Faculty of Medicine University of Jaffna Sri Lanka Health & Medical Essay

Nursing homework help

Florida National University HSA-5425 Health Care Law and Legislation: Week 2 Critical Reflection Paper: Chapters 4 to 6 Objective: To judgmentally reproduce your understanding of the readings and your skill to apply them to your Health care Setting. ASSIGNMENT GUIDELINES (10%): Students will critically appraise the readings from Chapter 4 to 7 in your textbook. This assignment is planned to help you assessment, examination, and apply the readings to your Health Care setting as well as become the foundation for all of your remaining assignments. You need to read the article (in the additional weekly reading resources localize in the Syllabus and also in the Lectures link) assigned for week 1 and develop a 2-3-page paper reflecting your understanding and ability to apply the readings to your Health Care Setting. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page. Similarity SafeAssign is required. EACH PAPER SHOULD INCLUDE THE FOLLOWING: 1. Introduction (25%) Provide a short-lived outline of the meaning (not a description) of each Chapter and articles you read, in your own words. 2. Your Critique (50%) What is your reaction to the content of the Chapters? What did you absorb about the tort law and their purpose? What did you acquire about criminal law, its classification and purpose? What did you learn about contract, the elements of a contract and the contract law? Did these Chapter and articles change your thoughts about the civils procedures, trial process and the purpose of the Judge’s charge to the jury? If so, how? If not, what remained the same? 3. Conclusion (15%) Rapidly summarize your thoughts & assumption to your critique of the articles and Chapter you read. How did these articles and Chapters impact your thoughts about the more common crimes that occur in the healthcare setting? Evaluation will be based on how clearly you respond to the above, in particular: a) The clarity with which you critique the articles; b) The depth, scope, and organization of your paper; and, c) Your conclusions, including a description of the impact of these articles and Chapters on any Health Care Setting. ASSIGNMENT RUBRICS Assignments Guidelines 10 Points Introduction 25 Points Your Critique 50 Points Conclusion 15 Points Total 100 points ASSIGNMENT GRADING SYSTEM A B+ B C+ C D F Dr. Gisela LLamas 90% – 100% 85% – 89% 80% – 84% 75% – 79% 70% – 74% 60% – 69% 50% – 59% Or less. 10% 25% 50% 15% 100% Chapter 4 Criminal Aspects of Health Care Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. LEARNING OBJECTIVES ▪ Explain what criminal law is, the classification of crimes, and its purpose. ▪ Describe several of the more common crimes that occur in the healthcare setting. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describe the criminal procedure process from arrest through trial. Criminal law ▪ What is the purpose of criminal law? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Criminal law (also known as penal law) is the body of statutory and common law that deals with crime and the legal punishment of criminal offenses. Purpose of Criminal Law ▪ Maintain Public Order & Safety ▪ Use Punishment as a Deterrent ▪ Provide for Criminal Rehabilitation ▪ What are the definitions of a crime, misdemeanor & felony? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Protect Individuals Definitions ▪ Crime – social harm defined & made punishable by law. ▪ Felony – imprisonment in a state or federal prison for more than a year. ▪ What is an arraignment? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Misdemeanor – offense punishable by less than 1 year in jail and/or a fine. Complaint, Investigation & Arrest Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Components of a Crime ▪ act itself (the actus reus or guilty act); ▪ requisite mental state/intent (the mens rea or guilty mind); and ▪ causation; harm that is the result of the act that was committed. The accused performed the act that caused the harm with the intent to cause that harm. Arraignment ▪ Formal reading of the accusatory instrument ▪ What is the purpose of a conference with the defendant and prosecutor? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ a generic term that describes a variety of documents, each of which accuses a defendant of an offense ▪ includes the setting of bail Indictment ▪ A formal charge or accusation of a serious crime. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Conference ▪ Meeting for purposes of deliberation ▪ Commences with the goal of an agreed-upon disposition ▪ If no disposition can be reached, a case may be assigned to a trial court. ▪ Describe the process of conducting a criminal trial. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Plea bargaining time Criminal Trial – I ▪ Jury selection ▪ Presentation of witnesses & evidence ▪ Standard of proof must be beyond a reasonable doubt. ▪ Summations © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Opening statements Criminal Trial – II ▪ Instructions to the jury by the judge ▪ Verdict ▪ must be unanimous ▪ Sentencing ▪ Opportunity for appeal ▪ What does the False Claims Act of 1986 prohibit? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Jury deliberations Health Care Fraud ▪ Unlawful Act generally deception for personal gain. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ FBI Primary agency for exposing & investigating healthcare fraud. False Claims Act – 1986 ▪ Knowingly presenting a false claim for payment. ▪ conspiring to defraud the government. ▪ making a false record to avoid an obligation to pay or transmit property to the government. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ making a false record to get a false claim paid. Ethics in Patient Referral Act – 1989 ▪ Requires Medicare providers to report the names & provider numbers of all physicians or their immediate relatives with ownership interests in a provider entity. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Prohibits physicians who have ownership interest or compensation arrangements with a clinical laboratory from referring Medicare patients to that laboratory. HIPPA -1989 ▪ Requires U.S. Attorney General & Secretary of DHHS, acting through the Office of Inspector General (OIG), to establish a national healthcare fraud & abuse control program. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Provides criminal & civil enforcement tools & funding to fight against healthcare fraud. Schemes to Defraud ▪ Billing for services not rendered ▪ Misrepresenting procedures performed to obtain payment for noncovered services ▪ Upcoding services (billing for a more costly service than the one actually performed, Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Falsifying a patient’s diagnosis to justify tests, surgeries, or other procedures that are not medically necessary Schemes to Defraud – II ▪ Billing for unnecessary services (services that are not medically indicated) ▪ Accepting kickbacks for patient referrals ▪ Waiving patient co-pays or deductibles ▪ Overbilling insurance carrier or benefit plan. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Unbundling (billing each stage of a procedure as if it were a separate procedure) Kickbacks ▪ Laboratory © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Architectural Contract Health Care Fraud: Text Cases ▪ Scheme to Defrauding Medicare & Medicaid ▪ Pharmacist Submits False Drug Claims ▪ Inflating Insurance Claims © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ False Medicaid Claims ▪ Physician & Office Manager Health Care Fraud: Text Cases – II ▪ Falsification of Records ▪ Misuse & Theft of Drugs ▪ Homecare Fraud Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Fraudulent Billing: Lab Tests Physicians Victims of Fraud How to Prevent Office Fraud ▪ familiarize themselves with patient billing & record keeping practices ▪ Conduct annual audit of office procedures & records Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Avoid having one person in charge of both billing & collection process Falsification of Records ▪ Anyone who suffers damage as a result of falsification of records may claim civil liability. ▪ The provider could lose Medicare & Medicaid funding. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Falsification of medical & business records is grounds for criminal prosecution. Fraud & Ethics ▪ Behind every act of healthcare fraud lies a lapse in ethics. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Patient Abuse ▪ Mistreatment or neglect of patients © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Types of abuse ▪ Physical ▪ Psychological ▪ Medical ▪ financial Misuse and Theft of Drugs ▪ Internet Pharmacy © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Failure to review patient prescriptions prior to dispensing. ▪ Fraudulent billing. ▪ Transfer of funds to offshore account. Physicians: Victims of Fraud Prevention ▪ Familiarize themselves with patient-billing & recordkeeping practices. ▪ Arrange for an annual audit of office procedures & records by an outside auditor. