In this age of
electronic health records, HIPAA
regulations, and ethical issues, healthcare workers must be aware of the
ramifications and benefits of complying with laws, ethics, and state and
federal regulations. Both employees and managers in the healthcare field should
be competently trained so that they are aware of what those ramifications are
and how to avoid non-compliance.
LAWS
In the United States, creation of a law
begins in the US house of representatives, where a bill is created, the bill is
then sent to the senate, and finally the president who signs the bill to make
it a law. Laws are enforced by the judicial system. Non-compliance of laws can
range anywhere from fees to imprisonment. Healthcare workers can be held liable
when non-compliant with the law.
When it comes to the healthcare field, there
are different theories of liability. These include:
·
Negligence - "Negligence
refers to the absence of, or failure to exercise, proper or ordinary care. It
means that an individual who had a legal obligation either omitted to do what
should have been done or did something that should not have been done"
(2008) In other words, the first surgeon did not provide proper care, therefore
he may be liable. In order to sue under negligence, the patient must provide
proof of the injury, and that the doctor's actions caused the injury. This is
known as causation.
·
Respondeat superior - which states
that "an employer is liable for the negligent act or omission of any
employee acting within the course and scope of his employment." (Thomas,
2010) In this case, John Smith could hold the hospital liable for negligence.
"This is a purely dependent or vicarious theory of liability, meaning a
finding of liability is not based on any improper action by the employer. The
fact that the employer may have acted reasonably in hiring, training,
supervising, and retaining the employee is irrelevant and does not provide a
basis on which the employer can avoid liability for the acts of employees"
(Thomas, 2010)
Liability occurs when there are specific
types of relationships in healthcare.
Relationships can take different forms in the health care industry.
There are physician-patient relationships, hospital-patient relationships, and
hospital-physician relationships. Each of these presents challenges when it
comes to liability.
The physician-patient relationship is
defined as "a fiduciary relationship, in which mutual trust and confidence
are essential. A physician is held to a standard of medical care defined by the
accepted standards of practice in his or her area of practice. Some of the
obligations of a physician's duty of due care include the obligation to fully
inform the patient of his or her condition, to continue to provide for medical
care once the physician-patient relationship has been established, to refer the
patient to a specialist, if necessary, and to obtain the patient's informed
consent to the medical treatment or operation."(Thornton, 2000)
The hospital-patient relationship is
very much the same as the physician-patient relationship. That is, it is a
fiduciary relationship in which the hospital is held to a standard of care,
entered into with both parties, not by any contract, but by obligation of the
hospital to provide that standard of care.
The hospital-physician relationship is a
little different than the patient-doctor or patient-hospital relationship. to
reference.md, the hospital-physician relationship is defined as, a relationship
"between hospitals, their governing boards, and administrators in regard
to physicians, whether or not the physicians are members of the medical staff
or have medical staff privileges." (reference.md, n.d)
ETHICS
When it comes to ethics, The American
Health Information Management Association (AHIMA) is the premier association of
health information management (HIM) professionals. AHIMA has a code of ethics that discusses the
obligations of health information management.
AHIMA states, " The ethical obligations of the health information
management (HIM) professional include the safeguarding of privacy and security
of health information; disclosure of health information; development, use, and
maintenance of health information systems and health information; and ensuring
the accessibility and integrity of health information." (AHIMA, 2011)
AHIMA
also states, " The AHIMA Code of Ethics serves seven purposes:
- Promotes high standards of HIM practice.
- Identifies core values on which the HIM mission is based.
- Summarizes broad ethical principles that reflect the profession's core values.
- Establishes a set of ethical principles to be used to guide decision-making and actions.
- Establishes a framework for professional behavior and responsibilities when professional obligations conflict or ethical uncertainties arise.
- Provides ethical principles by which the general public can hold the HIM professional accountable.
- Mentors practitioners new to the field to HIM's mission, values, and ethical principles."(2011)
Current ethical issues in healthcare can
be varied, but as we grow technologically, ethical issues facing healthcare
workers have changed. As we look into the future, we can determine what some of
those ethical issues are. According to Larsen of AMN Healthcare, issues facing
healthcare workers are:
·
Balancing
quality care and efficiency
·
Improving
access to care
·
Building
and sustaining the healthcare workers of the future
·
Addressing
end-of-life issues
·
Allocating
limited medications and donor organs.(2013)
Once the Affordable Healthcare Act is
enforced, these ethical issues will become more difficult to address.
Particularly balancing quality care and efficiency. Since tort law was not
changed along with the AHA, more doctors
are going to concierge medicine, which is a separate fee patients pay to have
access to their physician. This allows healthcare practices to decide which
patients they see, and how many patients they see each day. With the AHA,
doctors who do not retire or leave medicine, or decide on concierge medicine,
will be forced to see patients who cannot afford health insurance. As such,
these doctors are making less money, since they have to see more patients, in a
shorter period of time to make any money because they are paying such high
costs in medical malpractice insurance.
