Download Medical/Legal Issues & Professional Ethics

Medical/Legal Issues &
Professional Ethics
Rad Tech A – Week 14
The Importance of a
Professional Ethic
Ethics: the systematic study of
rightness and wrongness of
human conduct and character as
know by natural reason
Professional Ethic: the ethical
conduct of a profession
Definitions
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Ethics – The systematic study of rightness and
wrongness of human conduct and character as
known by natural reason.
Morals – Generally accepted customs,
principles, or habits of right living and conduct in
a society and the individual’s practice in relation
to these.
Values – Ideals & customs of a society toward
which the members of a group have an affective
regard; a value may be a quality desirable as an
end in itself.
Professional Ethics
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Internal controls of a profession based on
human values or moral principles.
Standards of conduct beyond mere
conformity to law.
Professionals may encounter conflicting
values or belief systems that can
compromise patient care.
ARRT Code of Ethics
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A guide by which RT’s and Candidates
may evaluate their professional conduct as
it relates to patients, health care
consumers, employers, colleagues, &
other members of the health care team.
Comprised of 10 principles
ARRT Code of Ethics
Appendix D pg. 435
1.
2.
3.
4.
5.
Professional manner, respond to pt
needs, support colleagues
Provide services to humanity w/ full
respect for mankind
Delivers pt care without discrimination
Practices & uses equipment appropriately
Acts in the best interest of the pt.
ARRT Code of Ethics
6. Obtains pertinent info for physician
7. Practices in accordance with accepted
standards, minimizes radiation exposure
8. Practices ethical conduct
9. Respects confidences and pt right to
privacy
10. Strives to improve knowledge & skills by
participating in C.E.
Ethical Dilemma
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Situation requiring moral judgment
between two or more equally “right”
alternatives. There are two or more
competing norms.
Four components to solve an ethical
dilemma:
1. Identify the problem
2. Develop alternative solutions
3. Select the best solution
4. Defend your selection
“I Think Dr. Jones Misread the Film”
You have just finished a routine radiologic procedure on
Mrs. Green. As you develop the film, it becomes clear
that Mrs. Green is probably suffering from a rare form
of bone disease. Dr. Jones, a young resident, glances
at the film and smiles. “I didn’t think Mrs. Green had
anything to worry about,” he says. “That joint pain
she was complaining about must be all in her head.”
Later, you see Dr. Jones talking to Mrs. Green’s family.
He is smiling and joking with them as he signs Mrs.
Green’s discharge papers. Shaken, you mutter to
yourself, “I think Dr. Jones misread the film.” What
should you do”
Ethical Theories
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Consequentialism – Evaluates the
rightness or wrongness of ethical decisions
by assessing the consequences on the pt.
Nonconsequentialism – Belief that actions
themselves, rather than consequences,
determine the worth of actions; actions
are right or wrong according to the
morality of the acts. Ex: Lying to a pt if
the lie might ultimately benefit the pt
Moral Principles
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Beneficence – Bringing about good
Nonmaleficence – Preventing harm, to do
no harm
Autonomy – Self-reliance, independence,
liberty rights, individual choice, freedom of
will
Veracity – Telling the truth
Fidelity – Being faithful
Justice – Acting with fairness or equity
Medical/Legal Issues
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The liability of the technologist is not the
same as the radiologist involved, but the
liability is potentially real.
Although the law is often a mirror image
of the failures of medicine, it is also a
book of lessons from which we can learn.
Causes of Legal Action
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Approx 10% of all medical negligence
claims are somehow related to diagnostic
imaging.
Medical Negligence – failure to use such
care as a reasonably prudent health care
professional would use in similar
circumstances.
Schloendorf v.
Society of New York Hospital
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Basic principle of law and lays a
foundation for the relation between
patients and health care practitioners.
Every human being of adult years and
sound mind has a right to determine what
shall be done with his own body, and a
surgeon who performs an operation
without his patient’s consent commits an
assault, for which he is liable in damages.
Doctrine Serves 6 Functions
1.
2.
3.
4.
5.
6.
Protects individual autonomy
Protects pt status as a human being
Avoids fraud and duress
Encourages health care practitioners to
consider their decisions carefully
Fosters rational decision making by the
pt
Involves the public in medicine
Standard of Care
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Degree of skill (proficiency), knowledge,
and care ordinarily possessed & employed
by members in good standing within a
profession.
To test whether the standard of care has
been met, one must determine what a
reasonable, prudent practitioner would
have done under similar circumstances.
Practice Standards for
Radiography Appendix A pg. 411
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Developed by a group of medical imaging
professionals & adopted by ASRT
Outline the practice of medical imaging in
three areas of Performance Standards:
1. Clinical Performance Standards
2. Quality Performance Standards
3. Professional Performance Standards
Causes of Legal Action
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Approx 10% of all medical negligence
claims are somehow related to diagnostic
imaging.
Medical Negligence – failure to use such
care as a reasonably prudent health care
professional would use in similar
circumstances.
