Week 9
- Look up physician assistant licensing laws for Florida
- Where is this located in the body (title/chapter, section/division/part number)?
- Under what circumstances do laws state that a PA’s license can be suspended or revoked?
- Provide citation
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Week 10
1.Look up "statutory consent to medically treat laws for florida – this assignment is related to the materials in this week's content. Do not research age of consent laws related to sex.
2. Where is the law located?
3. What does the law say about consent in emergency medical situations?
Cite your research and sources.
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Week 10 part 2
1. Research the following cases:
*Harold Glucksberg case (90s)
*Terri Schiavo case (90s to 2000s)
*Brittany Maynard case (2010s)
2. Summarize the facts of each case for the class
3. What laws and court cases are involved?
4. Summarize both sides of the argument
5. Besides the right to die, what are some related legal issues? (ex: disability rights, due process, advance directives)
Cite your research and sources.
Patient Records and Legal Reporting
Information Management
A process intended to facilitate the flow of information within and between departments and caregivers
Determine customer needs
Set goals and establish priorities
Improve accuracy of data collection
Provide uniformity in data collection definitions
Limit duplication of entries
Information Management
Deliver timely and accurate information
Provide easy access to information
Maintain security and confidentiality of information
Enhance patient care activities
Improve collaboration through information sharing
Information Management
Establish disaster plans for information recovery
Provide orientation and staff training
Annual review of information management plan
Scope
Organization
Objectives
Effectiveness
Medical Record: Means of Communication
Documentation of patient’s:
Illness
Symptoms
Diagnosis
Treatment
Medical Record: Means of Communication
Communication tool (e.g., progress notes)
Protect legal interests of patient and provider
Provide database for use in statistical reporting
Continuing education
Research
Provide information for billing
Medical Record Contents
Admission record
Age
Address
Reason for admission
Social security number
Marital status
Religion
Health insurance
Medical Record Contents
Consent authorization for treatment
Advance directives
History and physical exam
Diagnosis
Information that supports the diagnosis
Patient screenings and assessments
Medical Record Contents
Treatment plan
Physicians’ orders
Progress notes
Nursing notes
Integrated record includes physician progress and nursing notes along with the notes of other disciplines
Medical Record Contents
Diagnostic reports
For example, laboratory and imaging
Consultation reports
Vital signs
Fluid intake and output
Pain management records
Anesthesia assessment
Medical Record Contents
Operative reports
Medication administration records
Discharge planning
Patient education
Discharge summaries
Documentation of Care
Record accurate entries
Nurse’s charting
Documentation and reimbursement (DRGs)
Charting by exception
A system where nurses notes record concise and significant changes in a patient’s conditions
Failure to maintain records
Medical record battleground
Not to be used for complaining about others
Diagnosis-Related Groups (DRGs)
Patients classified into categories based on age, diagnosis and treatment required
Used by Medicare to reimburse providers
Based on preestablished average prices for each DRG
If hospitals can provide quality patient care at a lower cost, they keep the extra money
Incentive to keep costs under control
Privacy Act of 1974 5 U.S.C. 552
Enacted to safeguard individual privacy from misuse of federal records, to give individuals access to records concerning themselves that are maintained by federal agencies, and to establish a Privacy Protection Safety Commission.
Health Insurance Portability and Accountability Act (HIPAA)
Designed to protect the privacy, confidentiality, and security of patient information
Standards apply to all health information in all formats
HIPAA: Privacy Provision
Patients are able to access their records and request correction of errors.
Patients must be informed of how personal information will be used.
Patient consent for release of information for marketing purposes required.
Patients can ask insurers and providers to take reasonable steps to ensure their communications are confidential.
Patients can file privacy-related complaints.
HIPAA: Privacy Provision
Health insurers or providers document their privacy procedures.
Health insurers or providers designate a privacy officer and train their employees.
Providers may use patient information without patient consent for:
Purposes of providing treatment
Obtaining payment for services
Performing non-treatment operational tasks of the provider’s business
HIPAA: Security Provision
Policies and procedures are designed to show how the entity will comply with the act.
