 Good morning everybody, this is Leah, your lead course instructor here at ACT. So this morning we are going to discuss medical law and ethics in this lesson. And medical law and ethics will be very helpful for you and beneficial for you to know some of these concepts in terms that we'll be talking about as you move through your healthcare career. So whether you were a medical assistant or a patient care attack or you're moving on to medical school or nursing school or PA school, a lot of these concepts are going to be crucial for you to know as you move on. It will be crucial for your career as well. So we're going to first begin to discuss medical law and actually what it is. So it's important to understand that healthcare is one of the most regulated industries in the United States making healthcare compliance very crucial and important for the safety and wellbeing of patients. Healthcare laws intended to really ensure our patients receive the safest, highest quality care possible. And healthcare law refers to different federal, state and local laws, rules and regulations that are aimed at providers, payers and vendors to the healthcare industry and its patients in delivery of healthcare services. And it's all, all of this is with it an emphasis on operations regulatory and transactional and legal services. So some of the legal fundamentals here in medical law. First is civil law. So civil law describes law that pertains to person or people, things and relationships that develop among them. Civil law is most often applied to medical malpractice cases and cases handled in civil court generally fall into one of these four main categories here. So first there's breach of contract which involves a set of enforceable agreements that one person fails to complete. An example would be like a referer who doesn't complete work in a professional manner. Property disputes involve ownership and use of property. A homeowner who claims that neighbor spends and croaches on their property is an example of a property dispute within civil law. Then we have family cases and this deals with issues involving spouses, parents and children. Examples of these cases include divorce and adoptions. And then we have tort law and this involves a situation in which one party claims to have been damaged emotionally or physically by the other. And this could involve assault and battery or negligence that led to harm among other possible circumstances. Next we have criminal law. So there's the civil law which we just talked about and now there's criminal law. So criminal law refers to punishment of people and entities that break laws. So it deals with behaviors that are or can be construed as offenses against the public, society or the state even if a crime affects a private individual. So conviction results in a fine and or imprisonment. Crimes can be classified as misdemeanors or felonies. Examples of common crimes that people are charged with here in the United States include but are not limited to murder, assault, theft, driving while intoxicated. So continuing on here with medical law so in legal fundamentals within the medical law we also have administrative law and this is a body of law in the form of decisions, rules and regulations and orders created by administrative agencies under direction of the federal government to carry out the duties of those agencies. So these administrative agencies are responsible for protecting the civil rights privacy and safety of its citizens. And here's an example of the administrative law would be the regulation and operation of social security administration benefits as well as the administration of these benefits to people. So to break it down a little bit easier so specifically administrative law guides the regulation basically of food, safety, water quality, housing conditions, pharmaceuticals and chemicals, occupational safety and health and medical practice are some of the areas that this administrative law governs. So it also governs implementation and enforcement of public health policies and programs from retail licensing and let paint inspections to quarantine orders and eligibility and disbursement decisions for public benefits like Medicaid and special supplemental nutrition program for women otherwise known as SNAP and WIC. So moving on here to federal laws that affect healthcare. So some of these federal laws you may be familiar with others may be new to you but you're going to continue to see these federal laws over and over again in your practice on a daily basis again in whatever role that you will be in once you are finished with this ACT course and as you move on in your career. So first is the Affordable Care Act and this law was enacted to decrease the growth in healthcare spending in the United States and to help provide more Americans with affordable high quality health insurance. Next we have the occupational safety and health administration otherwise known as OSHA and this law makes employers accountable for providing a safe and healthy work environment for their employees and this is done through different training programs outreach education and assistance. Next the health insurance portability and accountability act of 1996 otherwise known as HIPAA. So HIPAA gave patients rights over their health information and it also sets rules and limits on who can look at and receive patients private information. You know HIPAA is a very, very big, big law and it'll be beneficial for you to really know what HIPAA is, how it works within the facility that you're working in and how that affects you. Also we have the health information technology for the economic and clinical health also known as the high tech act and this was a law that was passed as part of the American Recovery and Reinvestment Act of 2009 and it was passed to promote and adopt meaningful use of health information technology. So high tech addresses the privacy