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PubMed1995

An analysis of the law of confidentiality with special reference to the counselling of minors.

Although professional counsellors would be aware of the need to maintain confidentiality in their work with clients, the basis and scope of this obligation is generally less well understood. This article examines the issue of counsellor-client confidentiality from a legal perspective, and considers the potential bases of legal liability which counsellors may have with respect to the maintenance of client confidentiality as well as the circumstances under which disclosure of this information will be required or may be permitted. It is contended that the general issue of counsellor-client confidentiality presently poses particular difficulties for counsellors who work primarily with children and adolescents, especially when clinical services are provided directly to adolescents. In such instances, counsellors may be confronted by competing and even conflicting interests, and may be required to exercise judgement in relation to the disclosure of confidential information which has been provided by a minor. Although there is no clear law which directly relates to this area, it is argued that counsellors may presently have a primary obligation to respect the wishes which are expressed by a "mature minor" in relation to the provision of counselling services. It is further argued that awareness of general legal principles which are of relevance to areas of professional practice can provide much assistance to practitioners who could be required to make decisions in the course of their work which may later be examined in the context of legal proceedings.

Australia↗
PubMed2003

The business case for medication safety.

The decision to invest in a medication-safety system should take into account not only implementation costs but also reduced hospital costs for treating complications resulting from medication errors and potential liability. Medication-safety programs should be analyzed and planned the same as any other investment. Providers should base their projected return from a medication-safety system on intangible benefits to the organization as well as an ROI calculation. Investment in medication-safety systems can be justified in terms of risk management and legal liability.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Liability in relation to the use of professional medical guidelines.

The author discusses the concept of professional guidelines in medicine and their relationship to potential malpractice accusations. He cites a case of omission to give a patient prophylactic medicine against post-operative thrombosis, as previously recommended in a clinical guideline. This paper develops the discussion of the problems of professional autonomy in the light of standards of medical care being increasingly governed by clinical guidelines. The question of legal liability of medical practitioners in these situations is explored.

Anticoagulants↗
PubMed1986

Informed consent: medical, legal, and ethical implications.

The doctrine of informed consent lies at the very core of the interaction between medicine and law. Traditionally viewed as an issue of legal liability, it has implications far beyond the legal arena. It embodies cultural beliefs in the autonomy of the individual. Properly applied, it can improve the quality of care that physician assistants give to their patients.

Ethics, Medical↗
PubMedDate not supplied

PPO fiduciary responsibility.

This article will be frustrating for you. It warns you of comprehensive legal liability--but does not give you step-by-step guidance or checklists. Why? Because there are practically no examples or specifics or checklists in the Employee Retirement Income Security Act of 1974 (ERISA), especially for fiduciary duty and the new "knowing participant" fiduciary duty which applies to PPOs. Other than a relative handful of official Prohibited Transaction Exemptions (PTEs), everything is judged on a case-by-case basis. Even Department of Labor Opinion articles are merely that--opinions written with lots of caveats and not considered legal precedents. In defense of the Department of Labor, the slightest difference in circumstance can trigger a totally opposite ruling, so their hesitancy to give simple checklists is understandable. This article also takes a conservative approach. Enforcement of ERISA fiduciary duty has been sporadic. However, this article is important to you and timely. In recent years, the Department of Labor has devoted at least 50 percent of its employee review with criminal penalties of benefits cases deemed to be fraud, waste, or abuse. It is important to remember that the Department of Labor will judge your actions with 20/20 hindsight. Thus, it is important not only to have good intentions, but also to be sure that it looks like you have taken the most prudent action when all is said and done--even if the action defies common sense or normal business practices.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed2006

Sediment trend analysis of the Hylebos Waterway: implications for liability allocations.

