a murder case, intent (or “mens rea”) is the critical factor. The prosecution must establish beyond a reasonable doubt that the accused had the state of mind to either kill or cause serious harm or acted with reckless disregard for life. 2. Manslaughter Manslaughter is an unlawful killing that lacks the intent required for murder. It is often considered when the act causing death is either: Voluntary Manslaughter: The accused had an intention to harm or kill but acted in circumstances that partially excuse the killing, such as in cases of provocation or diminished responsibility. This could include situations where the accused acted in the "heat of passion." Involuntary Manslaughter: The killing was unintentional, but resulted from reckless or criminally negligentactions, such as gross negligence (e.g., failing to provide necessary medical care) or an unlawful act that led to death without intent to kill. For manslaughter, the prosecution must show that the act or omission of the accused was unlawful and resulted in death, but the level of intent or recklessness does not rise to the level required for murder. 3. Burden of Proof In criminal cases, the burden of proof lies with the prosecution. This means the prosecution must prove each element of the crime beyond a reasonable doubt. This standard is higher than in civil cases (where the standard is the "balance of probabilities") and is designed to ensure that only when the evidence is overwhelmingly convincing will someone be convicted of a serious crime. In murder and manslaughter cases, the prosecution must prove beyond a reasonable doubt that: The accused committed the unlawful act or omission. This act or omission caused the death of the victim. The accused had the requisite intent (for murder) or recklessness/negligence (for manslaughter). If the prosecution cannot meet this high standard, the accused will be acquitted. This principle reflects the presumption of innocence and the belief that it is better for a guilty person to go free than for an innocent person to be wrongfully convicted. Civil law: Burden of proof, Civil liability act In Australian civil law, the burden of proof and principles under the Civil Liability Act are key components in determining fault, responsibility, and compensation in non-criminal cases. These often involve disputes over negligence, personal injury, and other damages where a plaintiff seeks compensation from a defendant. 1. Burden of Proof in Civil Law In civil cases, the burden of proof lies with the plaintiff—the party bringing the claim. However, unlike in criminal law, the standard required is the balance of probabilities. This means the plaintiff must show that it is "more likely than not" that the defendant is liable for the harm or loss caused. Essentially, if the evidence tips even slightly in favor of the plaintiff, they meet this standard. This lower burden of proof compared to criminal law recognizes that civil cases typically involve disputes over private rights and compensation rather than penal consequences. 2. Civil Liability Act The Civil Liability Act (primarily the Civil Liability Act 2002 (NSW), with similar acts in other states and territories) governs civil claims for damages, particularly for personal injury and negligence. This legislation was introduced to limit certain types of claims and standardize liability across various situations. Key aspects include: Negligence and Duty of Care: The Act outlines the requirements for establishing negligence, emphasizing that a duty of care exists when it is "reasonably foreseeable" that one’s actions could harm another. To prove negligence, a plaintiff must demonstrate: 1. The existence of a duty of care. 2. Breach of that duty by the defendant. 3. Causation linking the breach to the harm. 4. That actual harm or loss resulted. Standard of Care: The Act defines a “reasonable person” standard, asking whether a reasonable person in the same situation would have acted differently to prevent harm. Causation and Scope of Liability: Causation requires showing that the breach of duty was a necessary condition of the harm, often applying the "but for" test (i.e., but for the defendant’s actions, the harm would not have occurred). Additionally, liability must fall within a reasonable scope—meaning it must not be too remote or unrelated to the breach of duty. Contributory Negligence: If the plaintiff contributed to their own harm, the Act allows courts to apportion liability between the plaintiff and defendant, potentially reducing the plaintiff’s compensation proportionally. Limits on Damages: The Civil Liability Act sets caps on certain damages, particularly for non-economic losses like pain and suffering, and restricts compensation for certain claims (e.g., purely psychological injury claims in some cases). Defenses to Liability: The Act outlines potential defenses, such as voluntary assumption of risk (where the plaintiff knowingly accepted a risk) and obvious risk (where the risk was clear to any reasonable person). The Civil Liability Act thus standardizes liability in civil claims, promoting fair compensation while limiting certain types of claims to avoid excessive litigation. This approach emphasizes responsible behavior, establishes clear guidelines for duty of care, and balances compensation with practical limitations. Confidentiality and the right to privacy Section 139 of the hospital and health boards act -> confidential information is information acquired by a person in the persons capacity as a designated person Section 25a human rights act says a person has a right