AMU Labor Laws and Healthcare Worker Protection Journal

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For this journal submission, you will demonstrate your synthesis of the concepts presented in this and previous units by addressing each of the following:

Begin with an introduction that summarizes the various federal labor acts.

Reflect on the various types of discrimination that occur in the workplace and the laws prohibiting       them.

Depict how the rights and       responsibilities of patients and health care providers are alike.

Summarize the rights and       responsibilities of health care providers and medical practices with       regard to professional liability insurance.

How do labor laws relate to healthcare       worker protection in alleged cases of negligence?

UNIT I STUDY GUIDE
History of Health Care and the Law
Course Learning Outcomes for Unit I
Upon completion of this unit, you should be able to:
2. Assess the sources of health care laws and regulations.
2.1 Describe how health care is affected by the evolution of the law.
2.2 Characterize the roles of the major departments within the Department of Health and Human
Services (HHS).
2.3 Connect the work of the DHHS to its impact on the health and welfare of the American people.
Required Unit Resources
Chapter 1: Hospitals Through the Ages
Chapter 2: Government, Law, and Ethics
Unit Lesson
What is Health Care Law?
Medical law protects individual rights, including health care professionals’ rights. It provides a yardstick to
measure or judge actions and punishes unlawful activities. Health care laws took decades to develop. As
incidences and circumstances occur in health care, the law evolves to provide safe and reasonably costeffective health care for Americans.
Why is it Important for Health Care Professionals to Know the Law?
A basic understanding of the laws regulating health care will help demystify how the law impacts the operation
of health care organizations, health care professionals, and how it protects patients from inadequate medical
care. As a health care professional, understanding health care law helps provide a framework for decisionmaking. It helps prevent actions that are against the law as well as lawsuits that might result from unlawful
actions.
Major Acts That Impact Health Care
The evolution of the health care system was influenced by the building of hospitals, the development of
medical schools for the training of health care professionals, and the incorporation of technology in health
care. The offering of health care plans to offset health care costs made health care more accessible, causing
a greater utilization of health care services. The advancement in health care, coupled with the increased
access, led to an alarming increase in medical errors, which resulted in patient injury. Now, the injured patient
makes a legal claim to seek compensation for their injuries, and a significant number of malpractice and
negligence claims against health care providers creates many court cases and an intersection where health
care and the law begin to be more intertwined.
Social Media Use in Health Care and the Health Information Technology for Economic and Clinical
Health Act (HITECH)
Social media provides the health care industry with tools that can help promote good health behaviors, share
health care information, and educate and interact with patients, caregivers, students, and colleagues. Social
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media helps improve health outcomes, develop a professional network, increase
personal
awareness
UNIT
x STUDY
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and discoveries, motivate patients, and provide health information to the community.
Title
Although there are positives in social media in health care, there are also disadvantages such as breach of
patient confidentiality and exposing health care providers and organizations to liability under federal HIPAA
laws (Health Insurance Portability and Accountability Act). The Health Information Technology for Economic
and Clinical Health Act (HITECH) details privacy-breach notification requirements. It addresses civil and
criminal penalties for violations based on the nature of the violation and resultant harm.
Below are three of the earliest laws implemented by the government to ensure that patients get proper care,
health care professionals abide by basic standards, and attempt to cut costs.
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Sources of Legal Systems
UNIT x STUDY GUIDE
Title
Our legal systems come from three sources: common law, statutory law, and administrative law. Over the
years, laws have become varied and complex. Health care management professionals need a basic
understanding of them to ensure that they and health care organizations operate within the law.
The legal system is used by legislative and regulatory agencies to establish laws to protect the public, ensure
access to health care, provide a standard by which medical professionals are held accountable, and ensure
proper compensation when due.
Government Organization
The three branches of the federal government, as illustrated in the figure below, are the legislative, executive,
and judicial branches and their functions. The constitutional framework is the separation of powers, meaning
no one branch of the government is dominant over the other two branches; however, in their functions, each
may affect and limit the activities, functions, and powers of the others. Each branch has its function as it
relates to the creation of laws.
The Three Branches of Government and Their Effect on Health Care
Health care in the United States is complicated and influenced by the three branches of government: the
legislative, executive, and judicial branches.
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UNIT x STUDY GUIDE
Title
The legislative branch determines:
•
•
•
•
•
•
health care services and programs it (the legislature) will pay for,
health care coverage for members of society under those services/programs,
the number and types of health care workers through the legislature’s subsidized health care
education,
state licensing laws through the legislative branch determine which health care worker provides
services,
reimbursement for services performed, and
the regulated and approved the use of controlled substances and devices.
The judicial branch determines:
•
an interpretation of health care laws (e.g., antitrust law).
The executive branch determines:
•
•
rules and regulations to help interpret the laws, and
implementation of health care programs.
The Department of Health and Human Services (HHS) and the Evolution of the Law
The Department of Health and Human Services (HHS) was created on April 11, 1953 and is responsible for
national health and human services policy objectives that strengthen the public health and welfare of the
American people. HHS fulfills this mission by “effective health and human services and fostering advances in
medicine, public health, and social services” (HHS, n.d., para. 1). Three departments within the HHS are
Medicare, the Centers for Disease Control and Prevention, and the Food and Drug Administration.
In the light of the COVID-19 pandemic impact on the United States, you can see first-hand the evolution of the
law as it relates to privacy issues. Although the discussion of privacy in health care is not a new topic, the
pandemic caused these issues to be even more critical. One issue that arose was telehealth visits. As part of
HHS’s pandemic response, HHS has made it clear that it will not be taking enforcement action involving
HIPAA security and privacy rules for telehealth visits. This means health care providers offering telehealth
visits should not be concerned about the details of the HIPAA security and privacy rules. This reducing of the
HIPPA laws is to help health care organizations and providers in a time when the health care system is
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stressed. Although this is just one example, there are many laws in light of theUNIT
pandemic
that are
now up for
x STUDY
GUIDE
debate and revision for the future of health care.
Title
Conclusion
The connection between health care and law goes back centuries. We still rely upon the health care laws that
were accepted practice generations ago. As we continue to search for ways to ensure we evaluate and
disperse health care resources and services in equitable ways, making it accessible, and offering high-quality
services at an affordable cost, health care will continue to evolve, and health care laws will also evolve. There
has been an incredible amount of advancement in health care over the decades, and it will continue with new
innovations in treatments and advancement in technologies for many generations to come.
Reference
U.S. Department of Health and Human Services. (n.d.). About HHS. https://www.hhs.gov/about/index.html
Suggested Unit Resources
In order to access the following resources, click the links below.
Review the following summary of the Chapter 1 content in order to enforce the main concepts presented.
Chapter 1 PowerPoint Presentation
Chapter 1 Presentation PDF
Review the following summary of the Chapter 2 content in order to enforce the main concepts presented.
Chapter 2 PowerPoint Presentation
Chapter 2 Presentation PDF
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UNIT II STUDY GUIDE
Criminal and Civil Law in Health Care
Course Learning Outcomes for Unit II
Upon completion of this unit, you should be able to:
4. Examine the rights of stakeholders in the health care system.
4.1 Explore types of violations of patients’ rights committed by health care providers.
4.2 Explain the responsibility of health care providers to protect their patients from harm.
Required Unit Resources
Chapter 3: Tort Law: Negligence
Chapter 4: Intentional Torts
Chapter 6: Criminal Aspects of Health Care
Unit Lesson
Criminal and Civil Law in Health Care
Criminal law addresses possible illegal actions that needs to be proven in court beyond a reasonable doubt.
Health care professionals can be found responsible for their actions, especially in areas of patient care and
billing. Civil law looks at wrongful actions against not just individuals but organizations as well. It has to do
with individual rights. The difference between criminal and civil law is criminal law concerns offenses against
the state or federal government; whereas, civil law concerns people committing wrongs against each other.
Tort Law
A tort is a civil wrong, other than a breach of contract, committed against a person or property (real or
personal) for which a court provides a remedy in the form of an action for damages. The purpose of the tort
law is to find the wrongdoing, discourage the wrongdoer from committing future wrongful acts, and
compensate the injured person(s).
Negligence
Negligence is a tort. It is the unintentional commission or omission of an act that a reasonably prudent person
would or would not do under given circumstances.
Examples of a commission of an act are:
•
•
Administering
o the wrong medication,
o the wrong dosage, or
o medication to the wrong patient.
Performing a procedure on
o the wrong patient,
o body part, or
o the wrong procedure.
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UNIT x STUDY GUIDE
Administering Medication to the Wrong Patient
Title
Nurse James had been working at Get Well Hospital for 10 years on the night shift. He recently got
divorced and had to move to a small apartment with his young child. Due to the divorce, he had to pick up
some extra shifts at other hospitals to cover expenses, so James worked three 12-hour night shifts at Get
Well Hospital and a two-day shift at another hospital not too far from his apartment. After 5 months of
working the additional job, Nurse James was exhausted. On one occasion, one of his coworkers found him
asleep in an empty patient’s room. On his last shift for the week, James felt exhausted, and the night shift,
although typically quiet, was very busy that night.
Martha, an 88-year-old patient who was very agitated that night, was continually pressing the call-light for
assistance, calling out for help and disturbing the other patients. Nurse James got agitated as he had other
patients to attend to and had to attend to Martha regularly. At 8 p.m., three patients under James’ care
were scheduled to receive their medicine. James accidentally switched up the medicines and
unintentionally administered another patient’s sleeping pill to Martha. James’ extreme fatigue caused him
to forget to verify the patients’ names on all three medicines. After he administered the sleeping pill, Martha
fell asleep for the entire night.
When the 7 a.m. shift nurse came on duty and checked on Martha, the nurse noticed the patient was dead.
After a thorough investigation, Nurse James was arrested and lost his nursing license. The patient’s
children sued the hospital for the wrongful death of their mother.