Sediment trend analysis (STA) is a technique that determines the net patterns of sediment movement and their dynamic behavior or stability. The data required are the complete particle size distributions obtained from bottom grab samples collected in a regular grid over the area of interest. Appendix 1 provides the particular details of how STA is undertaken. Because many contaminants are known to associate with the natural particles contained in sedimentary deposits, STA can provide additional weight-of-evidence in ecological risk assessment, remedial investigation, remediation itself, and litigation issues. The STA was applied to 242 sediment samples collected from the Hylebos Waterway, Tacoma, Washington, USA, in support of remedial action planning, contaminant source identification, and ultimately allocation of legal liability for contamination. The Waterway itself comprises a narrow shipping channel extending 3 miles from Commencement Bay (Puget Sound) where it ends in a dredged turning basin (Upper Turning Basin). A 2nd dredged turning basin (Lower Turning Basin) is located about three-quarters of the distance down its length. Both sides of the channel are home to an extensive industrial complex associated with significant contaminant releases into the water. The area was declared a Superfund Site in the early 1980s. The results of the STA showed a consistent pattern of sediment transport directed from the mouth of the Waterway to the turning basin at its head. Divided into 5 separate transport environments (TEs), the sediments within the Waterway progress from transport in Dynamic Equilibrium near the mouth, to Total Deposition (type 1) in the vicinity of the Lower Turning Basin, followed by Total Deposition (type 2) in the Upper Turning Basin. Assuming that contaminants associate preferentially with the finer, rather than the coarser, components of the grain size distributions, a probable behavior of contaminants that can be contained in the sediments is proposed for each TE. Maps showing the spatial distributions of existing contaminant data appear to conform very well to the patterns that might be expected from the STA results. This evidence was primarily used to demonstrate that potentially responsible parties (PRPs) located at the head of the Waterway could not be responsible for contaminated sediments toward its mouth. The findings, for example, effectively dismissed the assumption by the Natural Resource Damage Trustee agencies that contaminated sediments from a particular source would be as likely to migrate down the Waterway as up the Waterway. As a result, major documented sources of contamination near the mouth should be expected to bear a larger share of the total cleanup compared with sources farther toward the head. Furthermore, the STA provided explanations for apparent anomalies such as how hot spots of polychlorinated biphenyls (PCBs) could be located near a property where PCBs had never been released into the environment. If sediment gradient pattern analysis alone were used to allocate liability among PRPs, those located near such hot spots would receive a disproportionate share of liability.

Geologic Sediments↗
PubMed1993

Neuroleptic malignant syndrome: liability in nursing practice.

In the summer of 1991, the malpractice case Reyes v Houston International Hospital et al was settled for an amount in excess of $600,000. The case involved the psychiatric treatment received by Marjorie Reyes, a 27-year-old Latin-American mother of three, who was admitted to a psychiatric unit in late October 1986 with a diagnosis of atypical psychosis. Malpractice was charged because her treatment failed to meet any reasonably expected outcome for atypical psychosis. In fact, Reyes developed neuroleptic malignant syndrome (NMS) as a direct result of the antipsychotic medications she was administered. Her treatment outcome was nearly fatal and caused permanent, serious neurological disabilities. The litigation implicated the nursing care delivered in a psychiatric setting. This unfortunate situation illustrates general principles of legal liability in nursing practice as well as offers a unique opportunity to review NMS and to examine the specific implications for the assessment and evaluation of the side effects of antipsychotic medications. Additionally, methods of behavioral control, specifically as they relate to concepts concerning the use of medications, the importance of documentation, and the manner in which nurses plan care, were also addressed in the case. It is important for professionals to be familiar with general legal concepts and liabilities, the potential of the development of this serious side effect, and how clinical decisions regarding the administration of both routine and as-needed medications may incur legal accountability.

Adult↗
PubMed2002

Who should pay for bad genes?

Parents have long been able to influence the genetic composition of their children through their choice of a reproductive partner, if only very approximately. They are, however, increasingly able to determine the genetic make-up of their children in other, more precise ways, such as by selecting a particular gamete or embryo or by genetically modifying an embryo prior to artificial implantation. This Article discusses parents' obligations to their children and other members of the community stemming from their children's genes. In a just state, it argues, parents would be responsible for redressing any genetic disadvantage their children suffer as a result of parents' voluntary actions. Within the context of a liberal egalitarian account of distributive justice, this responsibility might most fairly be discharged through a compulsory insurance plan that provides compensation to genetically disadvantaged children when they might have had non-disadvantaged children instead would in some circumstances incur greater liability, because they could not fairly push the cost of their choices off on other members of the insurance pool. The Article also asks whether parents wrong a child by allowing it to be born with a genetic impairment when, had they taken steps to remove the impairment, the unimpaired child they had would have been a different person from the genetically disadvantaged child because the better-off child's capacities and experiences differed considerably from those that the disadvantaged child would have had. Contrary to many people's moral intuitions, the Article argues that parents do not wrong such a child. Nevertheless, parents remain morally obligated to bear any added costs occasioned by the child's impairment. Any other approach would allow them unjustly to shift the burden of their choices to other parents. Finally, the Article takes up the much debated question of whether parents harm a child by allowing it to be born with a life not worth living when they could have prevented its birth. It suggests that the answer to this question should be irrelevant to parents' legal liability. Acting on behalf of the parental insurance pool, the state may nonetheless adopt a variety of measures to help potential parents avoid giving birth to such children, which one can assume virtually all would prefer.

