LEGAL ASPECTS OF PRE-HOSPITAL CARE

1. LEGAL ASPECTS OF PRE-HOSPITAL CARE Temple College EMS Professions ECA

2. Topics • Morals • Ethics • Law • Scope of Practice • Standard of Care • Negligence • Abandonment • Consent

3. Morals • Definition per Webster: • The rules or habits of conduct • Concerned with the discernment of what is right and wrong • Individual

4. Ethics • Definition per Webster: • A body of principles of good conduct • Any set of moral principles or values • Set by a Group

5. Ethical Responsibility • Make patient’s needs a priority • Maintain skills and knowledge • Critically review performance • Be Honest

6. EMT Code of Ethics • Our statement to the Public • Written by: Charles Gillespie, M.D.Adopted by: The National Association of Emergency Medical Technicians, 1978

7. Law • Types • Constitutional • Legislative • Executive • Judicial • Administrative • Only defines what is illegal

8. Texas Laws of Interest • Health and Safety Code • Traffic Code • Detention of mentally ill individuals • DSHS Administrative Rules • Certification • Recertification • Disciplinary Action

9. Scope of Practice • Care providers are allowed to provide to the patient • Determines different Levels of Providers • Most States have very specific lists • In TEXAS - There is no “defined” scope of practice

10. Texas Scope of Practice • Established by Medical Director (In Texas) • Texas Medical Practice Act • Allows Physicians to delegate procedures to EMS personnel • Protocol • Standing Order • On-Line

11. Standard of Care • “- - - how a reasonably prudent person with similar training & experience would act under similar circumstances, with similar equipment, and in the same place.”

12. Standard of Care • Local Custom • Similar Training & Experience • Protocol • Other factors • Location • Hazards • Crowds

13. Standard of Care • Professional Standards • American Heart Association (AHA) • American Ambulance Association (AAA) • National Association of Emergency Medical Technicians (NAEMT) • Texas Department of State Health Services (DSHA) • Department of Transpiration

14. Standard of Care • Institutional Standards • Service • Regional Systems

15. Negligence • Simple (Ordinary) Negligence • Gross Negligence • Proving Negligence • Duty to Act • Breach of Duty • Damages • Causation

16. Abandonment • Failure to Continue Treatment: • Termination of care without Pt’s consent • Termination of care without provision for continued care

17. Abandonment Examples • Failure to transport • Handing over care to lesser trained personnel • EMT > EMT • EMT > EMT-P • EMT > ECA • EMT > Physician • EMT > Nurse

18. Consent • Permission to treat the patient • Obtained from conscious patients before assessment, treatment, and transport • Types • Expressed • Implied • Involuntary

19. Expressed Consent • Spoken or communicated consent • Must be informed • Injury/Illness • Risks • Not receiving treatment • Adverse consequences of treatment • Benefits • Alternatives

20. Expressed Consent • Able to give expressed consent if: • Patient of legal age (18) and rational • Married • Pregnant (and consent is for care of fetus) • Armed Services • Emancipated

21. Implied Consent • Pt. is unconscious or unable to communicate and is suffering from what appears to be a life-threatening injury or illness • Assumes patient would want to be treated

22. Involuntary Consent • An adult may be treated against his will only if: • Treatment is ordered by a magistrate • Treatment is ordered by a peace officer or corrections officer who has the patient under arrest or in custody • Consent of the Mentally Ill

23. Patient Refusal • Patients have the right to refusal treatment/transport! • Legally able to do so • Informed of injury/illness, risks, benefits, treatments, & alternatives • Obtain signature & witness

24. Options for Patient Refusal • Get help from other family members • Law enforcement • Medical Control When in doubt, err in favor of the patient!

25. Minor Consent • Minor - any person under 18 years of age who has never been married and who has not had his/her minority status changed by the court • Actual Consent (Informed, Expressed) • Parents • Guardian • Grandparents • Adult Brother/Sister • Adult Aunts/Uncles

26. Minor Consent • Implied Consent • Life or Limb Threatening • No Parental Refusal

27. Refusal for minors • Parents/Guardians have the right to refuse treatment and or transport • Mentally competent adults (Parent/Guardian) • Parent/Guardian must be informed of injury/illness, risks, benefits, treatments, & alternatives • Obtain signature of Parent/Guardian & witness

28. Assault & Battery • Assault • Unlawfully placing a person in fear of immediate bodily harm without consent • Battery • Unlawfully toughing a person In Texas – Assault is used to describe both fear of harm and actual unwanted physical contact

29. Immunity • Governmental (Sovereign) Immunity • “Good Samaritan” laws • Generally does not apply if on duty • Does not prevent lawsuits • Offer a defense for those who act in “Good Faith” and meet the Standard of Care” • Do not protect against Gross Negligence

30. Living Wills/Advance Directives • Patients have a right to determine what happens to them • “Living Will”/ “Advance Directives” must be Presented upon Patient Contact • Determine validity • Hospital vs Field documents

31. Advanced Directives • DNR • Power of Attorney for Healthcare

32. Do Not Resuscitate • Refusal to Honor • The patient is pregnant • There are unnatural or suspicious circumstances surrounding the death • The form is not signed twice by all who need to sign it or is filled out incorrectly • Consider Family Reaction • If in Doubt – Treat!

33. Texas OOH DNR • Bracelet/Necklace • Vinyl Band • Form

34. Organ Retrieval • Provide Care • Identify Possible Candidates • Donor Card or Driver’s License Sticker • Nature of Injury • Notify Proper Officials

35. Records & Reports • Complete & Accurate • Legible & Neat • An untidy or incomplete report is evidence of incomplete or inexpert care. • Legal Document • If it wasn’t written down, it didn’t happen!

36. Patient Confidentiality • Privacy Practices • HIPPA • Federal law • Protects patient • What information is protected • Protected health information (PHI) • Oral, written, and electronic information

37. Patient Confidentiality • Patient Confidentiality must be Kept: • To Ensure the Patient’s Right to Privacy • To Maintain the EMT’s Reputation of Professionalism • To Maintain the Service’s Reputation of Professionalism • It is No One else’s Business!

38. Patient Confidentiality • Patient Information May Only be Released: • It is necessary to ensure continuity of care • It is requested by Law Enforcement (Judge) • It is required for billing purposes • It is Subpoenaed • When the Patient Signs an Information Release Form

39. Special Reporting Requirements • Childbirth • Child Abuse • Report to: • Law Enforcement • Physician - Emergency Department • Child Protective Services (CPS) • Don’t Accuse - Report Observations Only • Immunity - Good Faith

40. Special Reporting Requirements • Elder Abuse • Injury During the Commission of a Felony • Drug Related Injuries

41. Special Reporting Requirements • Crime Scene • Scene Survey • Document • Preserve • Report to Law Enforcement

42. Special Reporting Requirements • Sexual Assault • Report to Law Enforcement (with Patient’s Permission) • Retain Evidence

43. Special Reporting Requirements • Dead on Scene • Document Absence of Vital sign • Contact Coroner • Contact Law Enforcement • Do Not Disturb or Move Body

44. As ECAs • We are given a great deal of power, and responsibility • People freely invite us into their homes • They trust of with their possessions • They trust us with their lives and that of their loved ones

45. As ECAs • We have a “duty to act” when call on for help. • We have an ethical responsibility to understand what is right or wrong for our patient, even if it goes against what we personally believe. • We have a responsibility to act to our standard of care.