Unlocking the Power of eSignature Lawfulness for Healthcare in United States

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

hi everybody quarantine this is dr a with your chapter 11 lesson from the u.s healthcare system we're going to talk about healthcare law okay so some of our learning objectives we're going to describe the legal relationship between a patient and provider we're going to apply civil and criminal liability concepts to healthcare providers and consumers and we're going to discuss the importance of the original patient builder rights all right so did you know the ethics in patient referral act of 1989 was passed because providers were referring patients to medical services in which they they or family members had financial interests so they're like oh go see me my brother the cardiologist you need a referral to go see them right big conflict of interest there in response to the affordable care act anti-fraud initiatives over 15 000 medicare providers were expelled from the system for fraudulent activities so medicare medicaid fraud is a big thing the most important relationship in healthcare system is a relationship between the patient the healthcare consumer and their provider which could be a physician organization such as a clinic or hospital where the physician has a relationship so to be an effective health care manager it is important to understand the basic legal and ethical principles that influence the work environment including the legal relationship between the organization and the consumer which is a healthcare provider in the patient all right so let's look at some basic concepts of health care law so first of all law is the body of rules for the conduct of individuals and organizations it is often interpreted differently and it may change over time it is created so there is at least a minimal standard of action as required by individuals and organizations and it is created by federal state and local governments as did judy shares some interprets previous legal decisions regarding a case they are creating common laws so the interpretation of the law in a case is common law and often so you your bare minimum standard is going to be the federal sometimes state can be more strict than a federal state has to follow the minimum of the federal and of course the local has to follow the minimum of the state and the federal so the minimum standards for action is federal law although state laws might be stricter so sometimes there are some things that can vary from state to state which still abide by the federal law but just each state gets to decide how strict or lenient they're going to be on certain things legislature creates laws that are called statutes both common law and statutes are then interpreted by administrative agencies by developing rules and regulations that interpret that law so for example when the affordable care act was you know became long put into place then medicare and medicaid cms develop a bunch of rules and regulations to comply with the law all right so in this first open any question um list sorry sorry allergy list an example of a health care law so some more basic concepts of health care laws there are civil and criminal laws that can affect the health care industry so first let's start with civil law so it focuses on the wrongful acts against individuals and organizations that are based on a contractual value about violation which means you had an established contract orders established contract between the patient and the provider and uh one or both or you know somebody violated that contract towards or is derived from the french word for wrong which is really in if you say it properly in french there are category of wrongful acts that occur in civil law but they may not have a pre-existing contract now to prove a civil infraction you do not need as much evidence as in a criminal case criminal law is concerned with actions that are illegal based on court decisions so for example if you had a surgeon that performed a surgery on they were supposed to maybe operate on the right knee and operated on the left knee you could sue them and they could be under civil law right because you had a contract to operate on one knee and he did it on the other so in a way he validated violated a contract so that would be a civil lawsuit criminal law would be um something where for example well medicare medicaid fraud will fall under criminal law if um as a provider you you are charged with hipaa violation that would be criminal also so in order to convict someone of a criminal activity it has to be proven without reasonable doubt of guilt so again examples or of criminal infractions would be medicare fraud as an example okay so approximately how many people die each year due to medical errors what is your thought ten thousand fifty thousand hundred thousand two and fifty thousand if you're near pod answer that and let's talk about medical malpractice so ing to the american heritage dictionary of 2000 medical malpractice is the improper or negligent treatment of a patient by a provider which results in injury damage or loss ing to the institution of medicine's landmark report to air as human medical malpractice has resulted in approximately 80 to 100 000 deaths each year disputes of improper care of a patient have hurt both providers and patients and patients at sued physicians because they feel their provider has not provided a proper level of care compared to just standard of care in the industry and they may be right or maybe they're wrong maybe the physician did abide by the proper standard of care they just think that just should have done more um and so this can be things where um you know a procedure was done that went wrong and then the physician assumed or it could be that somebody forgot to give a patient some a critical medication and this ensued harm to the patient of some sort right so um there are 80 200 000 deaths a year for that that's why ing to bowel the injured patient must show that the physician acted negligently in rendering care and that search negligence resulted in an