Ensuring Digital Signature Lawfulness for Healthcare in the United States

How to eSign a document: digital signature lawfulness for Healthcare in United States

concepts chapter 58 health care law goals for this concept presentation define and describe the concept describe the scope and sources of law governing healthcare discuss the application of healthcare law to nursing and healthcare in the civilized society laws are enacted for purposes of regulating behavior and guiding conduct a law is a rule or a set of principles enacted by a government or government agency that details how an individual or group must behave in a given circumstance a law may be prescriptive it defines something that must be done or pro descriptive it prohibits something from being done as a concept healthcare law represents both prescriptive and prescriptive principles covering a wide spectrum of topics just as the healthcare industry is composed of a vast network of people places and things health care law is likewise broad in its definition and scope there are many ways to define an examine health care law for the purposes of this concept presentation health care law is defined as the collection of laws that have a direct impact on the delivery of health care or on the relationships among those in the business of health care or between the providers and recipients of health care health care law is a complex concept representing a wide spectrum of both creation and application of laws the executive legislative and judicial branches of federal and state governments hold the authority for the creation of law the process for creating law is through legislation litigation or through regulatory activities by government agencies these processes are not linear rather they represent an interwoven process that fosters a continuing evolution in health care law for example laws may begin by a legislature identify an issue and drafting along to address the issue authority may be given to an existing federal agency to draft rules that support compliance with the policy goals of the initial law if a situation arises that does not completely fit within the law as drafted by the legislature or an individual affected by the law believes that the law is unconstitutional or in conflict with other laws a legal challenge in court may be presented sometimes the judicial ruling will stand alone as a law and sometimes the legislature will revise the law to be consistent with the court's ruling or perhaps the legal challenge preceded the legislation and the legislature may or may not decide to make the formal declaration of law sources of law health care law is derived from primary and secondary sources of law including constitutional law statutory law administrative law tort law common law contract law and criminal law constitutional law the powers of the federal government are specifically defined in article 1 section 8 of the US Constitution the powers specifically given to the federal government do not have a direct relationship to health care so are links to the Constitution as in due process or equal protection creates the necessary authority to draft federal health care laws for example the Due Process Clause of the Fourteenth Amendment was the constitutional legal principle under which the Supreme Court decided the landmark 1973 case of Roe vs. Wade which forbids States from criminalizing or otherwise banning first trimester abortions and recognized a constitutional right to privacy inclusive of a woman's right to terminate her pregnancy and the 1990 case of cruising versus Missouri which clarified a competent patient's right to refuse treatment state constitutional authority there is a more direct relationship to health care than the federal powers and influence areas such as public health and public safety common-law the role of the judge or the judicial branch of government is to interpret the law but often their interpretation of the law leads to law itself this type of law is referred to as common law or case law whereby statutory laws applicable regulations and legal precedents are analyzed in the context of the situation under review a decision is made based on this analysis sometimes the decision is limited to the exact facts of a case or limited to a specific state or area of the country and sometimes the decision impacts the country as a whole sometimes one area of the country may not have addressed a question that another area of the country has already answered in the courts and it may adopt the ruling of another area without going through the process of litigating the question in the courts contracts law has also shaped and influenced health care law to some degree routine conditions of admission and consent forms represent a contract between the patient and the healthcare facility or the healthcare provider principles of contract are also used to define the work agreements of those who provide services of healthcare such as an employment contract between a nurse and a healthcare organization criminal law criminal penalties have increasingly influenced healthcare laws with felonies associated with Medicare or insurance reimbursement fraud misrepresentation of qualifications are even purposeful breaches of protected health information becoming more commonplace there are specific situations in which the act of negligence is so reckless or done with such purposeful disregard that the Act may be considered criminal criminal liability considers the nature of the action not necessarily the result in harm and can attach even when there is no resulting injury or harm health care professionals have been found guilty of criminal neglect or abuse when they have shown extreme indifference to the needs of their patients such as restraining patients and then ignoring their cries for help or needs for repositioning toileting or other care in Arizona of the was found guilty of manslaughter for refusing to return to attend to a patient after she developed complications from an elective procedure attributes and criteria there are many accreditation requirements social expectations and customs that can influence and have an effect on the delivery of health care decision-making and organizational behavior however these are not the same as health care laws for example health care standards such as the Joint Commission accreditation standards can influence health care law but these standards are not laws health care laws can be distinguished and differentiated from accreditation requirements social expectations and customs by considering major and minor attributes presented in 50 8/1 Fox 58 / 1 on page 535 of content of concepts major attributes created by a government body with appropriate authorities such as the legislature agency or judiciary usually has enforceable sanctions like fines or imprisonment publicly available and accessible by an individual or group consistent with national and state constitutions can be modified