Lecture 7 - Torts & CAMRT PDF

Topic 7: Torts and the CAMRT CODE OF ETHICS https://www.camrt.ca/practice_in_medical_radiation_technology/story_html5.html?lms=1  Topic 7: Torts and the CAMRT CODE OF ETHICS LEARNING OUTCOME #5- Identify the various regulatory bodies and laws that govern the professio...

Topic 7: Torts and the CAMRT CODE OF ETHICS https://www.camrt.ca/practice_in_medical_radiation_technology/story_html5.html?lms=1  Topic 7: Torts and the CAMRT CODE OF ETHICS LEARNING OUTCOME #5- Identify the various regulatory bodies and laws that govern the profession MINISTERIAL COMPETENCIES LINKED TO THIS TOPIC 01PX; E5- Examiner les principales sources de droit régissant la profession des technologues en imagerie du domaine du radiodiagnostic OBJECTIVES: 7.1- 7.2- 7.3- Identify and define the roles of the national and provincial organizations that establish regulations and standards for practice of the profession: Equal Canada, CAMRT, OTIMROEPMQ, and OQLF (LO5 – 01PX; E5) 7.4- Know the professional Codes of Ethics: CAMRT & OTIMROEPMQ (LO5 – 01PX; E5) 7.5- Develop an awareness of the Charter of Rights and Freedoms, Civil Code, Criminal Code, health legislation, Technologist Act, and government programs. (LO5 – 01PX; E5)  The patient is the reason for the existence of the hospital organization, which has no life, no purpose, and no value without him/her. MITs are members of a team of health care professionals who work together to maximize patient wellness. The study of ethics provides the necessary foundation for MITs to apply professional standards and exercise personal integrity in responding correctly to the ethical challenges they will encounter. As a member of this health care team, the MIT is governed by a Code of Ethics and Moral Principles/values of Professional Conduct that incorporate all members of the profession  The Law Page 38, 39 - Torres A Law is a standard or rules of conduct established and enforced by the government of a society and are intended to protect the rights of the public. There are many types of laws that affect people in daily life, however, statutory law and common laws are most significant for the MIT in professional practice. Statutory Laws is written law set down by a governing authority such as parliament, etc. Common Laws Common law is the body of law that has evolved due to judgments in individual legal disputes. Two major classifications of the law: o criminal law An offense is regarded as criminal behavior if it is an offense against society or a member of society that has been prohibited by common or statutory law. o Civil law has been broken when another person's private legal rights have been offended. (ex: being discharged because of color, age, disability, a misdiagnosis by a Dr. causing injury etc.). Seeks compensation.  Litigation (Lawsuit/legal action) Litigation: the act, process, or practice of settling a dispute in a court of law such as a lawsuit Two of the most common causes for litigation in Radiology: o Patient falls in the diagnostic imaging department o Errors in medication administration/contrast media For a patient to have a claim there must be some breach of duty on the part of the HCW: o The patient suffered an injury while in the Radiology department o The patient thinks he has been injured o The patient received less than optimal care o The patient felt threatened in any way TORTS The word tort comes from the Latin tortum, meaning “wrong, injustice.” The purpose of tort law is not to punish wrongdoers; it is to provide damages to victims as compensation for their losses. A tort is a civil wrong that causes a claimant to suffer loss or harm, resulting in legal liability for the person who commits the tortious act. Intentional and unintentional torts  Unintentional Tort An unintentional tort is usually associated with negligence and occurs when the wrongdoer does not intend to cause harm, but nevertheless results. o The person who caused the accident is considered negligent because they failed to exercise the same degree of care that a reasonable person would have in the same situation. Negligence is simply a failure in care, a failure that arises by doing something (or failing to do something) that no reasonable person would do (or fail to do). Negligence is actionable when there is a duty to provide care and there is a failure in that duty resulting in injury to another person or to others. In the professional relationship there is an implied contract to supply reasonable care. In a negligence claim (unintentional tort), a person didn’t set out to cause harm. However, they are still legally responsible if their negligent action hurts someone else. The MIT is 100% responsible in Civil Law for negligence. o A standard of reasonable care requires that a person perform as any reasonable person of ordinary prudence with comparable education and skill would perform under similar circumstances. o Medical malpractice occurs when an injured patient is harmed by health care professionals who fail to competently perform their duties.  