to have their privacy, family, home or correspondence free from unlawful or arbitrary interference Confidential information is anything disclosed in the HCP-patient relationship Anything disclosed or observed in this setting is confidential Pts divulge highly sensitive information to HCPs with expectation that it will not be disclosed without consent Disclosures are made to a HCP on the basis it will remain confidential Establishes trust and encourages pts to talk openly If confidentiality is not guaranteed it discourages seeking help Protects patients  There is statutory provisions for confidential information to be disclosed o A dr must notify o Person in charge of hospital must notify Legal provisions for lawful breach of confidentiality o Actions by a person generally o Mandatory reporting by persons engaged in particular work o Disclosure is not a breach if required in a subpoena Consent and age of majority In Australia, the age of majority is 18 years old. This is the legal age at which a person is considered an adult and gains full legal rights and responsibilities. Once a person turns 18, they can legally make binding contracts, vote in elections, serve on a jury, buy alcohol and tobacco, and consent to medical treatment, among other rights. In Australian healthcare, consent is essential for legally protecting healthcare providers (HCPs) and empowering patients to make informed decisions. Here’s a detailed breakdown of the legal principles of consent and related statutory provisions. Legal Right to Consent in Healthcare Patients have a lawful right to make healthcare decisions, including the right to accept or reject recommended treatments. This principle aligns with respecting patient autonomy and upholding legal protection for healthcare providers who obtain valid consent. Types of Consent 1. Written Consent o Formal Documentation: Typically through a consent form signed by the patient and often witnessed, indicating agreement to specific procedures, especially those with significant risks. 2. Verbal Consent o Oral Agreement: Verbal agreement expressed by the patient, which is often sufficient for less invasive or routine procedures. 3. Implied Consent o Conduct-Based Agreement: Inferred from the patient’s actions, such as rolling up a sleeve for a blood test. Implied consent is generally restricted to simple, routine procedures where the patient likely understands what is involved. Criteria for Valid Consent Consent must meet the following criteria to be legally valid: Voluntary: The decision must be free from manipulation, coercion, or undue influence. Informed: Patients must receive clear information on their condition, the proposed treatment plan, risks, and alternatives, often "in broad terms" to ensure comprehension. Relevant to the Decision: Consent should cover only the specific procedures or treatments discussed and agreed upon. Capacity: The person must have the mental capacity to understand the information and make a decision. Capacity requirements are legally defined, and in cases where the patient lacks capacity, consent may be obtained from an authorized decision-maker. Legal Exceptions to Obtaining Consent Healthcare providers may legally proceed without consent in certain circumstances, such as emergencies where immediate action is necessary to prevent serious harm, or when a patient lacks decision-making capacity, and a legally authorized substitute decision-maker isn’t available. Relevant Legislation in Queensland 1. Public Health Act 2005 (Qld), Section 157B o Addresses health management in public health emergencies, where specific public health measures may override personal consent to prevent disease spread or protect public health. 2. Guardianship and Administration Act 2000 (Qld), Section 63 and Section 64 o Governs the process for appointing guardians and administrators for adults who cannot make personal or financial decisions independently. These sections outline circumstances under which a guardian may consent to or refuse treatment on behalf of an individual. 3. Powers of Attorney Act, Section 5A o Defines the legal role of enduring powers of attorney in making healthcare decisions for individuals who have lost capacity, establishing the conditions under which they may act in the person’s best interest. 4. Transplant and Anatomy Act 1979, Section 20 o Governs consent related to organ donation and anatomical gifts, specifying requirements for lawful authorization. Legal Definitions and Standards Life-Sustaining Measures and Good Medical Practice: These definitions impact end-of-life care and require careful adherence to standards that uphold patient welfare while following legal mandates. Reasonable Information Requirement: The information provided must be what a "reasonable person" would expect in similar circumstances, ensuring that patients have all necessary information to make an informed choice. The test for adequacy involves determining if a reasonable person would have made the same choice if given additional information. Medical Negligence and Consent The concepts of medical negligence and consent are closely linked, as failure to obtain valid consent can lead to negligence claims. Medical negligence occurs when: The healthcare provider fails to meet the standard of care, potentially including the failure to adequately inform the patient, leading to harm. The information provided must meet the standard of what a reasonable patient requires to understand treatment risks and benefits. In summary, obtaining consent in healthcare is about balancing patient autonomy with legal obligations to ensure patients are fully informed, decisions are voluntary, and capacity is assessed, with clear documentation when required. Ambulance act 1991 particularly powers that are established The Ambulance Service Act 1991 (Queensland) outlines the powers and responsibilities of the Queensland Ambulance Service (QAS) and its personnel. Here are some key powers established under the Act: 1. Establishment of Ambulance Service: The Act establishes the Queensland Ambulance Service as a statutory body responsible for providing ambulance services to the community. 