injury so to do so there are four elements legal elements that have to be proven one there was a professional duty owed to the patient by the physician so so maybe again in our case the physician was supposed to fix their right knee and instead he fixed the they went operated on the left knee okay so so he had a duty to do what he had contractually agreed to there was a breach of search duty so again negligence or wrongful act or something like that some something they did that violates the contract violates the agreement or the normal assumed duty that the provider has for its patient that injury caused there was an injury that was caused by this breach so violating that caused injury so obviously if they operated on your left knee instead of your right knee your right knee is still messed up now your lefty has been you know altered in some way and this can result in damages and stuff right so um you have you know damages because of the injury money damages if awarded typically take into account both actual economic loss and non-economic loss such as pain and suffering economic loss could be for example you were not able to go to work for x amount of time plus you also have to have maybe the other knee fixed or something like that all right so let's look at basics of health care torts so negligence is involves the unintentional act or the omission of an actual forgetting to do something that would contribute to the positive health of a patient so you either an intentionally harmed your patient because you forgot something well a mission would be forgetting something or you unintentionally did something that again affected them an example of negligence would be if a provider does not give appropriate care or withholds care that results in damages to the patient um so for example if you are a caregiver and working in a nursing home and you're supposed to feed a patient and a patient gets their meal and they can't feed themselves and you emit forget to feed that patient and then their food gets taken away having not eaten eaten then you can contribute to the harm because eating would normally contribute to the positive health of the patient now the patient's starving uh and even if it was unintentional you just forgot it still has caused us negligence to that patient intentional torts are things like assault and battery or invasion of privacy um in the healthcare industry an intentional tort would be in us such as a salt and battery for example would be our example of a surgeon performing surgery on a patient without his or her consent um and so this there's some gray areas there but um you know you have to obtain consent if at all possible before you do any kind of procedures to any patient all right so on this one just give me what is an example you can think of negligence and you can think specifically to your chosen field of for your practice healthcare field all right so tort reform so as a result of the number of malpractice claims in the u.s malpractice insurance premiums keep increasing and therefore providers have started doing what we call defensive medicine which means that they order like a battery of tests trying to cover absolutely all their bases to protect themselves from from malpractice lawsuits and sometimes it can be a joke even among providers or at least healthcare workers especially with er physicians like oh you come in and stubbed your toe you've got to have an ekg and all these other blood tests you came in and because you passed out oh you have to have ekg and all these other blood tests and some imaging and stuff like that you know oh you have diarrhea you have to have an ekg and all these blood tests and stuff and so that's defensive medicine er physicians are really widely known to do that more states have adopted a statutory cap on monetary damages that means they're limiting how much money a plaintiff can get in a malpractice claim so because the health insurance types before because the malpractice insurance payments have been going up they figured that oh if we put a cap on how much has to be paid out then it could slow this increase in the malpractice premiums that these insurances are charging to the physicians and stuff and trying to because that in turn of course increase the cost of practicing medicine increases healthcare costs so there are however many legal factors that have contributed to this increase in claims um for example voluntary hospitals are no longer longer exempt from malpractice suits therefore you have employers now have to take the responsibility for the employees is wrongdoing that has also increased claims so for example if you combine both of them if you were a hospital employee a nurse or something and you made a mistake and the patient sued it can sue the hospital and hospital is liable for your mistakes the concept of informed consent also for the patient has expanded and therefore increased claims uh and so we're going to talk about informal consent here in just a minute and the acceptable standard of care which used to be strictly based on a locality rule so simply you know whatever is normally done in a certain area it does now become a state or national standard which also has resulted in an increased amount of claims um recent federal studies have indicated that imposing caps on awards may be an effective method to reduce malpractice costs and to discourage frivolous lawsuits but there's still a lot of um it's not exactly as clean good as they think it is the us supreme court ruled that any awards must be included in an individual's tax income which means that you would owe taxes on it if you get an award as a plaintiff i do want you i'm going to link this i want you to want you to watch this video on torture form and then we're going to move on to the relationship between the provider and the consumer so a physician can establish a relationship with a patient in three ways you can establish contractual relationships to care for a designated population so they are caring for all the enrollees of a specific plan right like a special effect we've seen managed care you can establish