Chapters 6 public duties

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  • Read AMA ethics page 242 section III and VII
  • Autopsy Performed without Permission Leads to LawsuitA 47-year-old cleaning company supervisor passed out at work. He was taken to a hospital emergency room, but the attending physician was unable to revive him. The doctor issued a Notice of Death at 2:15 am, listing cardiac arrest as the cause of death. The deceased’s relatives arrived at the hospital 30 minutes after the patient died and told hospital personnel of both their Muslim faith and their desire to take the body to a mosque. The relatives were told to return to the hospital at 8:00 am and they did, but the hospital no longer had the body; at 7:00 am it had been sent to the medical examiner’s office. An autopsy was performed at 2:00 pm that same day. The relatives filed suit against the hospital and the patient’s attending physician for inflicting emotional injuries, alleging that the autopsy was unauthorized.The plaintiff’s sought partial summary judgment on the issue of liability, and the court granted the motion because state law limited the right of a hospital and its physicians to perform an autopsy without the consent of the deceased patient’s survivors.Hospital was found liable for performing an autopsy without consent.
  • 1850 Report of Sanitary Commission of Mass (Shattuck Report)Life expectancy in US 25-35 yearsMajor cause of death = infectious diseasePublic health revolution combined environmental and sanitation regulation with disease reporting and investigation; mandatory vaccinations; personal restrictions.US Supreme court gave public health unbridled powers over person and property when necessary to protect public health.Constitution gave broad powers to each state to control communicable diseaseFew challenges to law until HIV/AIDSWashington State = Health care providers shall:     (1) Notify the local health department where the patient resides (in the event that patient residence cannot be determined, notify the local health department where the health care providers practice) regarding:     (a) Cases or suspected cases of notifiable conditions specified as notifiable to local health departments in Table HC-1;     (b) Cases of conditions designated as notifiable by the local health officer within that health officer's jurisdiction;     (c) Outbreaks or suspected outbreaks of disease. These patterns include, but are not limited to, suspected or confirmed outbreaks of chickenpox, influenza, viral meningitis, nosocomial infection suspected due to contaminated food products or devices, or environmentally related disease;      (d) Known barriers which might impede or prevent compliance with orders for infection control or quarantine; and     (e) Name, address, and other pertinent information for any case, suspected case or carrier refusing to comply with prescribed infection control measures.     (3) Notify the department of pesticide poisoning that is fatal, causes hospitalization or occurs in a cluster.      (6) Cooperate with public health authorities during investigation ofCircumstances of a case or suspected case of notifiable conditionAn outbreak or suspected outbreak of disease     (7) Provide adequate and understandable instruction in disease control measures to each patient who has been diagnosed with a case of a communicable disease, and to contacts who may have been exposed to the disease.     (8) Maintain responsibility for deciding date of discharge for hospitalized tuberculosis patients.     (9) Notify the local health officer of intended discharge of tuberculosis patients in order to assure appropriate outpatient arrangements are arranged.
  • 1986 National Childhood Vaccine Injury ActVIS given to parent(form) VAERS (vaccine adverse event reporting system) (Maryland)Report includes date of administration manufacturer and lot # name and address of administrator adverse reactions
  • Definition of abuse RCW 74.34.020: "Abuse" means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult. In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a vulnerable adult, which have the following meanings:     (a) "Sexual abuse" means any form of nonconsensual sexual contact, including but not limited to unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under chapter 71A.12 RCW, whether or not it is consensual.     (b) "Physical abuse" means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to, striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints unless the restraints are consistent with licensing requirements, and includes restraints that are otherwise being used inappropriately.     (c) "Mental abuse" means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to, coercion, harassment, inappropriately isolating a vulnerable adult from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing.     (d) "Exploitation" means an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another.Child abuse reporting laws in Washington (timeline)1965 – practitioner1969 – add school personnel, registered nurse, social worker, psychologist, pharmacist, clergyman1975 – add licensed nurse, any other person to believe child suffer abuse1978 – add social service counselor, child care provider, juvenille probation officer1995 – add county coroner, law enforcement officer
  • Medical records are crucialHandle and destroy as little as possibleGenerally refer rape to hospital

Transcript

  • 1. MEDA 112Medical Law, Ethics & Bioethics
    Chapter 6 – Public Duties
  • 2. Objectives
    Duties of Physician birth & death certificates communicable/reportable diseases vaccinations reportable injuries abuse evidence collection substance abuse
    Good Samaritan Laws
    Informed and uninformed consent
    Doctrine of informed consent
  • 3. Physician’s Public Duties
    A physician is liable civilly and criminally once he/she obtains their license and MUST perform certain duties
  • 4. Public duties- birth & death certificates
    Legal documents
    Birth certificates used for proof of age, parentage, citizenship
    Death certificate necessary to collect insurance, bank accounts, dispersal of estate, Social Security and veteran’s benefits
  • 5. Public duties – Communicable Disease
    Protect public health from diseases that can be transmitted
    Notification to local health department
    http://www.doh.wa.gov/EHSPHL/Epidemiology/CD/#Notifiable%20Conditions%20A-Z
  • 6. Public duties - Vaccinations
    immunization schedules
    1986 National Childhood Vaccine Injury Act
    Vaccine Information Statement (VIS)
    VAERS
  • 7. Public duties – Reportable injuries
    Injury reportable when it concerns public welfare
  • 8. Public duties – AbuseRCW 74.34.020
  • 9. Public duties - Evidence
    Proper collection and preservation
    Documentation in medical record
  • 10. Public duties – Substance abuse
    Watch for doctor-shopping
    Keep prescription pads secure
  • 11. Good Samaritan Laws
    WAC 246-138-010 Definitions        (2) "GoodSamaritan" means a person rendering emergency care or transportation as described in RCW 4.24.300 and 4.24.310