2. Appointment of Officers: The Act allows for the appointment of ambulance officers and other staff necessary for the operation of the service. This includes paramedics, who are authorized to provide emergency medical care. 3. Power to Provide Care: Ambulance officers are granted the authority to provide care and treatment to patients, including the administration of medications and the use of medical equipment.  4. Authority to Transport Patients: The Act empowers ambulance officers to transport patients to medical facilities. This includes the right to determine the most appropriate facility for the patient’s care. 5. Power of Entry: Ambulance officers have the authority to enter premises (with or without consent) when it is necessary to provide care to a patient. This power is critical in emergency situations where immediate medical attention is required. 6. Delegation of Powers: The Act allows for the delegation of specific powers and functions to appropriately trained personnel, enabling efficient and effective service delivery. 7. Emergency Powers: In certain circumstances, ambulance officers may have special emergency powers, such as the authority to administer life- saving treatments without consent if the patient is unable to give consent due to their medical condition. 8. Compliance with Directions: Ambulance officers are required to comply with the operational guidelines and directions established by the QAS. 9. Reporting Obligations: The Act may include provisions requiring ambulance officers to report certain incidents or conditions encountered during their duties, ensuring accountability and transparency in operations. 10. Regulation Making Powers: The Act grants the authority to create regulations that further define the operational parameters and standards for ambulance services in Queensland. Role of OHO The purpose of the OHO is o Protect the health and safety of practitioners o Promote high standards in health service delivery o Facilitate the responsive complaint management The OHO operates in conjunction with the health practitioner regulation national law Section 11 of the health ombudsman act states the role and responsibility of the health ombudsman o OHO is responsible for receiving and dealing with health service complaints o OHO also deals with matters including the systemic issues in the health system Governance of paramedics within health practitioner regulation national law 2009 The Health Practitioner Regulation National Law Act 2009 (commonly referred to as the National Law) provides a framework for the regulation of health practitioners in Australia, including paramedics. Here’s an overview of how paramedics are governed under this law: 1. National Registration and Accreditation Scheme (NRAS) The National Law established the NRAS, which provides a unified system for the registration and accreditation of health practitioners across Australia. This scheme is designed to enhance the safety and quality of healthcare. 2. Regulatory Authority Under the National Law, paramedics are regulated by the Australian Health Practitioner Regulation Agency (AHPRA). AHPRA oversees the registration of health practitioners and the regulation of their practice. 3. Scope of Practice The National Law defines the scope of practice for paramedics, ensuring that they practice within their qualifications and competencies. This includes standards for education, training, and continuing professional development. 4. Registration Requirements Paramedics must meet specific eligibility criteria to be registered. This includes holding an approved qualification, demonstrating proficiency in their field, and passing a criminal history check. 5. Professional Standards The National Law sets forth professional standards that paramedics must adhere to, including: o Codes of conduct o Guidelines for ethical practice o Competency standards for safe and effective care 6. Complaints and Discipline AHPRA has mechanisms for handling complaints about paramedics' conduct or performance. This includes investigating allegations of misconduct, professional incompetence, or impairment. Disciplinary actions can include suspension or cancellation of registration, depending on the severity of the case. 7. Continuing Professional Development (CPD) Paramedics are required to engage in ongoing professional development to maintain their registration. This ensures that practitioners stay up-to- date with current practices, knowledge, and skills. 8. Collaboration with Other Health Professionals The National Law promotes collaboration among health professionals, allowing for integrated healthcare delivery. Paramedics work alongside other health practitioners, sharing knowledge and expertise to improve patient outcomes. 9. Public Safety and Accountability The overarching aim of the National Law is to protect public safety. By regulating paramedics, the law ensures that practitioners meet established standards of care and accountability. 