Entities must adopt a written set of privacy policies and procedures.
The privacy officer develops and implements policies and procedures.
Policies and procedures must reference management oversight & organization buy-in to comply with documented security controls.
Procedures identify employees who will have access to protected health information.
Access to protected health information (PHI) in all forms is restricted to employees who have a need for it to complete job function.
HIPAA: Security Provision
Procedures address access authorization, establishment, modification, and termination.
There is an ongoing training program.
Entities that outsource business processes to a third party ensure vendors have framework to comply with HIPAA.
Care is taken to determine if the vendor further outsources any data handling functions to other vendors, while monitoring whether appropriate contracts and controls are in place.
There is a contingency plan for responding to emergencies.
Covered entities are responsible for backing up their data and having disaster recovery procedures in place.
HIPAA: Security Provision
Recovery plan should document data priority and failure analysis, testing activities, and change control procedures.
Internal audits review operations with goal of identifying potential security violations.
Policies and procedures document scope, frequency, and procedures of audits.
Audits are routine and event based.
Procedures document instructions for addressing and responding to security breaches.
HIPAA: Physical Safeguards
Responsibility for security must be assigned to a specific person or department.
Controls must govern the introduction and removal of hardware and software from the network.
When equipment is retired, it must be disposed of properly to ensure that PHI is not compromised.
Access to equipment containing health information should be carefully controlled and monitored.
Access to hardware and software must be limited to properly authorized individuals.
HIPAA: Physical Safeguards
Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
Policies are required to address proper workstation use.
Workstations should be removed from high-traffic areas and monitor screens should not be in direct view of the public.
If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities.
HIPAA: Technical Safeguards
Information systems housing PHI must be protected from intrusion.
When information flows over open networks, some form of encryption must be utilized.
If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional.
Each covered entity is responsible for ensuring data within its systems has not been changed or erased in an unauthorized manner.
HIPAA: Technical Safeguards
Data corroboration, including use of check sum, double-keying, message authentication, and digital signature, may be used to ensure data integrity.
Covered entities must also authenticate entities with which they communicate.
Authentication consists of corroborating that an entity is who it claims to be.
Covered entities must make documentation of their HIPAA practices available to the government to determine compliance.
HIPAA: Technical Safeguards
Information technology documentation should also include a written record of all configuration settings on components of the network because these components are complex, configurable, and always changing.
Documented risk analysis and risk management programs are required.
HITECH Act
Health Information Technology for Economic and Clinical Health (HITECH) Act
Provides that the Secretary of HHS must post a listing of breaches of unsecured protected health information affecting 500 or more individuals
https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf
Medical Records: Ownership and Release
Ownership resides with the organization rendering treatment.
Right to privacy: the right to be kept out of the public spotlight
Organizations and physicians can withhold records if the info could be expected to cause substantial and identifiable harm to the patient
Medical Records: Ownership and Release
Request by patients
Failure to release records
Legal action
Requests by third parties
Insurance carriers processing claims
Medical researchers
Educators
Government agencies
Privacy exceptions
Criminal investigations
Medicaid fraud
Substance abuse records
Use Of Patient Data Gathered
Provider mistakes often occur because of unwieldy, unorganized, and voluminous amounts of information gathered on patients.
Caregivers who fail to use information collected when assessing patient needs may find themselves in a lawsuit.
Todd v. Sauls
Physician breached his duty of care for failure to read nursing notes
Retention of Records
Varies state to state
Failure to Preserve X-rays
Illinois Supreme Court held hospitals must retain X-rays and other such photographs or films as part of their regularly maintained records for a period of 5 years.
Rodgers v. St. Mary's Hosp. of Decatur
Electronic Medical Records: Advantages
Retrieves patient information
Improves productivity and quality
Reduces costs
Supports clinical research
Education
Computer-assisted diagnosis and treatment
Electronic Medical Records: Advantages
Allows for computer-generated prescriptions
Generates reminders for follow-up testing
Assists in decision-making process
Aids in standardizing treatment protocols
Assists in identification of drug–drug and food–drug interactions
Telecommunications
Electronic Medical Records: Disadvantages
Increased risk of lost confidentiality and unauthorized disclosure of information
Technology crime and related illegal activities
Increase in cyber crime
Costs to protect networks and critical infrastructures from cyber-based threats
One checkmark on a computer form can populate many fields and multiple pages, giving the impression that a thorough patient assessment was conducted.
