PowerPoint® to accompany

Medical Assisting Chapter 3

Second Edition

Ramutkowski  Booth  Pugh  Thompson  Whicker

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1
Legal and Ethical Issues in
Medical Practice, including HIPAA
Objectives
3-1 Define ethics, bioethics, and law.
3-2 Discuss the measures a medical practice
must take to avoid malpractice claims.
3-3 Describe OSHA requirements for a medical
office.
3-4 Describe procedures for handling an
incident of exposure to hazardous materials.
2
Legal and Ethical Issues in
Medical Practice, including HIPAA
Objectives (cont.)
3-5 Compare and contrast quality control and
quality assurance procedures.
3-6 Explain how to protect patient
confidentiality.
3-7 Understand basic overview of HIPAA.

3
Medical Law and Ethics
 Knowledge of Medical Law and Ethics
provides insight into:
 The rights, responsibilities, and concerns of
health care consumers.

 The legal and ethical issues facing society;

patients, and health care professionals as the
world changes.

 The impact of rising costs on the laws and

ethics of health care delivery.
4
Medical Law and Ethics (cont.)

A law is a rule of Ethics is a standard

conduct or action. of behavior.
Governments enact Moral values serve
laws to maintain as the basis for
order and public ethical conduct.
safety. Family, culture, and
Criminal and civil laws society help form
pertain to health care individual’s moral 5

practitioners. values.
Medical Law and Ethics (cont.)
 Criminal Law  Civil Law
 Involves crimes against  Involves crimes against
the state the person
 Criminal acts are  Includes a general
classified as either a category of laws known
felony or misdemeanor as torts
 Examples include:  Torts are either:
 Murder  Intentional (willful)
 Arson  Unintentional
 Rape (accidental)
 Burglary
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Medical Law and Ethics (cont.)
Intentional Torts
Assault Battery
To cause another person to feel An action that causes bodily harm to
threatened. another. Even touching without
permission.
Invasion of privacy Fraud
Interference with a person’s Depriving or attempting to deprive a
right to be left alone. person of his or her rights.

Defamation of Character False Imprisonment

Damaging a person’s reputation Intentional, unlawful restraint or
by making a public statement. confinement of a person. 7
Medical Law and Ethics (cont.)
Unintentional Torts
 Acts that are committed with no intent to cause harm
but are done with a disregard for the consequences.

 The term negligence is used to describe such actions

when health care practitioners fail to exercise ordinary
care resulting in patient injury.

 Malpractice is the negligent delivery of professional

services.
8
Medical Law and Ethics (cont.)
Contracts
A contract is a voluntary agreement between two parties
in which specific promises are made for a consideration.

4 Elements of a Contract

Agreement Consideration

Contractual Capacity Legal Subject Matter 9

Medical Law and Ethics (cont.)
Contracts
Types of Contracts
 Expressed Contracts
 Clearly stated in written or spoken words
 A payment contract is an example
 Implied Contracts
 Actions or conduct of the parties, rather than
words, create the contract
 A patient rolling up his/her sleeve to receive an
injection is an example 10
Medical Law and Ethics (cont.)
Terminating Care of a Patient
 A physician who no longer wants to manage a
patient’s care must withdraw in a formal, legal
manner by:
 Providing written communication to the patient
 Recommending that patient seek another physician
as soon as possible
 Mail letter by certified mail with return receipt
requested
 Summarize all communication in patient chart and
place copy of all documentation in chart
11
Medical Law and Ethics (cont.)
Terminating Care of a Patient
 Typical Reasons Physicians May
Terminate Care of a Patient:
 Refusal to follow physician instructions
 Personality conflicts
 Failure to pay for services rendered
 Repeated failure to keep appointments
 Patient family member complaints
 Disagreement regarding medication orders
12
Medical Law and Ethics (cont.)
Malpractice
 Malpractice claims are lawsuits by a patient
against a physician for errors in diagnosis or
treatment.
 Negligence cases are those in which a person
believes a medical professional’s actions, or
lack thereof, caused harm to the patient.