Unintentional Tort For a patient (plaintiff) to recover damages for injuries suffered because of alleged negligence, 4 elements must be proved: A duty of care to the patient by the health care practitioner/worker Breach of this duty by an act or by failing to perform some act Proof of a compensable injury/establish compensation that should be given/received A causal relation between the injury and the breach of duty/a direct cause of the harm Examples: o An MIT fails to put up the side rails on the stretcher once the exam is terminated; the patient moves around and falls from the stretcher to the floor, fracturing a hip. o forgetting to protect a patient from radiation while making radiographic exposures.  Intentional Tort Intentional Torts: wants/tries to cause harm The classic intentional tort in medical practice is forcing unwanted medical care on a patient Assault: is defined as a verbal attack, a threat of violence, psychological injury. o A threat of touching in an injurious way. The person need not be touched in any way for assault to occur. If the patient feels threatened and has cause to believe that he/she will be touched in a harmful manner, there may be justification for a charge of assault. o Threatening to repeat a painful examination if the patient does not hold still. Battery: is defined as offensive touching without consent causing bodily harm. o Battery consists of touching a person without permission. If the patient refuses to be touched, that wish must be respected. Actually, battery implies that the touch is a willful act to provoke or harm, but even the most well intentioned touch may fall into this category if it has been expressly forbidden by the patient. o If a patient is moved roughly about the radiographic table while being positioned for an exam o Forcibly removing a patient’s clothing. o Shoving a patient into a chair.  Intentional Tort False Imprisonment: False imprisonment becomes an issue when the patient wishes to leave and is not allowed to do so. o Restraints may be applied ONLY upon the order of a physician. Most prevalent with patients who are unable to cooperate: o Inebriated/intoxicated: if the threat of harm to self or the MIT exists, then physical restraints are permitted. o Senile: must obtain authorized consent before restraining from legal guardian o Pediatric: must obtain authorized consent before restraining from legal guardian or parent The most common intentional tort is battery.  Handing the Radiologist, the incorrect syringe Mixing up the wrong medication Freezing CM Errors can occur when loading power injector syringes. They are to be filled with CM. Sometimes in busy departments the syringes are not replaced with contrast and saline, because saline and contrast are clear they appear as filled and air can be injected in stead of CM Air embolism IMPROPER MARKING OF RADIOGRAPHIC IMAGES, OR NO MARKINGS X-rays can be flipped from front to back and vice versa. This increases the likelihood of errors. identifying the side and body position, if possible, at the time of exposure.  Respecting a patient’s modesty is a demonstration of compassion and displays concern for a patient’s physical privacy. A technologist is not only an employee of a healthcare institution but also a representative of their workplace  A patient may inadvertently expose themselves. A tech should be pro-active and offer a sheet to cover the lower body should this happen  Respect for Property - Keeping patients’ belongings safe Many items can be misplaced or forgotten in the department Ask if a patients has valuables in the bag under the bed. Tell the patient you will leave the bag nearby in the room, if putting the stretcher outside in the hallway. This reassures them and will establish trust that you have their well being at heart  Defamation (Libel and Slander) An action for defamation could be brought against any health care worker who breaches patient confidentiality, and this leaked information brings ridicule, scorn, contempt or some other injury to the patient, such as loss of home or job. Libel: is written defamation about a patient Slander: untruthful oral statement about a patient Ex: Information disclosed from medical records of patients who are HIV-positive or who have AIDS may cause them to lose their jobs or to be discriminated against  Two actions that create apprehension in a patient are haste and lack of preparation. It has been estimated that 10% of all medical negligence claims are somehow related to diagnostic imaging: improper diagnosis injuries to patients suffered during diagnostic procedures  MEDICAL LAW RES IPSA LOQUITUR "The thing speaks for itself." The patient could not have contributed to his/her injury in any way. A legal doctrine used to shift the burden of proof from the patient's proving the negligence to the defendant health care practitioner's proving that he was not negligent. Ex: A patient under anesthesia is injured during surgery when his hand is crushed between the portable X-ray machine and the operating table. RESPONDEAT SUPERIOR "The master speaks for the servant." The most common type of vicarious (indirect) liability; sometimes the negligence of one person can be imputed, or placed upon, another, even if the other is not present. The supervising physician and/or health care facility is liable in certain cases for the wrongful acts of its employees. Ex: The hospital and doctor in charge of a procedure could be liable in the case where a student allowed an overheated X-ray tube to touch and consequently burn a patient.  