LEGAL

PRACTICE
S
In a healthcare setting
OBJECTIVES
 5.21 Apply standards for HIPAA.
 5.22 Describe advance directives.
 5.23 Summarize the Patient’s Bill of
Rights.
 5.24 Understand informed consent.
 5.25 Explain laws governing harassment,
employment and scope of
practice.
HIPAA
 Health Insurance Portability and
Accountability Act
 Federal protection for privacy of health
information in all states.

The Health Insurance Portability and

Accountability Act of 1996 (HIPAA)
Privacy Rule
HIPAA
 Patients must sign HIPAA consent form for
health care provider.
HIPAA
 Only exception to confidentiality rules is
information that must be reported by law to
protect the safety and welfare of the public.
 Births and deaths
 Injuries caused by violence that require police
involvement
 Communicable diseases
 Sexually transmitted diseases
HIPAAQUIZ
1. What federal department regulates HIPAA?
2. Must a patient sign a HIPAA authorization
form before his/her physician’s office files an
insurance claim for the patient?
3. Can a physician give a son confidential
information about his father’s condition
without the father’s written consent?
4. Karen wants a copy of her dental x-rays. Can
the dental office charge her $10 to provide
her with a copy?
5. Brenda has a baby but does NOT want the
information made public. Can she refuse to
have the birth registered?
ADVANCE DIRECTIVES
 Also known as “legal directives”
 A legal document
 They allow individuals to state what medical
treatment they want and do not want if they
become incapacitated.
 Two main directives:
 Livingwill
 Durable power of attorney (POA)
LIVING WILL
 Document that states measures that should
not be taken to prolong life when the patient
is terminal.
 Must be signed when individual is competent
and witnessed by two adults who would not
benefit from the death.
 Most states have laws that honor living wills.
 Living wills often have a Do Not Resuscitate
(DNR) request.
 If so, a doctor may write a Do Not Resuscitate
order.
DURABLE POWER OF
ATTORNEY
 Also “Designation of Health Care
Surrogate” or “Medical Power of
Attorney”
 Permits an individual (known as a
principal) to appoint another person
(known as an agent) to make healthcare
decisions if the principal becomes
unable to make decisions.
 Usually given to spouse or adult
children.
 May be given to any qualified adult.
 POA must be signed by the principal, the
agent, and two adult witnesses.
PATIENT SELF
DETERMINATION ACT
 Abbreviated PSDA
 Federal law in 1990
 Facilities receiving federal aid must:
 Inform patients of their right to make decisions
concerning their medical care, including right-to-
die.
 Provide assistance in preparing advance
directives.
 Document advance directives in patient record.
 Provide written statements to implement the
patient’s requests.
 Affirm no discrimination because of advance
directives.
 QU
ADVANCE DIRECTIVES IZ
1. If a patient legally signs a living will, can a
physician refuse to cooperate?
2. What is the intent of the PSDA?
3. Robert has never been married and has no
children. Can he give durable power of
attorney to his cat?
4. Barney is very ill. His daughter puts a pen in
his hand and bullies him into signing a Living
Will. Is that legal?
5. Joe has signed a living will and the doctor
writes a DNR order. What should the nurse
caring for him do if he experiences cardiac
arrest?
PATIENT’S BILL OF RIGHTS
 Many different forms
 American Hospital Association – Patient’s Bill of
Rights
 Mental Health Patient’s Bill of Rights
 Patient’s Bill of Rights for Medicare and
Medicaid
 Resident’s Bill of Rights (OBRA)
 Managed Care Bill of Rights
 Complementary and Alternative Care Client Bill
of Rights
 Etc.
PATIENTS HAVE A RIGHT TO:
 Considerate and
respectful care.
 Obtain complete,
current
information
concerning
diagnosis,
treatment and
prognosis.
PATIENTS HAVE A RIGHT TO:
 Receive information I refuse.
necessary to give
informed consent prior
to the start of any
procedure.

 Have advance
directives for health
care and/or refuse
treatment to the
extent permitted under
law.
PATIENTS HAVE A RIGHT TO:
 Privacy concerning a
medical care
program.

 Confidential
treatment of all
communications and
records.