changed or upheld through authoritarian action minor attributes may contain incentives may be self limited expiring after some time period may vary in scope some are wide and sweeping but some are small and narrowly focused and may be established to promote a policy goal federal statutory laws impacting health care throughout the years a number of federal laws have had sweeping effects on the delivery of health care the Social Security Act of 1965 and 1983 amendment the patient self-determination Act of 1981 the Health Insurance Portability and Accountability Act the Patient Protection and Affordable Care Act and the controlled substance act are several such laws implementation of these laws requires significant efforts in the development of policy and in monitoring to ensure compliance administration and regulation federal context in nursing and health care continues the State Board of Nursing a State Board of Nursing holds the legal authority for Nursing Practice and regulates Nursing Practice through one establishing the requirements to obtain a nursing license to issuing nurses licenses three determining the scope of practice for setting minimum education standards and five managing disciplinary procedures our board is BV NPT which is the board of vocational nursing in psychiatric technicians to become an LVN context to nursing and health care continues professional Nursing Practice is regulated by the state's nurses must hold a state issued license to practice nursing details of the practice of Nursing are found in the scope of practice for each state practice can vary from state to state nurses should be familiar with the nurse Practice Act and scope of practice in the state in which they work negligence tort is the area of law under which cases of negligence are argued negligence is the failure to use reasonable prudent care in the same or similar circumstances also referred to as malpractice negligence is the most common tort holding nurses physicians and other health care providers liable to patients for damages for tort liability to attach to negligent conduct the individual actor must have done more than simply act in a negligent manner there are four elements that must be satisfied to establish liability duty for each injury and causation duty all persons OA duty to exercise ordinary care to avoid harming another person place or thing when negligence is alleged by a patient the evidence must establish that the nurse or health care provider owed a professional duty to the person harmed beyond the duty to exercise ordinary care this higher standard and professional duty arises from a special relationship between health care providers and patients in relation to health care law the physician patient relationship or nurse patient relationship is traditionally viewed as a special relationship that gives rise to a professional duty of care nurses Oh a professional duty of reasonable care to all of their assigned to patients the evidence must also also establish the standard of care which refers to an approved behavior or conduct established by the profession the standard of care for nurses is the degree of care that would be exercised by a quote reasonably prudent nurse unquote acting under the same or similar circumstances from a legal standpoint the nurse in a rural setting might be held accountable to a different standard of care than the nurse in an urban tertiary care setting likewise a nurse is held accountable to a different standard of care than other health professionals such as a physician and nurses with different areas of expertise or specialty practice are held accountable to the standards of care applicable to that specialty the practice of Nursing often involves the exercise of professional judgment as well as the application of advanced clinical and scientific knowledge because it may be confusing for a jury of lay persons to determine how a nurse violated the standard of care the standard of care is critical element that must be established by common sense expert testimony evidence-based standards and or other published standards such as accreditation or licensing regulation standards several states have laws that require expert witnesses to have the same or a similar clinical background as that of the defendant in Arizona for example the law requires that an expert witness in mentem coma malpractice be licensed as a health professional in the state of Arizona and have devoted a majority of professional time to active clinical practice of the same health profession as the defendant in the same specialty if the defendant claims to be a specialist several state courts have held that nurses may be used as experts to establish the standards of care for nurses instead of physicians who historically testified as expert witnesses on the standards of nursing care the second is breach of duty the second element that must be satisfied for negligence is the breach of duty health care providers breach their duty to patients when they fall below the standard of care or deviate from the standard in a manner that causes injury it is important to remember that not all deviations from the standard of care well result in negligent tort liability for example it is below the standard of care for a nursing professional to administer the wrong dose of medication to a patient if the medication error does not result in harm or injury to the patient the nurse will not face tort liability for his or her actions but may face termination from employment or licensure discipline depending on the circumstances causation is the third causation is the link between breach and injury what the injury have not occurred but for the defendants actions causation answers this question and establishes that the breach of Duty legally calls to the patient the breach of duty or violation of standard care must be the direct or proximate cause of the harm that the patient experienced in other words if the breach had not occurred no harm would have come to the patient in many instances causation can be difficult to prove in negligence cases the fourth is injury or harm the final element to be satisfied in a negligent action is proof of injury or harm the resultant hire may be physical or a combination of physical mental emotional or financial harm in other words in some states a patient cannot recover from emotional harm alone without an accompanying physical disability after injury is established by a preponderance of the evidence there's often considerable disagreement among the parties to the lawsuit about the monetary value to be placed on the injury employer employee liability professional liability can attach to an employer for the negligent acts of its employee this is known as vicarious liability and it rises from the common-law doctrine of respondeat superior a latin term that means let the master answer under vicarious liability an employer can be liable for the acts of its employee if the employee