PERFORMING A PROCEDURE ON THE WRONG BODY PART
Dana Carvey is a famous actor and comedian who is best known for his work as a cast member on the
long-running television show, Saturday Night Live, in the 1990s. Dana Carvey, who lived in Marin County,
California, sued Dr. Elias Hanna in San Francisco Superior Court after the surgeon operated on the wrong
artery during double bypass surgery to treat a blockage (SFGate, 2000). Carvey said he had to have the
blockage removed in a subsequent angioplasty, and he was barely able to work. Hanna’s lawyer argued
that Carey has “unusual anatomy” and that his blood vessels were in atypical positions. Carvey settled his
$7.5 million lawsuit against the surgeon and said the lawsuit was about accountability and making sure it
did not happen to anyone else.
Examples of omission of an act are failing to:
•
•
•
administer medications,
order diagnostic tests, and
follow up on abnormal test results.
FAILING TO ADMINISTER CORRECT DOSAGE OF MEDICATION
The Oklahoma State Board of Pharmacy cited a CVS pharmacy, and the pharmacists involved in
medication errors. A young man received only one-fourth of his prescribed dose of anticonvulsant
medication, according to the complaint. The patient’s father discovered the error, but only after the young
man had taken the incorrect dose for about 18 days, during which time his seizures became more frequent
and more violent, according to the complaint. His mother reported that during one seizure, he fell and
gashed his forehead (Gabler, 2020).
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UNIT x STUDY GUIDE
FAILING TO FOLLOW-UP ON ABNORMAL TEST
RESULTS
Title
Dr. Sanchez is the primary care physician in a small practice. One of his patients for a year was Mr. Jones,
who is 35 years old and has borderline hypertension. Dr. Sanchez advised the patient to stop smoking and
eat healthier and discussed the ramifications of both due to the patient being overweight. As part of the
workup, Dr. Sanchez ordered additional tests which indicated Mr. Jones had hematuria but did not mention
it to the patient. Three months later, another test was done and was negative for hematuria which was
noted in the chart. Mr. Jones moved out of the area and 3 years later he went to another doctor who ran a
urinalysis and saw there was blood in the urine. The new physician sent the patient to a urologist and after
a full workup was told he had advanced kidney cancer. Due to the late stage of the cancer, treatments
were limited, and Mr. Jones died a year later after he was diagnosed. Mr. Jones’ wife requested the
medical records from the previous physician and realized that hematuria was noted by the doctor, but he
did not mention it to her husband or herself. Mrs. Jones hired an attorney and sued Dr. Sanchez.
Intentional Tort
An intentional tort is when someone purposefully intends the action resulting in one’s injury. An intentional tort
is different from negligence in that when someone is negligent, they did not fulfill the necessary standard of
care. Whereas negligence is an unintentional act, an intentional tort is intended.
Examples of intentional torts include:
•
•
•
•
•
•
•
assault,
battery,
false imprisonment,
defamation,
fraud,
invasion of privacy, and
intentional infliction of mental distress.
INTENTIONAL TORT – ASSAULT
An egregious example of sexual assault in the medical field is that of Dr. George Tyndall. According to The
New York Times, the former gynecologist at the University of Southern California in Los Angeles, Dr.
Tyndall was charged with sexually assaulting 16 women at the student health center, ranging in age from
17 to 29. There were 400 allegations made by women to the police over his 27 years at USC. Tyndall lost
his license, and USC agreed to a $215 million federal class-action settlement with former patients. His
potential prison term was 53 years. He was 72 years old when arrested (Winton & Ryan, 2019).
Criminal Law
Criminal law addresses possible illegal actions taken and proven in court beyond a reasonable doubt. The
two main types of criminal law are:
•
•
Misdemeanor: Offense punishable by less than 1 year in jail or a fine
Felony: Imprisonment in a state or federal prison for more than 1 year
The following elements constitute the main focus of criminal law:
•
•
•
•
Retribution: Punishment for criminals
Deterrence: Imposition of a penalty for criminal offenses to deter future criminal activities by the
offender
Incapacitation: Protection of the public by keeping criminals out of society through imprisonment
Rehabilitation: Transformation of criminals into valuable members of society
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•
x STUDYstole
GUIDE
Restoration: Repairing of the damage done to a victim. For instance, ifUNIT
an employee
a million
dollars from the organization where he worked, the goal would be to compensate
the organization.
Title
Health care professionals can be found liable for their actions. Three main areas of concern as it relates to
criminal law in health care are:
•
•
•
ethical dilemmas,
billing and coding, and
patient care.
Criminal law helps maintain public order and safety. Criminal law helps to protect individuals, punishment as a
deterrent, or rehabilitation.
Examples of offenses committed by health care workers include:
•
•
•
•
•
•
•
falsifying medical records,
insurance fraud,
practicing without the required license,
misuse of drugs,
stealing of drugs,
abuse, and
murder.
When a crime is committed, the government, or plaintiff, brings charges against the alleged offender, or
defendant. Criminal law can involve minor to serious offenses. These offenses may result in the following
punishments:
•
•
•
•
•
•
community service
fines paid to the government
loss of license
probation
imprisonment, or
execution.
CRIMINAL LAW – PATIENT CARE
Denise is a medical doctor and has a California medical license, but she does not have a medical license
to see patients in New York. Denise needed more patients as her revenues were low, so she decided to be
a consulting physician on a popular website remotely.
Tommy lives in New York and has a medical condition requiring a prescription. He is feeling too ill to drive
to a doctor’s office and thought it would be better to get a prescription online and have it mailed to his
home. Tommy gets on the internet and goes to a website that offers prescriptions online, where he fills out
the questionnaire about his symptoms.
The administrator for the website sees Tommy’s request for a prescription and transfers it to Denise, the
doctor in California. Denise reviews the symptoms, determines that medication would be appropriate,
writes the prescription for the medication Tommy wants, and sends it via mail to Tommy.
Denise is now guilty of unauthorized practice of medicine in New York because she provided medical
treatment to Tommy, who lives in New York, and Denise does not have a medical license to practice
medicine in New York.
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Mandatory Reporting Required for Health care Professional
UNIT x STUDY GUIDE
Title
Mandatory reporting is enacted by most states in the United States and may vary from state to state. It
requires health care professionals to report sexual assault, suspected domestic violence, abuse, injuries, and
wounds being treated by a health care professional. It is distinctly different from elder abuse reporting laws
because the mandatory reporting laws are not limited to a protected group. It is important to understand the
policies in an organization as they relate to mandatory reporting of violent crimes because there are specific
procedures that must be followed to report such cases. Each organization has a policy for handling sexual
assault issues, for example, so getting familiar with those policies is essential.
In general, the following immediate action must be taken if abuse is suspected:
•
•
•
Immediately request that the abuse stop.
Report the abuse to your supervisor or a manager, and request an investigation be done.
Follow the guidelines of your supervisor/organization’s policy for the situation.
Mandatory reporting is designed to improve patient and public safety by the reduction of patients’ exposure to
harm. Although health care professionals are informed of the mandatory reporting, it is important to be
cognizant of the laws and requirements. If a health care professional fails to report suspected cases, for
example, of child abuse or elder abuse, they will be subject to subject to discipline by the licensing board or
agency, by the health care organization in which they work, and the law.
References
Gabler, E. (2020, February 21). At Walgreens, complaints of medication errors go missing. The New York
Times. https://www.nytimes.com/2020/02/21/health/pharmacies-prescription-errors.html
SFGate. (2000, May 27). San Francisco / Dana Carvey settles lawsuit against surgeon.
https://www.sfgate.com/health/article/SAN-FRANCISCO-Dana-Carvey-Settles-Lawsuit-2757809.php
Winton, R., & Ryan, H. (2019, June 26). Former USC gynecologist George Tyndall charged with 29
felonies in sex abuse case. Los Angeles Times. https://www.latimes.com/local/lanow/la-megeorge-tyndall-arrest-usc-sexual-abuse-20190626-story.html
Suggested Unit Resources
In order to access the following resources, click the links below.
Review the following summary of the Chapter 3 content in order to enforce the main concepts presented.
Chapter 3 PowerPoint Presentation
Chapter 3 Presentation PDF
Review the following summary of the Chapter 4 content in order to enforce the main concepts presented.
Chapter 4 PowerPoint Presentation
Chapter 4 Presentation PDF
Review the following summary of the Chapter 6 content in order to enforce the main concepts presented.
Chapter 6 PowerPoint Presentation
Chapter 6 Presentation PDF
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UNIT III STUDY GUIDE
Health Care Ethics
Course Learning Outcomes for Unit III
Upon completion of this unit, you should be able to:
1. Analyze ethical dilemmas in the health care environment.
1.1 Apply ethical theories and reasoning to complex medical and ethical scenarios.
1.2 Recommend solutions to specific ethical dilemmas in the health care industry.
Required Unit Resources
Chapter 16: Healthcare Ethics
Chapter 17: Procreation and Ethical Dilemmas
In order to access the following resource, click the link below.
Cal OES. (2018, January 12). PSA: Price gouging is not only wrong, it’s illegal [Video]. Cielo24.
https://c24.page/9quce42ug3hqd47srk2zazhp2h
A transcript and closed captioning are available once you access the video.
Unit Lesson
Introduction to Health Care Ethics
The study of health care ethics is not just a theoretical study; it is applied ethics, meaning it applies across all
health care practices. The four basic principles accepted are:
•
•
•
•
autonomy,
beneficence,
nonmaleficence, and
justice.
Autonomy is the ability to make one’s own decisions. Each individual has a right to make decisions about their
health care. Respect for autonomy means the patient needs to be informed of the truth and full details
concerning their condition, the risks, benefits of the treatment, and alternative treatments. A health care
professional cannot make decisions concerning a patient’s health without the consent of the patient or patient
guardian.
Beneficence is the act of being kind. The health care provider is to provide care that is in the best interest of
the patient.