Hospital Liability Insurance for Technologists o Hospitals nearly always carry liability insurance which covers employees. It is essential that MITs learn the extent of provisions for malpractice coverage in their institution. o MITs are also covered by their fees to the OTIMROEPMQ. o During clinical training, the CI is liable for the student's actions; the College also has malpractice insurance which covers students in stage.  Interpersonal Relations Team members bring their own personal and professional values and norms to health care team and in the process of building a new team or becoming part of an already formed team, there must be an accommodation among the various norms and values involved. The manner in which variations are accommodated and the norms that develop will be indicative of the health and strength of the team and whether maximum use can be made of its potential. The team itself should become a means of support, growth, and increased effectiveness for the health professional who wants to maximize his or her strengths as a person, while performing the necessary professional tasks.  Conflict Management Techniques Conflict Resolution techniques are necessary factors of the workplace in order to maintain a harmonious and fair work environment. If conflicts are not dealt with, they can have repercussions on teamwork and patient care. Using conflict resolution strategies implemented by your employer will help maintain a healthy work environment. Listen to the employee’s issue. Listen to all parties involved to completely understand the nature of conflict. Meet with all involved parties to discuss the issue. Give everyone a chance to speak and hear all sides in order to get a full understanding of the conflict. Be Neutral and don’t take sides. Try to access the situation from all sides to come up with a fair and reasonable solution. Do Not Postpone Resolution, address the conflict immediately. Otherwise, the situation could escalate and could affect employee performance. Promote Teamwork, encouragement and motivation are powerful.  Interdepartmental Relations Scenario: A patient from ICU is required to come to the department for an examination of his abdomen. The patient is on 100% O2, has a feeding tube and unable to move from his bed.  CODE OF ETHICS Definitions of Ethics the study of moral principles that govern one’s course of action. o Moral principles are a set of standards that establish what is right or good Ethics is a combination of the attributes of honesty, integrity, caring, respect, citizenship, competence and accountability All individuals have a personal CoE that centers around their cultural & environmental background All professionals have a set of professional values, and ethical principles or a CoE that governs professional behaviour The student entering the profession of Medical Imaging brings a personal CoE, moral principles, and personal values. Rules of conduct standards of right and wrong that define what humans should do in terms of rights, obligations, fairness and benefit to society  CODE OF ETHICS Ethics according to CAMRT: Ethics is the study of dealing with professional standards of behaviours related to what is right and wrong, as well as the system or code of morals of a particular group or profession. o Morals usually refer to personal standards. o Ethics conduct is behaviour conforming to accepted professional standards of conduct. Two major ethical theories/philosophies are generally used to analyse ethical dilemmas. These theories view the dilemma from different reference points and, after analysis, may produce very different results. Utilitarianism: (consequentialism) Notions of duties and obligations which maximize benefits or minimize harm. The largest number of persons is benefitted by the decisions made. o example: Provide care to the least critical so they will survive; care is given last to the critically ill; since chance of survival is less Deontology: (duty/obligation) Rules are to be always followed by all individuals. One judges if it is a ʺdutyʺ. o Example: Provide care to the most critical since those less critical would survive longer without care. Focuses on the rightness of an act and not on what results from the act.  CODE OF ETHICS ethical dilemmas a situation in which a difficult choice must be made between two courses of action, either of which entails transgressing a moral principle: he is faced with an ethical dilemma: leave his post to help save his father's life, or follow his sense of duty" imaging professionals must apply professional standards and exercise personal integrity to respond correctly to ethical dilemma situations Read Ethical Principles in Radiography (Torres page. 32) & Patient Rights (Torres page. 32)  CODE OF ETHICS To resolve ethical dilemmas, one may apply an established set of principles: o Autonomy o Justice Patients have the right to make decisions concerning their All persons being treated equally according to need lives o Nonmaleficence o Beneficence the duty to abstain from inflicting harm All acts are meant to attain beneficial results, prevent harm o Paternalism or do the greatest good for the patient To make justifiable decisions