Legal Proceedings and the Medical Record
Complete, accurate, and timely records
Reconstructs events surrounding alleged negligence
Aid police in investigations
Provides information as to the cause of death
Aids in information recall for witnesses
Falsification of Medical Records
Falsifying Medical or Business Records
Alteration and Destruction of Medical Records
Tampering with Medical Records
Nurse Changes Record Entries
Illegible Handwriting
Poor penmanship can lead to patient injury.
The American Medical Association encourages physicians to print, type, or computerize their orders.
A Harvard study found that penmanship was among the causes of 220 prescription errors out of 30,000 cases.
Timely Completion: Medical Records
Caregivers must promptly complete records.
Failure to timely record patient information can lead to forgetfulness and documenting the wrong information on the wrong record.
Failure to complete records as required by policy can be the basis for suspension of privileges.
Confidential and Privileged: Communications
Health Care Quality Improvement Act of 1986
Insulates certain medical peer activities affecting medical staff privileges from antitrust liability
Reasonable belief that it is conducted in furtherance of health care
Remember, ordinary business documents are NOT privileged
Burden to establish privilege on party seeking to shield info from discovery
Confidential and Privileged: Communications
Attorney–client privilege
Preclude discovery of memoranda written to an organization’s risk management director
Physician–patient confidentiality
Info acquired by physicians will not be disclosed, unless the patient consents or the law requires disclosure
HIV confidentiality
Duty to disclose vs. rights of confidentiality
Confidential and Privileged: Communications
Privileging and credentialing
Committee’s action or its exchange of honest self-critical study (peer review) vs. factual accountings of otherwise discoverable facts (ex: committee minutes, general policies and procedures for staff monitoring)
Courts’ opinions are mixed, depends on state law, scope and legislative intent
Ex: application for staff privileges
Confidential and Privileged: Communications
Privileged information considerations
Extent to which the information may be available from other sources
Degree of harm that the litigant will suffer from its unavailability
Possible prejudice in the agency’s decision
Charting: Helpful Advice
Complete and pertinent entries
Timely entries
Legible entries
Clear and meaningful entries
Complete
Charting: Helpful Advice
Avoid
Defensive and derogatory notes
Erasures and correction fluids
Criticism
Complaints
Tampering with the chart
Secure records pending legal action
Charting: Helpful Advice
Obtain legal advice
Entries made by others must not be ignored
Patient care is a collaborative interdisciplinary team effort
Entries made by healthcare professionals provide valuable information in treating the patient
Charting: Helpful Advice
Reasoning for not following the advice of a consultant should be noted in the medical record, not so as to discredit the consultant, but to show the reasoning why a consultant’s advice was not followed.
Find and Research Laws
https://www.loc.gov/law/help/guide.php (Library of Congress legal research site)
https://uscode.house.gov/browse.xhtml (Federal Statutes)
https://www.law.cornell.edu/cfr/text
(Federal Regulations)
Find and Research Laws
State Laws
https://www.loc.gov/law/help/guide/states.php
Also use state legislature websites
Case Law/Court Opinions
Individual Exercise 1: Research Laws
Look up physician assistant licensing laws for the state you were assigned
Where is this located in the body (title/chapter, section/division/part number)?
Under what circumstances do laws state that a PA’s license can be suspended or revoked?
Provide citation
Legal Reporting Requirements
Abuse
Abuse in the healthcare setting often occurs to those who are most vulnerable and dependent on others for care.
Abuse can take many forms, such as physical, psychological, medical, and financial.
Abuse is not always easy to identify because injuries can often be attributed to other causes.