Nonmaleficence means to do no harm. Health care professionals’ treatments should not be harmful to the
patient. Health care professionals are bound by the Hippocratic Oath, which says, “First do no harm.” Harm
could be an act of omission; for instance, forgetting to raise the rail of a patient’s bed could lead to the patient
falling due to this omission. Another way is an act of commission. An example of this would be to give a
patient the wrong dose of a medication.
Justice refers to fairness in treatment. Justice is not only fairness to the patient, but it also includes fairness to
the health care professional. Justice also relates to the equitable distribution of health care services to the
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population and how health care is delivered to individuals. For instance, the Patient
and Affordable
UNIT xProtection
STUDY GUIDE
Care Act (PPACA) attempts to help Americans gain access to health care services
Title at reasonable costs.
There are many factors to consider, some of which conflict with each other, which increases the stress on an
already burdened health care system. This can result in difficult ethical decisions that must be made by health
care professionals every day. You can see some of these factors in the rest of the lesson that addresses
ethics specifically with the experience of the COVID-19 pandemic.
The COVID-19 Pandemic and Ethical Considerations
COVID-19, also known as the Coronavirus pandemic, is a global pandemic, which began in 2019. The
outbreak was identified in December 2019 in Wuhan, China. The World Health Organization (WHO) declared
it as a public health emergency in January 2020, and, by March, declared it a pandemic. COVID-19 is a
severe acute respiratory syndrome primarily spread between people during close contact via small droplets
produced by coughing, sneezing, or talking. The virus can be contracted by breathing in particles in the air or
by touching contaminated surfaces and touching the face. According to the Centers for Disease Control and
Prevention (CDC), there were over 100 and a half million total cases and over a million total deaths and
climbing in the United States as of January 1, 2023 (CDC, n.d.). You can view the latest (or final) numbers at
the CDC website COVID-19 data tracker page.
The common symptoms of COVID-19 include:
1.
2.
3.
4.
5.
fever,
cough,
fatigue,
shortness of breath, and
loss of smell.
Preventative measures include:
1.
2.
3.
4.
5.
6.
hand washing,
covering the mouth when coughing or talking,
maintaining distance from others,
wearing a face mask in public settings,
disinfecting surfaces, and
self-isolation if infected or exposed to others that are infected.
Public Health Concerns vs. Economic Concerns of the COVID-19 Pandemic
The COVID-19 pandemic was an extraordinary global event that called for extraordinary crisis management.
It was a global pandemic that caused global, social, and economic disruption and the most significant global
recession since the Great Depression of the 1930s. Millions were infected, and hundreds of thousands died
from the virus. The hospitals were overflowing with COVID-19 patients, causing health care professionals to
also be impacted by a lack of safety supplies and, therefore, causing them to fear for their lives. Many nonessential businesses were shut down, and those that remained open saw a significant reduction in revenue
as they made significant changes in the way they did business. Some businesses permanently closed while
others experienced significant losses and filed for bankruptcy. The closure of businesses created an
unprecedented amount of people finding themselves without jobs and worried about their health care benefits.
Filing for unemployment benefits became a challenge as there was also an unprecedented number of claims.
Homelessness, domestic abuse, violence, hunger, poverty, suicide, and famine were all on the rise (Samuel,
2020). There were postponements or cancellations of sporting, religious, political, and cultural events;
schools, universities, and colleges were closed temporarily for the safety of the children and the teachers. All
of this was an effort to contain the virus.
As the country shut down to prevent further spreading of the virus, there was a shortage of essential foods,
toilet paper, and sanitizers, creating panic buying, which in turn triggered a higher price for these items. The
unknowns and fast-paced changes affected daily living tremendously and forced everyone to start making
some tough decisions such as whether or not to go to work or stay home, how to keep their families safe from
the virus, how to keep their businesses open, and how to ration supplies. Health care workers sometimes had
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to consider who got a chance to live and who did not as respirators ran low. As
an individual,
business, or a
UNIT
x STUDY aGUIDE
health care professional in such a situation, these are tough decisions to make,
and there are ethical
Title
challenges in making them.
COVID-19 Impact on Daily Life
Many people lost family and friends to the coronavirus disease. Some states required people to wear a mask
when out in public while others just made it a recommendation (Markowitz, 2020). As a nation, we had to stay
at home more than usual; could not meet in groups of more than 10; had to maintain social distancing;
needed to cancel our trips, travels, and gatherings with family and friends; and could not go to a restaurant
and sit and eat. Businesses, like movie theaters and gyms, were closed. At first, many believed that this virus
was like every other virus and would go away, and then things would be normal again; however, after a while,
we saw that this was not the case, so many became angry and then depressed. Many decided to wear a
mask for a couple of weeks and stay home for another week, hoping that the virus would then go away.
However, we see how different life became, and all the adverse effects of it all: the deaths, the closure of
businesses, the loss of jobs, the rising homelessness, suicide, violence, and the shortage of essential items
such as toilet paper. Some accepted it as a new way of life and hoped there will be a vaccination that would
cure it soon; however, health care providers must go through these same feelings while attending to their
patients and make tough decisions.
COVID-19 Effects on Health Care Providers
Health care providers are compassionate and provide competent care, but the COVID-19 pandemic put them
at risk. Health care providers struggled with feeling physically unsafe in the response situation, such as in
times of scarce resources where supplies of such items as personal protective equipment may have been
inadequate. Health care professionals are concerned about professional, ethical, and legal protection when
asked to provide care in such high-risk situations such as those the COVID-19 pandemic presented. Health
care providers are also concerned about the risks of losing their own lives in the service of others and
infecting their own families.
The pandemic demanded a specific type of leadership that must consider actions carefully and, even more
importantly, the consequences of their actions, particularly the ethical and moral consequences. It is said that
when the chips are down, this is when you find out the true character of a person—this is true of a person,
and it is true of companies as well. To help make the best decisions, health care professionals should look at
ethics as a guide to help us make the best decisions possible in a crisis like this. Making decisions through
ethical lenses in the pandemic was extremely valuable as we consider virtues, rules, and tradeoffs we may
have to make.
Virtue Ethical Decisions
Virtue ethics is focused on character development. This is developed over time as one makes virtuous
decisions. Virtue ethics help answer the question what sort of person am I? While making decisions, it is
important to ask yourself some questions; for instance, what kind of person will I become if I take this action?
Is the decision I am about to make consistent with my values and best self? It is essential to communicate
with compassion to show that we understand what others are going through and never ask what we are not
willing to do ourselves.
The concept of duty is rules-based; do unto others as you would have them do unto you. Human beings are
to be valued simply because we are all humans and should never be seen as a means to get to where we
want to go. So, health care providers should never engage in price gouging, the practice of raising prices
dramatically while taking advantage of a crisis and attempting to gain higher profits even though many have
lost their jobs and are struggling to find the means to pay for needed items. However, price gouging is not
seen as an ethical or moral wrong by everyone, even though it is illegal in several states. Learn more about
this interesting ethical dilemma by viewing PSA: Price Gouging is Not Only Wrong, It’s Illegal to compare the
two points of view.
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Legal Ethical Decisions
UNIT x STUDY GUIDE
Title
Legally and ethically, it is important to obey the rules even when someone is not looking. During the height of
the pandemic, it was generally expected, and often mandated that everyone wear a mask when in close
proximity to others, do social distancing, and stop gathering in a large group even if the police are not
watching. We should comply with the law because it is the right thing to do.
Utilitarian Ethical Decisions
Utilitarian decisions are meant to achieve the best possible outcome for the highest number of people. Some
excruciating utilitarian decisions must be made during a health crisis, especially in the hospitals where there
are scarce resources: not enough ventilators and not enough personal safety equipment for health care staff.
Health care workers were being forced to make calculations about life and death such as who will benefit the
most from ventilators and who will die anyway, and then they must act on those calculations. For instance,
they might decide not to use a ventilator for an elderly person who is already sick, already old, and will not live
much longer. Instead, it is used on a younger patient with a potential for a longer life who is more likely to
survive. These are horrible decisions to make, but this is one of the ways a decision is made for the best
outcome that can be achieved for the highest number of people.
Companies are reducing the pay of top management to keep the lower employees employed. Other
companies are reducing hours of the employees to prevent termination or layoffs of other employees. These
are examples of making utilitarian decisions to achieve the best possible outcome for the highest number of
people.
Conclusion
The COVID-19 pandemic was an uncharted territory filled with uncertainty. As health care providers faced the
uncertainties and difficult decisions created by the COVID-19 pandemic, ethics becomes a guide to help
make the best ethical decisions possible that align with each provider’s values.
References
Centers for Disease Control and Prevention. (n.d.). CDC COVID data tracker. Retrieved January 3, 2023,
from https://covid.cdc.gov/covid-data-tracker/#cases
Markowitz, A. (2020, October 22). State-by-state guide to face mask requirements. AARP.
https://www.aarp.org/health/healthy-living/info-2020/states-mask-mandates-coronavirus.html
Samuel, S. (2020, May 11). COVID-19 could reverse decades of global progress. Vox.
https://www.vox.com/future-perfect/2020/5/11/21246992/coronavirus-pandemic-collateral-damagehunger-poverty
Suggested Unit Resources
In order to access the following resources, click the links below.
Review the following summary of the Chapter 16 content in order to enforce the main concepts presented.
Chapter 16 PowerPoint Presentation
Chapter 16 Presentation PDF
Review the following summary of the Chapter 17 content in order to enforce the main concepts presented.
Chapter 17 PowerPoint Presentation
Chapter 17 Presentation PDF
HCA 5302, Legal Foundations of Health Care
4
UNIT IV STUDY GUIDE
Legal Issues for Health Care Providers
Course Learning Outcomes for Unit IV
Upon completion of this unit, you should be able to:
5. Analyze the characteristics of negligence in the health care environment.
5.1 Describe the various types of legal risks that can be encountered.
5.2 Outline ways that health care professionals can avoid being sued for negligence in the
workplace.
Required Unit Resources
Chapter 10: Medical Staff Organization and Malpractice
Chapter 11: Nursing and the Law
In order to access the following resource, click the link below.
