HI 103

1. © 2017 American Health Information Management Association© 2017 American Health Information Management Association
Chapter 14: Patient Rights and
Responsibilities
Fundamentals of Law for Health
Informatics and Information
Management, Third Edition

2. © 2017 American Health Information Management Association
Patient Rights
• Addresses conduct between healthcare provider
and patient
– Ability to receive high-quality health care
• Skillful care with desired clinical outcomes
• Respectful and compassionate care
– Provider-patient partnership
• Patient empowerment
• Consideration of family involvement
• Ensure patients are educated and knowledgeable about their
conditions
• Informed about health information use, disclosure, protection,
and individual rights

3. © 2017 American Health Information Management Association
Patient Rights—Patient-
Provider Relationship
• Patient-Provider Relationship
– Paternalistic: Provider is the authority; patient
is passive recipient
– Informative: Provider dispenses information;
patients makes the decisions
– Interpretive: Shared decision making between
provider and patient

4. © 2017 American Health Information Management Association
Patient Rights—Right to
Healthcare
• US Constitution does not provide a right to healthcare, but
various statutes and regulations do provide this right
• Tax-exempt providers may be required to provide some
charity care per the IRS community benefit standard
• Elective treatment
– No obligation to treat non-emergency cases as long as anti-
discrimination laws are not violated
• Hill-Burton Act
– Hospitals that received federal assistance to construct and
modernize hospitals were obligated to provide some
uncompensated care
– This obligation has ceased, but many Hill-Burton hospital retain
a mission to provide uncompensated care

5. © 2017 American Health Information Management Association
Patient Rights—Right to
Healthcare (continued)
• Emergency Treatment
– Emergency Medical Treatment and Active
Labor Act (EMTALA): Passed to eliminate
“patient dumping” for inability to pay
• Applies to hospitals that
– Participate in the Medicare program and
– Offer emergency services
• If EMTALA applies, hospitals must treat all patients
who present for emergency treatment equally

6. © 2017 American Health Information Management Association
Patient Rights—Right to
Healthcare (continued)
• Emergency treatment (cont.)
– EMTALA required steps for patients who
present for emergency services:
• Conduct medical screening exam (MSE)
• If emergency medical condition (EMC) is found:
– Treat and stabilize the condition without delay
– May transfer without stabilization only if:
» Patient requests
» Medical benefits of transfer outweigh risks

7. © 2017 American Health Information Management Association
Patient Rights—Right to
Healthcare (continued)
• Right to accept or refuse treatment
– Competent adults have the right to accept or
refuse treatment, even if death may result
– A court may find a compelling state interest to
preserve the person’s life despite refusal
• Right to discharge
– Competent adult patients may discharge
themselves unless considered danger to self or
others
– May be a discharge against medical advice

8. © 2017 American Health Information Management Association
Patient Rights—Sources
• AHA Patient Care Partnership
• Joint Commission Standards
– Policies and procedures must exist to address patient rights and
responsibilities
• Medicare Conditions of Participation
• Affordable Care Act (ACA)
– Provides healthcare coverage rights and protections
• State laws
• Organizational patient rights policies
– Should address applicable requirements of external bodies such as
Medicare Conditions of Participation and accrediting body standards
– Patients should be given a notice of their rights upon first encounter
– Includes personal rights and rights regarding patient property

9. © 2017 American Health Information Management Association
Patient Rights—Specific Issues
• Rights of patients with mental illnesses
– Involuntary civil commitment permitted if
patient is a danger to self or others
• Patients have right to procedural due process
• Substantive rights (shelter, nutrition, etc.)
• Mental illness does not automatically equate to
mental incompetence
• Civilly committed patients must be distinguished
from patients charged with crimes

10. © 2017 American Health Information Management Association
Patient Rights—Specific Issues
• Limits on seclusion and restraints
– Seclusion: Involuntary confinement of a patient
alone in a room or area; patient is prevented from
leaving
– Restraint: Device or drug that restricts an
individual’s freed of movement; is not for
diagnosis, treatment, or patient protection
– Medicare Conditions of Participation limit
seclusion and restraint and provide reporting
requirements for related injury or death

11. © 2017 American Health Information Management Association
Patient Rights—Health
Information
• Privacy and confidentiality
– Individual privacy and confidentiality of information shared
with a healthcare provider are longstanding mandated
rights
• HIPAA individual rights
– Access one’s own PHI
– Request amendment to PHI
– Request accounting of disclosures of PHI
– Request restrictions regarding use and disclosure of PHI
for treatment, payment and operations
– Request alternative location or method of communications

12. © 2017 American Health Information Management Association
Patient Rights—Health
Information (continued)
• AHIMA Consumer Health Information Bill of Rights
– Is consistent with HIPAA and furthers AHIMA’s
commitment to support and protect people’s rights
regarding their health information
• Patient health information portals
– Patient portals: Provider-hosted secure websites that
allow patients to access their own health information
• Patient portals can include personal health records (PHRs),
repositories where patients add their own health information

13. © 2017 American Health Information Management Association
Patient Rights—Health
Information (continued)
• Health literacy and cultural competence
– Health literacy: Capacity of an individual to obtain,
process, and understand health information needed
to make appropriate healthcare decisions
– Cultural competence: How an organization functions
effectively in cross-cultural situations
– Both must be considered as part of patient rights and
patient-centered care because they encompass
barriers to understanding health information including:
• Educational levels
• Language barriers

14. © 2017 American Health Information Management Association
Patient Rights—Health
Information (continued)
• Transparency of healthcare costs
– The cost of healthcare has historically been
elusive to patients
– New area of patient rights relates to
healthcare costs
• Billing advocates: Act on behalf of patient to
negotiate and lower medical bills
• Several states require hospital charge data to be
made available prospectively to consumers (e.g.,
price lists)

15. © 2017 American Health Information Management Association
Patient Responsibilities
• In addition to being given rights, patients also have
responsibilities in the patient-provider relationship
• Codes of patient responsibility typically require
patients to:
– Provide full and honest information
– Ask questions if they do not understand
– Work with providers to carry out agreed-on treatment
plan
– Respect providers and other patients
– Make good-faith efforts to meet financial obligations