Child Abuse
Intentional serious mental, emotional, sexual, and/or physical injury inflicted by family or other person responsible for care
Child Abuse Prevention and Treatment Act (CAPTA)
Minimum standards states must incorporate in their statutory definitions of child abuse and neglect
Child Abuse: Who Should Report
Healthcare setting
Administrators, physicians, interns, registered nurses, chiropractors, social service workers, psychologists, dentists, osteopaths, optometrists, podiatrists, mental health professionals, & volunteers in residential facilities
Penalties for failure to report
States vary on penalties
Good faith reporting immune to liability
Child Abuse: How to Detect
Indicators of abuse and maltreatment that appear to be part of a pattern
Physical indicators
Bruises
Sprains
Fractures
Cigarette burns
Child Abuse: How to Detect
Behavioral indicators
Diminished psychological or intellectual functioning
Failure to thrive
No control of aggression
Self-destructive impulses
Decreased ability to think and reason
Acting out and misbehavior, or habitual truancy
Senior Abuse
Mistreatment: Results in harm or loss
It can involve:
Physical and sexual abuse
Domestic and psychological abuse
Financial abuse
Neglect
Failure to provide needed care
Senate Select Committee on Aging
Less likely to be reported than child abuse
Most instances of senior abuse
Repeated events
Not one-time occurrences
Senate Select Committee on Aging
Victims are often 75 years of age or older, & women more likely to be abused than men.
Seniors often ashamed to admit their loved ones abuse them.
May fear reprisals if they complain
Family members are resentful of a frail & dependent senior parent.
Majority of abusers are relatives or caregivers
National Center on Elder Abuse
The National Center on Elder Abuse (NCEA), directed by the U.S. Administration on Aging, is committed to helping national, state, and local partners in the field be fully prepared to ensure that older Americans will live with dignity, integrity, and independence, and without abuse, neglect, and exploitation.
Preventing Abuse: Policies and Procedures
Prohibition of mistreatment
Description of reporting procedures regarding alleged abuse
Maintenance of evidence of alleged abuse
Investigation of alleged abuse
Prevention of further potential abuse while investigation is in progress
Abuse: Documentation
Suspected abuse should be defined clearly and objectively.
Witnesses: Reporters of abuse must describe statements made by others as accurately as possible.
What actions were taken, by whom, when, where, etc.
Information should be included about how witnesses may be contacted.
Photographs: It may be necessary to photograph wounds or injuries.
Hospital emergency room or the police department can be asked to photograph in emergency situations.
Communicable Diseases
Reported to protect citizens from infectious diseases
Reporting required by statutes
AIDS
State HIV required reporting
Mandatory testing
Births and Deaths
Reportable by statute (all births and deaths)
Physician that pronounces death must sign death certificate
Necessary to maintain accurate census
Medical examiner
Suspicious deaths
Determines cause of death
Adverse Drug Reactions
Harmful drug reactions that occur as a result of administration of a drug or combination of drugs
Medwatch
FDA program for reporting harmful reactions
Physician Competency
Health Care Quality Improvement Act
Encourage physicians to participate in peer review
Restricts ability of incompetent physicians to move from state to state without disclosure/discovery of their previous substandard care or unprofessional conduct
Authorizes National Practitioner Data Bank to collect & release information on professional competence & conduct of healthcare practitioners
National Practitioner Data Bank
Created by Congress as national repository of information with primary purpose of facilitating a comprehensive review of healthcare practitioners’ professional credentials
Operates under authority of the Secretary of DHHS
Applies to healthcare entities and healthcare practitioners
Hospitals must report adverse actions within 30 days
Confidential information
Incident Reporting
States’ reportable incidents
Serious injury or death
Hospital-acquired infections
Fires
Loss of power
Employment strikes
Incident Reporting
Are incident reports discoverable?
Conflicting case law
Report prepared in anticipation of litigation
Prepared in ordinary course of business
Factual narratives
Sentinel Events
Unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof
“Or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.
Unanticipated death
Major permanent loss of function
Sentinel Events Examples
Suicide
Unanticipated death of a full-term infant
Infant abduction