Latin term which means “The thing speaks for itself.”

13
Medical Law and Ethics (cont.)
Malpractice
 Examples of Negligence:
 Abandonment
 Delayed treatment
 Legal Terms used to classify Negligence
 Malfeasance (unlawful act or misconduct)
 Misfeasance (lawful act done incorrectly)
 Nonfeasance (failure to perform an act that is
one’s required duty or that is required by law)
14
Medical Law and Ethics (cont.)
Malpractice
The 4 Ds of Negligence
amages Patients must prove that they suffered injury.

Patients must show that the physician failed to

erelict comply with the standards of the profession.

Patients must show that a physician-patient relationship

uty existed.

Patients must show that any damages were a

irect Cause direct cause of a physician’s breach of duty.

Patients must be able to prove all 4 Ds in order to move forward

15
with a malpractice suit.
Medical Law and Ethics (cont.)
Malpractice
Settling Malpractice Suits
 Arbitration
 Persons outside the court system with special
knowledge in the field listen to the case, and
decide the dispute.
 Court
 Written court orders (subpoena) are delivered to
involved parties.
 Subpoena duces tecum is a court order to 16

produce documents like patient records.

Medical Law and Ethics (cont.)
Malpractice
 Law of Agency
 Employees are considered to be agents of the
physician while performing professional tasks.
 Physicians are thereby responsible or liable for
the negligence of employees.
 Respondeat superior is a Latin term meaning
“Let the master answer.”
Employees are also legally responsible for their own
actions, and they can be sued directly.
17
Medical Law and Ethics (cont.)
Standard of Care
According to the AAMA, medical assistants
should uphold legal concepts by:
 Maintaining confidentiality.
 Practicing within the scope of training and
capabilities.
 Preparing and maintaining medical records.
 Documenting accurately.
 Using proper guidelines when releasing
information. 18
Medical Law and Ethics (cont.)
Standard of Care (cont.)
 Follow employer’s established policies dealing with
the health-care contract.
 Follow legal guidelines and maintain awareness of
health-care legislation and regulations.
 Maintain and dispose of regulated substances in
compliance with government guidelines.
 Follow established risk-management and safety
procedures.
 Recognize professional credentialing criteria.
 Help develop and maintain personnel, policy, and
procedure manuals.
19
Medical Law and Ethics (cont.)
Administrative Duties and the Law
 Examples of duties related to legal requirements:
 Vital statistics (births & deaths)
 Abuse (drug abuse & child abuse)
 Violent Injuries
 STD’s (sexually transmitted diseases)
 Patient consent forms
 Insurance billing
 Appointment books
 Patient records and information
20
Medical Law and Ethics (cont.)
Controlled Substances and the Law
Medical Assistants must
follow the correct procedure
for keeping and disposing of
controlled substances.

• Be familiar with correct dosages, potential

complications, and refill rules.
• Keep prescription pads secure and out of reach.
21
Medical Law and Ethics (cont.)
Communication and the Law
 Medical assistants are not allowed to decide
what information is to be disclosed to the
patient.
 The role of the medical assistant is to foster
supportive, respectful communication with
patients.
 Good, clear, nonjudgmental communication
can prevent misunderstandings and legal
confrontations.
22
Medical Law and Ethics (cont.)
Legal Documents and the Patient
A legal document stating types of treatment the
patient does and does not want in an event of
Living terminal illness, unconsciousness, or comatose
Wills state.
(Advance Patients with living wills are asked to name
someone that will make decisions on their behalf
Directives) (durable power of attorney) if they are unable to
do so.
Uniform
A legal document that states a person’s wish Donor
to donate one or more organs as a gift. Even Card
total body anatomical gifts are made.
23
Medical Law and Ethics (cont.)
Confidentiality Issues
 All patient information must be kept
confidential and shared only with the
appropriate staff involved in the care of the
patient.

