WK11-PRINCIPLE-OF-LIABILITY-IN-HOSPOTAL-ADMINISTRATION PDF

LEADERSHIP AND MANAGEMENT 1st Year | A.Y. 2024-2025 Lecture: PRINCIPLE OF LIABILITY IN HOSPITAL ADMINISTRATION Prepared by:GROUP 7 Lecturer: DR. MARYAM- LIZBETH LEE- SAHIJUAN Date: 10/15/2024 PHYSICIAN-PATIENT RELATIONSHIP “P...

LEADERSHIP AND MANAGEMENT 1st Year | A.Y. 2024-2025 Lecture: PRINCIPLE OF LIABILITY IN HOSPITAL ADMINISTRATION Prepared by:GROUP 7 Lecturer: DR. MARYAM- LIZBETH LEE- SAHIJUAN Date: 10/15/2024 PHYSICIAN-PATIENT RELATIONSHIP “Principle of Informed Consent and Free Decision” Traditionally served as the Corner-Stone of health care in Informed Consent is the decision, which must be written, the country. “Begins when the patient requests treatment dated and signed, to take part in a procedure, taken freely and the physician agrees to render that treatment”. This after being duly informed of its nature, significance, relationship is CONTRACTUAL because it involves both an implications, risks and appropriately documented, by any offer and acceptance. This contractual relationship can person capable of giving consent or, where the person is exist as either an express contract or an implied contract not capable of giving consent, by his or her legal HEALTH-CARE RELATIONSHIP representative; Before an individual can bring a lawsuit to establish some “if the person concerned is unable to write, oral consent in form of liability against a health-care provider, the the presence of at least one witness may be given in individual must have established a relationship with the exceptional cases, as provided for in aid of legislation”. provider. Without this relationship, the parties to a lawsuit TERMINATING PHYSICIAN-PATIENT RELATIONSHIP are basically strangers who have no obligation to each The physician may withdraw from the contract other that could serve as the basis for a malpractice The patient may dismiss the physician lawsuit. The physician and patient may mutually agree to end the EXPRESS CONTRACT relationship In terms, Rights, and Responsibilities of the parties are IMPORTANT… agreed on either orally or in writing. It is established when If the physician decides to withdraw from the contract, he a physician and the patient agree, in advance, of any or she must give the patient a reasonable notice so that the treatment, on the amount the patient must pay, and what patient may obtain alternative treatment. treatment or result the physician will render for the Most often, termination is due to the fact that the patient payment is either cured or has died. IMPLIED CONTRACT HOSPITAL-PATIENT RELATIONSHIP It exist when the conduct of the parties and the The relationship begins when the patient is voluntarily circumstances of the situation create an understanding admitted to the hospital. that an agreement has been reached. The details of the At the time of admission, the patients signs certain forms, contract are not reached in advance of treatment since the agreeing to pay for the treatment that will be rendered. healthcare provider treats the patient prior to an The act establishes an express contract to receive health agreement on terms of payment and treatment care. CONSENT vs COVENANT Important… the hospital-patient relationship ends when “COVENANT” the patient is discharged or leaves the hospital against A usually formal, solemn, and binding agreement: medical advice. COMPACT A written agreement or promise usually under AS A GENERAL RULE… seal between 2 or more parties especially for the “A hospital does not have a responsibility to treat every performance of some action. It is a common-law action patient who arrives at its door”. The only exception to this to recover damages for breach of such a contract. rule is an emergency-care situation. “CONSENT” This rule has been modified… hospitals must have, at A permission for something to happen or agreement to minimum, a procedure for assessing whether an ill or do something. Is the voluntary agreement by a person in injured person who appears at the hospital`s door can be the possession and exercise of sufficient mentality to make treated at that hospital or be transferred to another facility an intelligent choice to allow something proposed by for appropriate treatment. another to be performed on himself or herself. It can As part of Anti-Deposit Law… it requires hospitals and either be express or implied consent. physicians to treat a patient who is in active labor or in an EXPRESS CONSENT emergency medical condition until the condition is A verbal agreement to undergo a medical procedure. stabilized. It can be accomplished through the execution of a signed Anti-detention law consent form. ONCE CONDITION IS STABILIZED In modern healthcare, written consent is the preferred There are 3 choices… method of obtaining consent. 