LEGAL ASPECTS

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INTRODUCTION 

Medically and legally EMT-Is are accountable for their actions.  It is imperative that EMT-1s understand the laws that regulate their practice.  The following topics will be discussed during this lesson:

 

            •           Sources of law

 

            •           Prehospital legislation

 

            •           Malpractice

 

·                      Standards of Care

 

·                      Specific Prehospital References

 

LESSON OBJECTIVES

At the end of this lesson the participants will be able to:

 

  1.       State four sources of law.

 

  2.       Name the two types of law.

 

  3.       Identify the legislation which authorizes prehospital care in California.

 

  4.       Discuss the 4 elements of negligence.

 

  5.       Describe 3 ways that the EMT-I can avoid being held liable for patient abandonment.

 

  6.       Understand the difference between implied and expressed consent.

 

  7.       Describe the circumstances under which involuntary consent might be used.

 

  8.       Verbalize understanding of the patients right to refuse medical assistance.

 

  9.       Understand how the EMT-I may be held liable for slander and libel.

 

10.       Describe how the EMT-I can avoid being held liable for slander and libel.

 

11.       Describe how standards of care are developed and discuss how they relate to liability.

 

12.       Discuss how the EMT-I can avoid malpractice.

 

13.       Discuss L.A. County Reference #s:

                        802      EMT-I Scope of Practice

                        802.2   EMT-I Expanded Scope of Practice

                        803      EMT-I Scope of Practice

                        808      Base Hospital Contact

                        814      Determination of death

                        815      Horning Prehospital DNR Orders

                        815.1   L.A. County DNR Form

                        815.2   State DNR Form

                        815.3   State DNR Medallion

                        819      Organ Donor Identification

                        820      Patient transfer from one Prehospital Team to another

                        832      Treatment and transport of Minors

                        834      Patient Refusal of Treatment or Transport

                        838      Application of Patient Restraints

 

KEY VOCABULARY 

The following terms will be used during this lesson:

 

·          Abandonment - failure to provide care for the patient once it has been initiated.

 

·          Assault - an action that places a person in immediate fear of bodily harm.

 

·          Battery - touching another person without their consent.

 

·          Civil (tort) law - deals with noncriminal matters such as contract disputes, medical malpractice, and conflicts between two parties.  The parties sue each other.

 

·          Confidentiality - privacy of all patient related information

 

·          Consent - granting permission to treat

 

·          Criminal law - deals with crime and punishment.  The state sues an individual who is accused of committing a crime.

 

·          DNR - abbreviation for “Do Not Resuscitate”.

 

·          Emancipated Minor - a minor (under 18 years) that is responsible for his/her own maintenance and support.

 

·          Expert Witness - a witness that has special or extensive knowledge regarding the subject about which they are called to testify.

 

·          Expressed Consent - when a competent, adult patient gives permission to be treated.

 

·          Implied Consent - when a patient is unable to give expressed consent the law assumes that they would desire to have life-saving treatments rendered.

 

·          Lawsuit - a legal action initiated by one party against another.

 

·          Libel - injuring a person’s character or reputation by false or malicious writings.

 

·          Negligence - failure to administer the same degree of care that a reasonable person would exercise under the same circumstances.

 

·          Rights - liberties, allowed for under the law, for which each person is entitled

 

·          Scope of Practice - the knowledge and skills that an EMT-I is allowed to use in caring for patients as defined by state and county regulations.

 

·          Slander - injuring a person’s character or reputation by false or malicious words.

 

·          Standard of Care - what a reasonable and prudent person would do under similar circumstance.