10. Review and Reform The National Law allows for periodic reviews and reforms to the regulatory framework, ensuring it remains relevant and responsive to changes in healthcare delivery and community needs. In summary, the Health Practitioner Regulation National Law 2009 provides a comprehensive governance framework for paramedics in Australia, focusing on registration, professional standards, public safety, and accountability. This framework ensures that paramedics are well-regulated and capable of delivering high-quality healthcare. Coroners act 2003 and role of coroner The Coroners Act 2003 QLD - Details the role and powers of the coroner in QLD. - The functions of the corner are to hold inquests into reportable deaths and help prevent future deaths by allowing coroners at inquests to comment on matters connected with deaths, including matters that relate to public health and safety. What is a reportable death: Section 8 of Coroners Act 2003 QLD - Death happened in QLD - or although the death happened outside QLD o the person's body is QLD, o at time of death the person lived in QLD, o the person at time of death was on a journey to or from somewhere in QLD, o the death was caused by an event that happened in QLD - It is not known who the person is - Death was violent or unnatural - Suspicious circumstances - Death was a health care related death - Cause of death certificate has not been issued and is not likely to be issued - Death in care - Death in custody - Happened in the course of police operations (Death in Care): - Deceased had a disability under disability services act 2006 and was living or receiving services in/from level 3 residential service. - Forensic disability client - Being taken to or detained in an authorised mental health institution. - Child placed in care A coronial investigation is undertaken to establish: - The identify - When - Where - The medical cause of death - Circumstances in which death occurred. Section 27 states that a corner investigating a reportable death must hold an inquest if: - They consider the death in custody or care - They are directed to do so by the attorney general - Their own initiative or on application - The district court orders them Section 28 states that a coroner investigating a reportable death may hold an inquest if: - Public interest to do so - Deciding if it is in the publics interest to hold inquest, the coroner may consider o The extent to which drawing attention to the circumstances of the death may prevent similar death in the future Coronial inquests are: - Generally covered in magistrates courts - Police officer, or lawyer may assist - A person may seek permission to appear e.g., family member - A person can be ordered to attend, if they don’t comply, warrant for their arrets can be issued. MHA 2016: Definition of mental illness The Mental Health Act 2016 (Queensland) defines "mental illness" in Section 10. According to the Act, mental illness is characterized by: 1. Presence of a Disorder: It involves the presence of a disturbance in a person's thinking, emotional regulation, or behavior. 2. Severity: The disturbance must be of such severity that it significantly impairs the individual's capacity to function in one or more important areas of life, such as work, relationships, or self-care. 3. Duration: The condition should be persistent or recurrent over a period, rather than a temporary reaction to a stressful event or situation. 4. Exclusion of Normative Responses: The definition excludes normal reactions to life events or stressors, indicating that the symptoms must not be part of a normal response to a specific situation. Summary of the Definition In essence, "mental illness" as defined in the Mental Health Act 2016 encompasses a range of mental disorders that cause significant functional impairment and distress, necessitating intervention and treatment. The definition serves to guide the assessment and treatment of individuals with mental health issues while ensuring that normative emotional responses are not classified as mental illnesses. Purpose of the Act The Mental Health Act 2016 aims to provide a legal framework for the care, treatment, and protection of individuals with mental illness in Queensland. It focuses on promoting mental health and wellbeing while ensuring the rights and dignity of individuals receiving mental health services. Key Features of the Act 1. Rights of Persons with Mental Illness: o The Act emphasizes the rights of individuals with mental illness, including the right to be treated with dignity and respect, and to have their privacy protected. o It ensures that individuals are involved in decision-making regarding their care and treatment. 2. Principles of the Act:  o The Act is underpinned by principles that prioritize the least restrictive care possible, acknowledging the importance of personal autonomy and the need to support recovery. o It encourages care in a way that maximizes an individual’s recovery, inclusion, and participation in the community. 3. Mental Health Services: o The Act provides a framework for the delivery of mental health services, including the establishment of mental health facilities and the roles of mental health professionals. o It outlines the types of treatment that can be provided, ranging from voluntary to involuntary treatment, depending on the individual's circumstances. 4. Involuntary Treatment: o The Act defines the criteria for involuntary treatment, which includes situations where an individual poses a risk to themselves or others due to their mental illness. o Processes for assessment and treatment orders are established to ensure that involuntary treatment is applied fairly and justly, with safeguards to protect the rights of the individual. 