This is also going to be an issue with
improving access to care. How are those without health insurance going to find
a doctor, if a good deal of them will retire or go concierge.
Forbes magazine's Sally Pipes says, "Right
now, the United States is short some 20,000 doctors, according to the
Association of American Medical Colleges. The shortage could quintuple over the
next decade, thanks to the aging of the American population — and the aging and
consequent retirement of many physicians. Nearly half of the 800,000-plus
doctors in the United States are over the age of 50.
Obamacare
is further thinning the doctor corps. A Physicians Foundation survey of 13,000
doctors found that 60 percent of doctors would retire today if they could, up
from 45 percent before the law passed." (Pipes, 2013)
HEALTH RECORDS
Where
health records are concerned, healthcare organizations must follow certain
guidelines. These guidelines are set by The Health Insurance Portability and
Accountability Act (HIPAA) of 1996. The US Department of Health and Human
Services oversees HIPAA regulations. The Privacy Rule covers HIPAA regulations
on medical records. According to HIPAA, " The Privacy Rule gives you, with
few exceptions, the right to inspect, review, and receive a copy of your
medical records and billing records that are held by health plans and health
care providers covered by the Privacy Rule." (hhs.gov, 2013)
Regarding medical records, HIPAA states, Only you or your personal representative has
the right to access your records. You must give written permission for
healthcare personnel to share your records with anyone, including other
physicians.
However,
when it comes to specialized medical records such as mental health or substance
abuse records, " You do not have the right to access a provider’s
psychotherapy notes. Psychotherapy notes are notes taken by a mental
health professional during a conversation with the patient and kept separate
from the patient’s medical and billing records. "(hhs.gov, 2013)
RISK MANAGEMENT
Risk
management is always a primary concern in the healthcare field. Organizations
must utilize all the tools at their disposal to avoid risks that can be costly
and even deadly. According to IHS.GOV, the risk management process comprises of
four steps:
- Diagnosis—Identification of risk or potential risk.
- Assessment—Calculation of the probability of adverse effect from the risk situation.
- Prognosis—Estimation of the impact of the adverse effect.
- Management—Control of the risk
These steps will help
healthcare organizations prepare and hopefully prevent risk.
Another factor of risk management is
compliance program that help reduce risk. In any organization or company, there are rules set to
protect the company and the employee, and in a healthcare setting, the patient.
Compliance programs are instituted in a hospital to ensure that all legal and
ethical issues are met. In an outline for compliance, the following should be
included:
- State and Federal laws regarding patient care, health records, etc.
- Ethical Standards such as patient interaction, co-worker interaction, and proper procedure.
- Consequences of violating laws such as HIPAA including, fines, infractions, and possible jail depending on the issue. This category also includes the hospital policies on consequences such as loss of employment at said hospital
As stated in the sections above,
there are a great deal of issues to deal with when it comes to healthcare
management. As we move forward into an age of government healthcare and
electronic medical records, we must be sure that legal and ethical standards
are adhered to. This is imperative to have a safe and secure patient
experience.
Theories of Liability.
(n.d.) West's Encyclopedia of American Law, edition 2. (2008).
Retrieved
Thornton, R. (2011) Responsibility
for the acts of others retrieved June 20, 2013 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900989/
Thornton
RG. The
edges of physician liability. Proc (Bayl Univ Med Cent). 2000 Jul;13(3):300-
PMID: 16389404 [PubMed]
REFERENCE.MD (n.d.), Hospital -Physician Relations retrieved
June 23, 2013 from
http://www.reference.md/files/D018/mD018578.html
AHIMA (2011) American Health Information Management
Association Code of Ethics retrieved
July 15, 2013 from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024277.hcsp?dDocName=bok1_024277
Larsen, J. (2013) Five
Top Ethical Issues in Healthcare, AMN Healthcare News, retrieved July 15,
2013
from
http://www.amnhealthcare.com/latest-healthcare-news/five-top-ethical-issues-healthcare/
Pipes, S. (2013) Thanks To Obamacare, A 20,000 Doctor
Shortage Is Set To Quintuple Forbes Magazine,
retrieved July 15, 2013 from
http://www.forbes.com/sites/sallypipes/2013/06/10/thanks-to-
obamacare-a-20000-doctor-shortage-is-set-to-quintuple/
HHS.GOV, (2013) Your
Medical Records retrieved July 15, 2013 from
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/medicalrecords.html
IHS.GOV, (2009) Risk
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http://www.ihs.gov/riskmanagement/index.cfm?module=part01
Beaty, K. (2013) Legal and Ethical Issues in Healthcare
Beaty, K. (2013) Legal and Ethical Issues in Healthcare
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