Ivanhoe Broadcast News (Producer). (2017). The doctor is in…your living room! [Video]. Films on Demand.
https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPl
aylists.aspx?wID=273866&xtid=167864
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Unit Lesson
At some point, all organizations will face or will need to deal with laws and regulations and legal issues. Some
industries experience far more legal issues than others; the health care industry is a legal minefield. In health
care, people’s lives are at stake; a single action can mean life or death for a patient. Creating a safe
environment for patients is why health care is highly regulated and held to a high standard. For health care
organizations and health care professionals to reduce legal challenges, it is crucial to stay abreast of the laws
and regulations governing health care, monitor changes as they occur, and abide by the laws, regulations,
and organizational policies. The health care landscape changes continuously at a fast-moving pace, and legal
issues will come up. Three legal issues that constantly plaque the health care industry are medical
malpractice, HIPAA compliance, and telemedicine legal concerns.
Medical Malpractice
When a health care professional or health care organization causes injury to a patient through negligence and
or omission, it is called medical malpractice. The advancement and reliance on technology in health care
makes health care even more vulnerable to malpractice lawsuits. Some ways to help avoid medical
malpractice are to work within your scope of duties, clearly understand the health care laws, regulations, and
policies, and abide by them. Below are three examples of malpractice:
HCA 5302, Legal Foundations of Health Care
1
1. Leaving patient unattended and the patient suffers injury because of it,UNIT
as inx the
case GUIDE
Vanhoy v.
STUDY
United States (2006) detailed below:
Title
•
•
•
•
•
Patient was injured as a result of being left unattended.
His endotracheal tube became dislodged.
The veteran suffered an anoxic brain injury.
The government was required to pay $3.5 million.
The delay in treatment resulted in the patient’s injury.
2. Failure to record patient’s care as in Pellerin v. Humedicenters, Inc. (1997) detailed below:
•
•
•
The nurse failed to record the administration of medication.
Failure to record falls below the standard of care for nursing.
Incomplete clinical documentation can cause a health care provider to lose their license, cause
inaccurate data, loss of reimbursement, poor patient care, and even create legal issues. If a
health care provider made an error in documentation, it should be corrected immediately with
proper procedures; write “mistaken entry” above the line drawn through the words that need to be
deleted, the author’s initials, date, and time.
3. One famous example of malpractice, which involves negligence in several aspects of drug
administration, resulted in the death of Michael Jackson in 2009. Mr. Jackson’s autopsy and
toxicology report showed he died due to a number of drugs in his system, including Propofol, a
powerful anesthetic generally used in surgical situations. It is very potent and has a variety of side
effects that require constant monitoring by physicians. As Jackson’s in-home physician, Dr. Conrad
Murray routinely administered Propofol to his only patient so that he could sleep soundly through the
night. Dr. Murray was arrested and charged with involuntary manslaughter for the death of Jackson,
given a 4-year prison sentence, had his medical licenses in Texas and California revoked, and was
ordered to pay the Jackson family $100 million in restitution (Medina, 2011).
These are just three instances of malpractice, but there are many other possible lawsuits for negligence or
omission. Medical error is a preventable adverse effect of care. Common medical errors can be found in
areas such as patient assessment, the failure to administer drugs, document drug wastage, administering
drugs without a prescription, administering the wrong medication, and failing to clarify orders. An example of
this is the administration of wrong dosage, negligent drug overdose.
HIPAA Compliance
The Health Insurance Portability and Accountability Act (HIPAA) protects the health care records of patients
and ensures medical practices are being followed according to HIPAA guidelines to protect the patients’
sensitive data. Health care organizations and professionals have the responsibility to protect these patients’
sensitive information. HIPAA compliance was not a costly event in the past, but with technological
advancements, storing of data online, and the advancement of equipment which now holds patient data,
patient information is more vulnerable to cyberattacks. This is a significant legal issue for the health care
industry. Online attacks are increasing, and it is vital for health care professionals and health care
organizations to take the necessary steps to ensure patient information is protected and secured.
A tremendous help is not only to have a dedicated technology information team but also to invest in and
implement the proper security software/systems. All health care professionals need to be trained in HIPAA
compliance. These efforts will help reduce the likelihood of a cyberattack. If a health care organization
becomes a victim of an attack and there is a breach in their data security, it is believed that the health care
professional or organization did not observe HIPAA compliance rules effectively and could find themselves in
a legal battle.
Telemedicine and the Law
Telemedicine is redefining and transforming health care. In a fragmented health care system, telemedicine
improves access to health care by accessing health care from anywhere at any time. You may be able to
get to communicate with your primary care sooner and receive treatment for non-emergency illnesses and
injuries 24/7 through virtual consultations. If extensive care is required, it is easy to access specialty care,
HCA 5302, Legal Foundations of Health Care
2
as many hospitals now connect with patients through telehealth. Due to telehealth,
to anGUIDE
emergency
UNIT visits
x STUDY
room for non-emergency care can be reduced, and costs can be lowered as patients
Title get the right care for
less money.
Telemedicine now has technologies that can remotely monitor the health conditions of patients recovering or
suffering from several illnesses. Health care professionals can monitor heart rates, oxygen levels, and even
blood pressure remotely. Patient data can even be monitored remotely by health care professionals to quickly
identify potential problems and contact patients for quick treatment.
Watch this brief video, The Doctor is in… your Living Room! to hear about how telemedicine has changed the
life of a man who lives in a rural area.
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Telemedicine is helping to revolutionize health care; however, there are some legal concerns to consider.
Cross-State Medical Practice
Doctors are licensed in the state in which they practice medicine, and the patients that visit them are usually
in that same state. Telemedicine has crossed that boundary, and doctors can now service patients from
anywhere, including outside of their state of license. The Interstate Medical Licensure Compact creates a
pathway to state licensure for physicians who want to practice medicine in multiple states. There are specific
qualifications and a process a physician will need to go through in order to get approval. Health care
professionals who do not acquire the proper licensure for the state they are practicing in are considered
practicing medicine without a license and could be convicted of a misdemeanor violation, face up to 364 days
in county jail, and/or a fine.
Malpractice Insurance
Malpractice insurance is an absolute necessity for all doctors; however, not all malpractice insurance covers
telemedicine, Telemedicine practitioners such as nurses, physician assistants, and hospitals without the
appropriate malpractice insurance may have to deal with any lawsuits on their own and become personally
liable for any settlements.
Conclusion
It is important for health care professionals to understand their scope of duties, work within it, and keep
informed of the laws and regulations related to their duties and ensure that they are in compliance at all-time.
Health care organizations protect their health care providers and patients by setting rules. There are times it
may appear these laws or rules prevent you from giving the best care to a patient, and you may consider
bending the rules in the interest of the patient. For instance, going beyond your scope of duties to help a
patient by performing a life-saving procedure or giving a patient a few extra pills because the patient is in pain
or cannot sleep. Once the rules are bent once, it becomes easier to bend it a second time, and a third time.
Although bending the rules might be done with the best intentions, it is risky to do so, and may land you in
trouble with the law, and may even cause you to lose your license. Understanding the laws that govern health
care and your scope of duties will keep you and your license safe.
References
Medina, J. (2011, November 7). Doctor is guilty in Michael Jackson’s death. The New York Times.
https://www.nytimes.com/2011/11/08/us/doctor-found-guilty-in-michael-jacksons-death.html
Pellerin v. Humedicenters, Inc., No. 696 So.2d 590 (1997).
Vanhoy v. United States, No. 03-1090 Section “J” (4) (E.D. La. Jul. 28, 2006).
HCA 5302, Legal Foundations of Health Care
3
Suggested Unit Resources
In order to access the following resources, click the links below.
UNIT x STUDY GUIDE
Title
Review the following summary of the Chapter 10 content in order to enforce the main concepts presented.
Chapter 10 PowerPoint Presentation
Chapter 10 Presentation PDF
Review the following summary of the Chapter 11 content in order to enforce the main concepts presented.
Chapter 11 PowerPoint Presentation
Chapter 11 Presentation PDF
HCA 5302, Legal Foundations of Health Care
4
UNIT V STUDY GUIDE
Informed Consent and Negligence
Course Learning Outcomes for Unit V
Upon completion of this unit, you should be able to:
5.
Analyze the characteristics of negligence in the health care environment.
5.3 Determine what constitutes negligence.
5.4 Explore the legal ramifications of health care worker negligence.
Required Unit Resources
Chapter 14: Patient Consent
Chapter 15: Patient Rights and Responsibilities
In order to access the following resources, click the links below.
The following video addresses the controversy of who the informed consent is designed to benefit: the doctor
or the patient.
Australian Broadcasting Corporation (Producer). (2011). Informed consent (Segment 6 of 9) [Video]. In Body
perception, heart diseases risks, diagnosing Alzheimer’s, and more: Tonic. Films on Demand.
https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPl
aylists.aspx?wID=273866&xtid=49563&loid=199597
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Promedion Productions (Producer). (2013). Informed consent and confidentiality clause (Segment 9 of 12)
[Video]. In Ethics in psychological research.
https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPl
aylists.aspx?wID=273866&xtid=115833&loid=427567
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Unit Lesson
Informed Consent – Why It is Needed in Health Care
Every patient has the right to make decisions as they relate to their health. It is shared decision-making
between the patient and the health care professional. Patients should understand and consider the potential
risks and benefits of medical treatments before deciding to get the treatment or refuse the treatment.
Patients are required to acknowledge those possible risks and benefits to make an informed decision to go
ahead with the treatment or not. Informed consent is when a health care professional, for instance, a nurse or
a doctor, explains the diagnosis, risks, and benefits of a procedure before the patient agrees to the medical
treatment.
HCA 5302, Legal Foundations of Health Care
1
There are four parts to the informed consent:
UNIT x STUDY GUIDE
Title
1. The patient must be mentally competent to understand the information and to make decisions.
2. The health care professional must explain in layman terms the information needed, such as possible
treatments, risks, and benefits, for the patient to make an informed decision.
