Legal Aspects of Health Care Management
LegalAspects of Health Care Management
LegalAspects of Health Care Management
Severalelements guarantee the safety of a patient in a healthcareinstitution. Their right to information and choice of treatmentmethods are some examples. Laws have been developed and institutionsestablished to ensure the security and rights of the patient areobserved during treatment (Healey& Marchese, 2012).Practitioners who omit or commit outside the set regulations are saidto be negligent and are subject to disciplinary action by concernedregulatory institutions. This paper analyzes informed consent,negligence in health care and cases to explain the elements of anegligence claim.
Paper1 – Part A
Thisis the process where a health care provider discloses someinformation to the patient regarding their treatment and require fromthem a form of approval to proceed with the treatment method. Thisprocess is supported by the patient’s legal and ethical rightsduring treatment established by regulators. In some situations, thehealth provider is required by law to seek consent before performinga procedure on the patient. It is also ethical for the patient or aqualified representative to be involved in their treatment process.The patient has the right to decline a consent request, and thus atreatment procedure if they have the capacity.
Thereare three kinds of permissions that are acceptable including awritten, verbal or implied consent. Written consents are associatedwith high-risk medical procedures, and as such, it is consideredacceptable only upon the appendage of the patient`s signature, orthat of their proxy`s in a particular form (Fakhoury, 2012). Verbalconsents are approved by the patient`s word of mouth and areassociated with procedures that carry less significant risk. The lastform of consent is supported by the patients’ actions or submissionto the provided instructions by the health care provider.
Severalelements require being communicated to declare that the form ofauthorization is an informed consent. These include the nature of theprocedure, any reasonable alternatives, its risks, and mostimportantly an assessment of the patient`s level of understanding.Due to their conditions, most patients are under excessive amounts ofstress, anxiety, fear or depression which might influence theirdecision-making abilities (Fakhoury, 2012). However, the actualdeterminants of the decision-making abilities of a patient are basedon whether the patient understands their condition, the risksinvolved with the procedure and their ability to communicate theirconsent based on the information.
Generaland Professional Liability
Generalliability in a healthcare setting arises due to the failure of thefacility and its workers to maintain a safe and habitable environmentfor their patients. For example when a patient falls after walking ona slippery hospital floor. Bodily injury and property damagesresulting from accidents within the health facilities which couldhave been avoided if the institution took precaution, frequentlyresults in general liability claims against the provider.Professional liability is directed towards the practitioner and issaid to have occurred after a `medical incident.` A `medicalincident` is said to have happened when it is proven that thepractitioner was negligent in the provision of care by ‘omission orcommission’ based on the professional standards of practice (Healey& Marchese, 2012). Bodily damage, additional medical expenses,and damages to the property of a patient resulting from the medicalincident against the healthcare practitioner like a dentist orcardiologist will be claimed in the professional liabilitylitigation. Both general and professional liabilities will requirethe institution and the practitioner to compensate the patient forthe resultant damages.
NecessaryElements of a Negligence in a Claim
Toprove that professional negligence has resulted in damages to themand that compensation is required from the practitioner, the patientmust prove the existence of the four elements of negligence in theclaim. The absence of evidence of any of the elements of negligencewill make the claim to be unsuccessful in the courts of law. Firstly,the patient must prove that the institution or specific practitionerowed them a duty to care at the moment (Mills, 2012). This may beproved by providing evidence from the organization’s definition oftheir duty to patients in their corporate policies.
Secondly,in professional liability the patient must prove that thepractitioner acted negligently with regards to the standards of theirprofession. Then the patient or claimant will also have the burden toprove that the duty of care owed to them was breached by theresponsible party. They must also prove that there has been materialdamage to their property, person or additional medical expenses haveresulted from the breached duty to care. Finally,the claimant must prove that the damage to their body or property isdirectly related to or is a result of the breach of duty by theresponsible party within the healthcare institution.
Paper1 – Part B
Elementsof Negligence in the Cases
Inthe first case, despite the fact that Mr. Floyd was not admitted intoWillacy County Hospital, the nurse on duty, Nurse Lunsford, owed hima duty to care by her position in the hospital. The fact that thenurse was trained to understand the condition the patient was in. Inthe second case, the nurse owed the patient the duty to report herquery to the physician in addition to confirming all the pre-surgerydocuments. This was also mentioned in her submissions before thecourt as part of her duty in such a situation.