1. continue to treat the patient Although the law requires consent for the intentional 2. transfer the patient touching that involves medical or surgical procedures to be 3. discharge the patient performed on a patient, “Exception do exist with respect to emergency situation” This relationship is not based on direct patient care, rather, INFORMED CONSENT it is based on the contract between hospital and physician Subject | Lecture no. 1 Ferviente 2028 LEADERSHIP AND MANAGEMENT 1st Year | A.Y. 2024-2025 Lecture: PRINCIPLE OF LIABILITY IN HOSPITAL ADMINISTRATION Prepared by:GROUP 7 Lecturer: DR. MARYAM- LIZBETH LEE- SAHIJUAN Date: 10/15/2024 that allows the physician to bring patients to the hospital Article 2180 to receive health care, thus, the hospital furnishes and The obligation imposed by article 2176 is demandable coordinates patient care along with the physician. not only for one own act or omissions, but also for those of persons for whom one is responsible. WHERE DOES RELATIONSHIP BEGINS “ diligence of a good father in the family” to prevent Relationship begins with the credentialing process. damage. In short, the mistake of a doctor, is the mistake In the Phil., mere being licensed as a physician is not of the hospital – vicarious liability of the employer. sufficient to become a member of a hospital`s medical staff. Employer/Employee CREDENTIALING PROCESS Involves… Superiors. 1. examination different chairperson in its respective Peers or Associates in Partnerships medical department Subordinates. 2. submission of supporting papers to the hospital Labor Organizations. credential committee office for screening of authenticity of documents. It is a doctrine under which the hospital is liable if it fails to 3. scheduling for an interview uphold the proper standard of care owed the patient, 4. endorsement of the applicant to the medical director which is to ensure the patient`s safety and well-being while 5. presentation to governing board of the hospital on the hospital. 6. admission as medical staff This theory creates a non-delegable duty… which the BEING A MEDICAL STAFF OF A HOSPITAL hospital owes directly to the patient. It is a mere… PRIVILEGE!!! An injured party does not have to rely on and establish The governing board of the hospital determines the the negligence of a third party. scope and limitations of the medical staff. This occurs when - when a health care corporation fails to They will review again, physician`s background, perform those duties it owes directly to the patient or to experience, and licensure against criteria established by anyone else to whom a duty may extend. the medical departments and specialties of the hospital. Important!!! The physician may exercise only those privileges that - If such duty is breached and a patient is injured, have been granted or be subject to a charge of practicing as a result of that breached, the institution can be held beyond the scope of his or her privileges. culpable under the theory of Corporate Negligence. Medical staff admission and privileges may be curtailed or Hospital is liable to a patient under the doctrine of terminated for a variety of reasons. corporate negligence for the negligent conduct of Among them; “the failure to meet applicable quality of independent physicians and who are neither employee nor care standards or misconduct by the physician”. agent of the hospital. Once allegedly charged… the physician may have the RIGHT to a formal hearing initially by the PEER HOW TO PREVENT CORPORATE NEGLIGENCE COMMITTEE, then later by the ETHICS BOARD, to challenge Effective credentialing the action taken against the physician. Continuing medical evaluation The hospital is allowed to politely suspend or restrict his Review programs for all members of a professional staff or her medical privileges to avoid imminent danger to patients and to the integrity of the quality care given by the The hospital generally owes a duty to ensure the hospital. competency of its medical staff and to evaluate the quality Hospitals have a DUTY to ensure that their medical staff of medical treatment rendered on its premise. are COMPETENT. Failure to perform this duty may result in a finding of Hospitals are in the best position to protect their patients direct liability to the patient and consequently have an independent duty to select and CORPORATE NEGLIGENCE retain competent independent physicians seeking staff the basic provision on quasi-delict, or culpa aquiliana or privileges. extra-contractual culpa, is article 2176 of the Civil Code which provides: RESPONDEAT SUPERIOR DOCTRINE “Whoever by act or omission causes damage to another, “Let the master answer” there being fault or negligence, is obliged to pay for the A common-law doctrine that makes an employer liable damage done. Such fault or negligence, if there is no pre- for the actions of an employee when the actions take place existing contractual relation between the parties, …is called within the scope of employment. a quasi-delict” An employee is an agent for her employer to the extent that the employee is authorized to act for the employer and Subject | Lecture no. 2 Ferviente 2028 LEADERSHIP AND MANAGEMENT 1st Year | A.Y. 2024-2025 Lecture: PRINCIPLE OF LIABILITY IN HOSPITAL ADMINISTRATION Prepared by:GROUP 7 Lecturer: DR. MARYAM- LIZBETH LEE- SAHIJUAN Date: 10/15/2024 is partially entrusted with the employer's business. The admission to the medical staff - procedures to be followed employer