3. The patient needs to understand the medical information presented by the health care professional.
4. It is ultimately the patient’s decision to get the treatment or not.
Informed consent should include the following:
•
•
•
•
diagnosis,
purpose and name of the treatment,
alternative treatments, and
the risks and benefits involved in each of the possible treatments.
Why do patients need to sign an informed consent form?
The informed consent form is a legal document that was created to inform patients of their rights and
responsibilities as they participate in research studies. It serves as an agreement to protect both the patient
as well as the organization conducting research, and it is a method of communication that is essential in
research studies. View the following video which discusses informed consent in research.
Informed consent and confidentiality clause (Segment 9 of 12) [Video]
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Once the patient’s health care professional provides the patient with risks, benefits, alternative treatments,
and answers any questions the patient has, the patient is then asked to sign an informed consent document
before the treatment begins.
When a patient signs an informed consent form, it is an agreement between the health care provider and the
patient. It is a legal document that could be used in court to support the patient or the doctor in case there is a
malpractice lawsuit. The patient agrees to the following when they sign informed consent:
•
•
•
•
The patient has been informed of the details about the treatment by the health care professional.
The patient fully understands the information given by the health care provider.
The information given is used to make a decision to complete the treatment or not.
The patient agrees to the treatment options voluntarily.
Once the patient signs the informed consent agreement, the health care professional can proceed with the
treatment. The patient can refuse to sign the informed consent and thus refuse the treatment.
Singing on the Patient’s Behalf
•
•
•
Patients 18 years and younger will need a parent or guardian to give consent on their behalf.
If an adult patient feels they cannot make the decision, they could appoint someone to make those
medical decisions for them by filling out an advance directive, a document that lays out instructions
for medical care. An example of this is when the patient is elderly and prefers their children to make
health care decisions.
Patients in a coma, who cannot give consent, will naturally permit another person to decide on their
behalf.
HCA 5302, Legal Foundations of Health Care
2
Types of Informed Consent
UNIT x STUDY GUIDE
Title
The main difference between consent and informed consent is the patient’s knowledge and understanding of
the treatment, risks, and benefits. There are three types of informed consent: implied, verbal, and written.
•
•
•
Implied consent: When a patient implicitly agrees to a procedure through their actions or lack of
action.
Verbal consent: When a patient consents verbally to treatment (specifically, not in writing). This type
of consent is acceptable for routine treatment such as diagnostic procedures.
Written consent: When consent is provided in writing. This type of consent must be given when there
is a risk of complication. Written informed consent is required for most surgeries, complex medical
tests, radiation to treat cancer, most vaccines, and blood tests, like HIV testing.
Exceptions to Consent
Some situations may occur where there are exceptions to the patient signing an informed consent. Under
these circumstances, the patient is either:
•
•
•
incapacitated,
has a life-threatening emergency with no time to get consent, or
voluntarily waived their consent.
If a patient’s decision is questionable or unclear, a psychiatrist’s evaluation will be completed to determine
competency. If a patient cannot decide and has not designated a decision-maker, a legal surrogate decisionmaker will be determined, or a legal guardian will be appointed by the court (depending on the state’s law).
Ethical Issues in Informed Consent
The importance of informed consent includes obligations to promote autonomy, provide information, and
avoid unethical forms of bias. Patients have the right to refuse medical treatment based on religious or any
other grounds if they are competent to do so.
View the following video which addresses the controversy of who the informed consent is designed to benefit:
the doctor or the patient.
Informed consent (Segment 6 of 9) [Video]
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Gross Negligence and Lack of Informed Consent
Gross negligence refers to conduct so reckless or mistaken that it is apparent to a person with no medical
training. An example of gross negligence is if a doctor were to perform surgery without a signed informed
consent from that patient, and the surgery results in injury to the patient. The patient could sue for gross
negligence because neglecting to inform and obtain informed consent from the patient is considered reckless.
A health care professional who fails to obtain a patient’s informed consent for specific procedures, such as
non-emergency surgery, could be charged with a criminal offense, such as battery or unauthorized patient
touch. The patient will need to prove that the doctor failed to inform the patient of the treatment risks and that
if the patient knew, he or she would have refused the treatment.
HCA 5302, Legal Foundations of Health Care
3
There are ways in which a physician can protect themselves against a negligence
UNITlawsuit.
x STUDY GUIDE
•
•
•
•
•
•
Title
Provide quality medical care to patients.
Communicate clearly and in detail and ensure the patient understands the information provided.
Get a signed, completed informed consent from the patient when the procedure requires it.
Keep accurate documentation of patient’s visit.
Follow proper procedures and laws.
Keep their license current.
As you can see, obtaining a completed and signed informed consent promotes trust between patient and
health care provider. It offers patient autonomy and confidence in their medical providers. It also reduces
unnecessary legal claims and lawsuits regarding medical care.
Suggested Unit Resources
In order to access the following resources, click the links below.
You are encouraged to read the following chapter in your eTextbook for an in-depth look at the law and its
application in the courtroom.
Chapter 8: Civil Procedure and Trial Practice
Review the following summary of the Chapter 8 content in order to enforce the main concepts presented.
Chapter 8 PowerPoint Presentation
Chapter 8 Presentation PDF
Review the following summary of the Chapter 14 content in order to enforce the main concepts presented.
Chapter 14 PowerPoint Presentation
Chapter 14 Presentation PDF
Review the following summary of the Chapter 15 content in order to enforce the main concepts presented.
Chapter 15 PowerPoint Presentation
Chapter 15 Presentation PDF
HCA 5302, Legal Foundations of Health Care
4
UNIT VI STUDY GUIDE
Patient Consent and Legal Obligations
Course Learning Outcomes for Unit VI
Upon completion of this unit, you should be able to:
6. Explain regulations regarding safeguarding of health information management.
6.1 Explain patient and provider obligations to protect private health information.
6.2 Describe a legal defense of an employee accused of mismanaging a patient’s health
information.
6.3 Explain the mandatory contents and legal obligation of providers to maintain accurate medical
records.
Required Unit Resources
Chapter 13: Information Management and Patient Records
Chapter 19: Legal Reporting Requirements
Unit Lesson
Health information (HI) is data in a patient’s medical record such as patient history, clinical information, and
diagnostic results, and health information management (HIM) is the practice of gathering, analyzing, storing,
and protecting a patient’s health information. This process is critical to providing quality data for patient care.
Health care organizations are under pressure to improve outcomes because patients are now informed and
are looking for treatment and facilities with superior care. Health information and its management is vital as it
helps in providing correct and timely diagnosis, provides the information needed to determine sound
treatment planning, and, with the seamless flow of health information between physicians and specialists,
plays a crucial role in providing the best outcomes for patients.
Duties of the Health Information Professional
Health information professionals should be well-versed in Health Insurance Portability and Accountability Act
(HIPAA) regulations, information management applications, and health care workflow process. They ensure
that patients’ medical records are accurate, complete, and protected. Health information professionals are a
vital link in the health care delivery system as they ensure the patients’ medical records’ quality, integrity, and
security (American Health Information Management Association, n.d.).
Legal Reporting Requirements
Health care providers have a legal reporting requirement mandated both by federal and state regulatory
agencies. Examples of items that must report are child abuse, elder abuse, communicable diseases such as
AIDS, births and deaths, suspicious deaths, are adverse drug reactions. Health care providers who fail to
report could face severe penalties.
Safeguarding of Health Information
Safeguarding health information has become a prominent part of health care these days because of the new
challenges presented by modern technology. Cybersecurity threats like malware help criminals gain access to
protected health information (PHI) regularly because health information can be sold on the black market at a
high price. The stolen health data is typically used by a criminal to try and do everything from getting medical
services in your name to applying for credit cards, bank loans, and even applying for social security and
HCA 5302, Legal Foundations of Health Care
1
unemployment claims, all in your name without you knowing. Many have become
so itGUIDE
is vital that
UNITvictims,
x STUDY
health information be protected.
Title
The HIPAA Journal (n.d.) reported that there have been more than 500 major breaches in 2019, and the
breaches had been increasing over the 10 years prior. You can view the largest health care data breaches at
the HIPAA journal website. According to the HIPAA Journal (n.d.), hacking is now the leading cause of health
care data breaches, although health care organizations have improved in protecting health information
against hacking.
There are steps one can take after their personal health information has been stolen:
•
•
•
•
•
•
Confirm with the health care provider that your information was exposed.
Accept any offer from the health care provider to assist you in repairing the damage and protect your
identity as this can be time-consuming and costly.
Change your online logins and passwords.
Check your credit reports and address anything that you may feel is incorrect.
Consider filing an identity theft report with the Federal Trade Commission.
Continue to monitor each of your accounts for any signs of unusual activities.
Patient and Provider Obligations to Protect Private Health Information
Health care providers are obligated by law to follow the Health Insurance Portability and Accountability Act
(HIPAA) Privacy Rule. It is a federal privacy law protecting individually identifiable health information. There
are several standard ways providers help protect health information:
•
•
•
•
•
•
•
•
•
•
Implement access controls to prevent unauthorized access.
PHI training for health care employees.
Get written authorization when required.
Back up data.
Implement firewalls.
Place PHI information in a drawer or folder when not being used.
Never leave paper PHI unattended.
Encrypt mobile devices.
Ensure passwords are changed regularly and not shared.
Keep antivirus and antimalware software up-to-date.
Patients should be proactive in protecting the privacy of their health information by asserting their rights.
Patients should:
•
•
•
•
•
review medical records for accuracy,
ensure any incorrect information in the records be corrected,
request notice of how personal health information may be used and shared,
consider when to permit personal health information to be used or shared, and
file a complaint with the health care provider or HHS if there is a concern that personal health
information is not protected.
