Telemedicine: legal, ethical, and liability considerations.
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Confidentiality↗
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Lessons in liability for pediatric nurses.
Education on the legal aspects of pediatric nursing practice can help nurses develop a proactive approach to prevent patient injury and subsequent legal liability. This is an important area of professional practice because the risk of malpractice liability is often greater with the pediatric population. Children's unique health care problems, limited ability to communicate their needs, and physiological immaturity increase liability risks. This article uses a case study approach to identify specific pediatric liability risks and nursing literature to formulate strategies that pediatric nurses can use to limit their liability.
Humans↗
The rule of medical confidentiality v. the moral duty to warn an endangered third party.
The legal situations of a medical practitioner who breaches the rule of medical confidentiality in warning an endangered third party on the one hand, and on the other a doctor who fails to warn an endangered third party (who subsequently suffers illness or other damages as a result) are addressed. There is no direct South African law applicable to either circumstance; accordingly these issues are examined in the light of general legal principles. Further, since there have been a series of important judicial decisions in the USA on this subject, American law is also considered. In the final analysis, it would appear that in South African law by breaching medical confidentiality in warning an endangered third party (subject to the doctor acting bona fide) a medical practitioner incurs no legal liability. It would also appear that failure to warn an endangered third party incurs no legal liability under South African law.
Confidentiality↗
Extended civil commitment for dangerous psychiatric patients.
Mental health clinicians are increasingly held civilly liable for the dangerous acts of their psychiatric patients. One area of liability is the negligent release of involuntarily committed patients who engage in dangerous acts after their hospital discharge. All states have provisions for extended involuntary commitment for mentally ill dangerous patients. We examined extended civil commitment petitions in Los Angeles County, California, and found that the great majority were rejected. While the standard for extended civil commitment in California includes verbal threats of substantial physical harm, deputy district attorneys tended to reject petitions initiated by clinicians when verbal threats were the sole criterion of dangerousness. This tendency by deputy district attorneys can be quite confusing for clinicians. Mental health professionals' liability has sensitized them to the legal implications of patients' verbal threats of harm; attorneys do not incur the same legal liability and are not so sensitized.
Adult↗
Legal issues in telemedicine.
The health care industry is in the process of addressing the problems that may arise from the development and implementation of telemedicine, including legal issues. Those issues include licensing of providers, confidentiality and privacy of patient information, and legal liability issues. The concerns expressed about licensing are addressed in legislation before the Michigan legislature. The technical aspects arising from concerns regarding privacy and confidentiality and legal liability issues have been recognized to exist as well. The following discussion will seek to highlight these issues to facilitate further analysis of them.
Confidentiality↗
Putting to rest unwarranted fears about trustee liability.
Common concerns about the legal liability of trustees include malpractice, contracts, medical staff discipline, and conflict of interest. Each of these topics is discussed here, as well as the use of directors and officers liability insurance to protect against anticipated risks.
Governing Board↗
The doctor's duty of disclosure and excessive information liability.
This article critically examines the recent phenomenon of legal liability for so-called excessive disclosure within the context of the informed consent doctrine. An attempt is made to formulate a set of workable principles to cater for both the doctor's dilemma and the patient's protection in over-information cases against the backdrop of the general principles of the doctor's duty to disclose.
Beneficence↗
Alcoholic beverage server liability and the reduction of alcohol-involved problems.
Legal liability of alcoholic beverage servers has been suggested as a means to stimulate preventive serving practices and thus reduce alcohol-involved problems. A number of variables contribute (both negatively and positively) to the potential of such liability and a conceptual model that links these variables was developed. In this project, an expert legal panel was used to identify and rate the major legal factors contributing to server liability. As a result each state was ranked according to its relative level of liability exposure. States that ranked highest in server liability were found to have more publicity about such liability, greater awareness and higher concern among licensed establishment owners/managers and different serving practices compared to states with lowest liability exposure. As a result we conclude that server liability has a real potential for reducing alcohol-involved problems but additional research is needed.
Accidents, Traffic↗
Student-faculty joint authorship: ethical and legal concerns.