controls, or has a right to control, the time, place, in medical emergencies - procedures for the review and and method of doing work. When the facts show that an appraisal of the quality and appropriateness of medical employer-employee (principal-agent) relationship exists, care rendered by each physician. the employer can be held responsible for the injuries By laws provided in medical staff supervision and policies: caused by the employee in the course of employment. -procedures and responsibility for maintaining adequate medical records. - procedures for dealing with disruptive DOCTRINE OF RESPONDEAT SUPERIOR physicians and abuse - procedures corrective actions. - In the Healthcare setting, an organization is liable for the procedures for arranging medical consultations. negligent act of its employees, even though there has been MEDICAL FREEDOM no wrongful conduction on the part of the institution. Non-employee doctors are independent contractor The question of liability frequently rest on: - whether which means… that the hospital cannot be held persons treating a patient are independent agents; responsible for the doctor's medical malpractice, even if meaning they are responsible for their own acts. - the malpractice happened in the hospital. employees of the institution. INDEPENDENT CONTRACTOR-PHYSICIAN For liability to be imputed to the employer: - a master- HOSPITAL must be a total stranger servant relationship must exist between the employer and It has no control or supervision over one`s physician in the employee. - the wrongful act of the employee must the exercise of his medical profession. have occurred within the scope of his or her employment. Relationship of hospital and consultants whether active Basic rationale - Imposing liability on an employer or visiting. --- DOCTORS are “employees” of the hospital. developed because the employer possesses the right to HOSPITAL exercise significant control in the hiring and control the physical acts of its employees. - Generally, the firing a consultants and in the conduct of their works within plaintiff’s attorney will file suit againts both the employer the hospital premises. and the employee. INDEPENDENT PHSICIAN - Not only may the injured party sue the employee directly, An organization’s independent duty to select and but also the employer, if sued may seek indemnification maintain a competent medical staff does not require an from the employee - The plaintiff has the burden for organization to fulfill its duty of reasonable care, to establishing an employee- employer relationship. - This is supervise a physician’s clinical practice. difficult in case of independent physicians. organization can not be held liable under the doctrine of - An officer or Director of a hospital is not, merely as a result corporate negligence for granting privileges to a non- of his or her position, personally liable for the torts of the employee doctor who commits malpractice while in his or employee. - To incur liability, the Director must be shown her private clinic of an organization`s premise. to have in some way or another participated in or directed INDEPENDENT CONTRACTOR-PHYSICIAN the tortous act. A consultantt who regularly fall short of the minimum standards acceptable to the hospital or its peer review BORROWED SERVANT DOCTRINE committee…. is normally and politely TERMINATED. A principle under which the party usually liable for a HOSPITAL KEEPS AN INCOMPETENT DOCTOR ON STAFF person’s actions—e.g., a hospital which has employed a A number of cases hold the hospital responsible if it gives particular nurse—is absolved of responsibility when that staff privileges to an incompetent or dangerous doctor, 'borrowed servant' is asked to do something- e.g., by a even if the doctor is an independent contractor. The surgeon—which is outside of the bounds of hospital policy hospital is also responsible if it should have known that a CAPTAIN OF THE SHIP DOCTRINE previously safe doctor had become incompetent or is a principle of medical-malpractice law, holding a dangerous. surgeon liable for the actions of assistants who are under HOSPITAL LIABILITY… the surgeon's control but who are employees of the For example, if a doctor becomes severely addicted to hospital, not the surgeon. drugs and the hospital management knew about it, or it The surgeon as "the captain of the ship," is directly was so obvious they should have known about it, a patient responsible for an alleged error or act of alleged negligence injured by that doctor can sue the hospital. because he or she controls and directs the actions of those A doctor is more likely to be an employee (rather than an in assistance. This common law doctrine is often used in independent contractor) if: operating room situations. the hospital controls the doctor's working hours Medica Staff and vacation time. By laws provided in medical staff supervision and policies: the hospital sets the fees the doctor can charge. -application requirements for clinical privileges and Exceptions: Subject | Lecture no. 3 Ferviente 2028 LEADERSHIP AND MANAGEMENT 1st Year | A.Y. 2024-2025 Lecture: PRINCIPLE OF LIABILITY