Legal Defense for an Employee
When an employee is accused of mismanaging a patient’s health information, the attorney will suggest
defenses under the law to support the health care employee’s side of the lawsuit. The following strategies
may be used to defend the employee:
•
•
Denial defense: The plaintiff (the accuser) has the burden to prove that defendant did something
wrong. Therefore, the most common defense in a malpractice lawsuit is denial on the part of the
employee.
Assumption of risk: Assumption of risk is the legal defense that prevents a plaintiff from recovering
damages if the plaintiff voluntarily accepts a risk associated with the activity.
HCA 5302, Legal Foundations of Health Care
2
•
•
•
•
•
UNIT x STUDY
GUIDEbecause
Statute of limitations: The statute of limitations protects a health care provider
from lawsuits
the time frame for a lawsuit to be filed may have passed. All states have
a statute of limitation.
Title
Res judicate: This phrase means, “The thing has been decided.” If a court decided a case, then the
plaintiff cannot bring a new lawsuit on the same matter. The court has already decided it.
Contributory negligence: This refers to unreasonable behavior on the part of the plaintiff contributing
to the injury.
Borrowed servant: This refers to when an employer lends an employee to someone else, so this
employee is the servant of the temporary employer; therefore, the employer is not liable for any
negligence caused by the employee while in the service of the temporary employer.
Comparative negligence: The plaintiff’s negligence helped caused the injury.
The Patient’s Recourse Against a Violation of Privacy
Patients believe their health information is private and protected, and they have a right to know who has their
health information. HIPAA’s Privacy Rule, which is a federal law, sets rules and limitations on who can look at
a patient’s health information, whether the format is electronic, oral, or written. Under federal law, the HIPAA
Security Rule requires security for electronic health information (Department of Health and Human Services,
n.d.). A lawsuit cannot be filed against an entity (like a hospital) or an individual for HIPAA violations of patient
privacy; however, patients can make a complaint to the Office of Civil Rights. Once they do, an investigation
will be performed, and the proper punishment enacted if appropriate. The patient will not be compensated, but
notification of the outcome will be sent to the patient. Under state law, if the patient suffered damages that can
be proven, a civil claim can be filed against the individual/entity who violated the patient’s HIPAA rights.
Case Example of a HIPAA Violation
Emily Byrne and Andro Mendoza were dating. When Emily got pregnant, they ended their relationship. Andro
Mendoza filed for custody of the child, and his attorney sent a subpoena to Avery Center of Obstetrics and
Gynecology for Emily’s medical records to support his case. The clerk complied with the subpoena and sent
the medical records to the attorney. The Connecticut Supreme Court ruled that it was a violation of medical
privacy under HIPAA because Emily Byrne’s medical records were improperly released without her
knowledge and consent. The jury awarded her $853,000 (Gueli, n.d.).
Conclusion
Patients and providers do have an obligation to protect private health information (PHI). Safeguarding health
information has become a prominent part of health care because of the new challenges presented by modern
technology. Cybersecurity threats like malware help criminals gain access to PHI regularly. HIPPA
regulations, information management applications, and health care workflow process are all geared to ensure
that patients’ medical records are accurate, complete, and protected. Violations of the proper handling of
patients’ private health information could lead to fines and even imprisonment, so every health care
professional should be well versed in the laws that govern private health information.
References
American Health Information Management Association. (n.d.). Health information is human information.
https://www.ahima.org/certification-careers/certifications-overview/career-tools/career-pages/healthinformation101/#:~:text=Health%20information%20(HI)%20professionals%20are,latest%20information%20mana
gement%20technology%20applications.&text=HI%20professionals%20care%20for%20patients,prote
ction%20of%20patients’%20health%20information.
Department of Health and Human Services. (n.d.). The security rule. https://www.hhs.gov/hipaa/forprofessionals/security/index.html#:~:text=The%20HIPAA%20Security%20Rule%20establishes,maint
ained%20by%20a%20covered%20entity
HCA 5302, Legal Foundations of Health Care
3
Gueli, C. R. (n.d.). HIPAA violations: Can you file a lawsuit to protect your rights?
Injury
ClaimGUIDE
Coach.
UNIT
x STUDY
https://www.injuryclaimcoach.com/hipaaTitle
violations.html#:~:text=The%20Connecticut%20Supreme%20Court%20ruled,lawsuit%20against%20t
he%20Avery%20Center.
HIPAA Journal. (n.d.). Healthcare data breach statistics. https://www.hipaajournal.com/healthcare-databreach-statistics/
Suggested Unit Resources
In order to access the following resources, click the links below.
Review the following summary of the Chapter 13 content in order to enforce the main concepts presented.
Chapter 13 PowerPoint Presentation
Chapter 13 Presentation PDF
Review the following summary of the Chapter 19 content in order to enforce the main concepts presented.
Chapter 19 PowerPoint Presentation
Chapter 19 Presentation PDF
HCA 5302, Legal Foundations of Health Care
4
UNIT VII STUDY GUIDE
Managed Care and the Patient Protection
and Affordable Care Act
Course Learning Outcomes for Unit VII
Upon completion of this unit, you should be able to:
3. Explain the features of federal assistance programs.
3.1 Determine the reasons behind the creation of the Patient Protection and Affordable Care Act
(PPACA).
3.2 Define managed care.
3.3 Examine the relationship of the PPACA to overall health care costs.
Required Unit Resources
Chapter 21: Managed Care and National Health Insurance
Unit Lesson
Managed Care
The managed care operation is such that a Health Maintenance Organization (HMO), an insurance firm, or a
hospital network mediates between the health care seeker and the physician. In the ’80s, the cost of receiving
health care services was sporadically on the rise. It became apparent that the health care industry was
displaying its incapacity to maintain manageable medical care costs—hence the emergence of third-party
payers that assist in cost control by managing access to health care.
Many celebrated the idea of a managed care program providing a team of physicians with different specialties
and different treatment methods for the patient’s benefit. Ultimately, patients felt safer because there was a
variety of medical doctors with different approaches and specialties overseeing the treatment. However,
millions had no access to health care due to not being eligible or because health care was not affordable.
Many who have insurance may not get the same type of benefits as others due to gender, age, high usage,
pre-existing conditions just to name a few. President Obama’s Patient Protection and Affordable Care Act of
2010 was created to address these and other issues in accessibility and affordability.
How Patient Protection and Affordable Care Act of 2010 (PPACA) transformed the U.S. Health Care
System
Ten years ago, the Affordable Care Act (ACA) was signed into law and transformed the American health care
system. Two major ways in which medical coverage was expanded by ACA were the launching of the
marketplace for private insurance coverage and the expansion of Medicaid, allowing millions of uninsured
Americans to gain access to health care.
Millions Gain Access to Health Insurance Coverage
In 2010, according to the Kaiser Family Foundation, 16% of the American population was not insured. After
ACA was put into law, the uninsured rate lowered to an all-time low of 9%. About 20 million people gained
health insurance (Tolbert et al., 2019). This was the largest expansion of health care coverage in the history
of the United States. There was less disparity in coverage for different ethnicities; all ages, both children and
adults, were covered. Many changes ensured the accessibility to health care by many.
HCA 5302, Legal Foundations of Health Care
1
Protection of Those with Pre-existing Conditions
UNIT x STUDY GUIDE
Title
Before ACA, people with pre-existing conditions could face discrimination. This is significant as nearly one in
two elderly adults may have a pre-existing condition (Centers for Medicare & Medicaid Services [CMS], n.d.).
ACA, through reforms, prohibits insurers from bias against those who have pre-existing conditions. Insurers
are also prohibited from making premiums based on gender and health history. ACA also limits their ability to
charge premiums based on age. Insurers must give a policy to anyone.
Inclusion of Essential Benefits
Another protection afforded by ACA is ensuring health care policies include essential benefits such as
maternity care, mental health services, and prescription drugs. Insurers can no longer exclude these benefits
because a patient utilizes these services more than a typical patient. The law also prevents insurers from
setting annual and lifetime limits on benefits.
Medicaid Expansion
ACA asks most states to expand Medicaid to 138% of the federal poverty level and provide 90% of the cost
(American College of Obstetricians and Gynaecologists [ACOG], 2013). This expansion enabled about 12
million low-income people and their families to access affordable health care coverage.
Affordable Health Care
The marketplace is a portal for purchasing health insurance, which was launched in 2013. Although the
monthly premiums were about $600, many low-income and middle-income Americans were eligible for
financial assistance with the monthly premiums making it affordable. Co-payments and other types of cosharing were eliminated for preventative services. For example, immunizations, screenings, and
contraception visits had no co-pay cost. Thanks to ACA, plans were mandated to include maternity,
breastfeeding and supplies services, annual wellness visits, screenings for cancer, and HIV, among other
coverage without co-payments.
Extended Coverage for Dependents
Young adults can now stay on their parents’ health insurance plan up until the age of 26. This serves young
adults who may not have a job. It will allow them to have health insurance and access to health care.
Better Access to Prescription Drugs
ACA required the marketplace to offer coverage for a wider variety of drugs and allowed out-of-pocket drug
expenses to count towards deductibles. This allows more access to brand-name and generic drugs at a
lower cost.
How PPACA influences Defensive Medicine within U.S. Health Care
Some positive measures include improved parking at managed care facilities, better tasting hospital food,
using best business practices and information technology in the health care setting, and moving medical
procedures and treatments to less costly facilities when possible.
Defensive Medicine
Defensive medicine refers to the practice of physicians ordering tests patients may not necessarily need to
have that help to drive up the cost of health care. If the health reforms were to be more effective, there would
be a need to tackle defensive medicine. Surveys vary, but a significant majority of physicians surveyed do
report practicing some defensive medicine. The reasons include avoiding being named in a lawsuit; defensive
medicine is the standard of care; patients demand that everything possible is done; there is a fear of missing
something crucial without the tests; and, perhaps surprisingly, there is peer pressure among doctors.