• Keep records out of sight, so night workers and

other patients cannot view it.
• Do not discuss the case with anyone outside the
medical office. 24
Medical Law and Ethics
Confidentiality Issues (cont.)

• August 21, 1996 is the date the U.S. Congress

HIPAA was passed
• Two main sections of the law:
• Title I: Health Care Portability
• Title II: Preventing Healthcare Fraud and
Abuse; Administrative Simplification; Medical
Liability Reform

25
Medical Law and Ethics
Confidentiality Issues (cont.)
 Title I: Health Care Portability
 Portability deals with protecting healthcare
coverage for employees who change jobs.
 Reduces the risk that individuals will lose their
existing health care coverage when changing
jobs.
 Allows workers to purchase insurance on their
own if coverage is lost under their employer.

26
Medical Law and Ethics
Confidentiality Issues (cont.)
 Title II: HIPAA Privacy Rule
 The HIPAA Standards for Privacy of
Individually Identifiable Health Information is
the first comprehensive federal protection for the
privacy of health information.
 The core of the HIPAA Privacy Rule is the
protection, use, and disclosure of protected
health information (PHI).

27
Medical Law and Ethics
Confidentiality Issues (cont.)
 Use and Disclosure are two important concepts under
HIPAA that must be understood.
Information is used when it moves within an organization.
Information is disclosed when it is transmitted between or among
organizations.
Examples of Use Examples of Disclosing
• Sharing • Release
• Employing • Transfer
• Applying • Provision of access to
• Utilizing • Divulging in any manner
• Examining
28
• Analyzing
Medical Law and Ethics
Confidentiality Issues (cont.)
HIPAA will allow the provider to use health care
information for:

reatment Providers are allowed to share information

in order to provide care to patients.

Providers are allowed to share information

ayment in order to receive payment for the
treatment provided.

Providers are allowed to share information

perations to conduct normal business activities, such
as quality improvement. 29
Medical Law and Ethics
Confidentiality Issues (cont.)
 The following information may be
disclosed without authorization:
• Medical researchers • Work related conditions
• Emergencies that may affect employee
• Funeral Directors/Coroners health
• Disaster Relief Services • Judicial/administrative
• Law enforcement proceedings at the patient
• Correctional Institutions request or as directed by a
• Abuse and Neglect subpoena or court order
• Organ and Tissue Donation
Centers
30
Medical Law and Ethics
Confidentiality Issues (cont.)

• First these rights are communicated through a

document called the Notice of Privacy Practices.
• The next step is to implement a document that
explains the policy of the medical facility on
obtaining authorization for use and disclosure of
patient information for purposes other than TPO
(treatment, payment, or health-care operations).
31
Medical Law and Ethics
Confidentiality Issues (cont.)
Security Rule
This rule specifies how patient information is protected on:
 Computer networks
 The internet
 Disks and other storage media and extranets

Other Security Avenues to Consider

 Chart security  Medical Assistant clinical
 Reception area security station security
 Fax security 32
Apply Your Knowledge -Answer
A 36-year-old patient comes to her initial office visit, and
the medical assistant begins to register the patient. While
the patient is completing her paperwork, she passes out in
the waiting room lobby. She is carried to the local
hospital and diagnosed with a severe stroke. As the
patient recovers, she verbalizes a desire to bring a
malpractice suit on the physician. Are all the elements
required for malpractice present?
No, for starters, duty has not yet been established which
is the first required element.
33
OSHA Regulations
 The Occupational Safety and Health Administration
(OSHA) is a division of the U.S. Department of
Labor.
 Regulations describe precautions that must be taken
to protect workers from exposure to infectious
diseases such as:
 Human immunodeficiency virus (HIV)
 Hepatitis B virus (HBV)

34
OSHA Regulations (cont.)
 OSHA requires that medical practices follow
Universal Precautions.
 Hospitals are required to follow Standard
Precautions, which is a combination of
Universal Precautions and Body Substance
Isolation guidelines.
 Both Universal Precautions and Standard
Precautions were developed by the Centers
for Disease Control and Prevention (CDC). 35
OSHA Regulations (cont.)