Although faculty mentoring through joint authorship with students offers benefits to both, the claim of joint authorship of students' works by faculty members may raise ethical and legal concerns. Whether based on institutional policies, faculty members' mandates or suggestions, or even students' invitations, such claims may violate principles of autonomy, fidelity, veracity, and justice. Moreover, such claims may be contrary to basic requirements of copyright law relating to joint authorship and derivative works. Unjustified claims to authorship may have adverse effects on the student-faculty relationship, give rise to professional embarrassment for the individual faculty and the institution, or lead to legal liability. The responsibility to address ethical and legal concerns inherent in such joint authorship rests with the administration and faculty of the individual nursing education department.
Authorship↗
Practice environment is associated with obstetric decision making regarding abnormal labor.
Nonmedical factors affecting obstetric decisions regarding abnormal labor were investigated in Maine, a rural state. Obstetricians were questioned about practice structure, hospital services, anesthesia support, and legal liability. Cesarean section rates specific for abnormal labor, based on hospital discharge summaries in the previous two years, correlated inversely with improved night coverage support, 24-hour blood bank availability, and more adequate anesthesia services. Neither the payment differential between vaginal and cesarean delivery nor previous legal liability were associated with increased cesarean rates for abnormal labor. We conclude that improved ancillary services may lead to lower dystocia-specific cesarean section rates.
Anesthesia, Obstetrical↗
Patient safety and health policy: a history and review.
Policy initiatives on many fronts have converged to improve patient safety. A major tension that characterizes this process is the attempt to achieve a balance between learning and control in complex systems with technical, social, and organizational components. Efforts to improve learning are marked by better information flow, discovery, flexibility in thinking, embracing of failures as learning opportunities, and core incentives to promote voluntary participation of all stakeholders in the process. Efforts to improve accountability are traditionally marked by public disclosure, meeting of certain widely disseminated standards, availability of performance measures, exposure to legal liability, and compliance with mandated directives (statutes, regulations, accreditation requirements). In some sense, these directions are mutually exclusive. Although a more collaborative regulatory-improvement model would be helpful in creating an industrywide safety culture, it is likely that learning and accountability functions will follow separate tracks. An exception would be policy that stimulates organizations to comply with regulation by showing how well and by what methods they are learning and how others can profit from these experiences. Any approach to improving patient safety should, at a minimum, include a nonpunitive in-depth mechanism for reporting incidents, postincident evaluations for identification of system changes to prevent subsequent occurrences, and state-guaranteed legislative protection from discovery for all aspects of information gathered to improve patient safety. Nonpunitive approaches have yielded useful results in other industries [43]. State and federal courts, state licensing boards, and accrediting bodies such as JCAHO all function to maintain accountability and standards; however, the very fear of existing legal liability or its misapplication are the greatest hurdles to pioneering patient-safety efforts. The health care system needs to transform the existing culture of blame and punishment that suppresses information about errors and adverse events into a culture of safety that focuses on openness and information sharing to improve health care and prevent adverse outcomes. Education and leadership will be most important to creating and sustaining a strong safety culture and arguably the most important defense against preventable harms. Safety culture cannot be legislated, just as the old adage states that it is easier to pull rather than push a piece of spaghetti. Given the imbalances and inefficiencies of market forces in health care, perverse incentives that have strengthened resistance to change, and secrecy when it comes to adverse event information, however, it is likely that policy initiatives will continue to play an important role in the transformation of the industry to more highly reliable, safer levels of care.
Delivery of Health Care↗
Consent and refusal of treatment.
Clearly, a multitude of potential consent problems can exist for the emergency physician. It is difficult at times to balance the concepts of patient autonomy with the desire to provide optimal medical care. Experienced emergency physicians should be able to individualize the type of consent needed in a particular situation, based on a clinical evaluation of the case. Some general principles apply, but no strict rules can guide the physician in every case. Documentation of consent and refusal of treatment are critical for quality of patient care and legal liability reasons. Principles of what is good, "appropriate" legal consent usually follow from good medical care and strict concern for the patient's health and rights.
Adult↗
Self-awareness of impairment and the decision to drive after an extended period of wakefulness.