5. Assessment and Treatment: o The Act provides for the assessment of individuals suspected of having a mental illness, detailing how assessments should be conducted and by whom. o It outlines the procedures for initiating treatment and the rights of individuals during the treatment process. 6. Detention and Review: o The Act includes provisions for the detention of individuals for treatment and assessment, specifying the duration of detention and the circumstances under which it may occur. o It mandates regular reviews of treatment and detention to ensure continued justification and appropriateness. 7. Mental Health Tribunal: o A key component of the Act is the establishment of a Mental Health Tribunal, which reviews involuntary treatment and detention orders. o The Tribunal provides an avenue for individuals to challenge their treatment and assert their rights. 8. Crisis Intervention: o The Act promotes the establishment of crisis intervention services and strategies to support individuals in acute mental health crises, facilitating timely and appropriate responses. 9. Collaboration and Integration: o The Act encourages collaboration between mental health services and other health and community services to provide integrated care. o It recognizes the importance of a holistic approach to mental health, considering physical health and social determinants. 10. Cultural Considerations: o The Act acknowledges the need for culturally appropriate mental health care, particularly for Aboriginal and Torres Strait Islander peoples, ensuring that services respect cultural beliefs and practices. EEAs within public health act 2005 Section 157B public health act 2005 Qld permits police and ambos to detain and transport a person A person must present with all of the following Test for capacity is not included in the public health act Section 157C states paramedics must take reasonable steps to ensure the person understands they are being detained and transported to an appropriate place of care Role of power of attorney act and health attorneys in end of life care Power of Attorney Act 1998 1. Definition and Purpose: o The Power of Attorney Act 1998 allows individuals to appoint others (known as attorneys) to make decisions on their behalf regarding personal, financial, and health matters when they are unable to do so themselves. 2. Types of Powers: o The Act enables the creation of two types of powers: ▪ General Power of Attorney: This allows the appointed attorney to make decisions about financial and legal matters. ▪ Enduring Power of Attorney: This specifically pertains to personal and health matters and remains in effect even if the principal loses capacity. 3. Health Matters: o An enduring power of attorney can include specific provisions for health care decisions, allowing the appointed attorney to make choices regarding medical treatment, end-of-life care, and other health-related issues. Role of Health Attorneys in End-of-Life Care 1. Decision-Making Authority: o Health attorneys, designated under an enduring power of attorney, have the authority to make decisions about medical treatment on behalf of the individual (the principal) when they are unable to communicate their wishes due to illness or incapacity. 2. Best Interests and Preferences: o Health attorneys are required to act in the best interests of the principal. They should consider any known wishes or preferences expressed by the principal regarding their medical treatment, including end-of-life care. o This can involve discussions about life-sustaining treatments, palliative care options, and the refusal of treatment. 3. Legal Framework: o The Power of Attorney Act provides a legal framework that governs the actions of health attorneys, ensuring they act within the scope of authority granted to them. o Health attorneys must comply with applicable laws and ethical guidelines when making decisions about the principal’s health care. 4. Collaboration with Healthcare Professionals: o Health attorneys often work closely with healthcare providers to understand the medical options available and to make informed decisions regarding the principal’s care. o Effective communication between the health attorney and healthcare professionals is vital to ensure the principal’s health care wishes are respected. 5. Advance Health Directives: o In conjunction with the Power of Attorney Act, individuals may create Advance Health Directives, which are legal documents that outline specific preferences for future medical treatment. o Health attorneys must take these directives into account when making decisions on behalf of the principal. 6. Limitations and Challenges: o There may be situations where the wishes of the health attorney conflict with the medical team’s recommendations or the principal’s advance health directive. In such cases, further consultation and legal advice may be necessary to resolve the issue. o Health attorneys must also navigate emotional and ethical challenges in end-of-life situations, balancing the principal’s wishes with family dynamics and medical realities. Voluntary assisted dying People with capacity can refused treatment and this refusal can lead to death Voluntary Assisted dying act (QLD) passed in 2023 There is significant support given to people with advanced and progressive terminal conditions Section 115 of the voluntary assisted dying act 2019 (WA) has similarities to the VIC version o Section 81 VAD act 2017 (VIC) -> VAD in QLD Voluntary