and security concerns associated with the electronic transmission of health information and parts through several provisions that strengthen the civil and criminal enforcement at HIPAA law. So I don't know if many of you remember or even know that before the use of computers and healthcare all the documentation was written down. We wrote everything down and now when documentation became computerized this is why this act was or this law was passed because there needed to be some law that governed how that information is stored and how it's transmitted. So that's the high tech act. So we will just move on here. So continuing with federal laws that it will affect that does affect healthcare in your practice. We have the controlled substance act and this regulates the manufacturing and distribution of controlled substances including narcotics, depressants and stimulants. The controlled substance act classifies medications into five schedules based on the likelihood of abuse and any medical benefit that the substance might have. There's the American with Disabilities Act or ADA and this law forbids discrimination against any applicant or employee who could perform a job regardless of a disability. So ADA requires an employer to provide accommodations that are necessary to help the employee perform a job successfully unless those accommodations are not possible. We have the Family Medical Leave Act or FMLA and this is a federal law that requires certain employers to give time off to employees for family or medical reasons. So basically this federal law protects your job, keeps your job and protects your job in the event that you were ill and you needed to be offered a period of time or if you were taking care of a sick spouse or a child at home that was sick as well. And then next we have the Joint Commission. So the Joint Commission is an accreditation body that helps healthcare organizations, especially hospitals position for the future of integrated care. It helps to strengthen patient safety and quality of care. And it also helps to improve risk management and risk reduction. And it helps to provide a framework for organizational structure and management. So if you start your career, you will begin, if you work in a hospital, you will hear about the Joint Commission a lot. They are really big on quality of care given to patients. All right, let's see here moving on to state laws. So some state laws that affect the practice of healthcare. So I've said this over and over and over again and this is something I really want you all to understand. Know your scope of practice for your current position. So the term scope of practice defines permissible activities for members of a healthcare profession. So in many cases, the scope is determined by laws within a particular state, professional standard boards and then administrators of specific healthcare facilities. So your scope of practice or a scope of practice for a nurse is going to be different from a scope of practice from a doctor and different from a scope of practice of a physician's assistant. And your position as a medical assistant or a patient care attack, your scope of practice is different than that of a nurse or PA. So it is important to know your scope of practice. Knowing what you are able, what type of activities, what type of procedures, things that you are allowed to perform in your current role. So here is the CCMA scope of practice. It's job duties that can vary from facility from facility to facility. Also they vary from state to state. So each state board offers its own scope of practice for the profession. So some activities and duties you can't perform in one state, you may be allowed to do in another. An example here is in California, you can perform additional supportive services such as skin tests or blood draws if you receive proper training from your employer. However, in Montana, a physician may delegate invasive procedures to you as long as they provide on-site supervision. But again, the key is to know and understand the guidelines for a medical assistance or what our patient care tech or nurse or whatever it is, whatever your role is in your state and this is your responsibility. Moving on with state laws that affect the practice of healthcare. Just some general tasks that fall in the recognized scope of practice for a medical assistant can include all of these things here. I'm not gonna read through each and every single one of them, but again, these are just some of the general tasks that you can perform as a medical assistant, a certified medical assistant. Next, we're going to talk about standard of care. So standard of care refers to how healthcare professionals are expected to follow while performing their specified duties. So standard of care is the degree of care or competence that one is expected to exercise in a particular role. So failure to act reasonably prudent as another individual within the same role would under similar circumstances can result in negligence. So tort law. Now I know we briefly touched on tort law back when we began talking about civil law. So a tort is a civil law that is reached committing against another in which the injured party can sue for damages in civil court. So there are two main types of tort and they include intentional. So an intentional tort occurs when someone wrongfully and purposefully acts and that causes harm to another. So they do not necessarily need to intend to cause the eventual outcome for the intentional court claim to be valid but they need to intend to commit the wrongful act according to most intentional tort cases in civil law doctrine. Continuing on with the tort law. So negligence. So negligence is an unintentional act and is a common tort in malpractice cases. So this is important for you to know. So to prove negligence, the plaintiff must prove the following often referenced to as the 40s of negligence. A