an express contract with a patient enter under a mutual agreement so you go see the physician for services and you usually have some signs and papers again uh establishing this contractual agreement between you and that provider and you can establish a relationship also under an implied contract meaning if you come for example to a physician and you talk to them and you ask advice and they give you advice that can impact your your health care then you have this implied relationship that has started so the relationship between a patient and a hospital a a contractual right to admission has been considered a contract if a hospital has contracted to treat certain members of an organization for example like a managed care organization a second example of this type of contractual right to admission is if government hospitals such as county hospitals are required to provide care for a patient regardless of ability to pay then there's automatically a contract that they have to care for that patient so a contracted care for a designated population is usually indicative of an hmo or a managed care contract a physician is contractually required to care for those members of patients of a managed care organization especially as long as that physician is in the contract with the managed care organization and then those patients are part of that managed care organization again an express contract is a simple contract is merely a mutual agreement of care between a physician and a patient uh the physician could define the limitations of the contract which could uh include pair uh parameters of care so it could be an extended contract so especially between you and your primary care provider you establish that contract when you first go see them and and a lot of times we don't read through them uh but one that would be for example that would be limited is if you're referred to an orthopedic surgeon for a surgery uh your contract will probably just limited to you know the pre-surgical stuff the surgery and then the post-surgical stuff and then to contract within some time after that because you don't need to be constantly under their care an implied contract again can be applied from a physician's action if a physician gives advice regarding a medical treatment then there's an implied contract and this is where you will often see this disclaimer so um any um information out there on the internet especially on youtube or on facebook or in podcasts and stuff often have these disclaimers saying the information on this youtube channel is not intended or implied to be a substitute for professional medical advice diagnosis and treatment all content including text graphics images information contained and or available through this channel is for general information purposes only this channel makes no representation and assumes no responsibility for the accuracy of information on or available through this channel and search information is subject to change without notice you are encouraged to confirm any information obtained from and or through this channel with other sources and review all information regarding any medical condition or treatment with your physician there you go that should be on any kind of medical type of type of channel or podcast or stuff so let's see emts bring a patient to the er who is in cardiac arrest the er team starts working on him immediately the contract between the er physician and the patient being cared for would be a contractual relationship an express contract or an implied contract which do you think it is all right um how does a relationship with a provider ends so to protect the physician from being accused of patient abandonment the physicians have to take step to properly end a relationship so yes a physician can end a relationship with you um for various reasons uh and sometimes it might be referred to like oh the physician has fired you as a patient or something like that because you could they could do that if you're completely non-compliant you won't do anything they say and all that they can't end that relationship so but if the patient withdraws from the relationship with the provider then the physician no longer has a duty to provide follow-up so if you always don't quit going to see that physician they haven't seen you in years then they're pretty much automatically released from from that also if medical care is no longer needed the relationship is naturally completed that would be an example with the knee surgery osteopathic referral uh if it's to fix a certain problem and that problem has been fixed you've had the follow-up and everything's back to more or less normal then that is a natural completion of a relationship between a patient or provider the ama provides the following five steps for a physician to terminate a relationship with the patients so first you want to give the patient a written notice preferably by certified mail or something where they they have to acknowledge receipts then provide the patient with a specific reason for determination so it could be they're completely non-compliant with any other devices but what about what about if the physician is relocating you know they might be uh you know relocating to a completely different state or something like that continuing to provide care for a reasonable period of time so the patient can find other care right so okay we'll see you i'm here for another month or whatever we'll see for x amount more days or months until you can transition to a different primary care provider a lot of times they'll go ahead and list some primary care providers that might be able to take the patient on and then it can also offer to transfer all the medical records with the patient permission to their new provider again uh so this was another one on malpractice and physician communication this is really a good video i'm going to link it below and it's in your near part of it so you can play it and so have you ever felt that the doctor or health care provider treating you was not listening to you or did not care about you it's a simple yes or no hold and let's look