assisted dying act 2021 passed in 2021 and was available from 2023 There is 5 criteria o Have an eligible condition which is: Advanced, progressive and will cause death Expected to cause death in the next 12 months Causing suffering that the person considers to be intolerable, suffering includes ▪ Physical, mental, treatment Intolerable is subjective to the pt o Have decision-making capacity  - Voluntarily and without coercion - At least 18 o VAD is only available to adults - Meet residency and citizenship requirements o Must be an: ▪ Aus citizen OR ▪ Be PR including NZ special category visa OR ▪ Have ordinarily been a resident for three years prior OR ▪ Have been granted an exemption AND ▪ Must have been ordinarily a resident in qld 12 months prior to request Granted a qld residency exemption - QLD health grants residency exemptions for: o Compassionate grounds o Person has substantial connection to QLD AHDs and their role and limitations Adults in qld are entitled to section 35(I) of the powers of attorney act to give direction about health matters for their future healthcare, this is an AHD o Paramedics are entitled to sight the original or a certified copy of the AHD AHDs cannot be relied upon if: o Document is defective (pages missing, unsigned or undated) o Directions are unclear/ambiguous o Directions are inconsistent with good medical practice o Clinical circumstances differ from those set out in AHD o Pts medical circumstances have changed such that the AHD is not appropriate o Pt has done something suggesting they have changed their mind Autonomy and right to self determination Autonomy 1. Definition: o Autonomy refers to an individual’s right and capacity to make informed choices about their own life and health care without external influence or coercion. It encompasses the ability to understand and weigh options, express preferences, and act upon those decisions. 2. Importance in Healthcare: o In healthcare, respect for patient autonomy is essential for ethical practice. Patients should have the freedom to make decisions regarding their treatment options, including the right to accept or refuse medical interventions. o Healthcare professionals are obligated to provide patients with all necessary information regarding their conditions, treatment options, risks, and benefits, enabling informed decision-making.  3. Informed Consent: o Autonomy is closely linked to the concept of informed consent, which requires healthcare providers to ensure that patients understand the implications of their treatment choices. Patients must be fully informed about their diagnosis, potential treatments, and outcomes before consenting to any procedure. 4. Challenges to Autonomy: o Autonomy can be challenged by factors such as mental incapacity, coercion, cultural influences, and societal norms. In such c ases, surrogate decision-makers, such as health attorneys or family members, may be involved to represent the patient's interests. - People with capacity can make choices irrespective of whether those choices are rational or irrational judged by objective standards. - Patients have the right to be informed and they can make a choice, ask questions and seek information. - Respect is a key feature. - Autonomy and human rights share a common bond. - Liberty - independence from controlling influence - Agency - a capacity for intentional action. - The autonomous person acts intentionally, with understanding and without controlling influences determining outcomes. Right to Self-Determination 1. Definition: o The right to self-determination refers to the principle that individuals have the authority to make choices regarding their own lives, including their health and personal care. This right is often seen as a fundamental human right that allows individuals to pursue their own goals, values, and lifestyles. 2. Legal and Ethical Framework: o The right to self-determination is enshrined in various legal frameworks, including human rights laws and ethical guidelines. It emphasizes that individuals should have the freedom to make choices that affect their lives, including healthcare decisions, without undue interference. o In healthcare, this right supports the idea that patients should be empowered to direct their own treatment and care based on their values and preferences. 3. End-of-Life Care: o The right to self-determination is particularly significant in end-of-life care decisions, where individuals may wish to refuse life- sustaining treatments or choose palliative care options. o Advance health directives, which outline a person’s wishes regarding their medical treatment in the event they become incapacitated, are a critical expression of the right to self-determination. 4. Cultural Considerations: o Different cultures may interpret autonomy and self-determination in various ways, leading to differing expectations and practices in healthcare settings. Healthcare providers must navigate these cultural differences to ensure that patients’ rights are respected while also honouring their cultural beliefs and values. Refusal and valid refusal criteria - An adult pt who suffers no mental incapacity has an absolute right to choose one rather than another of treatment offered. The right is not limited to decisions which others regard as sensible - HCPs have a duty to provide full information regarding condition, treatment and consequences of decision to refuse and assess the patient to determine that the decision to refuse is valid - Elements of refusal have evolved from common law - Decisions must be: o Voluntary, related to the current