duty existed. There was dereliction of the duty. The misconduct of the defendant was the direct cause of the injury and damages occurred as a result of this misconduct. So moving on to consent. So in the clinical setting, there are two types of consent. So first there is implied consent. So this type of consent is suggested or implied by the patient's actions. So it's not specifically written down. So for example, if you have a fever and you see your doctor, your visit to your doctor is implying that you want treatment. So another example is if you break your ankle and you visit the healthcare provider for crutches. So this is implied consent. Informed consent is different. So informed consent is when a healthcare provider like a doctor, a nurse or other healthcare professional, a nurse practitioner or physician's assistant explains a medical treatment or medical procedure to a patient before the patient agrees to it. So this type of communication lets the patient ask questions and accept or deny the treatment. In a healthcare setting, the process of informed consent includes your, you have to have the ability to decide. Explanation of the information needed to make the decision. So meaning that the doctor or the surgeon or the nurse practitioner or the PA has given you enough information, has explained the whole procedure or the treatment to you and you feel that you have enough information to make an informed consent, to make an informed decision about whether you agree to that. You understand that medical information and your voluntary decision to get treatment. Meaning that you, nobody is forcing you to do this. This is something you've decided to do on your own based on all the information that has been given to you. So this usually happens before surgery, before the procedure, you'll have to complete and sign the consent form. So this form is a legal document that shows your participation and the decision and agreement to have the procedure completed. So that, now we're gonna move on to the ethics portion of this lesson. So everything prior to this was all about medical law and the laws that you need to be aware of that are going to affect your practice and how you care for patients. So next we're gonna talk about ethics now and ethics. The overview is at ethics is a discipline concerned with what is morally good and bad or right and wrong. Ethics can be debated depending on a person's beliefs or way of thinking and individuals, personal morals and religious upbringings often contribute to their personal ethics and professional ethics are a set of accepted behaviors and values that a person is expected to possess in a particular organization or profession. So the code of ethics. So a code of ethics is I pledge to guide a member's behavior or an employee's behavior or a professional's behavior. Each credentialing organization will have its own code of ethics for the professionals that they certify. So although organizations have different sets of ethics, they all are committed to abiding by the laws. I just put an example here of the NHA or the National Healthcare Association's code of ethics since you'll most likely be certified through them if you're in the CCMA or the APCT course. So their code of ethics, you's not gonna read them all to you because you can read but this is the National Healthcare Association's code of ethics. All right, so moving on here to our continuing on here with the code of ethics. So the American Association of Medical Assistance code of ethics are here as follows. So I wanted to just add another set of code of ethics by the American Association of Medical Assistance since you are in the CCMA course or APCT course. But again, you can go ahead and read this on your own. I'm not gonna read all of these to you out loud. Important to know these though for sure if you're going to be a medical assistant and there's patient care, tech code of ethics, there'll be a code of ethics for the facility or the organization you're working for as well. So just make sure you familiarize yourself with those according to your role and your position and the organization for what you are employed. So we're gonna talk about personal values, attitudes and beliefs as part of ethics. So our values, experiences, attitudes and beliefs are part of what makes you who you are. They affect how you think, how you do things and how you do it. So generally our background or upbringing experiences and relationships all have played a part in the way we see things, how we view things and how we judge them. And so an individual's values often impact one's ethics. So patients will sometimes have beliefs and values that affect their decision surrounding their care that may be different from your own. And this is known as a moral dilemma or ethical dilemma for you as in your role as a whatever that might be. So some of the current and common ethical issues leading to a moral dilemma can include end of life care, resuscitation orders, abortion and that's a big one right now in national news, also birth control and genetic testing. So just because you have different attitudes and beliefs and values based upon some of these issues, your patient that you're caring for may have a different view on them. They might have a different attitude or belief towards them. And so that can sometimes become difficult when you are practicing and you have to provide care to them and maybe you don't agree with a decision they're making because your ethics and your beliefs are not in line with theirs. And that's gonna happen to you throughout your time in the healthcare. So it's really important to be aware of your own personal ethics and your personal values and attitudes and beliefs. And just moving on with that same issue and the thought is that just because your patient's personal values, their attitudes, beliefs or ethics are different from your own and they aren't in line, that