Patient Fall in Radiology Dept
~NEGLIGENCE~
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Favalora v. Aetna Casualty & Surety Co.
Pt. admitted to hospital for general checkup &
GI series.
Pt complaint: Stomach pains, general fatigue,
and fainting.
While undergoing x-ray exam, pt fainted, fell,
and fx’d her neck & femur – requiring surgery.
Surgery caused a pulmonary embolism
Radiologist was negligent for not securing
medical hx prior to exam, pt won lawsuit.
Four Elements to Prove
Negligence
1.
2.
3.
4.
Must establish a duty to the patient by
the health care provider
Breach of this duty by an act or by failing
to perform some act.
A compensable injury
A causal relation between the injury and
the breach of duty.
Cause of Legal Action
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Tort – Civil wrong committed by one
individual against another. May be
classified as either intentional or
unintentional. This type of claim arises
from a breach of duty.
Assault – Any willful attempt or threat to
inflict injury on the person and any
intentional display of force that would give
the victim reason to fear or expect
immediate bodily harm.
Cause of Legal Action
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Battery – An unlawful touching of another
that is without justification or excuse.
False Imprisonment – Conscious restraint
of another without proper authorization,
privilege, or consent.
Defamation – Holding up a person to
ridicule, scorn, or contempt in a
respectable & considerable part of the
community.
Patient Rights &
Responsibilities
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Patient rights informs the pt of the right to
be well informed, to participate in
treatment decisions, and to communicate
openly with the physicians.
Patient also has the responsibility to
provide accurate medical history, to ask
questions, and inform if pt is unable to
follow treatment.
Hospitals may (and do) list other very
specific responsibilities.
Res Ipsa Loquitur
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The thing speaks for itself
Burden of proof shifts from the plaintiff to the
defendant.
Must have 3 elements:
1. Type of injury did not occur except for
negligence.
2. Activity was under complete control of
defendant.
3. Plaintiff did not contribute to his own
injury
Res Ipsa Loquitur
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Franklin v. Collins Chapel Correctional
Hospital
82 yr. senile female – wrongful death after
sustaining 3rd degree water burns while
bathing
Res Ipsa Loquitur - Injuries suffered by
the resident do not occur in a nursing
facility in the absence of negligence, and
the deceased was in the defendant’s sole
care custody & control.
Respondeat Superior
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The master speaks for the servant; the
master is liable in certain cases for the
wrongful acts of his or her servants.
“Deep Pockets” approach.
If a radiographer is sued, the hospital and
physician would also be named as
defendants. Well established theory that
the physician or health care facility is
responsible for the negligent acts of its
employees.
Corporate Liability
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Requires the hospital or health care entity
to be responsible for the quality of care
delivered to consumers.
Health care corp. must assess & evaluate
the quality of care delivered & must be
prepared to make changes as needed.
The corp. may be required to intervene if
suboptimal care is being provided by one
of its independent contractors.
Informed Consent
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A person’s agreement to allow something
to happen (i.e surgery) that is based on
full disclosure of the facts: knowledge of
benefits, risks, and alternatives to the
procedure.
Required when a patient is subjected to
any type of invasive procedure.
If the pt consents to a procedure & then
revokes the consent, the doctor must stop
the procedure.
Documentation
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In court, if you testify that you properly
assessed the patients medical risk and
obtained consent from the patient verbally
prior to the examination; will that serve as
meeting the Technologist Standard of
Practice?
HIPAA
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The Health Insurance Portability and
Accountability Act of 1996 mandates that federal
laws or regulations ensure the confidentiality of
medical records.
Patients or representatives should have access
to all records except in the event the provider
feels that it is not in the best interest of the
patient’s health to have access or if the
knowledge of the health care information could
cause danger to the life or safety of any person.
HIPAA
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Health Insurance Portability and
Accountability Act
Privacy of records and confidentiality
Confidentiality standards establish
guidelines for the storage, access, and
transmission of individual health
information.
Patients must authorize the release of
health information.
HIPAA
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Within radiology:
Technologists are sometimes asked by
patients if they can examine their records
while in transit, waiting for a procedure or
undergoing an examination. The record
information should not be shred with the
patient in this fashion as this may lead to
misinterpretation of information.
HIPAA Video
Must be viewed prior to observing at our affiliated hospitals.
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Be careful ….. the walls sometimes have
ears
Schedule for video
Case Study – Life or Death, the right to
choose
Pt. Vega & her husband (Jehova’s Witnesses) signed a
release requesting that no blood or blood products be
administered to her during her hospital stay to deliver a
baby. Following her delivery, she began to bleed heavily.
Her doctor ordered a D&C which she agreed to but
refused a blood transfusion. She continued to bleed and
was eventually transferred to the ICU. Her doctors told
her that she would die if she did not receive the blood
transfusion. Both her and her husband continued to
refuse the blood transfusion. Because her doctor and the
hospital felt that it was essential for her to receive the
blood, they filed a complaint requesting that the court
issue an injunction that would permit the hospital to
administer the blood transfusion.