Impacts of Legislation and Teamwork in the Health Care System

Blog Segment Title: Leave It to the Legislature

Describe a particular issue that relates to health care, such as abortion rights. Examine how each of the three levels of government (local, state, and federal) has addressed the issue through legislation.     

Both the local and state governments have attempted to restrict and even ban abortion. (Planned Parenthood 2015) This is an ongoing battle as they attempt to restrict access to abortion clinics leaving women to pay the price by endangering their health and in some cases their safety. (Planned Parenthood 2015)  Some of the requirements the local and state legislatures has proposed or passed are: mandatory ultrasounds before an abortion the biggest problem with this requirement is a victim of rape or incest is still required to this regulation, a waiting period before an abortion can be performed this waiting period could be 72 hours, not allowing private insurance to cover abortions. (Planned Parenthood 2015)

The federal government has criminalized abortions done in the second trimester, even though doctors say this is the safest and sometimes the best way to protect the women’s health however, this ban also affects the doctors who care for the women who need the abortion, the Supreme Court's decision abandoned more than 30 years of precedent that put women’s health first when it came to laws that restrict access to abortion. (Planned Parenthood 2015)

Explain how the legislation you identified affects you as a practitioner. 

This type of legislation affects a practitioner because you have to decide what is more important taking the chance of committing a crime do to the fact that the federal government criminalizing abortion or protecting your patient’s right to choose their medical treatment and most importantly putting making sure you are doing what’s right to protect your patient’s safety and health.

Define and contrast the differences between civil, criminal, and administrative law. Provide medically related examples of each, and how medical professionals are affected by each in their private practices.  

Civil law is a body of rules that delineate private rights between individuals in areas like; contracts, property, and family law distinct from criminal or public law. (The Free Dictionary 2015)

Criminal law is a body of rules and statutes that defines conduct prohibited by the government because it threatens and harms public safety and welfare and that establishes punishment to be imposed for the commission of such acts. (The Free Dictionary 2015)

Administrative law is the procedures created by administrative agencies like governmental bodies of the city, county, state or Federal government that involves rules, regulations, applications, licenses, permits, available information, hearings, appeals and decision-making. (The Free Dictionary 2015)

The differences between civil, criminal and administrative laws are: Civil law involves; a lawsuit for damages, requests for court orders, disputes over contracts or other agreements, appeals from administrative. (Smith E. & Runes K. 2004) Criminal law involves; arrest, initial appearance, preliminary hearing, grand jury, information, arraignment, discovery, pre-trial motions, jury selection, trial and verdict and administrative law involves; various organs of the state government, creation of a commission or board that passes general laws regarding  activities. (Smith E. & Runes K. 2004)

The Free Dictionary (2015) civil law. Retrieved From: http://legal-dictionary.thefreedictionary.com/civil+law

Planned Parenthood (2015) Act No Matter What: Federal and State Bans and Restrictions on Abortion. Retrieved From: http://www.plannedparenthoodaction.org/issues/abortion-access/federal-and-state-bans-and-restrictions-on-abortion/

The Free Dictionary (2015) criminal law. Retrieved From: http://legal-dictionary.thefreedictionary.com/criminal+law

The Free Dictionary (2015) Administrative law. Retrieved From:

http://legal-dictionary.thefreedictionary.com/Administrative+law

Smith E. & Runes K. (2004) Understanding the Legal System. Retrieved From: http://www.fromcallingtocourtroom.net/chap3.htm

Blog Segment Title: There's No "I" in Team

Develop a fictitious scenario in which you overheard a conversation between two co-workers. Create a dialogue detailing the conversation during the co-workers' lunch break. The conversation pertains to each member's role in the office and how it is vital to the success of the practice. Take this opportunity to highlight each role in terms of standard of care and each team member's unique contribution to the overall standard of care within a professional environment. 

Medical Biller and Medical Assistant during their lunch break:

Medical Biller: God I am so glad it’s lunch time!

Medical Assistant: I hear ya there it has been a long day already.

M.B.: I feel like all I did is call people back today because they felt like they should not have to pay their bills.

M.A.: I tell ya my last patient was complaining today that she owes $45.00 and Mandy had the nerve to ask for payment

M.B.: I know I tried to tell her yesterday when she called that my job at the office is to take care of any billing issues and I could help her set up a payment plan to get her bill taken care of.

M.A.: I told her my job was to make sure I could do what is needed regarding her health and the doctor’s needs to make sure she receives the care that is needed. I let her know I had no control over her bill however, I could get you to help her figure it out, and she did not seem pleased.

M.B.: I told her, her health was our number concern but, we do need payment from our patients to help pay the bills the practice has and to be able to continue offering her along with other patients a certain standard that they deserve.

Choose one position in a health-care team, and briefly describe the individual's responsibilities in adhering to the standards of medical law and professional ethics. 