Fatigue is an increasingly noted factor in road accidents. The ability to predict and be aware of impairment in terms of driving capability is important for potential legal liability and road safety. However, to date, there have been few studies that have investigated the accuracy of individuals in predicting how safely they could drive during conditions of sleep loss. Research has demonstrated that individuals rate themselves as better than the population average in a number of domains, including driving-related skills. Therefore, this study also aimed to investigate self-ratings of predicted driving ability during extended wakefulness and compare them to ratings made of a hypothetical other person under the same conditions. Thirty-two participants remained awake for a period of 40 h. Every 2 h, they completed the Psychomotor Vigilance Task (PVT) and rated on a seven-point scale how well they thought they could drive safely, react quickly in an emergency, and stay in their own lane. They were also asked to assess how they thought someone else in their own position could drive. The participants rated their driving ability as becoming significantly poorer at the same time that their PVT performance became significantly slower. Self-ratings indicating a qualitative assessment of poorer than neutral driving occurred at 03:00 h for both the "drive safely" and "react quickly" questions, after 19 h of continuous wakefulness (starting at 08:00 h). This occurred at 05:00 h for the "keep in my lane" question. Previous studies with a similar protocol demonstrated that under these conditions, individuals exhibit a performance decrements equivalent to someone with a blood alcohol concentration of 0.05% (the legal driving limit in Australia). Participants consistently rated the ability of others to drive as poorer than their own. The main implication from this study for road safety and legal liability is that it is reasonable to focus on a person's perception of the situation, as it does align with objective reality to a certain extent. A concern in terms of road safety is potential overconfidence, indicated by rating others consistently poorer than themselves.
Adolescent↗
Physical examinations and company liability: a legal update.
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Humans↗
[The physician's liability and legal rights].
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Insurance, Health↗
Physical restraint use in critical care: legal issues.
Landmark federal legislation and several other social and clinical forces have induced nursing homes to reduce their use of physical or mechanical restraints on their residents during the past decade. Attention is being paid to the overuse of restraining devices and methods in acute care hospitals, including critical care units, and the need to develop strategies for their reduction or elimination. One of the most serious barriers to accomplishing this objective is anxiety on the part of health professionals and administrators about potential legal liability for patient injury. This article discusses the potential legal implications of physical restraint reduction in hospitals, with special emphasis on the critical care context. It places risks in realistic perspective, ultimately arguing that developing suitable alternatives to restraint use in most cases best serves the legal--as well as the clinical, ethical, and financial--interests of all concerned parties.
Aged↗
Legal aspects of clinical ethics committees.
In an increasingly litigious society where ritual demands for accountability and "taking responsibility" are now commonplace, it is not surprising that members of clinical ethics committees (CECs) are becoming more aware of their potential legal liability. Yet the vulnerability of committee members to legal action is difficult to assess with any certainty. This is because the CECs which have been set up in the UK are--if the American experience is followed--likely to vary significantly in terms of their functions, procedures, composition, structures and authority. As a consequence it is difficult to generalize about the legal implications. Nevertheless, despite these difficulties this article will outline the broad legal principles governing the potential liability of committee members. It will also consider the relationship between CECs and the courts. It begins, however, with a brief analysis of the relationship between ethics and law in committee deliberations, and in particular of the role of law and legal expertise on CECs.
Committee Membership↗
Legal consequences of standard setting for competitive athletes with cardiovascular abnormalities.
This paper addresses the issue of whether establishing consensus standards for the treatment of particular medical conditions increases a physician's exposure to legal liability. The conclusion reached is that the legal effects of standard setting, rather than representing a significant threat of liability, should be seen as beneficial to the medical profession. A fundamental point is that the legal test for liability is entirely dependent on the medical profession's definition of what constitutes adequate care. The law incorporates the standard of care defined by the medical profession and does not impose an external norm. In the absence of formally stated standards, the process of defining relevant medical criteria will involve a great deal of uncertainty. Outcomes of legal contests will be affected by such extraneous factors as the relative experience of the lawyers involved, their access to knowledgeable expert witnesses, and their strategic decisions made with respect to tactics and procedures. Establishment of formal standards has the salutory effect of limiting the influence of these factors and thus reducing the randomness of the results reached. Formal standards also have the advantage of being easily replicated in unrelated proceedings and thereby contribute to the development of a consistent, evenly applied rule of liability. Finally, even if formal standards are either more, or less, progressive than the actual state of medical practice, there is relatively little risk that they will produce untoward results.
Heart Diseases↗