PTA Unit 17 Medical laws & Ethics in PT – Flashcards
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2/Objectives: Describe the PT's responsibility and accountability for the PTA's performance in the clinic
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2/Objectives: Develop a plan of action for a given ethical problem
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2/Objectives: Discuss the provisions within the state practice act as it relates to the roles of and relationship between the PT, PTA, and supportive personnel
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2/Objectives: Describe how to locate a state practice act in the state of Connecticut as well as other states
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2/Objectives: Discuss the provisions of the CT State practice act as they relate to the PTA
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2/Objectives: Identify responsibilities of reporting sexual harassment
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2/Objectives: Identify circumstances requiring a report of fraud, abuse or neglect
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2/Objectives: Identify and discuss the ethics, laws, and professional organization guidelines related to the provision of physical therapy services
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2/Objectives: Differentiate between ethics and law
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2/Objectives: Discuss the application of Standards of Ethical Conduct for the PTA
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2/Objectives: identify resources for dealing with ethical or legal situations
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2/Objectives: Describe the potential legal and ethical consequences of a particular situation (eg, failing to obtain patient/client consent)
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2/Objectives: Discuss the implications of federal laws such as the ADA and IDEA.
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2/Objectives: Discuss patients' rights and responsibilities
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2/Objectives: Discuss HIPAA and its implications on physical therapy
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2/Objectives: Page 4 of 15
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2/Objectives: discuss negligence and malpractice with regard to the physical therapy profession
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2/Objectives: Problem-solve conflicts between ethical and legal principles and assume responsibility for the selected course of action
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2/Objectives: Engage in verbal and written reflection on ethical and legal issues affecting PTAs
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3/Ethics vs. Law: Define Ethics
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Ethics - a system of moral principles or standards governing a person's conduct
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3/Ethics vs. Law: Define Morals
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Morals - basis for ethical conduct: Individual's beliefs, principles and values about what is right and wrong
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3/Ethics vs. Law: Define Law
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Law - a binding custom or practice of a community; a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority (Merriam-Webster)
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4/Medical Ethics & Medical Law: What is medical ethics?
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Medical ethics - a system of principles governing conduct of healthcare professionals
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4/Medical Ethics & Medical Law: List the relationships covered under medical ethics. (4)
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Relationships of healthcare provider to: 1 - Patient 2 - Patient's family 3 - Fellow physicians 4 - Society
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4/Medical Ethics & Medical Law: What is medical Law?
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Medical law - establishment of social rules for conduct; violation may create criminal and civil liability
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5/Biomedical Ethical Principles: What is Beneficence?
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Beneficence - doing the best for the patient
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5/Biomedical Ethical Principles: What is Nonmaleficence?
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Nonmaleficence - do no harm
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5/Biomedical Ethical Principles: What is Justice?
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Justice - fair and equal treatment to every patient
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5/Biomedical Ethical Principles: What is Veracity?
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Veracity - practitioner and patient have a responsibility to tell the truth
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5/Biomedical Ethical Principles: What is Confidentiality?
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Confidentiality - respecting privileged patient info
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5/Biomedical Ethical Principles: What is Autonomy?
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Autonomy - patient is free to make decisions for himself/herself
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6/Physical Therapy Ethics: What is PT Ethics?
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Set forth by professional organization (APTA), Standards of conduct; not enforceable by law
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6/Physical Therapy Ethics: List the PTA relationships covered under PT ethics. (6)
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Relationship of the PTA to: 1 - Patient 2 - Patient's family 3 - PTs 4 - Fellow PTAs 5 - Associates 6 - Society at large
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7/Physical Therapy Ethics: How is the APTA involved in PT ethics?
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APTA - maintain and promote ethical principles and standards of conduct for its members. Code of Ethics for the Physical Therapist. Standards of Ethical Conduct for the PTA (http://www.apta.org/Ethics/Core/)
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8/Standards of Ethical Conduct for the PTA: Describe Standard #1 of the Ethical Conduct for the PTA.
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Standard #1: Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals.
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8/Standards of Ethical Conduct for the PTA: Describe Standard #2 of the Ethical Conduct for the PTA.