• Disposable gloves
• Masks
• Goggles/Face Shield
• Gowns

The law requires that the employer provide all necessary

protective clothing to employees free of charge.
36
OSHA Regulations (cont.)
 Decontamination
 All exposed work surfaces must be sprayed with a 10%
bleach solution or other agent approved by the
Environmental Protection Agency (EPA)
 Sharp Equipment
 To prevent exposure, sharps are to be placed in a leak-
proof, puncture-resistant, color-coded, labeled container
 Exposure Incidents
 Incidents are to be reported immediately
 Current procedures may need to be modified
37
OSHA Regulations (cont.)
 Postexposure Procedures
 Employers must offer a free medical evaluation to
exposed employee
 Employers must also refer employee to a licensed
health-care provider for blood sampling,
appropriate treatment, and counseling
 Employees may refuse treatment by signing a
waiver
 When a medical worker is first employed, the
employer must offer at no cost the opportunity to
have the HBV vaccination within 10 days 38
OSHA Regulations (cont.)
 Laundry
 All laundry must be labeled and bagged
appropriately.
 Hazardous Materials
 Employers must keep an inventory of all
hazardous materials in the workplace (MSDS
Sheets.)
 Training Requirements
 All employees that may be exposed must be 39

given free, annual training during work hours.

OSHA Regulations (cont.)
General Regulations
 General Work Area Laws
Restrict:
 Eating & Drinking
 Smoking
 Applying lip balm &
cosmetics
 Handling contact lenses
 Storing food or drinks in
refrigerators used to store
blood or other potentially
infectious materials 40
OSHA Regulations (cont.)
 Documentation
 Inspections are done in response to complaints and at
random. The office must have a written Exposure Control
Plan and keep necessary forms on file as indicated.
 OSHA Inspections
 Inspections are done in response to complaints and at
random
 Penalties include fines and monies paid to the federal
treasury
 Serious violations in the laboratory may result in
suspension of laboratory payments from Medicare
41
Apply Your Knowledge -Answer
A medical assistant working in a local medical office has
a severe allergy to latex. What should she do when
handling potentially hazardous materials?

The physician, according to OSHA, must supply the

necessary protective equipment, so latex-free gloves
should be on hand in such situations.

42
Quality Control and Assurance
 The Clinical Laboratory Improvement
Amendments of 1988 (CLIA’88) set
standards for the quality of work performed in
a laboratory and the accuracy of test results.
 CLIA requires that every medical office have
a quality assurance program.
 Three categories of laboratory tests:
 Waived
 Moderate-complexity
 High-complexity 43
Quality Control and Assurance (cont.)
 Elements of the Quality Assurance (QA)
Program
 Written policies on standards of patient care and
professional behavior
 A quality control (QC) program
 Training and continuing education programs
 Documentation requirements
 Evaluation methods

44
Quality Control and Assurance (cont.)
 The Laboratory QC Program must cover:
 Patient Preparation Procedures
 Collection of Specimens
 Labeling
 Preserving & Transporting Specimens
 Test Methods
 Inconsistent Results
 Use & Maintenance of Equipment
 Personnel Training
 Complaints & Investigations
 Corrective Actions
45
Code of Ethics
 Bioethics
 Pertains to issues that arise due to medical
advances
 Principles of medical ethics have developed over
time dating back to Hippocrates
 A document called the Patient’s Bill of Rights
lists ethical principles that protect the patient

46
Apply Your Knowledge -Answer
A 26-year-old patient is very upset about her proposed
treatment plan and refuses to be taken to the hospital as
the physician has suggested. The patient attempts to
leave the office, but the physician instructs the medical
assistant to give the patient a sedative, so she can wait
until her husband arrives. What are implications of this
situation?
Even though the physician believes he is acting on the best
interest of the patient, the patient refused care and has the
right to do so as long as she is competent. The administration
of the sedative could be classified as a form of false 47
End of Chapter

48