Child↗
PubMed2000

Fraud and abuse: a pain physician's guide.

The growing burden of regulations and statutes that physicians in the United States must comply with has become an inescapable aspect of the practice of medicine. With the advent of this heightened regulation has also come a new governmental commitment to discover and punish fraud and abuse in the practice of medicine. It is thus incumbent upon pain practitioners to be aware of the basic principles in fraud and abuse law so as to avoid obvious situations of legal liability and to know when to seek expert legal advice in the structuring of business transactions affecting their practice.

Journal Article↗
PubMed2003

Firearm counseling by physicians: coverage under medical liability insurance policies.

BACKGROUND: Physicians who offer firearms counseling may increase their legal liability, depending on the attitudes of their medical malpractice insurance carriers. METHODS: A survey was mailed to the 100 largest medical malpractice insurers. Requested data included their experience with claims involving allegations of negligent firearm counseling by physicians, their opinion regarding whether firearm counseling by physicians would be covered under their medical malpractice policies, and their prediction of how their insurance group or company would handle such claims. RESULTS: Fourteen surveys were returned. No respondents reported having dealt with a case involving an allegation of negligent firearm counseling by a physician. Eight respondents (57%) thought that such counseling would not be covered under their medical malpractice policy, whereas six respondents (43%) said that it would. CONCLUSION: A majority of responding insurers thought that physician firearm counseling would not be covered under their medical malpractice policies. Physicians wishing to counsel their patients about the risks and benefits of owning and using firearms are advised to seek assurance of medical malpractice insurance coverage from their insurers or the annexation of a rider to their current policies.

Costs and Cost Analysis↗
PubMed1994

Liability issues in the management of pain.

Liability issues associated with pain management are important to health-care providers, patients, pharmaceutical companies, manufacturers of pain-management devices, health-care payors, and society at large. This article discusses five specific legal liability concerns: (a) health-care providers' liability to patients and/or exposure to professional discipline for inappropriate pain management, (b) health-care providers' liability to third parties for injury caused by patients treated for pain, (c) the legal distinction between pain management and euthanasia or physician-assisted suicide, (d) health-care payors' liability to patients for cost-containment decisions that impact on pain management, and (e) manufacturers' and health-care providers' liability for the risks and side effects of prescription drugs and pain-management devices.

Cost Control↗
PubMed1993

[Medical and legal aspects of medical liability lawsuits].

The principal legal resolutions about medical liability lawsuits in Chile are analyzed. The causes for the accusations and for the increase in the number of suits in Chile, according to research performed by the authors, are described. An improvement in patient-physician relationships, a better alliance among physicians, a correct certification of medical specialties, the demand of adequate technological and humans resources to perform medical functions optimally, the supervision of medical work and the legal support and advice of medical societies are recommended strategies to prevent these lawsuits.

Chile↗
PubMedDate not supplied

Low rate of generic prescribing in the Republic of Ireland compared to England and Northern Ireland: prescribers' concerns.

We compared the level of generic prescribing in the Republic of Ireland, Northern Ireland and England and surveyed the views of Irish College of General Practitioners members. In 1993, generic drugs (pure generics and branded generics together) comprised 17.4% of total dispensing in the General Medical Services Scheme, significantly less than Northern Ireland or England where pure generics alone comprised 25% and 38% respectively of total dispensing in the National Health Services. General practitioners accurately self-estimated their level of generic prescribing but are concerned about the reliability/quality of generic products on the market, possible legal liabilities associated with their use and the fact that pharmacists may legally dispense more expensive proprietary preparations in the case of private prescriptions written generically. Prescribers need reassurance regarding legal and quality assurance aspects of generic prescribing if the level of generic drug use is to increase.

Drug Prescriptions↗
PubMed1990

Legal authority for HIV testing of adolescents.

Human immunodeficiency virus (HIV) infection in adolescents has been reported in a number of studies, but little attention has been given to the potential for an epidemic spread among inner city adolescents. Voluntary HIV testing and counseling without parental consent should be available to all adolescents, especially those at high risk of infection. Although physicians may fear legal liability as a consequence of testing and counseling adolescents without parental permission, legal authority to do so exists in most jurisdictions in the United States. The sources for that authority differ from state to state. This article analyzes these sources. Requirements for confidentiality or the disclosure of test results to parents vary from state to state, but in most instances there is no authority to disclose the confidence of a minor patient who has independently consented to his or her own treatment.

AIDS Serodiagnosis↗