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Standard #2: Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients.
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8/Standards of Ethical Conduct for the PTA: Describe Standard #3 of the Ethical Conduct for the PTA.
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Standard #3: Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations.
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8/Standards of Ethical Conduct for the PTA: Describe Standard #4 of the Ethical Conduct for the PTA.
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Standard #4: Physical terapist assistants shall demonstrate integrity in their relationships with patients/clients, families, colleague, students, other health care providers, employers, payers, and the public.
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8/Standards of Ethical Conduct for the PTA: Describe Standard #5 of the Ethical Conduct for the PTA.
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Standard #5: Physical therapist assistants shall fulfill their legal and ethical obligations.
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8/Standards of Ethical Conduct for the PTA: Describe Standard #6 of the Ethical Conduct for the PTA.
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Standard #6: Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities.
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8/Standards of Ethical Conduct for the PTA: Describe Standard #7 of the Ethical Conduct for the PTA.
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Standard #7: Physical therapist assistants shall support organizational behaviors and business practices that benefit patients/clients and society.
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8/Standards of Ethical Conduct for the PTA: Describe Standard #8 of the Ethical Conduct for the PTA.
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Standard #8: Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, or globally.
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8/Standards of Ethical Conduct for the PTA: What would happen if ethical conduct not followed?
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Lack of public trust in PT.
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9/Effective Ethics Education: What is the best way to teach ethics? What is a good source?
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Teaching principles and standards, apply principles and standards to actual cases. Good example found in PT Magazine's "Ethics In Action" column is now PT In Motion "Ethics in Practice"
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10/Ethics in Action/Ethics in Practice: What is the RIPS model?
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Realm-Individual Process-Situation (RIPS) model: Realm - where the decision is made; Individual process - elements of ethical behavior, including ethical decision-making; Situation - specific scenario that demands moral action
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11/Framework for Ethical Decision Making: What is Step 1 in framework for ethical decision making?
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Step 1: Recognize and define ethical issue - Know what you need to decide.
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11/Framework for Ethical Decision Making: What is Step 2 in framework for ethical decision making?
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Step 2: Reflect - Think about it
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11/Framework for Ethical Decision Making: What is Step 3 in framework for ethical decision making?
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Step 3: Decide the right thing to do - Decide
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11/Framework for Ethical Decision Making: What is Step 4 in framework for ethical decision making?
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Step 4: Implement, Evaluate, Reassess - Take Action
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12/RIPS Model- step 1: What is the RIPS model used for?
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Used to recognize and define the ethical issue (Step 1)
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12/RIPS Model- step 1: What are the 3 parts of the RIPS model?
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Three parts: 1 - Realm 2 - Individual Process 3 - Situation
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13/RIPS Model - Realm- step 1: What is the context of the ethical situation, individually?
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Individual realm: 1 - Concerned with the good of the patient/client. 2 - Focuses on the rights, duties, relationships and behaviors between individuals.
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13/RIPS Model - Realm- step 1: What is the context of the ethical situation, institutionally or organizationally?
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Institutional/organizational realm: 1 - Concerned with the good of the organization. 2 - Focuses on structures and systems that will facilitate organizational or institutional goals.
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13/RIPS Model - Realm- step 1: What is the context of the ethical situation, societal?
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Societal realm: 1 - concerned with the common good. 2 - Most complex
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14/RIPS Model - Individual Process- step 1: What does the ethical situation require of the individual?
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Moral Courage, Moral Motivation, Moral Judgment, & Moral Sensitivity
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14/RIPS Model - Individual Process- step 1: Describe: Moral Courage
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Moral courage: Implementing the chosen ethical action even though doing so causes adversity.
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14/RIPS Model - Individual Process- step 1: Describe: Moral Motivation
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Moral motivation: Prioritizing ethical values over financial gain or self interest.
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14/RIPS Model - Individual Process- step 1: Describe: Moral Judgment
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Moral judgment: Deciding between right and wrong actions.
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14/RIPS Model - Individual Process- step 1: Describe: Moral Sensitivity
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Moral sensitivity: Recognizing, interpreting and framing ethical situations.