Inthe first case Nurse Lunsford transferred Mr. Floyd despite the clearknowledge of the complications that are expected. Her initialobservation at the waiting room led the nurse to the judgment thatMr. Floyd was suffering from a heart condition and required immediateadmission. Despite this knowledge expected of anyone with hertraining in that position, she proceeded to turn him to a hospitalthat was 25 miles away, which is a breach of her professional duty(Croke,2006).In the second case, the nurse went ahead to operate on the right armof Susan Muskopf even after she questioned the position. The nursereviewed all the pre-surgery documents which proved her earliernotion and ignored the last bit of due diligence. She failed toconsult the physician in charge of the case as per the procedureswhich makes it an omission and thus negligence.
Inthe first case, Mr. Floyd died five miles from Willacy CountyHospital while headed to Valley Baptist Hospital as per NurseLunsford’s diversion directive despite his condition. This led tothe nurse’s license to be suspended for a year. In the second caseSusan Muskopf suffered injury from surgery on the wrong arm.
Impactsof Regulation on Patient Care and Injury Prevention Strategies
Theregulations on patient care ensure that the healthcare institution isheld responsible for any breaches conducted within the institution.As seen in the second case, the institution was held liable togetherwith the nurse who failed to complete the due diligence (Croke,2006).This has ensured that organizations develop company-wide strategiesfor prevention of injury and patient care, to safeguard themselvesagainst costly litigations. This has however improved the level ofpatient care.
Howthe Incident could have been Prevented
Inboth cases, frequent training on the standards of care expected ofthe care givers is necessary. This will ensure in what there is anunderstanding as to the condition the hospital should admit a patientdespite not having a physician, in the first case. The differentpoints of establishment of legal nurse-patient relationship should bediscussed in the first organization (Croke,2006).It will also ensure that complete due diligence is done before majorprocedures are conducted on a patient. In addition, communicationwithin the two institution should be fostered and any necessaryinfrastructure to enhance the same should be installed as a matter ofpriority.
Ageneral and professional liability claim may be instituted against ahealthcare organization or its employees for negligence duringtreatment. The patients consent to treatment should be sought duringtreatments. Actions by practitioners that breach duty of care owed tothe patient may result in a negligence suit against them. Theclaimant has the burden of proof in a negligence claim and has toprovide evidence of the elements of negligence.
PAPER2 – PART A
Everyorganization operates within a political jurisdiction and as suchmust adhere to the rules and regulations in the business environmentcreated by the authorities. This ensures that consumers are protectedby the regulations and the institution avoid litigations from thestate (InOster & Sigma Theta Tau International, 2016).Regulations are necessary in the healthcare department to ensure thatthere is uniformity in the practice across any jurisdiction. Thispaper is a research on the compliance of healthcare institutions withregulatory agencies and the patient care laws.
RegulatoryAgencies and their Responsibilities
Inthe US, several agencies exist to support the health care operations.The Department of Health and Human Services Office for Civil Rights(OCR) and the Centers for Medicare and Medicaid Services (CMS) ensurethat the institutions comply with the HIPAA that controls prices andprotects patients against the unexpected standards of service withinthe institutions. In addition to the above, CMS ensure that Medicareand Medicaid operate effectively.
TheOffice of Health Care Quality (OHCQ),that uses both state and federal regulations to set the minimumstandards of care and conduct compliance audits within the 14000healthcare institutions within Maryland (Cohen,Hoffman & Sage, 2017).The Agencyfor Healthcare Research and Quality(AHRQ)isone conducts the necessary research to guarantee highest standards ofquality is achieved at the lowest cost possible to the patient. TheJoint Commission on Accreditation of Healthcare Organizations (JCAHO)is a private entity mandated with accrediting health institutions fortheir eligibility to support Medicare in its structure.HealthCare Laws
Thereare several laws that govern the healthcare environment in the UnitedStates. Privacy Act of 1974 ensures that the information extractedfrom a patient in the treatment process is known and authenticated bythem. Alcohol and Drug Abuse Patient Confidentiality Act ensures thatthe patient’s information during any government controlledsubstance abuse programs is as confidential as possible. Conditionsfor Coverage of Specialized Services by Suppliers also aims to leavethe control of the use of patient’s information to them. Thislegislation is a part of Medicare. HealthInformation Technology for Economic and Clinical Health (HITECH) wasenacted in 2009 to control the implementation of technology in healthinstitutions across the country.