circumstances o Informed o Pt must have capacity o Must be free from undue influence - Support and advice are not undue influence - HCPs must be mindful of exactly what the pt is refusing - The patients intentions must be established in regard to decisions applying now, in changed circumstances - If the paramedic believes that the pt has decision-making capacity and the decision is valid they must: o Respect the decision o Provide the pt with advice promoting the pts comfort and safety o Comprehensively document - If paramedic believes decision making is impaired then: o Obtain consent from an authorised person to provide consent for pt o If no substitute decision maker then provide urgent and necessary interventions o Explore options to safely facilitate transport in a timely manner o Document comprehensively Capacity A person has capacity if: o A person can have capacity to consent to treatment even though the person decides to not receive treatment A person may be supported by someone else to understand subsection a The section does not affect the common law in relation to: o Mental health is separate to capacity Mental illness can reduce capacity but this is not a certainty for all MH pts All individuals over 18 have capacity until proven otherwise Child protection act 1999 and reporting of child maltreatment Children's Health Law - Not a distinct area of health law however, children are distinct in the eyes of the law - Until the age of 18 they lack capacity. Capacity being a key element of autonomy - There is power imbalance between adults and children therefore the law needs to treat children differently - Children's rights are vested in care givers Child Maltreatment and Child Protection - Maltreatment and abuse are used interchangeably - Children suffer harm from adults and other children for many reasons - Not all harm is attributed to malice, malevolence, malfunction, malversation etc. - Adverse childhood events can include abuse and neglect but also other things o The consequence of these can be as damaging as being a victim of abuse o It includes things such as exposure to violence or bullying - - As a HCP it is highly important to be aware of these things as it can save lives Responding to and reporting responsibilities of HCPs - Children cannot protect themselves and rely on others to shield them from harm - As EMS providers are often called to the home they have an important role in identifying and recording information that other health professionals don’t see  - There may be overlap in these forms of abuse - Children exposed to DV are 3-9 times more likely to be maltreated than children not exposed - More than half of children exposed to DV were also maltreated - The key to making the right call is knowing the causes and how to identify maltreatment Mandatory reporting Doctors, nurses (and midwives) are under section 158 of the public health act (QLD) and section 13E of the child protection act (QLD) required to mandatorily report suspected child maltreatment Other HCPs are not prevented from reporting o The child protection act sections 159Q and 197A protect people from liability in relation to reporting suspected child maltreatment Mandatory reporting helps remove doubt as to whether a report should be made Child protection is part of a HCPs care profile Questions to ask in relation to maltreatment o Could the child be self inflicting their presentation o Could it be caused by other children o Does the reported history account for the child's presentation Differentials are a part of abuse -> could it be something else It is challenging to identify abuse  Paramedics are not mandatory reporters however they have moral obligation to report When reporting write factually, objectively and accurately be careful what you write Report what is observed Failure to protect a child from sexual offence and failure to report/disclose sexual offending August 2017 a royal commission was released on institutional response to child sexual abuse The criminal code (child sexual offences reform) and other legislation amendment act 2020 received assent in September 2020 to incorporate the recommendations to qld law The amendments relate to new offences for failure to protect a child from sexual offence o This places a positive obligation on third parties to report, failure may lead to criminal conviction In qld the offences relate to those under 16 HCPs can be charged with failure to report if they treat a pt who makes a disclosure and this is not documented QLD health is an institution under these amendments with requirement to report The next section relates to any person including ordinary citizens - Changes in mandatory reporting laws are related to sexual offences only - For other abuse and neglect mandatory reporting remains the same - VIC also has similar laws Legal test for capacity in MH act 2016, powers of attorney act and the dictionary of the guardianship act 1. Mental Health Act 2016 In most Australian states and territories, the Mental Health Act (e.g., Queensland's Mental Health Act 2016) defines capacity specifically for individuals requiring mental health treatment. Capacity Criteria: Under this act, a person is considered to have capacity if they can: o Understand information relevant to a decision about treatment. o Make a decision freely and voluntarily. o Communicate their decision in some way. This test is specific to the person's ability to make decisions regarding their mental health treatment and may allow for involuntary treatment if a person is deemed unable to make an informed decision. 