was acting as the agent of the employer and the actions that resulted in injury occurred within the scope of employment thus an employer would not be liable for injury that happened while the employee was not at work or injury that resulted from activities that were outside of the employees scope of practice laws that empower patient decision-making consent for treatment although consent laws have been largely shaped by the common law many states have enacted laws that designate hookans consent or make decisions for an incapacitated patient if the patient has not already designated someone the concept of consent arises from the ethical principle of autonomy and the fundamentally accepted tenant the patient's have a right to be involved in decisions about their health care it is also a protective response to the tort of battery which is the purposeful unwelcome harmful touching of another performing a procedure without patient consent could constitute battery even if the procedure was done competently and the outcome was good to obtain a valid consent the provider who will be performing the procedure must provide the patient with a description of the procedure an explanation of the risks and benefits and a discussion of any alternatives to the proposed procedure consent by the patient must be voluntarily given and the person who consents must have the capacity to consume capacity can be determined by the health care provider and may be affected by drugs or the current underlying medical condition in short the provider must be sure that the patient understands the information provided and the consent is voluntarily given if the patient is unable to give consent directly he or she may designate a person who can give consent on his or her behalf if such a person is not designated by the patient most states provide a statutory solution a law that lists statutory surrogates individuals who based on the relationship to the patient would be given priority to consent on the patient's behalf advanced directives all states have laws that provide guidelines for the execution and enforcement of health care directives these directives include living wills medical power of attorney for healthcare decisions and pre-hospital do not resuscitate orders these directives identify how a patient wishes to be treated in the event of certain medical conditions and also identify who the patient wants to make decisions on his or her behalf in the event that the patient is unable to do so these laws encourage comply with the patient's directive by giving healthcare providers who act in reliance with these documents immunity from civil or criminal liability in some states impose criminal liability if a patient's advanced directives are not followed Death with Dignity laws national discussion regarding whether mentally competent but terminally ill patients should have the right to hasten their death has been a topic of health care since Jack Kevorkian championed the issue in the early 1990s in the midst of the so-called right to die or assisted suicide movement Oregon enacted the nation's first Death with Dignity Act in 1997 Washington passed a similar initiative in 2008 the Montana Supreme Court ruled in favor of physician-assisted death by lethal medication dose in 2009 and Vermont passed the patient's pay the state's patient choice and controls and end-of-life act in 2013 these laws allow physicians to write a prescription for a lethal dose of medication that a mentally competent but terminally ill patient can use to end his or her life if the patient has less than six months to live each state's law contains various safeguards and protocols to be followed by the prescribing physician for instance Oregon's Death with Dignity Act requires in part that the physician excuse me that the patient make two or all requests at least 15 days apart to the physician followed by a written request signed in the presence of two witnesses one of whom cannot be a relative of the patient it also requires two physicians to confirm the patient's diagnosis and prognosis and assess the patient's competency in mental health in the landmark case of Gonzales versus Oregon the US Supreme Court upheld Oregon's Death with Dignity Act and ruled that the federal government's Controlled Substances Act did not bestow upon the Attorney General of the u.s. the authority to ban physicians from prescribing lethal doses of controlled substances for use in physician assisted suicide under state law permitting the procedure and two related concepts three concepts are closely interrelated to healthcare law health policy ethics and healthcare economics at its most basic level a law is a set of rules that is designed to help meet a specific policy or goal analogizing to the nursing process health policy is the goal or expected outcome and healthcare laws are the interventions that are intended to affect the expected outcome ethics are the framework or boundaries in which many of these policies and laws are made in other words adherence to an ethical principle may drive a desire to adopt a policy and create laws that promote the policy another concept that is closely interrelated is healthcare economics as previously described many laws have a financial incentive to compel compliance with the law there are organizations and departments within healthcare organizations whose job it is to ensure compliance with many healthcare laws and regulations within a healthcare organization or hospital this task may be the responsibility of the compliance officer or compliance department the compliance officer monitors the organization's activities so that the organization can continue to receive payments from the government and is not subject to any fines which amendment to the Constitution states the powers not delegated to the US by the Constitution nor prohibited by it to the states are reserved to the States respectively or to the people is it the First Amendment the 5th the 10th or the 20th the answer is 3 it's the 10th amendment this means that the powers of the state government include anything and everything that is not specifically described as being a power of the United States question 2 what is the area of law called under which cases of negligence including malpractice cases are argued is a tort is a criminal is a contract or constitutional it should be tort tort law has been responsible for shaping and defining many of our patient care quality parameters question three the creation of what program has given federal government increased influence in the realm of health care law is that Food and Drug Administration Centers for Disease Control and Prevention the US Department of Health and Human Services or Medicare the answer is for Medicare because the federal government is spending money on the Medicare program it can decide what rules the health care organizations must follow if they wish to be reimbursed for care this is the end of the slideshow