without consulting the o Confidentiality person affected All patients have the right to have information concerning o Sanctity of Life their state of health and personal information kept private Life is the highest good and nobody has the right to o Double effect judge another person’s quality of life Some actions may produce a good or bad effect o Veracity o Fidelity Honesty in all aspects The duty to fulfill one’s commitments o Respect for Property  Keeping patients’ belongings safe  not intentionally damaging/wasting equip/supplies Read Ethical Principles in Radiography (Torres page. 32) & Patient Rights (Torres page. 32)  RIGHTS OF PATIENTS Failing to do the following are infringements in patient’s rights and the MIT is legally liable: Acting in the role of a diagnostician and providing a patient with results, impressions, or diagnoses of diagnostic imaging examinations. o A tech is NOT an MD & cannot give results or diagnosis. This is the Rad’s mandate.  obtain appropriate consent from women of childbearing age before performing a diagnostic imaging procedure before exam is performed o obtain a complete history from a patient before administering an iodinated contrast agent.  Important to screen for contra-indications such as allergies and meds o explain a diagnostic imaging procedure to a patient before the exam o correctly identify a patient before performing an examination o document technical factors/parameters used to facilitate dose calculations if required o maintain a patient’s physical privacy during an exam  DIGNITY - provide appropriate o provide patient with the lowest possible radiation dose & maintaining images of diagnostic value  CAMRT Mission CAMRT works to advance the profession through leadership in advocacy, education, and research. CAMRT supports MRTs to provide the highest quality of patient care throughout their careers by providing a highly respected certification process, exceptional continuing education, timely and evidence-based practice resources, and valuable member services. The CAMRT recognizes its obligation to identify and promote exemplary professional standards of practice, conduct and performance. Adherence to these standards is the personal and professional responsibility of each member. Canadian Association of Medical Radiation Technologists | Member Code of Ethics and Professional Conduct (camrt.ca)  CAMRT Code of Ethics & Professional Conduct Each member of the association has a personal responsibility to understand, adopt, and promote the values and behaviors described in this code.  CAMRT Code of Ethics & Professional Conduct 1. Patient-centered care driven by the goal to meet the needs of patients and their family or caregivers in all aspects of their healthcare interactions. In their capacity as CAMRT members, MITs will fulfill their role as patient-centered caregivers by: 1.A - Advocating and collaborating for optimal patient care Collaborating and consulting with patients, appropriate decision-makers, and other healthcare providers to facilitate optimal patient care 1.B - Involving patients in their own care Educating patients, families, & caregivers by providing info. that can be understood and used to make informed decisions about their care Answering patient and family questions fully and honestly within the limits of MRT knowledge, authority, and responsibility. The MRT may be required to seek additional information or refer the patient to the most appropriate healthcare provider 1.C - Respecting patient dignity and rights Facilitating and supporting the free and informed choices of patients, families, or caregivers, including decisions to refuse or withdraw from treatment; (decision is based on honesty and fairness) Ensuring the principles of informed consent are upheld throughout the patient’s interaction within the MIT environment Treating all individuals with respect and dignity, providing care regardless of race, national or ethnic origin, colour, gender, sexual orientation, religious or political affiliation, age, type of illness, mental or physical ability 1.D - Protecting confidentiality Making every effort to ensure the physical privacy of the patient (provide gown, sheet, close door) Respecting the patient’s right to privacy of personal information (RIS access) Ensuring confidentiality of the patient’s health information and documentation; (ex: patient has AIDS and is divulged to co-workers).  CAMRT Code of Ethics & Professional Conduct 2. Maintaining competence Competence in disciplines of practice is key to delivering quality, patient-centered care. CAMRT members will fulfill their responsibility for competent practice by: o Performing only EXAMS for which the MIT has acquired competence. Example: Bill 90 in Quebec and acquiring new competencies and skills o Engaging in lifelong learning to maintain a consistent level of competence in their disciplines of practice, including accredited training and/or Continuing Professional Development (CPD) where required Store | (force.com)  BILL 90 - QUEBEC An Act to amend the Quebec’s Professional Code (The Professional Code is a Quebec law that governs the professional system of the province of Quebec, in Canada) and other legislative provisions in the health sector. It came into effect in 