HealthInsurance Portability and Accountability Act (HIPAA)wasenacted to control the prices and quality of health services insupport of the ACA. The AffordableCare Act (ACA)of 2010 was enacted to increase the health coverage across thecountry by making the services affordable (In Oster & Sigma ThetaTau International, 2016). The Food and Drug Administration Safety andInnovation Act (FDASIA) is an act that aims to control innovation inhealthcare especially mobile applications and reducing the overallcost. The Medicare Access & CHIP (Children’s Health InsuranceProgram) Reauthorization Act (MACRA)of 2015 has the goals of ensuring that providers are reimbursedfairly on Medicare and increase the standards of care in the country.The 21stCentury Cures Act of 2016 aims at making care as modern and personalas possible with innovation.Strategiesthat may Increase Compliance in Health Care Organizations
Thehealth care organization may hire a compliance officer to develop adepartment within the organization – depending on its size. Theofficer and the department will work to ensure that the company doesnot negatively change its compliance status. The company may alsocarry out frequent staff education and training to ensure that theteam is well aware of the expected standards of care and the damagesin case of a breach (Sadeghi, 2013). The organization may alsoimplement a system of monitoring per-capita compliance levels whichmay be incorporated into the payroll system to encourage individualbest practice.
TheRole of the Patient Care Committee
Theparent care committee has the overall goal of monitoring the qualityof care provided across the country and has several roles. Firstly,the committee recommends the expected standards of quality across thedifferent facets of care provision. It oversees the process ofpatient education, hospital staff training and validates thestandards of care. The committee also provides guidance on the use ofanesthesia in hospital and other settings. Monitors the quality ofcare supported by Quality Control. Performs annual reviews on theplan for patient care provision in the country. The work of theCommittee is aimed at ensuring that the patients’ bill of rightsare attained across the country including their confidentiality, theexpected quality of care, their safety while at the healthinstitution and right to information among others.
PAPER2 – PART B
TheDepartment of Health and Human Services (HHS) through the Centers forMedicare & Medicaid Services, (CMS) examined the incident in arandom validation review of the organization and its systems (Modernhealthcare, 2017).
Incidentthat Resulted in Noncompliance
Thedeath of a patient at Massachusetts General was caused by one mainissue. The volume on the patient’s bedside crisis alarm was turnedoff. This is explained later by the hospital’s senior vicepresident on safety and quality, as caused by the lack of enoughtraining and knowledge by the staff on the ease of the volume of thealarm being turned of unknowingly.
Thehospital has reacted swiftly to this challenge which has resolved theearlier challenges. There were no punitive penalties to MassachusettsGeneral however CMS prescribed the measures to be implemented toavoid recurrence. The off button on the alarm was removed from thesystem. Staff training was enabled by the establishment of programand more speakers were placed inside the hospital to increase thereach of an alarm.
Stepsto avoid this Type of Non-Compliance
Theinstitutionshouldhave a training system for its staff on any emerging issues andtechnologies in healthcare provision to ensure full individualcompliance. The off button on the alarms require to be addressed byeither removing it completely or modifying the system to make it askfor additional authority to turn the alarm volume off (Modernhealthcare, 2017).Alarm should also be placed strategically to ensure that they areheard from almost any corner of the hospital for instant reaction. Aback-up system of communicating crisis mages should be implemented tocomplement the existing system.
Complianceof healthcare institutions to the set standards of care guaranteesthe safety of patients and also avoids litigations and penalties.Several laws and institutions exist to ensure that standards ofquality across the industry are maintained. Healthcare institutionsshould establish strategies to avoid non-compliance with theregulations.
Croke,E. (2006). Nursing malpractice: Determining liability elements fornegligent acts. Journal of Legal Nurse Consulting, 17(3), 3–7, 24.http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com/login.aspx?
Fakhoury,J. (2012). Informedconsent: Comparing psychologists` approaches to obtaining informedconsent in correctional versus non-correctional settings.
Healey,B. J., & Marchese, M. C. (2012). Foundationsof health care management: Principles and methods.San Francisco: Jossey-Bass.
Mills,K. (2012). MedicalNegligence.Bloomington, IN: Authorhouse
InCohen, I. G., In Hoffman, A., & In Sage, W. M. (2017). TheOxford handbook of U.S. Health Law.New York, NY: Oxford University Press
InOster, C., In Braaten, J., & Sigma Theta Tau International,(2016). Highreliability organizations: A healthcare handbook for patient safety &quality.Indianapolis, IN: Sigma Theta tau International, Honor Society ofNursing
Modernhealthcare. (2017). Alarm fatigue sets off bells. Retrieved on 10thApril 2017 from,http://www.modernhealthcare.com/article/20100412/MAGAZINE/100409955
Sadeghi,S. (2013). Integratingquality and strategy in health care organizations.Burlington, Mass: Jones & Bartlett Learning.
No related posts.