a little bit at health care related legislation so health care consumer law so first we have the hill burden act of 1946 federal grants were provided to states for hospital construction to ensure that there were 4.5 beds per um 1 000 people so it just dispered the growth and development of a lot of hospitals then we have the amtada act of 1986. it requires that medicare participants receive emergency care for life-threatening condition from a hospital or medical entity that provides dedicated emergency services facilities can be fined thousands of dollars for not returning to the mtellus so they cannot refuse um treatment patients that are in an emergency situation or in active labor the children's health insurance program actorship was enacted under the balance budget act of 97 it is titled 21 of the social security act and is jointly financed by federal and state funding and administered by the states and the cms and the purpose of this program again was to provide coverage for low-income children that were longer younger than 19 years of age whose family income exceeds the income level requirements for medicaid but there are still some income requirement levels they're just a little higher they can make a little bit more money than uh is required to qualify for the threshold for medicaid threshold for medicaid is pretty low um benefits improvement and protection act of 2000 formerly called the medicare medicaid and ship benefits improvement and protection act it modified medicare payment rates for many services it added coverage for preventive and therapeutic services and increased federal funding to state programs and then hipaa health insurance portability and accountability act um national standards it was passed in 2002 to protect a patient's personal medical records and other personal health information that was maintained by healthcare providers hospital insurance companies and health plans especially when all of this went computerized and then all of a sudden a whole lot more people had access to your your health data so before before the 2000s i mean there were some computers but everything was just kind of just local and a lot of your medical records were just really on paper so for a person to have access to it they have to physically get your chart and that was a lot harder to do right so some of the anti-trust laws so the purpose of an anti-trust law is to protect consumers by ensuring there's a market-driven driven by competition so consumers have a choice for health care um anti-trust laws also apply to businesses so basically you're trying to prevent monopolies and so the sherman act of 1890 prohibited monopolies which means that one organization cannot dominate a market which eliminates consumers choice and then they can do price fixing it also targets the price fixing among competitors that prohibits the consumer from paying a fair price because com the competitors sorry establish a certain price amongst themselves to stabilize the market so basically it's like the competitors are they get together that's prospects and say oh we're all going to jack up the price but we all jack them up together everybody will make more money and consumers can't go anywhere else because we're all the ones that are just providing the service that scene sometimes if you've seen um in emergencies especially remember after 9 11 in new york there were a lot of gas stations that were accused of price fixing because there was such a need people were trying to leave so some people were coming in to help and all of that um and so prospects in price gouging that kind of stuff is uh definitely illegal and can be fine and stuff the sherman act also prohibits the following market division which occurs when one or more health organization decides which type of services will be offered at each organization for example to say hospital basis we'll do the chemo chemo treatment or we'll we'll do all the radiation treatments if you do all the chemo or will be the only ones that give chemo and then the other one would be like okay we'll be the only ones where you can go get an mri i don't know something like that tying is uh refers to healthcare providers that will only sell a product to a consumer who will also buy a second product from them so it's like bundling services but it's like well i don't really want to sell it no you have to buy it that's called tying that's not that's not adequate that's not good and then boycotts is when healthcare providers have an agreement to not deal with anyone outside of their group it is considering considered interfering with consumers right to choose okay so what is an example of services of businesses that are not healthcare related that could be prone to monopolies if you think one is for healthcare related that's fine too if you want to uh can you think of any services around um you know where you live or things that you like wish you had more choice um i personally can tell you uh internet especially if you live in a rural area and those you know you your choices are very limited for internet service the clayton act it places restriction on hospital mergers and acquisitions it allows individuals to sue for three times their actual damages plus legal costs um the hot scott rodino antitrust improvement act of 1976 was an amendment to the clayton act and it ensures that the hospitals and other entities that have entered into mergers and acquisitions and joint ventures have to first notify the department of justice and the fair trade commission before any final decisions and final acquisitions and all that are made okay let's talk about informed consent so informed consent is based on a patient's right to make an informed decision regarding medical treatment it's a legal requirement in all 50 states and the provider is responsible for discussing with the patient one to diagnosis if it has been established if you know the diagnosis okay you have to tell the patient you have been diagnosed with cancer this is this type of cancer that you have you can't hide it from them okay the nature of a proposed treatment or operation