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15/RIPS Model - Situation- step 1: What type of ethical situation is it? (5)
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1. Issue/Problem 2. Temptation 3. Distress 4. Dilemma 5. Silence
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15/RIPS Model - Situation- step 1: Describe the Issue/Problem ethical situation.
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Issue/Problem: Important moral values are being challenged
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15/RIPS Model - Situation- step 1: Describe the Temptation ethical situation.
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Temptation: 1 - Choice between a right and wrong actino, where the decision-maker may benefit from making the wrong decision. 2 - Doing the right thing means the decision maker relinquishes personal gain.
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15/RIPS Model - Situation- step 1: Describe the Distress ethical situation.
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Distress: Practitioner knows the right thig to do but encounters a barrier: Type A: institutional or financial barrier. Type B: "something" is wrong, but what?
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15/RIPS Model - Situation- step 1: Describe the Dilemma ethical situation.
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Dilemma: 1- two or more correct principles that are at odds. 2 - Not possible to follow both courses of action
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15/RIPS Model - Situation- step 1: Describe the Silence ethical situation.
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Silence: Values are challenged, but no one is addressing it.
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17/Framework for Ethical Decision Making - Step 2: Reflect: Step 2, list the 6 questions to help you reflect
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1 - What are the relevant facts? 2 - Who are the major stakeholders? 3 - What are the potential consequences, intended or unintended? 4 - What are the relevant laws, duties, and ethical principles (beneficence, nonmaleficence, justice, veracity, confidentiality, autonomy) ? 5 - What professional guidance is there? 6 - What are the results of the "right vs. wrong" tests?
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18/Right vs. Wrong Tests- step 2: What are the 5 Right vs Wrong tests to possibly use?
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1 - Legal test 2 - Stench test 3 - Font page test 4 - Mom (parent) test 5 - Professional ethics violation test
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18/Right vs. Wrong Tests- step 2: Describe the Legal test
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Legal test: Did anyone break the law?
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18/Right vs. Wrong Tests- step 2: Describe the Stench test
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Stench test: Does this situation feel wrong?
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18/Right vs. Wrong Tests- step 2: Describe the Font page test
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Font page test: What if everyone knew?
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18/Right vs. Wrong Tests- step 2: Describe the Mom (parent) test
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Mom (parent) test: What would Mom Do? (WWMD?)
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18/Right vs. Wrong Tests- step 2: Describe the Professional ethics violation test
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Professional ethics violation test: Are there principles that would apply?
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20/Framework for Ethical Decision Making - Step 3: Decide the Right Thing To Do: What should you do if the situation fails the test in the step 2 reflect process?
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If situation fails a test, the answer is clear - do the right thing, if not, work through the answer.
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20/Framework for Ethical Decision Making - Step 3: Decide the Right Thing To Do: What are the possible approaches for working through the answer? (3)
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Three possible approaches: 1 - Rule-based - follow only the principle you want everyone else to follow. 2 - Ends-based - do whatever produces the greatest good for the greatest number. 3 - Care-based - do unto others as you would have them do unto you (Golden Rule)
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22/Framework for Ethical Decision Making - Step 4: Implement, Evaluate, Reassess: What occurs in step 4? (3)
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1 - Decision is made; 2 - action is taken, 3 - now reflect on the course of action.
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22/Framework for Ethical Decision Making - Step 4: Implement, Evaluate, Reassess: What are the 3 questions to ask yourself when reassessing?
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1 - Should a change in policy be made? 2 - What can you, as a professional, learn from this case? 3 - What did you learn about your strengths and weaknesses?
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25/Laws and Regulations: What is constitutional law?
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Constitutional law - created from the federal Constitution
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25/Laws and Regulations: What is statutory law?
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Statutory law - enacted by Congress and state legislatures
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25/Laws and Regulations: Provide 5 examples of statutory law that impact healthcare.
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Sample Statutory laws: 1 - Medicare and Medicaid laws 2 - Workers' Compensation acts 3 - 1973 Rehabilitation Act 4 - Americans With Disabilities Act (ADA) of 1990 5 - Individuals with Disabilities Education Act (IDEA)of 1997
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26/Laws and Regulations: How is common law established?