An example of defensive medicine is the over-treatment using antibiotics. For instance, a guardian may
expect a prescription for antibiotics when they take their child to the doctor for a cold. The doctor knows it is
HCA 5302, Legal Foundations of Health Care
2
not needed, but the doctor gives in due to pressures from the guardian. Now the
patient’s
normal
bacteria are
UNIT
x STUDY
GUIDE
killed by the antibiotic, leaving only antibiotic-resistant bacteria.
Title
Conclusion
Overall, there are issues with managed care: limited access for those that do not have health insurance, rigid
rules, too busy networks, and long wait times; however, there are many benefits such as lower costs for
needed services, prescription management is easy, and certain guarantee of care within the network. ACA
helped millions gain access to health care and at an affordable cost. It is life-changing for many Americans,
especially for uninsured and low-income people and people with pre-existing conditions.
References
American College of Obstetricians and Gynecologists. (2013). Benefits to women of Medicaid expansion
through the Affordable Care Act. https://www.acog.org/clinical/clinical-guidance/committeeopinion/articles/2013/01/benefits-to-women-of-medicaid-expansion-through-the-affordable-care-act#
Centers for Medicare & Medicaid Services. (n.d.). At risk: Pre-existing conditions could affect 1 in 2
Americans: 129 million people could be denied affordable coverage without health reform.
https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/preexisting
Tolbert, J., Orgera, K., Singer, N., & Damico, A. (2019, December 13). Key facts about the uninsured
population. Kaiser Family Foundation. https://www.kff.org/uninsured/issue-brief/key-facts-about-theuninsured-population/
Suggested Unit Resources
In order to access the following resources, click the links below.
Review the following summary of the Chapter 21 content in order to enforce the main concepts presented.
Chapter 21 PowerPoint Presentation
Chapter 21 Presentation PDF
HCA 5302, Legal Foundations of Health Care
3
UNIT V STUDY GUIDE
Informed Consent and Negligence
Course Learning Outcomes for Unit V
Upon completion of this unit, you should be able to:
5.
Analyze the characteristics of negligence in the health care environment.
5.3 Determine what constitutes negligence.
5.4 Explore the legal ramifications of health care worker negligence.
Required Unit Resources
Chapter 14: Patient Consent
Chapter 15: Patient Rights and Responsibilities
In order to access the following resources, click the links below.
The following video addresses the controversy of who the informed consent is designed to benefit: the doctor
or the patient.
Australian Broadcasting Corporation (Producer). (2011). Informed consent (Segment 6 of 9) [Video]. In Body
perception, heart diseases risks, diagnosing Alzheimer’s, and more: Tonic. Films on Demand.
https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPl
aylists.aspx?wID=273866&xtid=49563&loid=199597
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Promedion Productions (Producer). (2013). Informed consent and confidentiality clause (Segment 9 of 12)
[Video]. In Ethics in psychological research.
https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPl
aylists.aspx?wID=273866&xtid=115833&loid=427567
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Unit Lesson
Informed Consent – Why It is Needed in Health Care
Every patient has the right to make decisions as they relate to their health. It is shared decision-making
between the patient and the health care professional. Patients should understand and consider the potential
risks and benefits of medical treatments before deciding to get the treatment or refuse the treatment.
Patients are required to acknowledge those possible risks and benefits to make an informed decision to go
ahead with the treatment or not. Informed consent is when a health care professional, for instance, a nurse or
a doctor, explains the diagnosis, risks, and benefits of a procedure before the patient agrees to the medical
treatment.
HCA 5302, Legal Foundations of Health Care
1
There are four parts to the informed consent:
UNIT x STUDY GUIDE
Title
1. The patient must be mentally competent to understand the information and to make decisions.
2. The health care professional must explain in layman terms the information needed, such as possible
treatments, risks, and benefits, for the patient to make an informed decision.
3. The patient needs to understand the medical information presented by the health care professional.
4. It is ultimately the patient’s decision to get the treatment or not.
Informed consent should include the following:
•
•
•
•
diagnosis,
purpose and name of the treatment,
alternative treatments, and
the risks and benefits involved in each of the possible treatments.
Why do patients need to sign an informed consent form?
The informed consent form is a legal document that was created to inform patients of their rights and
responsibilities as they participate in research studies. It serves as an agreement to protect both the patient
as well as the organization conducting research, and it is a method of communication that is essential in
research studies. View the following video which discusses informed consent in research.
Informed consent and confidentiality clause (Segment 9 of 12) [Video]
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Once the patient’s health care professional provides the patient with risks, benefits, alternative treatments,
and answers any questions the patient has, the patient is then asked to sign an informed consent document
before the treatment begins.
When a patient signs an informed consent form, it is an agreement between the health care provider and the
patient. It is a legal document that could be used in court to support the patient or the doctor in case there is a
malpractice lawsuit. The patient agrees to the following when they sign informed consent:
•
•
•
•
The patient has been informed of the details about the treatment by the health care professional.
The patient fully understands the information given by the health care provider.
The information given is used to make a decision to complete the treatment or not.
The patient agrees to the treatment options voluntarily.
Once the patient signs the informed consent agreement, the health care professional can proceed with the
treatment. The patient can refuse to sign the informed consent and thus refuse the treatment.
Singing on the Patient’s Behalf
•
•
•
Patients 18 years and younger will need a parent or guardian to give consent on their behalf.
If an adult patient feels they cannot make the decision, they could appoint someone to make those
medical decisions for them by filling out an advance directive, a document that lays out instructions
for medical care. An example of this is when the patient is elderly and prefers their children to make
health care decisions.
Patients in a coma, who cannot give consent, will naturally permit another person to decide on their
behalf.
HCA 5302, Legal Foundations of Health Care
2
Types of Informed Consent
UNIT x STUDY GUIDE
Title
The main difference between consent and informed consent is the patient’s knowledge and understanding of
the treatment, risks, and benefits. There are three types of informed consent: implied, verbal, and written.
•
•
•
Implied consent: When a patient implicitly agrees to a procedure through their actions or lack of
action.
Verbal consent: When a patient consents verbally to treatment (specifically, not in writing). This type
of consent is acceptable for routine treatment such as diagnostic procedures.
Written consent: When consent is provided in writing. This type of consent must be given when there
is a risk of complication. Written informed consent is required for most surgeries, complex medical
tests, radiation to treat cancer, most vaccines, and blood tests, like HIV testing.
Exceptions to Consent
Some situations may occur where there are exceptions to the patient signing an informed consent. Under
these circumstances, the patient is either:
•
•
•
incapacitated,
has a life-threatening emergency with no time to get consent, or
voluntarily waived their consent.
If a patient’s decision is questionable or unclear, a psychiatrist’s evaluation will be completed to determine
competency. If a patient cannot decide and has not designated a decision-maker, a legal surrogate decisionmaker will be determined, or a legal guardian will be appointed by the court (depending on the state’s law).
Ethical Issues in Informed Consent
The importance of informed consent includes obligations to promote autonomy, provide information, and
avoid unethical forms of bias. Patients have the right to refuse medical treatment based on religious or any
other grounds if they are competent to do so.
View the following video which addresses the controversy of who the informed consent is designed to benefit:
the doctor or the patient.
Informed consent (Segment 6 of 9) [Video]
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
Gross Negligence and Lack of Informed Consent
Gross negligence refers to conduct so reckless or mistaken that it is apparent to a person with no medical
training. An example of gross negligence is if a doctor were to perform surgery without a signed informed
consent from that patient, and the surgery results in injury to the patient. The patient could sue for gross
negligence because neglecting to inform and obtain informed consent from the patient is considered reckless.
A health care professional who fails to obtain a patient’s informed consent for specific procedures, such as
non-emergency surgery, could be charged with a criminal offense, such as battery or unauthorized patient
touch. The patient will need to prove that the doctor failed to inform the patient of the treatment risks and that
if the patient knew, he or she would have refused the treatment.
HCA 5302, Legal Foundations of Health Care
3
There are ways in which a physician can protect themselves against a negligence
UNITlawsuit.
x STUDY GUIDE
•
•
•
•
•
•
Title
Provide quality medical care to patients.
Communicate clearly and in detail and ensure the patient understands the information provided.
Get a signed, completed informed consent from the patient when the procedure requires it.
Keep accurate documentation of patient’s visit.
Follow proper procedures and laws.
Keep their license current.
As you can see, obtaining a completed and signed informed consent promotes trust between patient and
health care provider. It offers patient autonomy and confidence in their medical providers. It also reduces
unnecessary legal claims and lawsuits regarding medical care.
Suggested Unit Resources
In order to access the following resources, click the links below.
You are encouraged to read the following chapter in your eTextbook for an in-depth look at the law and its
application in the courtroom.
Chapter 8: Civil Procedure and Trial Practice
Review the following summary of the Chapter 8 content in order to enforce the main concepts presented.
Chapter 8 PowerPoint Presentation
Chapter 8 Presentation PDF
Review the following summary of the Chapter 14 content in order to enforce the main concepts presented.
Chapter 14 PowerPoint Presentation
Chapter 14 Presentation PDF
Review the following summary of the Chapter 15 content in order to enforce the main concepts presented.
Chapter 15 PowerPoint Presentation
Chapter 15 Presentation PDF
HCA 5302, Legal Foundations of Health Care
4
UNIT VII STUDY GUIDE
Managed Care and the Patient Protection
and Affordable Care Act
Course Learning Outcomes for Unit VII
Upon completion of this unit, you should be able to:
3. Explain the features of federal assistance programs.
3.1 Determine the reasons behind the creation of the Patient Protection and Affordable Care Act
(PPACA).
3.2 Define managed care.
3.3 Examine the relationship of the PPACA to overall health care costs.
Required Unit Resources
Chapter 21: Managed Care and National Health Insurance
Unit Lesson
Managed Care
The managed care operation is such that a Health Maintenance Organization (HMO), an insurance firm, or a
hospital network mediates between the health care seeker and the physician. In the ’80s, the cost of receiving
health care services was sporadically on the rise. It became apparent that the health care industry was
displaying its incapacity to maintain manageable medical care costs—hence the emergence of third-party
payers that assist in cost control by managing access to health care.