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Avoid having one individual in charge of billing & collection procedures. Forms of Abuse ▪ Physical ▪ Medical ▪ Financial © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Psychological CRIMINAL NEGLIGENCE ▪ Abuse & Revocation of License ▪ Abusive Search ▪ Cruelty to the Infirm © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Neglect of Residents HOMICIDE ▪ Unusual Number of Deaths ▪ Fatal Injection of Pavulon © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Nurse Sentenced for Diabolical Acts Removal of Life Support Not Murder ▪ No duty to continue use once it has become futile & ineffective to do so Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Generally duty to provide life-sustaining equipment in immediate aftermath of cardiopulmonary arrest. Manslaughter Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Commission of an unintentional act that results in the death of another person. ▪ Voluntary manslaughter: intentional killing of another person without premeditation or malice of forethought ▪ Involuntary manslaughter: negligent act that occurs when defendant does not intend to kill the victim but acted in a criminally negligent or reckless manner that resulted in a death. Rape & Sexual Assault ▪ Statutory rape occurs when a person under the age of legal consent has sexual intercourse with another. ▪ Text Case: Dupree v. Plantation Pointe ▪ plaintiff’s mother sexually assaulted at the nursing home by a dementia patient. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Rape occurs when one person is forced, without giving consent, to have sexual intercourse with another. Theft ▪ Cost Millions Annually ▪ Staff Valuables ▪ Supplies ▪ Medical Equipment ▪ Text Case: ▪ Commingling Resident’s Personal Funds © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Patient Valuables Review Questions © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. What are the objectives of criminal law? 2. Describe the difference between a misdemeanor & a felony. Give an example of each. 3. List the processes of a criminal trial. 4. Why has health care fraud been so costly? Review Questions – II Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. Based on cases in the chapter, discuss why physicians historically have been reluctant to remove a patient’s life-support systems. 2. Discuss why you believe patients are sometimes reluctant to complain about their health care. Chapter 1 Reflections of the Past Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com History is relevant to understanding the Past, defining the Present, and influencing the Future. Who Am I? © 2014 Jones and Bartlett Publishers 3 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com I was Created at the End of the Renaissance, Watched Pirates Rule the Oceans, As Ivan the Terrible Ruled Russia, And witnessed the arrest of Galileo, For Believing the Earth Revolved Around the Sun. I AM HISTORY Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again. −Maya Angelou Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com We can learn from history how past generations thought and acted, how they responded to the demands of their time and how they solved their problems. We can learn by analogy, not by example, for our circumstances will always be different than theirs were. The main thing history can teach us is that human actions have consequences and that certain choices, once made, cannot be undone. They foreclose the possibility of making other choices and thus they determine future events. —Gerda Lerner Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Those who cannot remember the past are condemned to repeat it.” —George Bernard Shaw LEARNING OBJECTIVES ▪ Explain how advances in medicine through the ages led to the rise of the modern day hospital and improving the quality of patient care. © 2014 Jones and Bartlett Publishers 7 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Discuss how the conflicts of society due to politics, religion, and warfare have often impeded the growth of hospitals, as well as, contributed to their progress. LEARNING OBJECTIVES © 2014 Jones and Bartlett Publishers 8 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describe how knowledge gained from best practices (e.g., infection control) can lead to progress while at the same time result in patient harm if not consistently followed over time. Early Hindu & Egyptian Hospitals ▪ 6th century BC: Buddha appointed a physician for every 10 villages Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ built hospitals for the crippled & the poor; ▪ Provided Fresh Fruits & Vegetables ▪ Administered Medications ▪ Provided Massages ▪ Maintained Rules of Personal Cleanliness Hindu Physicians © 2014 Jones and Bartlett Publishers 10 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Took Daily Baths ▪ Keep Hair & Nails Short ▪ Wore White Clothes ▪ Respected Confidence of Patients Egyptian Physicians ▪ Used Castor Oil & Opium ▪ Surgery mostly limited to Fractures ▪ Medical Care in the Home ▪ Temples functioned as Hospitals © 2014 Jones and Bartlett Publishers 11 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Used Wooden Mallet for Anesthesia Greek & Roman Hospitals © 2014 Jones and Bartlett Publishers 12 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hospital derives from Latin word hospitalist, which relates to guests & their treatment ▪ Early use of these institutions not merely as places of healing but as havens for the poor & weary travelers ▪ Medical Practice Rife with Mysticism Greek Temple Medicine – I © 2014 Jones and Bartlett Publishers 13 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hospitals first appeared in Greece as Aesculapia ▪ named after Greek god of medicine ▪ Patients Presented Gifts before Altar ▪ Greek Temples – Refuge for Sick ▪ Holistic Medicine – Body & Soul ▪ Medications – Salt, Honey, Sacred Springs ▪ Hot & Cold Baths ▪ Sunshine, Sea Air, Pleasant Vistas ▪ Libraries for Visitors Temple at Epidaurus ▪ 1st Clinical records © 2014 Jones and Bartlett Publishers 14 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Inscribed on columns of temple ▪ Recorded ▪ Patients Names ▪ Brief Histories ▪ Treatment Outcomes Hippocrates – The Physician ▪ Noted for: © 2014 Jones and Bartlett Publishers 15 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Principles of Percussion & Auscultation ▪ Performed surgery ▪ Wrote about fractures ▪ Described Epilepsy, TB, Malaria, & Ulcers ▪ Maintained detailed records Hospitals of the Early Christian Era © 2014 Jones and Bartlett Publishers 16 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hospitals Outgrowth of Religion ▪ Care included – Magical & Religious Rites ▪ Doctrines of Jesus – Love & Pity ▪ Sick treated outside temples & churches Islamic Hospitals ▪ home to world’s oldest known teaching hospital © 2014 Jones and Bartlett Publishers 17 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Luxurious hospital accommodations frequently provided School at Gundishapur ▪ Medical care free ▪ Gundishapur Persian Physician Rhazes © 2014 Jones and Bartlett Publishers 18 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Skilled in Surgery ▪ Used Sheep Intestines for Suturing ▪ Cleansed Wounds with Alcohol ▪ 1st descriptions of smallpox & measles Islamic Medicine – I © 2014 Jones and Bartlett Publishers 19 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Inhalation Anesthesia ▪ Precautions against Adulterated Drugs ▪ Origination of New Drugs ▪ Asylums for Mentally Ill ▪ Brilliant beginnings in Medicine ▪ Promise that glowed in early medicine not fulfilled ▪ Wars, Politics, Superstitions, stunted growth Early Military Hospitals – I ▪ Limestone pillar – 2920 B.C. ▪ Moses laid down rules of Military Hygiene ▪ Hippocrates – “war is the only proper school for a surgeon” ▪ Under Romans, Surgery Advanced ▪ Experience through military surgery © 2014 Jones and Bartlett Publishers 20 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Pictures illustrating wounded Medieval Hospitals – I Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Religion – dominant influence in hospitals ▪ England built Municipal Hospitals ▪ Military Hospitals during Crusades ▪ Lazar Houses Established Hotel Dieu of Paris © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Provided rooms for various stages of disease ▪ Provided room for Convalescents ▪ Provided room for Maternity Patients ▪ Two persons often shared 1 bed ▪ Draperies not washed, infection spread ▪ Patients often worked on hospital’s farm Dark Age of Hospitals © 2014 Jones and Bartlett Publishers 23 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hospitals Commonly crowded patients into one bed ▪ Monks preserved the writings of Hippocrates ▪ Al-Mansur Hospital, built in Cairo in 1276 ▪ Equipped with separate wards for the more serious diseases ▪ laid the groundwork for hospital progress to come in later centuries Hospitals of the Renaissance – I © 2014 Jones and Bartlett Publishers 24 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Building of hospitals continued ▪ New Drugs ▪ Anatomy – Recognized Study ▪ New writings Printed ▪ New writings Printed ▪ Dissections Performed ▪ Surgery was more scientific ▪ Van Leeuwenhoek- Microscope Hospitals of the Renaissance – II ▪ 16th Century © 2014 Jones and Bartlett Publishers 25 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hospitals associated with Catholic Church ordered by Henry VIII to be given over to secular uses or destroyed ▪ Sick Turned into Streets ▪ Hospitals conditions intolerable ▪ St. Bartholomew’s restored Hospitals of the Renaissance – III ▪ Long robed surgeons ▪ Short robed surgeons (barber-surgeons) ▪ Generally allowed only to leech & shave © 2014 Jones and Bartlett Publishers 26 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Trained in universities ▪ Permitted to perform all surgeries ▪ Royal College of Surgeons founded-1540 Hospitals of the 18th Century ▪ Royal College of Physicians Establishes Dispensary © 2014 Jones and Bartlett Publishers 27 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Medications Distributed at cost to Poor ▪ Free Medical Care for Poor ▪ Controversies & lawsuits ▪ Untimely End to Early Clinic Westminster Charitable Society ▪ Infirmary built – voluntary subscription ▪ Staff provide services gratuitously ▪ Deterioration of hospitals continues © 2014 Jones and Bartlett Publishers 28 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Established Similar Dispensary in 1715 ▪ Established Westminster hospital in 1719 Early Hospitals in the U.S. – I ▪ Manhattan Island ▪ Philadelphia ▪ 1st Almshouse Established – Philadelphia ▪ The Pennsylvania Hospital – 1st chartered ▪ Williamsburg, VA ▪ Site of 1st Psychiatric Hospital © 2014 Jones and Bartlett Publishers 29 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ 1st account of hospital for sick soldiers Early Hospitals in the U.S. – II © 2014 Jones and Bartlett Publishers 30 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hotel-Dieu Paris, Dr. Jones wrote ▪ 3-5 patients placed in 1 bed ▪ Convalescent patients placed with dying ▪ Fracture cases placed with infectious cases ▪ 1/5th of 22,000 patients died each year ▪ Patient wounds washed with same sponge ▪ Infection rate said to be as high as 100% ▪ Mortality after amputation as high as 60% Early Hospitals in the U.S. – III © 2014 Jones and Bartlett Publishers 31 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Increase in Surgical Procedures ▪ Inappropriate Wound Care Administered ▪ Wards Filled with Discharging Wounds ▪ Nurses of that period are said to have used snuff to make conditions tolerable Late 19th Century Renaissance – I ▪ Nurses used Snuff to make Conditions Tolerable ▪ Same Bed Linens Served Several Patients ▪ Mortality from Operations 90 to 100% © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ OR Coats Worn for Months without Washing Late 19th Century Renaissance – II ▪ Florence Nightingale improves care ▪ Crawford Long uses ether as anesthetic to remove small tumor ▪ American Medical Association founded – 1847 ▪ Chloroform 1st used as an anesthetic – 1847 © 2014 Jones and Bartlett Publishers 33 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Considered 1st hospital administrator ▪ Founded Nightingale School of Nursing – 1860 Mass General Hospital – 1846 ▪ Surgery at Operating Theater – Mass General © 2014 Jones and Bartlett Publishers 34 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ W.T.G. Morgan Develops Sulfuric Ether ▪ Morgan arranges for 1st operation under Anesthesia, using ether vapors W.T.G. Morgan ▪ Patient did not Scream ▪ “Gentlemen,” Dr. Warren proclaimed, “this is no humbug!” ▪ Discipline of anesthesiology was born. © 2014 Jones and Bartlett Publishers 35 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Morgan performed surgery with on looking skeptical audience ▪ Audience Astonished Semmelweis Of Vienna ▪ Determined Deaths from Puerperal Fever of Maternity patients © 2014 Jones and Bartlett Publishers 36 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ due to infections transmitted by students leaving dissecting room to take care of maternity patients without washing hands. Civil War Days © 2014 Jones and Bartlett Publishers 37 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ As many as 25 to 50 beds in ward ▪ Little provision for segregation of patients. Roosevelt Hospital – 1871 ▪ became know as the American plan © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Built on lines of pavilion ▪ small wards ▪ set the style for new type of architecture Dr. W.G. Wylie – 1877 ▪ to be destroyed when it became infected. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Favored Roosevelt Hospital pavilion ▪ Wylie advocated temporary structure America’s 1st Nursing Schools ▪ Brigham and Women’s Hospital – 1872 © 2014 Jones and Bartlett Publishers 40 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Bellevue – 1873 ▪ Massachusetts General Hospital – 1873 Medicine 1880 – 1890 © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Tubercle Bacillus Discovered ▪ Pasteur vaccinated against anthrax ▪ Koch Isolates Cholera Bacillus ▪ Diphtheria 1st treated with antitoxin ▪ Tetanus Bacillus & Parasite of Malarial Fever Isolated ▪ Rabies Inoculation Successful ▪ Halstead & Rubber Gloves – 1890 ▪ Bergmann & steam sterilization – 1886 ▪ Roentgen discovers the X-ray – 1895 19th Century Inventions ▪ Clinical Thermometer ▪ Hermann Helmholtz Ophthalmoscope © 2014 Jones and Bartlett Publishers 42 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Laryngoscope Medicine 1880 – 1890 © 2014 Jones and Bartlett Publishers 43 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hospitals crowded, patients suffering ▪ Scarlet Fever ▪ Diphtheria ▪ Typhoid ▪ Smallpox ▪ Most Disorders Untreated for ▪ Metabolism ▪ Glandular Disturbances ▪ Nutritional Diseases 20th Century Progress © 2014 Jones and Bartlett Publishers 44 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Treatment of ▪ Metabolic Diseases ▪ Nutritional & Vitamin Deficiencies ▪ Rickets with Ultra-Violet Light ▪ Banting’s Introduction of Insulin ▪ Treatment of Pernicious Anemia 20th Century Inventions © 2014 Jones and Bartlett Publishers 45 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Einthoven invents Electro-cardiograph ▪ Wassermann Test for Pancreatic Function ▪ Introduction of Radium for Treatment of Malignant Growths ▪ Increased use of Examination of Tissue Hospital Standardization – 1918 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ American College of Surgeons – development of “Minimum Standards” for Hospitals ▪ Established Requirements for Care of Patients ▪ First Survey Conducted – 1918 ▪ Today known as “The Joint Commission” 1929 Trying Period for Hospitals Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Critical economic conditions ▪ Lowered bed occupancy ▪ Decreasing revenues from endowments Latter Half of 20th Century ▪ CT, MRI, & PET scanners ▪ For-profit chains spring up ▪ Competing delivery systems ▪ Many new medications introduced © 2014 Jones and Bartlett Publishers 48 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Increased hospital competition ▪ Notable advances in medical technology Healthcare in the 21st Century ▪ Grading Hospital Safety ▪ Minimally Invasive Surgery ▪ Surgical Simulation Training ▪ Social Media Impacts Caregivers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Translational Medicine Healthcare in the 21st Century – II ▪ National Health Insurance ▪ Medical Errors Plague Hospitals Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Boutique Medicine History Challenges Us to Do Better Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The maintenance of hospitals today is a result of the human emotions of fear, pity, and sympathy, together with civic consciousness and religious zeal. If society has changed, human nature has remained much the same, for it was with these fundamental emotions which led ancient peoples to build hospitals for their sick and injured. Malcolm T. MacEachern, MD., C.M., D.Sc., L.L.D.— Review Questions – I © 2014 Jones and Bartlett Publishers 52 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. Who is often recognized as being the first hospital administrator? 2. Which invention attributed to Van Leeuwenhoek had a pronounced influence on the creation of the sciences of cytology, bacteriology, and pathology? 3. What issue did Florence Nightingale identify in the 1800s as being a major source/vehicle for the spread of infection and continues to be so today? Questions – II © 2014 Jones and Bartlett Publishers 53 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 4. What data did Semmelweis collect? What was the significance of that data as related to performance improvement in the present-day hospital? 5. What were two of the greatest influences in the development of presentday hospitals? 6. Describe how you think history is repeating itself in todays health care system. Chapter 2 Government, Law, and Ethics “Laws are the very bulwarks of Liberty; they define every man’s rights, and defend the individual Liberties of all men.” – J.G. Holland (1819-1881) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. LEARNING OBJECTIVES ▪ Describe organization structure of Department of Health and Human Services. ▪ Explain the development and sources of law. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Discuss 3 branches of government, & importance of separation of powers. LEARNING OBJECTIVES – II ▪ Explain the term political malpractice and give an example of how it might apply to government officials. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describe the function of various government ethics committees herein presented. Government Organization ▪ Executive Branch ▪ Judicial Branch Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Legislative Branch Branches & Powers of Government Executive Judicial Write laws Implement & Enforce Laws Veto Laws Interpret Laws Enact, amend, Apply Laws or repeal Laws Declare War Commander-inDeclare laws unconstitutional Confirm Justices Chief Armed Forces Enact Taxes & Appoint Justices Compel set the budget Testimony Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Legislative −Alexis de Tocqueville (1805–1859) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Scarcely any political question arises in the United States that is not resolved, sooner or later, into a judicial question. Judicial Branch Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ When government bureaus & agencies go awry, which are adjuncts of the legislative or executive branches, the people flee to the third branch, their courts, for solace & justice. Federal Court System ▪ District Courts ▪ Supreme Court Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ U.S. Circuit Court of Appeals U.S. District Court ▪ Trial courts of the Federal System ▪ Jurisdiction over all categories of federal cases ▪ including civil & criminal matters Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ 96 Courts U.S. Court of Appeals ▪ Reviews ▪ District court decisions ▪ Administrative agency decisions © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Created to help reduce workload of U.S. Supreme Court ▪ 12 Regional Court ▪ 1 Judicial Circuit in DC U.S. Supreme Court ▪ Highest federal court ▪ Comprised of 8 Associate & 1 Chief Justice © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Only court created by federal constitution −Justice J. Henderson, Supreme Ct. of S. D. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com “As I have said in the past, when government bureaus and agencies go awry, which are adjuncts of the legislative or executive branches, the people flee to the third branch, their courts, for solace and justice.” Separation of Powers Model for Government ▪ Under this model government is divided into branches © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Each branch ▪ has separate & independent powers ▪ areas of responsibility ▪ each branch is also able to place limited restraints on the power exerted by the other branches. Dept of Health & Human Services ▪ Centers for Medicare & Medicaid ▪ National Institutes of Health ▪ Centers for Disease Control and Prevention ▪ Food & Drug Administration ▪ Health Resources & Services Administration © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Public Health Service Public Health Service includes ▪ Agency for Healthcare Research and Quality ▪ Indian Health Service © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Agency for Toxic Substances & Disease Registry Laws © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Govern the relationships between private individuals and organizations; and between both of these parties and government. Categories of Law ▪ Private Law ▪ Deals with relationships among individuals. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Public Law ▪ Deals with the relationships between government and individuals. Sources of Law ▪ Statutory Law ▪ written laws ▪ Administrative Law ▪ public law, rules & regulations issued by administrative agencies to direct the enacted laws of the federal and state governments. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Common Law ▪ derived from judicial decisions. Common Law in U.S. ▪ Origins in English Common Law. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Body of principles that has evolved and expanded from judicial decisions. Common Law Principles ▪ Res Judicata: ▪ means the thing is decided—refers to that which has been previously acted on or decided by the courts. ▪ Stare Decisis: ▪ common-law principle meaning let the decision stand. ▪ based on similar cases and fact patterns. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Precedent: ▪ a judicial decision that may be used as a standard in subsequent similar cases. Statutory Law © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Written law emanating from a legislative body. ▪ Hierarchical Order ▪ U.S. Constitution: highest in hierarchy of laws ▪ State Constitution Constitution: Article VI © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ This Constitution and Law of the United States . . . Shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby . … Administrative Law © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Extensive body of public law issued by administrative agencies to direct enacted laws of federal & state governments. Administrative Procedures Act – I Describes different procedures under which federal administrative agencies must operate. ▪ Prescribes procedural responsibilities & authority of administrative agencies. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Administrative Procedures Act – II ▪ Provides legal remedies for those wronged by agency actions. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Rules & regulations established by administrative agency must be administered within scope of authority delegated Congress. Conflict of Laws © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ When state & federal laws conflict ▪ Resolution sought in appropriate federal court. GOVERNMENT ETHICS ▪ Executive Branch: Office of Government Ethics ▪ U.S. Senate Select Committee on Ethics ▪ Judicial Branch: U.S. Judical Code of Conduct ▪ Office of Congressional Ethics © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ House of Representative Committee on Ethics Political Malpractice ▪ Negligent conduct by an elected or appointed political official Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com © 2014 Jones and Bartlett Publishers −Martin Luther King, Jr. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com The tragedy of society is not the noisiness of the so-called bad people, but the appalling silence of the so-called good people. Review Questions – I 1. Define the term law and describe the sources from which law is derived. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2. Define the legal terms: a. precedent b. res judicata c. stare decisis d. original jurisdiction e. appellate jurisdiction Review Questions – II 3. Describe the function of each branch of government. 5. What is the function of an administrative agency? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 4. What is the meaning of separation of powers? Review Questions – III Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 6. Describe the responsibilities of the DHHS. 7. Describe how ethical issues are addressed in the Executive, Legislative, and Judicial branches of government. Chapter 3 Tort Law and Reform Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. LEARNING OBJECTIVES ▪ Describe what a tort is and the purpose of tort law. ▪ Identify various intentional torts and their application in the healthcare setting. ▪ Explain the theories a plaintiff could use in pursuing a products liability case. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describe the elements of negligence. LEARNING OBJECTIVES – II ▪ Describe the meaning of defensive medicine. ▪ Describe the various ways to reduce the number of negligence claims. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describe various programs designed to lower the cost of malpractice insurance. Tort © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A civil wrong, other than a breach of contract, committed against a person or property for which a court provides a remedy in form of an action for damages. Objectives of Tort Law ▪ Preservation of peace between individuals. ▪ Deterrence by discouraging the wrongdoer from committing future tortious acts ▪ Compensation to indemnify injured person/s. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Find fault for wrongdoing. Categories of Tort Law ▪ Negligence ▪ Strict liability regardless of fault ▪ e.g., products liability © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Intentional Negligence © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Commission or omission of an act that a reasonably prudent person would or would not do under given circumstances. Commission of an Act Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Administering the wrong medication ▪ Administering the wrong dosage of a medication ▪ Administering medication to the wrong patient ▪ Performing a surgical procedure without patient consent ▪ Performing a surgical procedure on the wrong patient ▪ Performing the wrong surgical procedure Omission of an Act © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Failing to conduct a thorough history & physical examination ▪ Failing to assess & reassess a patient’s nutritional needs ▪ Failing to administer medications ▪ Failing to order diagnostic tests ▪ Failing to follow up on abnormal test results Malpractice ▪ Negligence of a professional person © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ surgeon who conducts a surgical procedure on wrong body part Criminal Negligence ▪ Reckless disregard for safety of another. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Willful indifference to injury that could follow an act. Forms of Negligence Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Malfeasance ▪ Execution of an unlawful or improper act, i.e., performing a partial birth abortion when prohibited by law ▪ Misfeasance ▪ Improper performance of an act, i.e., wrong sided surgery. ▪ Nonfeasance ▪ Failure to act when there is a duty to act, i.e., failing to prescribe medications that should have been under the circumstances Degrees of Negligence © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Slight ▪ Minor deviation of what is expected under the circumstances. ▪ Ordinary Negligence ▪ Failure to do what a reasonably prudent person would or would not do. ▪ Gross Negligence ▪ Intention or wanton “omission of care” that would be proper to provide or the “commission of an act” that would be improper to perform. Elements of Negligence ▪ Duty to Use Due Care ▪ Breach of Duty ▪ Injury/Actual Damages ▪ Proximate Cause/Causation ▪ Foreseeability © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Standard of care I. Duty to Care ▪ Obligation to conform to a recognized standard of care. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com © 2014 Jones and Bartlett Publishers Standard of Care ▪ Describes the conduct expected of an individual in a given situation. ▪ Measuring stick for properly assessing actual conduct required of an individual. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describes how a “reasonably prudent person” would or would not act under “similar circumstances”. Reasonably Prudent Person © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A nonexistent – hypothetical person who is put forward as community ideal of what would be considered reasonable behavior. Similar Circumstances ▪ Circumstances at the time of the injury. ▪ Age ▪ Physical condition ▪ Education & training ▪ Licenses held ▪ Mental capacity, etc. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Circumstances of the alleged wrongdoer/s at the time of injury. Determining Standard Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Established by legislative enactment or administrative regulation. ▪ Adopted by the court from a legislative enactment or administrative regulation. ▪ Established by judicial decision. ▪ Applied to the facts of the case by the trial judge or jury, if there is no such enactment, regulation or decision. ▪ courts often rely on testimony of an expert witness as to the standard of care required. Community v. National Standard ▪ Community Standard ▪ National Standard ▪ most currently accepted standard of care on a national basis. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ hometown standard (we want to do things our way). Case: Hiring Practices ▪ Nurse hired sight unseen over telephone. ▪ His license was not verified by the employer. ▪ He had committed 56 criminal offenses of theft. ▪ He assaulted a resident a resident & broke his leg. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Applicant falsely stated in an employee application that he was licensed as an LPN. Case: Hiring Practices Duty Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Standard expected: ▪ Employer had a “duty” to validate the nurse’s professional license. II. Breach of Duty Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Deviation from the recognized standard of care. ▪ Failure to adhere to an obligation. ▪ Failure to conform to or the departure from a required duty of care owed to a person. ▪ Occurs when ▪ a physician fails to respond to his/her on-call duties. ▪ an employer fails to adequately conduct a pre-employment check (e.g., licensure, background check). Case: Hiring Practices Breach of Duty ▪ The employer failed to verify the applicant’s licensure. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A more thorough background check should have revealed this employee’s previous criminal conduct. III. Injury ▪ Actual damages must be established. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ If there are no injuries, no damages are due. Case: Hiring Practices Injury ▪ The resident suffered a broken leg. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Hospital vicariously liable for nurse’s conduct. IV. Causation ▪ But-for Rule ▪ the defendant’s action, the injury would not have occurred © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Proximate cause ▪ breach of duty was the proximate cause of the injury Case: Hiring Practices Causation ▪ Reasonable anticipation that harm or injury was likely to occur. ▪ Departing from recognized standard of care ▪ failure to verify licensure & conduct an adequate background check © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The patient suffered a broken leg Hiring Practices – III ▪ Injury resulted from the breach of duty. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Injury was foreseeable. Failure to Hydrate Causation ▪ Failure to administer proper hydration. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Not unreasonable to conclude that one’s dehydration can be caused by failing to provide water. Foreseeability © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Reasonable anticipation that harm or injury is likely to result from an act or an omission to act. Test for Foreseeability © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The test for foreseeability is whether a person of ordinary prudence and intelligence should have anticipated danger to others caused by his or her negligent act. Case: Hiring Practices Foreseeability © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A person of ordinary prudence and intelligence should have anticipated the danger to the resident caused by the employer’s negligent act. Hot Radiator Foreseeability ▪ The defendant had knowledge of the plaintiff’s condition. ▪ The defendant should have shielded the radiator or not placed the plaintiff next to it. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A patient’s left foot came in contact with a radiator and she suffered thirddegree burns. Sponge & Instrument Count Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Dr. Smith owns the local Outpatient Surgery Center. ▪ He instructs employees to count all instruments & surgical sponges following a surgical procedure, prior to closing the surgical site. ▪ Annie, an employee, failed to conduct the count following Bills surgery. ▪ Two months later, Bill, suffering from extreme abdominal pain, was noted to have several sponges and an instrument in his abdomen. ▪ He had developed a massive infection. ▪ Was the doctrine of Vicarious liability applicable in this case? YES ▪ To determine otherwise would undermine the doctrine of vicarious liability, since employers would almost always escape liability by presenting evidence that employees were given careful instructions. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Even though Annie had strict instructions to count the sponges & surgical instruments prior to closing the surgical site, she failed to do so. Failure to Follow Instructions ▪ She was instructed not to drive home after release. Her daughter Leslie picks her up. ▪ On the way home Leslie stops for a donuts. Meanwhile, her mother moves to the driver seat. ▪ Upon leaving the parking lot, Sarah hits Carol’s car. ▪ Carol sustains a broken arm & sues ABC for releasing Sarah before she is completely recovered from the anesthesia. ▪ Was the hospital liable for Sarah’s injuries? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Sarah has a minor surgical procedure under general anesthesia at ABC Surgery Center. NO! ▪ It was Sarah’s duty not to drive and her breach of that duty that caused Carol’s injury. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Sarah was negligent, not the hospital. She failed to adhere to both verbal & written instructions not to drive following anesthesia. Remember © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The four elements of negligence must be presented in order for the plaintiff to recover damages caused by negligence. Intentional Torts ▪ Assault and Battery ▪ Defamation of Character ▪ Fraud ▪ Invasion of Privacy ▪ Intentional Infliction of Mental Distress © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ False Imprisonment Assault 1. Person attempting to touch another unlawfully must possess apparent present ability to commit battery. 2. Person threatened must be aware of or have actual knowledge of an immediate threat of a battery and must fear it. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Deliberate threat, coupled with apparent ability to do physical harm to another. Actual contact not necessary. Battery ▪ Failure to obtain consent prior to surgery. ▪ Administering blood against patient’s express wishes. ▪ Physically restraining one who refuses to eat. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Intentional touching of another’s person in socially impermissible manner without person’s consent. False Imprisonment ▪ Restraining patient without cause. ▪ Locking patient in secluded room for failing to attend therapy session. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Unlawful restraint of individual’s personal liberty or unlawful restraining or confining an individual. Legal Justification for Restraint or Seclusion ▪ Person represents a danger to self or others. ▪ Persons with highly contagious diseases, as provided by state or federal statutes. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Criminal conduct. Reducing Use of Restraints – I ▪ Education & orientation of staff ▪ Education for patients & families ▪ Sound appraisal of need for restraints ▪ Application of least restrictive restraints ▪ Continuous monitoring of patients to determine continuing need for restraints Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Development of policies and procedures that conform to state & federal guidelines Defamation of Character ▪ False oral or written communications to someone other than person defamed that tends to hold that person’s reputation up to scorn or ridicule in eyes of others. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The offense of injuring a person’s character, fame, or reputation by false & malicious statements. Defamation of Character ▪ Slander – oral form of defamation © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Libel – written form of defamation ▪ Signs ▪ Letters ▪ Photographs ▪ Cartoons Proof of Defamation ▪ A false & defamatory statement. ▪ Fault on the part of the defendant. ▪ Special monetary harm. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Communication of a statement to a person other than the plaintiff. Proof of Harm Not Required to recover damages when: ▪ Accusing a person of a crime. ▪ Using words are harmful to a person’s profession or business. ▪ Calling a woman unchaste. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Accusing a person of having a loathsome disease. Libel – Performance Appraisals ▪ Performance appraisals are not meant for general publication. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ To recover damages, the appraisal must be published in defamatory manner that injures one’s reputation. Cartoon – I ▪ Can a defamatory statement can take the form of a cartoon? ▪ Yes, a defamatory statement can take the form of a cartoon because it is capable of adversely affecting a person’s reputation. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Jack draws a cartoon depicting Paul having a rendezvous with a new grad nurse in an empty patient room. The incident in fact never occurred. Newspapers Articles Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Newspaper editorial cartoon depicting 3 persons resembling gangsters in dilapidated building, identified as particular facility that had been closed by state order, was an expression of pure opinion and was protected by 1st Amendment. Accused of an Affair ▪ Assuming Dr. Smith’s letter is defamatory, is it libel or slander? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Nurse Rachet suggests to Dr. Smith that he should leave his wife Sharon because she is having an affair with Dr. Doe. Dr. Smith writes a letter to Mrs. Doe, repeating Rachet’s statement. Accused of an Affair ▪ It is libel, even though Dr. Doe is repeating a slanderous statement. ▪ The rule is: once libel, always libel. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The reverse is not true – the spoken repetition of a written defamation is still considered libel. Slander ▪ Person who brings suit must prove special damages. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ When defamatory words refer to person in professional capacity, professional need not show that words caused damage. Defenses to a Defamation Action ▪ Truth – no liability for defamation if it can be shown that statement is true. ▪ Absolute ▪ Qualified © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Privilege Absolute Privilege ▪ Statements made during judicial & legislative hearings © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Confidential communications between spouses Qualified Privilege ▪ Statements must be without malice © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Statements made as result of a legal or moral duty to speak in interests of 3rd persons Public Figures ▪ Vulnerable to public scrutiny ▪ malice ▪ actual knowledge statements are false ▪ recklessness as to truth © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Suits generally dismissed in absence of Proof of Fraud ▪ Misrepresentation by the defendant. ▪ Intent to reduce reliance on misrepresentation. ▪ Justifiable reliance by the plaintiff. ▪ Damage to the plaintiff. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Knowledge of falsity. Health Care Fraud ▪ Billing Tradename Drugs/Issuing Generic ▪ Billing for Services not Rendered ▪ Accepting referral fees © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Office Visits/Double Billing Invasion of Privacy Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The right to ▪ be left alone ▪ be free from unwarranted publicity ▪ be free from exposure to public view ▪ be free from unwarranted intrusions into a one’s personal affairs ▪ personal privacy ▪ have records/kept confidential Intentional Infliction of Mental Distress © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Conduct that is so outrageous that it goes beyond bounds tolerated by decent society. Mental Distress ▪ Grief ▪ Public humiliation ▪ Despair ▪ Shame ▪ Human pride © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Shame Mental Distress ▪ Verbally abusive physician to patient and/or spouse. Greer v. Medders © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Mother shown premature infant in a jar. Johnson v. Womens Hospital Fraud © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Willful & intentional misrepresentation that could cause harm or loss to person or property. ▪ e.g., purposeful concealment from patient of the presence of surgical sponges in his/her abdomen following surgery. Products Liability © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Liability of a manufacturer, seller, or supplier of chattels to a buyer, or other third party for injuries sustained because of a defect in a product. Products Liability Legal Theories ▪ Negligence ▪ Strict liability © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Breach of warranty ▪ Express ▪ Implied Negligence ▪ Breach ▪ Product defective when it left the manufacturer ▪ Injury ▪ Plaintiff/s injured by the product ▪ Causation ▪ Product proximate cause of injury © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Duty ▪ Product manufactured by the defendant Defective X-ray Unit – I ▪ While in the control room, Mindy hears a crash. ▪ She rushes to the patient & finds that a section of the x-ray unit fell on Candice, further injuring her already broken leg. ▪ Candice sues the manufacturer for negligence. ▪ Can the manufacture be held liable for the plaintiff’s injuries? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Mindy places Candice on the table of the hospital’s newly manufacturerinstalled x-ray unit. YES! ▪ Duty: manufacturer to properly install the x-ray unit. ▪ Injury: plaintiff suffered injury. ▪ Causation: improper installation was the proximate cause of the plaintiff’s injury. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Breach: failure to properly install the x-ray unit. Express Warranty ▪ Includes specific promises or affirmations made by seller to buyer. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ e.g., drug manufacturer represents the product as free from addiction & is not Crocker v. Winthrop Laboratories Implied Warranty ▪ e.g., consumers have right to assume that food is not contaminated Jacob E. Decker & Sons v. Capps Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A warranty that exists by operation of the law as a matter of “public policy” for protection of the public. Strict Liability ▪ Liability without fault © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Elements required to establish strict liability ▪ Product manufactured by defendant ▪ Product defective at time it left manufacturer ▪ Plaintiff injured by product ▪ Defective product proximate cause of injuries Wrong Medication – I ▪ Prior to taking his nightly dosage, he noticed the pill appeared larger than normal. ▪ He phoned D Drugs & explained his concern. ▪ The Pharmacist assured Stanley generic drugs sometimes are larger because of formula fillers but that the medication dosage in his drug was correct. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Stanley refills his drug prescription at D Drugs, where he has been a customer for 10 years. Wrong Medication – II ▪ The container from which the pharmacist filled Stanley’s prescription had been mislabeled by the manufacturer. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Stanley took the drug & never woke up; the dosage given was 5 times that which had been prescribed. Wrong Medication – III Court’s Decision ▪ Product was manufactured by the defendant ▪ Plaintiff injured by the product ▪ Stanley passed away in his sleep. ▪ Defective product proximate cause of injuries ▪ The mislabeled container was the proximate cause of Stanley’s death. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Product defective at time it left manufacturer ▪ The drug was placed in a mislabeled container. Products Liability Res Ipsa Loquitur © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Must establish ▪ Product did not perform in way intended ▪ Product not tampered with by buyer/3rd parties ▪ Defect existed at time it left defendant Products Liability Cases ▪ Manufacture of unsafe drugs ▪ Merck’s Vioxx © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Tainted Tylenol Capsules ▪ Elsroth v. Johnson & Johnson Products Liability Defenses – I ▪ Assumption of the Risk ▪ Intervening Cause ▪ an IV solution contaminated by product user ▪ Contributory Negligence ▪ use of product in a way it was not intended to be used. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ voluntary exposure to risks: Smoking, radiation therapy, Chemotherapy Products Liability Defenses – III ▪ Comparative Fault ▪ Disclaimers ▪ manufacturers inserts © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ injury due to concurrent negligence of both manufacturer & plaintiff. Review Questions – I 1. Describe the objectives of tort law. 3. What forms of negligence are described in this chapter? 4. How does one distinguish between negligence and malpractice? 5. What elements must be proven in order to be successful in a negligence suit? Illustrate your answer with a case (the facts of the case can be hypothetical). © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 2. Discuss the distinctions among negligent torts, intentional torts, and strict liability. Review Questions – III 7. Describe the categories of intentional torts. 8. How does slander differ from libel? Give an example of each. 9. What is products liability? Describe what legal theories an injured party may use in proceeding with a lawsuit against a seller, manufacturer, or supplier of goods. 10. Describe the defenses often used in a products liability case. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 6. Can a “duty to care” be established by statute or contract? Discuss your answer. Chapter 4 Criminal Aspects of Health Care Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. LEARNING OBJECTIVES ▪ Explain what criminal law is, the classification of crimes, and its purpose. ▪ Describe several of the more common crimes that occur in the healthcare setting. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describe the criminal procedure process from arrest through trial. Criminal law ▪ What is the purpose of criminal law? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Criminal law (also known as penal law) is the body of statutory and common law that deals with crime and the legal punishment of criminal offenses. Purpose of Criminal Law ▪ Maintain Public Order & Safety ▪ Use Punishment as a Deterrent ▪ Provide for Criminal Rehabilitation ▪ What are the definitions of a crime, misdemeanor & felony? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Protect Individuals Definitions ▪ Crime – social harm defined & made punishable by law. ▪ Felony – imprisonment in a state or federal prison for more than a year. ▪ What is an arraignment? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Misdemeanor – offense punishable by less than 1 year in jail and/or a fine. Complaint, Investigation & Arrest Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Components of a Crime ▪ act itself (the actus reus or guilty act); ▪ requisite mental state/intent (the mens rea or guilty mind); and ▪ causation; harm that is the result of the act that was committed. The accused performed the act that caused the harm with the intent to cause that harm. Arraignment ▪ Formal reading of the accusatory instrument ▪ What is the purpose of a conference with the defendant and prosecutor? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ a generic term that describes a variety of documents, each of which accuses a defendant of an offense ▪ includes the setting of bail Indictment ▪ A formal charge or accusation of a serious crime. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Conference ▪ Meeting for purposes of deliberation ▪ Commences with the goal of an agreed-upon disposition ▪ If no disposition can be reached, a case may be assigned to a trial court. ▪ Describe the process of conducting a criminal trial. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Plea bargaining time Criminal Trial – I ▪ Jury selection ▪ Presentation of witnesses & evidence ▪ Standard of proof must be beyond a reasonable doubt. ▪ Summations © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Opening statements Criminal Trial – II ▪ Instructions to the jury by the judge ▪ Verdict ▪ must be unanimous ▪ Sentencing ▪ Opportunity for appeal ▪ What does the False Claims Act of 1986 prohibit? © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Jury deliberations Health Care Fraud ▪ Unlawful Act generally deception for personal gain. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ FBI Primary agency for exposing & investigating healthcare fraud. False Claims Act – 1986 ▪ Knowingly presenting a false claim for payment. ▪ conspiring to defraud the government. ▪ making a false record to avoid an obligation to pay or transmit property to the government. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ making a false record to get a false claim paid. Ethics in Patient Referral Act – 1989 ▪ Requires Medicare providers to report the names & provider numbers of all physicians or their immediate relatives with ownership interests in a provider entity. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Prohibits physicians who have ownership interest or compensation arrangements with a clinical laboratory from referring Medicare patients to that laboratory. HIPPA -1989 ▪ Requires U.S. Attorney General & Secretary of DHHS, acting through the Office of Inspector General (OIG), to establish a national healthcare fraud & abuse control program. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Provides criminal & civil enforcement tools & funding to fight against healthcare fraud. Schemes to Defraud ▪ Billing for services not rendered ▪ Misrepresenting procedures performed to obtain payment for noncovered services ▪ Upcoding services (billing for a more costly service than the one actually performed, Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Falsifying a patient’s diagnosis to justify tests, surgeries, or other procedures that are not medically necessary Schemes to Defraud – II ▪ Billing for unnecessary services (services that are not medically indicated) ▪ Accepting kickbacks for patient referrals ▪ Waiving patient co-pays or deductibles ▪ Overbilling insurance carrier or benefit plan. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Unbundling (billing each stage of a procedure as if it were a separate procedure) Kickbacks ▪ Laboratory © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Architectural Contract Health Care Fraud: Text Cases ▪ Scheme to Defrauding Medicare & Medicaid ▪ Pharmacist Submits False Drug Claims ▪ Inflating Insurance Claims © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ False Medicaid Claims ▪ Physician & Office Manager Health Care Fraud: Text Cases – II ▪ Falsification of Records ▪ Misuse & Theft of Drugs ▪ Homecare Fraud Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Fraudulent Billing: Lab Tests Physicians Victims of Fraud How to Prevent Office Fraud ▪ familiarize themselves with patient billing & record keeping practices ▪ Conduct annual audit of office procedures & records Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Avoid having one person in charge of both billing & collection process Falsification of Records ▪ Anyone who suffers damage as a result of falsification of records may claim civil liability. ▪ The provider could lose Medicare & Medicaid funding. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Falsification of medical & business records is grounds for criminal prosecution. Fraud & Ethics ▪ Behind every act of healthcare fraud lies a lapse in ethics. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Patient Abuse ▪ Mistreatment or neglect of patients © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Types of abuse ▪ Physical ▪ Psychological ▪ Medical ▪ financial Misuse and Theft of Drugs ▪ Internet Pharmacy © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Failure to review patient prescriptions prior to dispensing. ▪ Fraudulent billing. ▪ Transfer of funds to offshore account. Physicians: Victims of Fraud Prevention ▪ Familiarize themselves with patient-billing & recordkeeping practices. ▪ Arrange for an annual audit of office procedures & records by an outside auditor. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Avoid having one individual in charge of billing & collection procedures. Forms of Abuse ▪ Physical ▪ Medical ▪ Financial © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Psychological CRIMINAL NEGLIGENCE ▪ Abuse & Revocation of License ▪ Abusive Search ▪ Cruelty to the Infirm © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Neglect of Residents HOMICIDE ▪ Unusual Number of Deaths ▪ Fatal Injection of Pavulon © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Nurse Sentenced for Diabolical Acts Removal of Life Support Not Murder ▪ No duty to continue use once it has become futile & ineffective to do so Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Generally duty to provide life-sustaining equipment in immediate aftermath of cardiopulmonary arrest. Manslaughter Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Commission of an unintentional act that results in the death of another person. ▪ Voluntary manslaughter: intentional killing of another person without premeditation or malice of forethought ▪ Involuntary manslaughter: negligent act that occurs when defendant does not intend to kill the victim but acted in a criminally negligent or reckless manner that resulted in a death. Rape & Sexual Assault ▪ Statutory rape occurs when a person under the age of legal consent has sexual intercourse with another. ▪ Text Case: Dupree v. Plantation Pointe ▪ plaintiff’s mother sexually assaulted at the nursing home by a dementia patient. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Rape occurs when one person is forced, without giving consent, to have sexual intercourse with another. Theft ▪ Cost Millions Annually ▪ Staff Valuables ▪ Supplies ▪ Medical Equipment ▪ Text Case: ▪ Commingling Resident’s Personal Funds © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Patient Valuables Review Questions © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. What are the objectives of criminal law? 2. Describe the difference between a misdemeanor & a felony. Give an example of each. 3. List the processes of a criminal trial. 4. Why has health care fraud been so costly? Review Questions – II Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. Based on cases in the chapter, discuss why physicians historically have been reluctant to remove a patient’s life-support systems. 2. Discuss why you believe patients are sometimes reluctant to complain about their health care. Chapter 6 Civil Procedure & Trial Practice Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. LEARNING OBJECTIVES ▪ Discuss the pretrial discovery process. ▪ Explain the purpose of the judge’s charge to the jury. ▪ Describe the types of damages and how they are awarded. ▪ Discuss the appeals process and execution of judgments. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Describe the trial process. Pleadings ▪ Generally include: ▪ Complaint ▪ Demurrer ▪ Counterclaim ▪ answer ▪ bill of particulars Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Written statements of fact & law filed with a court by the parties to a lawsuit. Pleadings – II Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Parties to a Lawsuit ▪ Plaintiff: person who initiates filing a complaint. ▪ Defendant: person against whom a lawsuit is brought. Summons Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Summons ▪ Legal document issued by a court and served on an individual announcing a legal proceeding has been commenced. ▪ Provides date & place where the defendant must appear to respond to and answer the complaint. • Note: some jurisdictions, a complaint must accompany the summons (announcement to defendant that legal action has been commenced). Complaint Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Complaint ▪ 1st pleading in a lawsuit filed by the plaintiff(s) ▪ Sets forth; ▪ relevant allegations of fact that give rise to one or more legal causes of action & ▪ damages requested. Demurrer ▪ Defendant claims evidence presented by the plaintiff is insufficient to sustain a lawsuit. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Pleading filed by defendant[s] challenging legal sufficiency of a complaint. Answer Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Defendant responds to the allegations in the complaint ▪ statute of limitations has tolled ▪ contributory negligence on part of plaintiff ▪ obligation has been paid ▪ general release was presented to the defendant ▪ contract was illegal & therefore null & void Answer – II ▪ Complaint filed with court having jurisdiction Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Copy provided to plaintiff[s] attorney. Counterclaim Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Generally filed with the answer ▪ denying the plaintiff’s claims Bill of Particulars Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Request for written itemization of claims made ▪ date & time of day negligence ▪ where the alleged malpractice occurred ▪ the act negligent alleged to have occurred ▪ how the alleged the negligence occurred ▪ listing of injuries claimed ▪ listing of any witnesses alleged malpractice Discovery ▪ Process of investigating facts of a case before trial. ▪ Parties to a lawsuit have a right to discovery & to examine witnesses before trial. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Discovery rules promulgated to prevent trial by ambush. Discovery – II Objectives ▪ Obtain evidence that might not be obtainable at time of trial. ▪ Gather knowledge of the existence of additional evidence that may be admissible at trial. ▪ Obtain leads to enable discovering party to gather further evidence. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Isolate & narrow issues for trial; Attorney-Client Privilege ▪ Confidential communications made by a client & his attorney. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Elements Needed to Establish Attorney-Client Privilege ▪ Client must seek advice from an attorney in his or her capacity as a legal advisor. ▪ Communication between attorney & client must be identified to be confidential. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Both parties must agree that the attorney-client relationship does or will exist. Incident Reports ▪ Statistical Data – Not Always Privileged ▪ Case Example: Braverman, in Braverman v. Columbia Hospital, Inc. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Incident Reports ▪ not generally protected from discovery Examination Before Trial ▪ A deposition, taken at an EBT, is the testimony of a witness that has been recorded in a written format. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ EBT may reveal sufficient facts discouraging plaintiff from continuing the case or encourage parties to settle the case. Preparation of Witnesses ▪ Review records ▪ Be organized in: ▪ thinking ▪ recollection of facts ▪ Answer “only” questions asked ▪ Explain simply, succinctly Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Do not be antagonistic Preparation of Witnesses – II ▪ Do not over-dramatize ▪ Be polite, sincere, & courteous ▪ Dress appropriately ▪ Be well groomed ▪ Listen for objections Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Do not become over-powered by cross-examiner Preparation of Witnesses – III ▪ Review your EBT before trial ▪ Do not show displeasure ▪ Ask for questions to be repeated for clarification ▪ Not sure of answer – indicate you are not sure Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Be honest with examiner Pre-Trial Motions ▪ Motion for Summary Judgment ▪ Either party to a suit may believe that there are no triable issues of fact & only issues of law to be decided. ▪ In such event, either party may make a motion for summary judgment. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Motion to Dismiss a case ▪ Defendant alleges plaintiff‘s complaint does not set forth a claim or cause of action recognized by law. Pre-Trial Conference ▪ May be ordered at the judge’s initiative or parties to a lawsuit. ▪ Parties agree on the issues, and settle procedural matters prior to trial. ▪ Cases can be settled outside the courtroom. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Eliminate matters not in dispute. Notice of Trial Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Once a decision to go forward is reached, the case is placed on a court calendar. Memorandum of Law (Trial Briefs) ▪ Aids the court regarding points of law. ▪ Trial briefs prepared by both plaintiff/s and the defendant/s attorneys. ▪ A trial brief is not always required, but is a recommended strategy. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Presents to the court nature of the case, cites case decisions to substantiate arguments. Judge ▪ Handles conduct of trial ▪ Determines issues of procedure ▪ Decides if evidence admissible ▪ Charges the jury ▪ May direct a verdict Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Decides questions of law Jury ▪ Selected from jury list ▪ Determines damages, if any Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Determines issues of fact Jury Selection Process ▪ The defendant can waive the right to trial by jury. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Counsel for both parties to a lawsuit questions each prospective jury member for impartiality, bias, and prejudicial thinking. ▪ This process is referred to as the voir dire. Subpoena Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A legal order requiring the appearance of a witness and/or the presentation of documents at a legal proceeding. Types of Subpoenas ▪ Subpoena duces tecm ▪ Subpoena of records Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Subpoena ad testificandum ▪ Subpoena for a witness Burden of Proof Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Obligation of the plaintiff to persuade the jury regarding the truth of his or her case. Res Ipsa Loquitur ▪ The thing speaks for itself Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Legal doctrine that shifts the burden of proof from the plaintiff to the defendant. Res Ipsa Loquitur: Proof Required Event causing injury – would not normally have occurred in the absence of negligence 2. Defendant – must have exclusive control over instrument causing injury 3. Plaintiff – must not have contributed to the event causing injury. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 1. Case: Wrong Medication ▪ Stanley refills his drug prescription at Discount Drugs. ▪ He phoned Discount Drugs & explained his concern. ▪ The Pharmacist, stating he was busy, assured Stanley generic drugs sometimes are larger & the medication was correct. © 2014 Jones and Bartlett Publishers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Prior to taking his nightly dosage he noticed the pills appeared larger than normal. Case: Wrong Medication – II ▪ The pharmacist filled Stanley’s prescription from the wrong container. ▪ Is the pharmacy liable for Stanley’s death? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Stanley took the drug & never woke up; the dosage given was five times that prescribed. Yes ▪ See res ipsa loquitur above. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The plaintiff, Stanley, need not prove conclusively that the defendantpharmacist’s negligence resulted in injury, only that all reasonably probable causes of the accident can be traced to the defendant. Opening Statements ▪ Defense attorney: explains the facts as they apply to the case for the defendant. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Plaintiff’s attorney: provides, in capsule form, the facts of the case, what he or she intends to prove by means of a summary of the evidence to be presented, and a description of the damages to his or her client. Examination of Witnesses ▪ Following opening statements, the judge calls for the plaintiff’s witnesses. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Preliminary Questions for Physician Witness ▪ Please state your name, residence, and any prior residences. ▪ Are you licensed in this state? ▪ Where did you serve your residency? ▪ Describe the treatment you rendered? ∙∙∙ Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Where did you attend medical school? EVIDENCE ▪ Evidence consists of the facts proved or disproved during a lawsuit. ▪ Rules of evidence govern the admission of items of proof in a lawsuit. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Law of evidence is a body of rules under which facts are proved. Direct Evidence ▪ Evidence offered through direct testimony. ▪ Violation of a statute may constitute direct evidence of negligence ▪ Policy and Procedure violations can be offered as direct evidence Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Statutory Judicial Notice Rule Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Well-known facts universally recognized as truth without need for evidence. ▪ Need for a CT scan or MRI, as a diagnostic tool to diagnose a suspected skull fracture, can be considered a matter of common knowledge. ▪ A court, in the absence of expert testimony, can take judicial notice that such evidence is within the realm of common knowledge.. Expert Testimony Copyright © 2021 by Jones & Bartlett Learning,…