IN HOSPITAL ADMINISTRATION Prepared by:GROUP 7 Lecturer: DR. MARYAM- LIZBETH LEE- SAHIJUAN Date: 10/15/2024 When Hospitals Are Liable for Non-Employee Doctors' ANOTHER EXAMPLE….. Actions…. However, if a doctor makes a mistake and injures a patient Even if a hospital would generally not be liable for an while working in the hospital, the hospital will not be liable independent contractor doctor's malpractice, a hospital for the doctor's mistake unless the doctor is an employee… may be held responsible in certain situations. A medical error is defined as a mistake made by a health EMPLOYER-EMPLOYEES RELATIONSHIP DOCTRINE… care professional, which can result in injury or death to the When an employer hires a new employee, he is not just patient. bringing a new member of the workforce aboard, he is also Medical error is a form of medical malpractice because starting a new relationship. the mistake often constitutes a failure to meet medical Because employers and employees often work in close standards of practice, which would preclude such errors. quarters, they necessarily develop relationships. Medical error is the cousin of medical negligence, which Managing these relationships is vital for success in involves a medical professional’s failure to act in meeting medical administrative management. professional standards CONTROL TEST: MEDICAL ERRORS…. The selection and engagement of the employee Hospitals can be held liable for any type of medical error The payment of wages that occurs within their facilities or as a… “result of their The power of dismissal medical professional staff’s actions or negligence”. The power to control the employee`s conduct The most important elements to establish employer- PATIENT’S LEGAL RIGHTS TO A MEDICAL MALPRACTICE employees relationship CLAIM ARE DOCTORS HOSPITAL EMPLOYEES? Citizens have a constitutional right to seek compensation Whether a doctor is a hospital employee depends on the when they suffer harm at the hands of hospitals or medical nature of his or her relationship with the hospital. Though professionals. In addition to protecting other patients from some doctors are hospital employees, most doctors are subsequent harm, medical malpractice lawsuits can help not. victims and their families seek compensation for: HOSPITAL APPEARED TO BE THE DOCTOR'S EMPLOYER Loss of wages and reduced earning potential If the hospital does not make it clear to a patient that the Medical care costs doctor is not an employee,… the patient can sue the Out of pocket expenses hospital for the doctor's malpractice. Quality of life Hospitals attempt to avoid this problem by informing Loss of a child, spouse or other loved one patients in the admission forms that the doctor is not a Disfigurement hospital employee. Disability QUESTION??? Pain If you are injured when receiving treatment in a hospital, Loss of fertility can you sue the hospital for negligence or medical Loss of limb or sight malpractice? And more related damages Though hospitals are often on the hook for incompetent care provided by employees like paramedics, nurses, and A hospital can be held vicariously liable for the negligent medical technicians, they often are not responsible for a act of a physician providing care at the hospital, regardless doctor's medical malpractice. of whether the physician is an independent contractor, Hospitals Are Liable for Employee Actions… unless the patient knows, or should have known, that the If someone is an employee of a hospital, …the hospital is physician is an independent contractor. responsible (liable) if that employee hurts a patient by in general, hospital is not liable for the negligence of an acting incompetently. independent contractor-physician. In other words, if the employee is negligent (is not There is an exception to this principle… reasonably cautious when treating or dealing with a “ the hospital may be liable if the physician is the “ patient), the hospital is on the hook for any resulting ostensible agent” of the hospital. injuries to the patient. DOCTRINE OF APPARENT AUTHORITY Keep in mind that not every mistake or unfortunate event that happens in a hospital rises to the level of negligence. FOR A HOSPITAL TO BE LIABLE UNDER THE DOCTRINE OF Typically, nurses, medical DOCTORS, and paramedics are APPRENT AUTHORITY hospital employees. As long as the employee was doing The hospital or its agent, acted in a manner that would something job related when he or she injured the patient, lead a reasonable prudent person to conclude that the the patient can sue the hospital. Subject | Lecture no. 4 Ferviente 2028 LEADERSHIP AND MANAGEMENT 1st Year | A.Y. 2024-2025 Lecture: PRINCIPLE OF LIABILITY IN HOSPITAL ADMINISTRATION Prepared by:GROUP 7 Lecturer: DR. MARYAM- LIZBETH LEE- SAHIJUAN Date: 10/15/2024 individual who was alleged to be negligent was an employee or agent of the hospital. Where the acts of the agent create the appearance of authority and the hospital has knowledge on it. The plaintiff acted in reliance upon the conduct of the hospital or its consistent with ordinary care and prudence Additional Info: Subject | Lecture no. 5 Ferviente 2028