Many celebrated the idea of a managed care program providing a team of physicians with different specialties
and different treatment methods for the patient’s benefit. Ultimately, patients felt safer because there was a
variety of medical doctors with different approaches and specialties overseeing the treatment. However,
millions had no access to health care due to not being eligible or because health care was not affordable.
Many who have insurance may not get the same type of benefits as others due to gender, age, high usage,
pre-existing conditions just to name a few. President Obama’s Patient Protection and Affordable Care Act of
2010 was created to address these and other issues in accessibility and affordability.
How Patient Protection and Affordable Care Act of 2010 (PPACA) transformed the U.S. Health Care
System
Ten years ago, the Affordable Care Act (ACA) was signed into law and transformed the American health care
system. Two major ways in which medical coverage was expanded by ACA were the launching of the
marketplace for private insurance coverage and the expansion of Medicaid, allowing millions of uninsured
Americans to gain access to health care.
Millions Gain Access to Health Insurance Coverage
In 2010, according to the Kaiser Family Foundation, 16% of the American population was not insured. After
ACA was put into law, the uninsured rate lowered to an all-time low of 9%. About 20 million people gained
health insurance (Tolbert et al., 2019). This was the largest expansion of health care coverage in the history
of the United States. There was less disparity in coverage for different ethnicities; all ages, both children and
adults, were covered. Many changes ensured the accessibility to health care by many.
HCA 5302, Legal Foundations of Health Care
1
Protection of Those with Pre-existing Conditions
UNIT x STUDY GUIDE
Title
Before ACA, people with pre-existing conditions could face discrimination. This is significant as nearly one in
two elderly adults may have a pre-existing condition (Centers for Medicare & Medicaid Services [CMS], n.d.).
ACA, through reforms, prohibits insurers from bias against those who have pre-existing conditions. Insurers
are also prohibited from making premiums based on gender and health history. ACA also limits their ability to
charge premiums based on age. Insurers must give a policy to anyone.
Inclusion of Essential Benefits
Another protection afforded by ACA is ensuring health care policies include essential benefits such as
maternity care, mental health services, and prescription drugs. Insurers can no longer exclude these benefits
because a patient utilizes these services more than a typical patient. The law also prevents insurers from
setting annual and lifetime limits on benefits.
Medicaid Expansion
ACA asks most states to expand Medicaid to 138% of the federal poverty level and provide 90% of the cost
(American College of Obstetricians and Gynaecologists [ACOG], 2013). This expansion enabled about 12
million low-income people and their families to access affordable health care coverage.
Affordable Health Care
The marketplace is a portal for purchasing health insurance, which was launched in 2013. Although the
monthly premiums were about $600, many low-income and middle-income Americans were eligible for
financial assistance with the monthly premiums making it affordable. Co-payments and other types of cosharing were eliminated for preventative services. For example, immunizations, screenings, and
contraception visits had no co-pay cost. Thanks to ACA, plans were mandated to include maternity,
breastfeeding and supplies services, annual wellness visits, screenings for cancer, and HIV, among other
coverage without co-payments.
Extended Coverage for Dependents
Young adults can now stay on their parents’ health insurance plan up until the age of 26. This serves young
adults who may not have a job. It will allow them to have health insurance and access to health care.
Better Access to Prescription Drugs
ACA required the marketplace to offer coverage for a wider variety of drugs and allowed out-of-pocket drug
expenses to count towards deductibles. This allows more access to brand-name and generic drugs at a
lower cost.
How PPACA influences Defensive Medicine within U.S. Health Care
Some positive measures include improved parking at managed care facilities, better tasting hospital food,
using best business practices and information technology in the health care setting, and moving medical
procedures and treatments to less costly facilities when possible.
Defensive Medicine
Defensive medicine refers to the practice of physicians ordering tests patients may not necessarily need to
have that help to drive up the cost of health care. If the health reforms were to be more effective, there would
be a need to tackle defensive medicine. Surveys vary, but a significant majority of physicians surveyed do
report practicing some defensive medicine. The reasons include avoiding being named in a lawsuit; defensive
medicine is the standard of care; patients demand that everything possible is done; there is a fear of missing
something crucial without the tests; and, perhaps surprisingly, there is peer pressure among doctors.
An example of defensive medicine is the over-treatment using antibiotics. For instance, a guardian may
expect a prescription for antibiotics when they take their child to the doctor for a cold. The doctor knows it is
HCA 5302, Legal Foundations of Health Care
2
not needed, but the doctor gives in due to pressures from the guardian. Now the
patient’s
normal
bacteria are
UNIT
x STUDY
GUIDE
killed by the antibiotic, leaving only antibiotic-resistant bacteria.
Title
Conclusion
Overall, there are issues with managed care: limited access for those that do not have health insurance, rigid
rules, too busy networks, and long wait times; however, there are many benefits such as lower costs for
needed services, prescription management is easy, and certain guarantee of care within the network. ACA
helped millions gain access to health care and at an affordable cost. It is life-changing for many Americans,
especially for uninsured and low-income people and people with pre-existing conditions.
References
American College of Obstetricians and Gynecologists. (2013). Benefits to women of Medicaid expansion
through the Affordable Care Act. https://www.acog.org/clinical/clinical-guidance/committeeopinion/articles/2013/01/benefits-to-women-of-medicaid-expansion-through-the-affordable-care-act#
Centers for Medicare & Medicaid Services. (n.d.). At risk: Pre-existing conditions could affect 1 in 2
Americans: 129 million people could be denied affordable coverage without health reform.
https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/preexisting
Tolbert, J., Orgera, K., Singer, N., & Damico, A. (2019, December 13). Key facts about the uninsured
population. Kaiser Family Foundation. https://www.kff.org/uninsured/issue-brief/key-facts-about-theuninsured-population/
Suggested Unit Resources
In order to access the following resources, click the links below.
Review the following summary of the Chapter 21 content in order to enforce the main concepts presented.
Chapter 21 PowerPoint Presentation
Chapter 21 Presentation PDF
HCA 5302, Legal Foundations of Health Care
3
UNIT VIII STUDY GUIDE
Professional Liability and Employee Relations
Course Learning Outcomes for Unit VIII
Upon completion of this unit, you should be able to:
2. Assess the sources of health care laws and regulations.
2.4 Summarize the various federal labor acts.
2.5 Illustrate the various types of discrimination that occur in the workplace and the laws prohibiting
them.
4. Examine the rights of stakeholders in the health care system.
4.3 Depict how the rights and responsibilities of patients and health care providers are alike.
4.4 Summarize the rights and responsibilities of health care providers and medical practices with
regard to professional liability insurance.
Required Unit Resources
Chapter 20: Human Resources
Chapter 22: Professional Liability Insurance
Unit Lesson
Labor Laws that Protect Health Care Workers
There are labor laws that protect health care workers, and each health care professional must be aware of it.
The Fair Labor Standards Act (FLSA) was enacted in 1938 and impacted the private sector, federal, state,
and local governments. Its primary purpose is to establish a minimum wage, overtime pay, youth employment
standards, and nonexempt workers. The guidelines protect employees in the workforce (U.S. Department of
Labor, n.d.).
The Occupational Safety and Health Act
The Occupational Safety and Health Act was established in 1970 to ensure a safe and healthy working
environment. The Occupational Safety and Health Administration (OSHA) was created to set and enforce
standards for the working environment and provide training, outreach education, and assistance. The
standards are rules that employers must follow to protect employees from hazards. OSHA’s most common
violations are related to hazard communication, respiratory protection, electrical wiring, and ladders.
Violations of OSHA standards could carry a maximum of 5 years in prison, about $250,000 in fines, and even
the shutting down of the company (OSHA, n.d.-a; OSHA, n.d.-c).
OSHA’s Whistleblower Protection Program
To protect employees who notify OSHA of an unsafe workplace, the OSHA’s Whistleblower Protection
Program protects employees that contact OSHA from retaliation of the employer. The whistle-blower will need
to report the incident within 30 days of it happening; an investigation into the retaliation would take place, and,
if determined that retaliation did in fact take place, the employee would be reinstated in their former position
with back pay. OSHA will take action against any employer through the court system that retaliates against a
whistle-blower (OSHA, n.d.-b).
HCA 5302, Legal Foundations of Health Care
1
Needlestick Safety and Prevention Act (NSPA)
UNIT x STUDY GUIDE
Title
The Needlestick Safety and Prevention Act of 1992 was signed into law by Bill Clinton and revised in
2001.This act mandates universal precautions and reporting of injures incurred by injection needles. The
purpose of this act is to ensure employers identify, evaluate, and implement safer medical devices, to address
accidental sharps injuries, and exposure to blood pathogens (Pyrek, 2010).
The Health Care Quality Improvement Act (HCQIA)
Physicians has been required to conduct peer reviews in hospitals since 1952. In 1986, the Healthcare
Quality Improvement Act (HCQIA) was enacted to provide immunity for medical professionals and institutions
during these conduct assessments. It was meant to protect medical professionals from abuse of the peer
review system (Vyas & Hozain, 2014).
Civil Rights Act of 1964
Workplace discrimination spans from age difference to sexual harassment, and the United States Equal
Employment Commission identifies and classifies this workplace discrimination. This Act protects employees
from the following things:
•
•
•
•
Sexual harassment in the workplace, which includes unwanted verbal or physical sexual advances or
offers of quid pro quo. Sometimes, it comes from an employer to the employees and sometimes vice
versa.
Gender inequality.
Discrimination against workers or applicants based on race.
Discrimination based on religion, whether you are an atheist, Christian, or Muslim. It implores
employers to create a reasonable space for religious practices except in exceptional cases (Equal
Employment Opportunity Commission [EEOP], n.d.).
Workers are also protected from the following:
•
•
Discrimination due to genetic information. The Nondiscrimination Act of 2008 makes it a violation for
an employer to discriminate against a worker based on their genetic information.
Discrimination against employees over the age of 40 according to the Age Discriminati…

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