2003. Bill 90 permits a reflection on the evolution of the competencies of health care professionals in Quebec and makes their practice as autonomous as possible. BILL 90 AMMENDED SECTION 7 OF THE ACT RESPECTING MEDICAL IMAGING TECHNOLOGISTS, RADIATION ONCOLOGY TECHNOLOGISTS AND MEDICAL ELECTROPHYSIOLOGY TECHNOLOGISTS Section 7 of the Radiology Technologists Act (R.S.Q., chapter T-5) is replaced by the following section: The practice of MITs, and ROTs consists in using ionizing radiation, radioelements and other forms of energy for treatment or to produce images or data for diagnostic or therapeutic purposes. The following activities in the practice of medical imaging technology and radiation oncology are reserved to MITs: 1) administering prescribed medications or other prescribed substances 2) using ionizing radiation, radioelements or other forms of energy, according to a prescription 3) monitoring reactions to medications and other substances 4) introducing an instrument, according to a prescription, in and beyond the pharynx or beyond the urinary meatus, labia majora or anal margin or into a peripheral vein or artificial opening 5) mixing substances to complete the preparation of a medication, according to a prescription  CAMRT Code of Ethics & Professional Conduct 3. Evidence-based and reflective practice MRTs continually improve their practice to ensure the best possible patient care by committing to the principles of evidence-based and reflective practice. CAMRT members will fulfill their responsibility for best practice by: Delivering care based on professional judgements that consider their clinical experience and the patient’s needs Remaining current on MRT trends, basing their practice choices on evidence, and applying this knowledge to the clinical & research environments as deemed appropriate Using guidelines (institutional, regional, prov., fed.) in combination with clinical experience to reflect and continually improve their practice Promoting a culture of research in the MRT field, which will improve quality of evidence- based recommendations in the future  CAMRT Code of Ethics & Professional Conduct 4. Providing a safe environment The safety of all who come into contact with medical radiation technology is of paramount importance. CAMRT members will fulfill their responsibility for best practice by: Maintaining current knowledge of safety standards pertaining to the MRT’s practice and conducting all procedures and examinations in keeping with these standards. (e.g., COVID standard precautions) Ensuring a safe environment & taking steps to minimize exposure to potential risks (e.g., Workplace Hazardous Materials Information System (WHMIS) - radiation exposure, strong magnetic fields, risk of infection) Intervening in circumstances of abuse or unsafe, incompetent, or unethical practice  CAMRT Code of Ethics & Professional Conduct 5. Acting with professional integrity Professional integrity is key to maintaining trust in the MRT profession. CAMRT members show professional integrity by: Treating all persons with dignity and respect Always aspiring to a high level of professional efficacy Maintaining and enhancing personal well-being and never performing responsibilities when under the influence of substances or affected by any condition that could impede the quality or safety of care Complying with provincial, territorial, or federal laws and regulations Being accountable for professional actions and decisions, including errors committed Providing professional services that are safe, legal, and in the best interest of patients Ensuring all oral and written statements are truthful, clear, and concise Ensuring all professional activities are appropriate and are not a conflict of interest Upholding the profession by conducting all professional activities in a manner that will maintain public trust & confidence Making use of appropriate professional, institutional, or regulatory mechanisms to intervene when witness to abuse or unsafe, incompetent, or unethical practice while supporting colleagues who appropriately notify relevant authorities  Mrs Woo, a 75-year-old lady is the last patient of the day and arrives 5 minutes before the radiology clinic closing time. She is accompanied by a family member for a plain cervical spine x-ray exam. Her companion notifies the MIT that she is returning home after the exam is done and a follow up appointment with her MD is in a month. The exam starts at 17:25 after the patient slowly changes into a gown. Everyone in the clinic has left except for the MIT performing the exam. When reviewing the images, the MIT notices a severe compression of the spinal cord at the level of C4 which is commonly known by MITs as a primary indication of serious spinal instability that can lead to paralysis. After the examination is completed, the MIT informs the patient that the report will be sent to her MD and sends the patient home. What CAMRT code of ethic has been infringed by the technologist?  PROFESSIONAL INTEGRITY Ability to carry out professional activities in an honest, professional and ethical manner. To promote and support a climate of trust and fairness in all interactions with patients and their family members or companions, coworkers and other professionals.