patient still must receive the standard of care. So you still have to provide care to that patient even though you may not agree with their ethics or their beliefs or their attitudes. And here's a really good example of that. I used to work in a level one trauma emergency room. And so if you could imagine, we get a lot of traumatic patients, a lot of traumas. And so traumatic injuries. And so I can count on more than one occasion where we would have an assault victim come in and then they were assaulted somewhere in the street or at home, the police got involved and now the perpetrator was shot and apprehended by the police. And so they bring the perpetrator in as well. So you have, unfortunately, you have the victim in one room and then you have the perpetrator in another. And I'm still, even though we know what this person just did to the victim, we know what happened, we know what he did. We still have to still provide the same standard of care that we're giving to the victim. And that can be difficult. So you just have to really be aware of those situations. And so here are some helpful tips to deal with something like that. So just be aware of your own, your own personal values, attitudes and beliefs. Understand the uniqueness of the dilemma and you could always refer back to the code of ethics for your organization or your role. You can also seek ethics education and then always speak up. If you're uncomfortable with something or if you really know that you're not gonna be able to provide that same standard of care for a perpetrator as you were to a victim, speak up. Because we're not alone in healthcare, we always have help. And so speak up, let somebody know and maybe somebody else can take over the care for that patient, hopefully. That's gonna be really important for you. Now moving on to medical directives. So medical directives can sit at a set of requests that patients put in writing for their provider, their family and other healthcare professionals to carry out surrounding end-of-life medical treatment. So the provider must obtain, review and comply with these directives. A medical directive will indicate what medical treatment patients wish to have if they are dying or permanently unconscious. So if this was the situation the patient identifies an agent, so if they were permanently unconscious and unable to make decisions for themselves in this medical directive, they would assign an agent or somebody to make decisions on their behalf. So medical directives are legally valid as soon as the patient signs the document with a required witness present and this is usually signed in the presence of a notary public. So here are the different types of medical directives. We have the living will and this is a document that states what procedures the patient would want, which ones she would not want under the conditions such as like dialysis, blood transfusions and do not resuscitate orders. We also have the durable power of attorney and this is known as a medical power of attorney. It's a legal document in which you name a person to be your proxy or your agent which we just discussed on the last slide to make all your healthcare decisions in the event that you were unable to do so. Then next we have DNR, do not resuscitate orders. So meaning that you decide whether you want to have life-saving measures such as CPR or the use of an automated external defibrillator or AED or placed on a ventilator or breathing machine in the event that your heart would stop. If you do sign a DNR, none of these CPR, AED, breathing machines, none of that would be used. We also have a post as a form that helps describe your wishes for healthcare but is not an advanced directive. So it's a little bit different but a post form has a set of specific medical orders that a seriously ill person can fill in and ask their healthcare provider to sign. So a post form addresses your wishes in an emergency such as whether to use CPR. And most of the time these posts are like a bright pink form or sheet that your doctor or the healthcare provider will sign. And the patient usually has a copy of it and it's brought to the hospital with them and placed on their charts. So we know what their wishes are. And then we of course have the organ tissue and donation and we all know what that is. So organ tissue and donation, if you don't specifically say that you or an organ donor, usually that's on your license, your driver's license, your parent, your family, the next of kin will be approached and ask about organ tissue and donation in the event that you are on your deathbed. And you're expected to pass away and then next 12 hours, there is always somebody from a organ tissue and donation center around the United States in emergency rooms and hospitals who will begin asking those questions, tough questions to your family members in the event that you have not already stated that you want to be an organ donor. So it's important to have those conversations with your family members as well. So how does all of this affect me? Well, or affect you or all of us in healthcare. So the future of healthcare and healthcare law is ever changing and these laws will continue to guide the healthcare industry in response to a rapidly changing society. So patients will continue to be more educated on their medical directives, their treatments and have a greater effect on their healthcare. So medical assistants and nurses, doctors and patient care techs and physicians assistants must stay current with the law and the regulations related to healthcare to protect themselves as well as their patients. So thank you all again for going along on this journey here with me. If you have any questions or concerns, if you need clarification about anything, please do reach out to me via email or you could always schedule office hours with me. So I hope you all have a wonderful rest of your day and I will see you soon.