including risks benefits alternatives and the risks and benefits of the alternatives cancer treatment unfortunately uh so sometimes like not getting treatment or maybe doing uh natural therapies and stuff like that a lot of cancer treatment physicians don't see that as an alternative and so they pretty much propose their only solution is their chemo or their surgery and stuff like that and so that could be a lack of informed consent because you haven't given all the alternatives because maybe you don't think those are good alternatives or something like that the risk and benefits of not agreeing to the procedural treatment so okay if you want to refuse treatment then this is what you're looking at because remember the patient still has the right to refuse okay so this video is really good about informed consent it'll make you think one of the things that we have to be really careful um being in the health care field is like you develop this jargon this this language that you know what it means all your other peeps know what it means but a lot of times to the patient they have no clue what you're talking about and so you have to explain a lot of things to patients like assuming they're like a five-year-old basically you don't treat them like they're a five-year-old but you need to explain it to them on that level so if a patient did not provide informed consent for a procedure or treatment then it is considered a case of negligence a medical emergency might may eliminate the need for an informed consent for example if a patient cannot clinically give consent to a life-saving medical treatment then what we call statutory consent may be considered which presumes a reasonable person would give consent to the life-saving procedure then consent may be implied in a non-emergency situation also if the patient volunteers for a procedure says yeah sure i'll have this done that implies consent even without oral written verification the patient might be considered to have given then at that time if they volunteered an informed consent so it can be statutory if they're not able but it would be reasonable to assume that they would or it could be also implied in just that non-emergency if you volunteer to determine what constitutes informed consent there are two legal standards that have to be applied that can be applied so you have the reasonable patient standard this focuses on the patient's information needs including the risk benefits that allow the patient to make a decision and it needs to be explained in terms of the patient again can understand and then the reasonable physician standard focuses on the standard information that would be given by any physician to the patient that contemplates the same procedure or treatments so most states utilize a reasonable patient standard again focusing on a patient because it's it's more important for the patient to have all their questions answered understand exactly what is going on what all the options are what each of options entail risks benefit etc etc even cost if that's something that can be given to them okay so give me a barrier to informed consent something that would prevent a patient from fully understanding what's going on and given true informed consent and lastly we're going to talk about the patient bill of rights so the patient's self-determination act of 1990 requires that hospital nursing homes home health providers hospices and managed care organizations that provide services to medicare and medicaid eligible patients they have to supply information on a patient's rights to the patient upon admission so that's usually one of the many forms that you sign when you're admitted into a hospital or nursing home or home health or whatever and it applies to virtually every type of health care facility and um the facility must provide the adult patients with written information under state law about making health care decisions and sometimes they'll hand it to you in the form of a packet sometimes they'll be like here's you know you you can have access to his information this is where it's located do you want to see if you don't want to see it assigned this is where you find it but then you sign receipt that you you acknowledge that that you've been made aware of that so um based on it's based on the concept of informed consent then in 1972 the board of trustees of the american hospital association developed the patient bill of rights and the patient bill of rights states that the patient has the right to all information from his provider regarding any testing diagnoses and treatments this information has to be provided to the patient in terms of the patient will be able to understand so you really really really do not want to use medical jargon medical words you want to dumb it down unless you are absolutely certain that maybe you're talking to a peer that really understands what's going on so in conclusion to be an effective healthcare manager is important to understand all these basic legal principles that can influence the work environments including the legal relationship between the organization and the consumer as both the health care manager and healthcare consumer it's imperative that you're familiar with the different federal and state laws that impact a healthcare organization it's also important that you understand the difference between civil and criminal law and the penalties that may be imposed for breaking those laws especially you're going to see in your homework about hipaa you better understand that one really really really well because if you violate it you could it could it's criminal federal crime uh you can become a felon and be completely banned from working in health care very important to understand those new laws have been passed and older laws have been amended to reflect the needed changes regarding healthcare to continue to protect participants from both from a patient and an employer employee perspective some of that is going to be reflected also more in your homework all right and if you have any questions you may list it there and i thank you for your attention