Medical receptionist

A medical receptionist responsibilities and professional ethics are; answering phones, greeting patients and visitors and scheduling appointments all while rendering  service with full respect and dignity as well as maintain confidential information. (Fremgen B. 2012) Medical receptionist responsibilities regarding the standards of medical law plays an important role; we live in a society where some patients are looking to sue health-care practitioners and their facilities, because of this it is important for a medical receptionist to help in making sure one’s health information is protected pertaining to HIPAA . (Fremgen B. 2012)

Fremgen B. (2012) Medical Law and Ethics. Fourth Edition. Retrieved From: Pearson Education, Inc.

Hicks. (2015) about money: Medical Office Receptionist. Retrieved From: http://medicaloffice.about.com/od/jobdescriptions/p/Medical-receptionist.htm

Blog Segment Title: The Strength of Standard Practices

Examine a situation where a report must be filed with proper authorities, such as providing care to an HIV-positive patient. Highlight the personal challenges of dealing with such a sensitive issue, emphasizing the importance of maintaining standards of care to all patients.

With the increased survival of HIV positive patients, the management of care has becoming increasingly common in primary care facilities; because of this guidelines for primary care have been created by the Medical Foundation for AIDS & Sexual Health. (PMC 2015) When dealing with the presence of HIV the whole staff must be sensitive to all aspects of care and any patient finding out for the first time may need more emotional support than someone coming in for follow up care, as they may have be unaware of their risk until they were diagnosed. (PMC 2015)  Everyone in any facility should become aware of both state and regional HIV testing laws as well as an HIV patient’s rights to privacy. (PMC 2015)   The standard of care for all patients is highly important and no one person regardless of their health issues should be treated any different. (Fremgen B. 2012) For example HIV patients have an increased risk for cardiovascular disease, diabetes and women are more prone to human papillomavirus-related diseases; so the need for many other specialist are common even though the patient is HIV positive, this does not mean you can just call the specialist and say “by the way the patient I am referring to you is HIV positive” you have an obligation to the patient to protect their privacy so you must explain and get consent from the patient and let the patient know that you are informing the provider that he/she is positive for HIV as this is your ethical obligation as a medical professional to protect all other medical professionals by offering limited information to ensure they can protect themselves from any infectious disease.(PMC 2015)

Highlight the importance of well-kept medical records by "recalling" a fictional scenario you overheard in a doctor's office where you once interned, when a patient's record contained information gaps. Examine the information required in a medical record, correct ways to make record alterations, and ramifications for mismanagement of medical records. 

My fictional scenario as an intern is, I was going through and scanning paperwork in to the EMR of many patients from an employee that had walked of the job earlier that week she had worked for the office for over 18 years and when the EMR’s became a factor she was making many mistakes that went unknown for many years until everyone from the receptionist , billing department and anyone needing access to chart to treat the patient stared seeing all the mistakes and it was brought up to the office managers attention she was so upset she just left one day and never came back. There were many mistakes and improper alterations to the charts. Well-kept medical records in health care facilities should follow the standards set forth by the Joint Commission (previously known as the Joint Commission on Accreditation of Healthcare Organizations) for what should be included in the medical record. (Fremgen B. 2012)  These requirements include legal documents that serve as protections for the medical provider, including the following: consents to treatment and/or procedures, financial agreements, personal identifying information, all laboratory, X-ray, and procedure records, acknowledgement of disclosure of privacy practices, records of communication between physician and patient, physician, nurse, and any other health care provider involvement, consultations, assessments, diagnoses, and treatment/medications recommended, discharge summary. (Fremgen B. 2012) When you make alterations to any medical chart you should never use white out and never scribble the information you are changing, drawing a line through the information you want to change along with your initials is the best policy. (Fremgen B. 2012) For example; if a physician receives notice of a lawsuit and looks into the chart to “clarify” certain points and he/she finds alteration, the alterations are considered a deliberate misrepresentation of facts and during medical liability litigation it seriously impacts the ability to defend the claim. (Fremgen B. 2012) The ramifications for mismanagement of medical records are lawsuits, mismanagement of medical records are consider malpractice and the results are punitive damages or nominal damages and can overall affect the doctors reputation along with any of his patients. (Fremgen B. 2012)

Blog Segment Title: Addressing Patient Concerns Regarding Confidentiality

Define for students the Health Insurance Portability and Accountability Act (HIPAA) and its everyday applications in the workplace. Highlight the required permissions necessary to disclose patient information, and the penalties for non-compliance with HIPAA regulations. To help students better relate the issues to a real-world scenario; summarize a legal case where HIPAA regulations were violated.   