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Common law - developed by judges
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26/Laws and Regulations: What type of health care law is derived from common law?
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Most American civil laws related to health care derived from common law
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26/Laws and Regulations: What is Administrative or Regulatory law? What levels can they be enacted?
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Administrative (Regulatory) law - enacted by administrative or regulatory agencies at the local, state and federal level
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26/Laws and Regulations: Provide 2 examples of regulatory law that impacts health care.
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Examples of Administrative or Regulatory law: 1 - Occupational Safety and Health Administration (OSHA) 2 - Centers for Medicare and Medicaid Services (CMS)
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27/Americans With Disabilities Act of 1990: List 3 attributes of the Americans with Disabilities Act of 1990.
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1 - Modeled after the 1973 Rehabilitation Act. 2 - Prevents discrimination against persons with disabilities. 3 - Employment, public accommodations, state and local government services and telecommunications.
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27/Americans With Disabilities Act of 1990: What are the 3 criteria for being designated with a disability?
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Disability: 1 - Physical or mental impairment that substantially limits one or more major life activities. 2 - Must be a record of the impairment. 3 - Person with the disability has such an impairment
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28/Individuals with Disabilities Education Act: 1970 - U.S. schools educated only one in five children with disabilities, Why? (2)
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1 - Many states had laws excluding certain students, including children who were deaf, blind, emotionally disturbed, or mentally retarded 2 - Many lived in institutions with limited basic resources and no interventions aimed at improving quality of life
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28/Individuals with Disabilities Education Act: What does the 1975 - Education for All Handicapped Children Act provide?
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1975 - Education for All Handicapped Children Act, guaranteed a free, appropriate public education to each child with a disability in every state and locality across the country
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29/Individuals with Disabilities Education Act: What does the 1997 - Individuals with Disabilities Education Act (IDEA) provide?
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1997 - Individuals with Disabilities Education Act (IDEA), Provides additional amendments to 1975 law
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29/Individuals with Disabilities Education Act: What are the 3 main points for the 2004 - Individuals with Disabilities Education Improvement Act (IDEIA)?
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2004 - Individuals with Disabilities Education Improvement Act (IDEIA): 1 - An extensive definition of "highly qualified" special education teachers and requirement that all special education teachers be highly qualified; 2 - Provisions aimed at reducing paperwork and other non-educational activities. 3 - Extensive provisions aimed at ensuring special education and related services for children with disabilities who are homeless or otherwise members of highly mobile populations
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30/Violence Against Women Act of 2000: What does the Violence Against Women Act of 2000 address?
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Addresses domestic violence, sexual assault and stalking
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30/Violence Against Women Act of 2000: What percent of women will experience physical violence in an intimate relationship? What percent is regular an ongoing? What is the percent for obstectrical patients?
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Domestic Violence: Over 50% of women will experience physical violence in an intimate relationship (24-30% - regular and ongoing abuse.) While 10—25% of obstetrical patients are abused
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30/Violence Against Women Act of 2000: How do healthcare professionals play a role in violence against women? (2)
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Healthcare professionals play major role in:1 - Helping victims disclose that violence is taking place. 2 - Providing advice and support
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30/Violence Against Women Act of 2000: What should a PTA do if they suspect domestic violence?
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If a PTA suspects domestic violence, report to PT
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31/The Joint Commission: Reporting Guidelines: What are the 6 guidelines published by the Joint Commisison?
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1 - Facilities should develop objective criteria for identifying domestic violence victims. 2 - Appropriate personnel should be aware of criteria provided by supervisors. 3 - Consent should be obtained. 4 - Follow policies for collecting evidence. 5 - Notification to proper authorities as legally required. 6 - List of referrals available
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32/Screening and Reporting: What is the recommendation for screening and reporting by the APTA?
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APTA advises PTs to routinely screen for domestic violence
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32/Screening and Reporting: Where should the pt. me interviewed for screening?