 

KEY CONCEPTS 

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

 

THE LAW:  OVERVIEW

Sources of Law

·        Constitution of the United States

·          Constitutional Law

·          Provides constitutional rights for all American Citizens

 

·        Legislative Branch

·          Statutory Law

·          Makes laws by passing statutes

·          Congress (senate and house of representatives) and state legislatures are responsible

 

·        Executive Branch

·          Enforces and implements law

·          The president is responsible

 

·        Judicial Branch

·          Common Law (Case Law) is based on court decisions at the local, state, and federal levels

·          Interpretation of the law is the function of the judicial branch

·          Supreme Court is responsible

 

Types of Law

·        Criminal Law

·          Prohibits conduct that is deemed injurious to the public

·          Prevents harm to society

 

·        Civil Law

·          Non-criminal actions between two parties

·          Protects individuals rights

 

Prehospital Legislation

·          State Authority

·          Health and Safety Code Division 2.5

·          California Code of Regulations Title 22

·          Local Authority

·          L.A. County EMS Agency

 

 

AREAS OF POTENTIAL MEDICAL LIABLITY

Negligence

 

·                      Duty to act:

 

 

·                      Breach of Duty:

 

 

 

·                      Damages:

 

 

·                      Proximate cause:

 

 

EMS workers have a duty to care for the patient

 

The EMS worker did not perform in the manner that could be expected of a reasonable person in similar circumstances

 

There must be harm done by the action of the EMS worker

 

There must be proof that the EMS worker’s actions were the immediate cause of the damage

 

 

Abandonment

 

EMT-Is may terminate the medical relationship without fear of being held liable for abandonment under the following circumstances:

 

·          Patient does not require medical assistance

·          Patient terminates the relationship

·          Patient care is transferred to another medical professional

 

Consent:

·        Expressed Consent

·          Verbal or non-verbal

·          Generally the act of calling an ambulance is considered consent

·        Implied Consent

·          Unconscious patients are assumed to desire life-saving treatment

·          Children without a responsible adult are treated by implied consent

·        Involuntary Consent

·          Used if the individual is a threat to the community

·          Often involves law enforcement

 

 

Refusal of Service:

·          Competent individuals have the right to refuse medical care

·          “Release of Liability” or “Refusal of Transport” form should be signed

·          Patient must fully understand the risk and consequences of refusal of medical care

 

 

Assault and Battery:

·          Failure to obtain appropriate consent may result in charges of assault and battery

·          May be criminal or civil charges or both

 

 

Libel and Slander:

·          Respect patient confidentiality

·          Avoid slang and labels

·          Unconscious persons can often hear!

 

 

STANDARDS OF CARE

·        State Statutes

·          Prime source for any standard

·        Local Ordinances

·          Requirements EMTs must follow

·        Protocols/Policies

·          Developed to comply with state and local law

·          The medical and Prehospital Care community offer suggestions

·          Provides the basis for standard of care in the prehospital setting

·        Medical Textbooks and Journals

·          Do not replace local treatment protocols

·        Medical Directors

·          Directly involved in establishing standards of care

·        Expert Witnesses

·          In legal settings they interpret the protocols and apply them to the facts of the case

 

PROTECTION FROM MALPRACTICE

·          Accurate and complete documentation

·          Professional demeanor

·          Know your Scope of Practice

·          Perform only those procedures that are in your scope of practice

·          Obtain informed consent

·          Maintain skill competency

·          Discuss patient information only with those that need to know

 

SPECIFIC PREHOSPITAL POLICIES

L.A. County Reference # 802

     EMT-I Basic Scope of Practice

L.A. County Reference # 802.2

      EMT-I Expanded Scope of Practice

L.A. County Reference # 803

      EMT-IA Scope of Practice

L.A. County Reference # 808

      Base Hospital Contact

L.A. County Reference # 814

     Determination of Death

L.A. County Reference # 815

     Honoring Prehospital DNR Orders

L.A. County Reference # 815.1

     L.A. County DNR Form

L.A. County Reference # 815.2

     State DNR Form

L.A. County Reference #815.3

     State DNR Medallion

L.A. County Reference # 820

     Patient Transfer from One Prehospital Team to Another

L.A. County Reference # 832

     Treatment and Transport of Minors

L.A. County Reference # 834

     Patient Refusal of Treatment or Transport

L.A. County Reference # 838

     Application of Patient Restraints

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