2. Powers of Attorney Act The Powers of Attorney Act (with state-specific variations, like Queensland’s Powers of Attorney Act 1998) governs the legal authority to appoint someone to make decisions on one's behalf. Capacity Criteria: For an individual to execute a power of attorney, they must have the capacity to understand: o The nature and effect of the document they are signing. o The scope of authority they are granting. o How this delegation affects their rights and autonomy. If a person lacks capacity, a power of attorney document cannot legally be executed, and the court may intervene to appoint a substitute decision-maker. 3. Guardianship Act (or Dictionary of the Guardianship Act) Guardianship Acts vary between states (e.g., New South Wales Guardianship Act 1987, Victoria Guardianship and Administration Act 2019), with each providing its own definitions of capacity and tests related to the appointment of guardians. Capacity Criteria: The criteria here often look at whether a person can: o Understand the nature and consequences of decisions related to personal and health matters. o Retain and weigh information for decision-making. o Communicate their decision.  Guardianship is usually invoked if a person is unable to make these decisions, and a tribunal may appoint a guardian to act in their best interests. Gillick competency - Legal guardians are allowed to make decisions regarding a child's healthcare until they reach the legal age of majority - The law is prepared to make exceptions to this based on a person's maturity and understanding of their health issue o Young persons (13-18) may have capacity - Gillick v West Norfolk and Wisbech Area health authority o A young person can make decisions about their health if it can be demonstrated that the young person is sufficiently mature and capable of understanding the nature and consequences of their decision o The test of competence is known as the 'Gillick test' - HCPs need to consider the age, maturity and emotional development of the young person as well as their level of education, intellect, social and family circumstances and the clinical circumstances - If the young person demonstrates this then they are deemed to be Gillick Competent - Consent is not necessary where a surgical procedure or medical treatment must be performed in an emergency and the pt does not have capacity or a legally authorised representative to give consent on their behalf - What if the parent refuses on their child's behalf o i.e. blood transfusion ▪ - - Parental responsibility relates to care, welfare and development of the child - Parents must act in the best interests of their child - Refusing life-saving treatment is not in the best interest of the child and the courts can intervene - The state may take a child into custody if a state authorised individual believes the child is at risk of harm Last question of exam: Be familiar with components of consent, valid refusal and capacity 1. Consent Definition: Consent is a person’s voluntary agreement to a proposed action, such as medical treatment or a legal decision. Key Components of Valid Consent: 1. Capacity: The person must have the mental ability to understand the decision they’re making. 2. Voluntariness: The decision must be made freely, without coercion, manipulation, or undue influence. 3. Informed: The person must be provided with all relevant information, including the nature of the procedure, potential risks, benefits, and alternatives. 4. Specificity: Consent must be specific to the action being proposed and cover what is intended. 2. Valid Refusal Definition: A valid refusal is the right of a person to decline a proposed intervention or treatment after understanding the implications. Key Components of Valid Refusal: 1. Informed: Like consent, refusal must be informed; the person should understand the consequences of refusing the action, including risks. 2. Voluntary: Refusal must be made without external pressures, ensuring the person is exercising their free will. 3. Capacity: The person must have the capacity to refuse; they must be able to understand and weigh the decision of refusing. Valid refusal is protected under law, even if the refusal may result in harm to the person (except in specific cases like emergency interventions where refusal may be overridden to preserve life). 3. Capacity Definition: Capacity is a person’s ability to understand information relevant to a decision and to make and communicate a decision based on that understanding. Key Aspects of Capacity: 1. Understanding: The person must comprehend the information necessary to make the decision. 2. Retention: They must be able to remember the information long enough to make a decision. 3. Weighing and Using Information: They should be able to process the information, weigh it against alternatives, and consider the consequences. 4. Communication: They must be able to communicate their decision, whether verbally or by other means. Decision-Specific: Capacity is not all-or-nothing. A person might have the capacity for certain decisions but not others, depending on the complexity of the decision and the individual’s understanding. Application in Healthcare or Legal Contexts These components are often applied in medical settings to determine if a patient can consent to or refuse treatment, or in legal contexts where a person’s decision-making ability may impact contracts, wills, or powers of attorney. Professionals assess capacity before proceeding, ensuring respect for patient autonomy while protecting individuals from harm if they cannot make informed choices.