 Reasonable response
to a request for
services.
PATIENTS HAVE A RIGHT TO:
 Obtain information
regarding facility
relationships to other
healthcare and
educational
institutions.
 Right to refuse to
participate in
research.
 Reasonable continuity
of care.
PATIENTS HAVE A RIGHT TO:
 Review medical
records, examine
bills, get
explanations of
You owe
care and $9,999,99
charges. 9 for your
office
 Be informed of visit!
hospital rules and
regulations, and
available
resources to
resolve disputes
or grievances.
RESIDENT’S RIGHTS
INCLUDE:
 Freedom from abuse and
chemical/physical restraints.
 Participate in family/resident
groups and in social, religious
and community activities.
 Manage personal funds and use
personal possessions.
 To share a room with his/her
spouse if both are residents.
 QU
PATIENT’S RIGHTS IZ
1. A physician walks into a patient’s room with
three medical students. Does the patient
have the right to ask the medical students
to leave?
2. Does a patient have the right to challenge
charges on his/her hospital bill?
3. A nurse anesthetist visits a patient before
surgery, but the patient is not comfortable
with the anesthetist. What should he/she
do?
4. Do you think nursing homes ever violate
any residents’ rights? Which ones?
INFORMED CONSENT
 Informed consent is permission granted
voluntarily by a person who is of sound mind
after the procedure and all risks have been
explained in terms the person can
understand.
 Can be verbal, but for most procedures,
should be in writing.
Conse
 Person can withdraw consent at any nt
time. Form
 Procedures should not be performed
if the patient does not give consent.
 QU
INFORMED CONSENT IZ
1. If a patient gives permission for a procedure
but is heavily drugged at the time, is that
legal?
2. If a patient signs a consent form without
reading the form, have the rules for
informed consent been legally met?
3. If a patient signs a consent form and, while
of sound mind, changes his mind about
having the procedure, can the physician still
perform the procedure?
LABOR AND EMPLOYMENT
 Americans with Disabilities Act
 Preventsemployment discrimination against
disabled workers who are qualified to perform
the job with reasonable accommodations.
 Civil Rights Act of 1964
 Prevents hiring discrimination on the basis of
race, color, religion, sex, age or national origin.
 Occupational Safety and Health Act (OSHA)
 Prevents unsafe working conditions.
SEXUAL HARASSMENT
 Unwelcome actions that are sexual in
nature.
 Victim and harasser may be man or woman,
and may not be of the opposite sex.
 Harasser can be a supervisor, coworker, or
nonemployee.
 Victim can be anyone affected by offensive
conduct.
One of these days
you’re going to stop
pretending you
don’t want to go out
with me.
SEXUAL HARASSMENT
 Victims should first speak Doctor Jay, please
directly to the harasser. do not ask me out
again. I have a
 Clearly identify the boyfriend and you
unwelcome behavior and are making me very
uncomfortable.
that it must stop.
 If the harassment
continues, follow the
facility’s sexual
harassment policy.
AVOID SEXUAL HARASSMENT
 Avoid discussing sexual matters not
related to the job.
 Do NOT tell dirty jokes.
 Avoid sharing intimate details of your
personal life at work.
 Do NOT joke about sexual matters.
 Avoid touching coworkers and patients in
suggestive ways.
GRIEVANCE
 A complaint about a circumstance
considered to be unfair or potentially
harmful.
 Learn facility grievance policy.
 Usually best to resolve workplace issues
at the lowest level possible.

G Fo
 Start with your immediate

r ie r
va ms
supervisor.

nc
e
 Only file a grievance after working
up the chain of command.
SCOPE OF PRACTICE
 What one is legally allowed to do in one’s
profession.
 You MUST understand and practice within the
guidelines of your profession.
 A supervisor should only ask you to perform
activities within your scope of practice.
 In most instances, you should refuse to
perform skills outside your scope of practice.
HARASSMENT, LABOR, AND
QUIZ
SCOPE OF PRACTICE
1. A healthcare worker tells dirty jokes to
coworkers who encourage the jokes. Is this
sexual harassment?
2. A male pharmacist makes crude comments
about women to nobody in particular. A
pharmacy assistant who hears his remarks
finds the remarks offensive. Is this sexual
harassment?
3. Are workplace romances considered sexual
harassment?
4. What should you do if someone at work
makes sexual comments that make you
HARASSMENT, LABOR, AND
QUIZ
SCOPE OF PRACTICE
5. What role does OSHA play in protecting the
worker?
6. Roxy applies for a job as a medical
receptionist. She is well qualified for the
job, but is a double-amputee and uses a
wheelchair. Can she be denied the job
because her wheelchair use might require
the office to make some renovations?
7. When should you file a grievance?
8. Do nursing assistants have a scope of
practice?
CONCLUSION
 Healthcare workers must know and follow the
law in the practice of his/her profession – in
order to safeguard the rights of the patient
and the integrity of the profession.
 Spend your career here . . . . not here.