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Patient must be interviewed in private, away from partner/family members
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32/Screening and Reporting: How should you frame the questions with patients?
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Frame questions in the context of domestic violence being a common problem
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32/Screening and Reporting: Some states mandate reporting. What conditions would need to be reported if mandated?
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Some states mandate reporting of suspected abuse, CT Gen. Stat. § 17b-451, Report of Suspected Abuse, Neglect, Exploitation, Abandonment or Need for Protective Services
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32/Screening and Reporting: What is mandated in CT?
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CT., mandatory reporting of Gun Shot Wound (GSW), elder & child abuse
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33/Licensure Laws: List the 4 attributes of licensure laws
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1 - State level. 2 - Licensees have exclusive right to practice their professions. 3 - Protect the consumer. 4 - Regulatory practice acts
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34/Regulatory Practice Acts: What 9 items can be found in a regulatory practice act?
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1 - Requirements for licensure. 2 - Requirements for continuing education. 3 - Temporary licensure. 4 - Periodic re-licensure. 5 - Mandatory reporting of perceived unethical conduct. 6 - Scope of practice. 7 - Restrictions on practice without referral. 8 - Licensure boards. 9 - Disciplinary action
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35/PTA Licensure: How many jurisdictions require PTAs to be licensed? What is the makeup?
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As of June 25, 2009 Michigan became 42nd jurisdiction to license PTAs. 39 states, D.C. & Puerto Rico license
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35/PTA Licensure: How many states require certification or registration?
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8 states require certification or registration
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35/PTA Licensure: What 2 states do not currently have requirements?
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No requirements for PTAs - Hawaii, Colorado
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36/CT PTA Licensure: What is required to be licensed PTA in CT?
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1 - Graduation from an accredited program. 2 - Successful completion of NPTE. 3 - Application
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37/Malpractice Laws: Civil law is derived from what other type of law?
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Civil laws derived from common laws
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37/Malpractice Laws: What is malpractice?
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"liability-generating conduct on the part of a primary health care professional associated with an adverse outcome of patient care"
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37/Malpractice Laws: Malpractice can be from what 3 situations?
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From: 1 - Professional negligence. 2 - Intentional misconduct. 3 - Patient injury resulting from dangerous activities/products
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37/Malpractice Laws: Describe what happens if a PTA is sued. What can the penalty consist of?
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PTAs can be sued; liability prevails with PT of record, penalties include: fines, license restrictions or suspensions
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38/Negligence: What is negligence?
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Failure to give reasonable care or the giving of unreasonable care
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38/Negligence: What must have occurred in order to prove negligence?
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Harm must be caused to the patient
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38/Negligence: What is duty of care?
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"Duty of Care", Standards of practice expected in the community under similar circumstances. Must be proven in place for law suit.
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39/Negligence: Who has the burden of proof?
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Burden of proof on plaintiff
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39/Negligence: Describe burden of proof. (3)
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Types of Proof: 1 - Healthcare provider owed the patient a duty of care. 2 - Defendant failed to comply with the legal duty of care. 3 - Breach of duty of care cause injury to the plaintiff.
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39/Negligence: How will judgment be awarded?
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Plaintiff sustained damages for which a court will award monetary judgment
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39/Negligence: What is contributory negligence?
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Contributory negligence: plaintiff may have also contributed by not following instructions/precautions/warnings.
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39/Negligence: What are 2 examples of malpractice by PT/PTAs?
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Examples of malpractice acts: 1 - Burns, defective equipment, patient fall, exercise injuries. 2 - Actions inconsistent with APTA's ethical principles or standards of practice
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40/PTA Student Malpractice: Are PTA students liable for their own negligence?
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Yes, PTA students liable for their own negligence
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40/PTA Student Malpractice: What does NCC provide for PTA Students? What insurance company? For what amount/occurrence What is the cap on aggregate occurrence?
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NCC provides liability coverage to PTA students: 1 - American Casualty Company of Reading. 2 - $1 million each occurrence. 3 - $5 million aggregate
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40/PTA Student Malpractice: T/F sPTA cannot have their own liability policy.
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FALSE. They can have their own personal liability policy