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), is to standardize the electronic exchange of data between health care organizations, providers and clearinghouses and to protect the security and confidentiality for patient’s health information. (Fremgen B. 2012) The required permission necessary to disclose patient information must be in writing from the patient that stated who you can receive such information and what amount of information;  health information cannot be used or shared without your written permission unless this law allows it. (Fremgen B. 2012) The penalties for non-compliance with HIPAA regulations are: civil penalties which are$100-$50,000 for each violation up to a maximum of $1.5 million for identical provisions during a calendar year. (Fremgen B. 2012) criminal penalties which are; up to 10 years in jail/prison plus fines up to $250,000.  (Fremgen B. 2012)

Here is a legal case where HIPAA regulations were violated; in July a jury in Marion County, Indiana awarded $1.44 million to a Walgreens customer based on allegations that the customer's pharmacist used her information for personal reasons. (Fox C. 2013) The pharmacist's husband had previously been involved with the customer which resulted in the birth of a child when the customer demanded child support from said husband, he in returned used the information that his wife (pharmacist) provided him with to intimidate her. (Fox C. 2013)

Explore patient confidentiality from both a legal and ethical standpoint. Compose a brief case study for students, written from a patient's perspective, in which the patient expresses concerns over his or her records being shown to a third party.    

My case study is; Jane is a 28 year old female who has been diagnosed with genital warts.

Doctor I am so worried that my family and my boyfriend’s family is going to find out. What are you going to tell the insurance company regarding treatment, will my employer find out because the insurance I have is through them, do you sell any information to drug companies or anyone else or can they track me based on meds you prescribed.

Highlight the many rights of the patient, such as informed consent, and the legal responsibilities a medical professional has to honor those rights.   

The patient has the right to be treated with dignity regardless of the situation they are in and receive standard of care no matter their sex, religion or race. (Fremgen B. 2012) Informed consent not only protects the provider but the patient as well, it basically means the doctor does not have the right to treat or touch a patient without their approval. (Fremgen B. 2012) The legal responsibilities a medical professional has to honor regarding the rights of patients are; HIPAA, as HIPAA was put in place to protect ones privacy regarding personal or medical information.  (Fremgen B. 2012)

As a patient, what concerns do you have regarding confidentiality, and how can medical professionals put those concerns to rest?      

I personal do not have any big concerns regarding a medical professional keeping my confidential information private even though I am aware things like this do go on. I think the way medical professionals can put these types of concerns to rest is to inform their patients with what are all the safe guards, and inform them with what violating HIPAA would do to a practices and a provider.

Fremgen B. (2012) Medical Law and Ethics. Fourth Edition. Retrieved From: Pearson Education, Inc.

PMC. (2003) GPs should encourage more HIV testing says AIDS foundation. Retrieved From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140377/

Fox C. (2013) United States: HIPAA Violation Results In $1.44 Million Jury Verdict Against Walgreens. Retrieved From: http://www.mondaq.com/unitedstates/x/258310/Professional+Negligence/HIPAA+Violation+Results+in+144+Million+Jury+Verdict+Against+Walgreens+Pharmacist

Observing Cultural Beliefs in a Health-Care Setting

Resume the identity of the fictional medical professional to help explore the importance of cultural diversity in a health care setting.

A Jewish nurse

Write a diary entry in which you recall specific memories where cultural sensitivities had to be taken into account, such as having to care for an individual whose religious beliefs impacted how a procedure was performed.     

2/27/2015

Tonight I pounder in thought as I think of yesterday’s encounter, unfortunately a patient of ours has become deathly ill and her family does not agree with American medical treatment  and her end of life is among her and the family. This is a lovely Korean family which I have learned many things about but I never thought about their religious beliefs I guess it never came up. The family wants to fly her home to Korea to die and the doctor is not approving of this nor is he giving medical clearance however, he did call hospice in for her to be placed in their care, the family refused as they felt it was their responsibility to care for her. (Shin K.; Shin C.; Blanchette P.) I wonder if she still alive; did they somehow get her back to Korea or has she passed, I guess I will never know.

Step back from this "diary" entry to define the most important reasons for cultural sensitivity and professionalism in the medical field.

The most important reason for cultural sensitivity and professionalism in the medical field are; the communication with the patient and the patient’s family can improve which this leads to understanding of one’s cultural and these factors can enhance the healthcare provided.

Cite important cases such as Prince v. Commonwealth of Massachusetts as examples of how the legal system has ruled on religious and cultural beliefs within a medical setting. 

Commonwealth v. Twitchell:

 In this case there was the most prominent of a series of criminal cases in the late 1980s and early 1990s where parents who were members of the Christian Science church were prosecuted for the deaths of children because they chose to treat their children’s medical conditions had been treated only by Christian Science prayer. (Case Brief Summary 2012)

In 1988, Massachusetts prosecutors charged David and Ginger Twitchell with manslaughter in death of their two-year-old son Robyn. (Case Brief Summary 2012)  It was declared their son had died due to a bowel obstruction which would have been easy to correct. (Case Brief Summary 2012) The defense the couple was going with are they were within their First Amendment rights to treat their son's illness with prayer and that Massachusetts had recognized this right in an exemption to the statute outlawing child neglect. (Case Brief Summary 2012)  The parents were convicted of involuntary manslaughter and were sentenced to ten years’ probation, the court also order that their remaining children visit the pediatrician regularly. (Case Brief Summary 2012)   The conviction was overturned by the Massachusetts Supreme Judicial Court on a legal technicality that the law is now clear: parents cannot sacrifice the lives of their children in the name of religious freedom. (Case Brief Summary 2012)    

Case Brief Summary. (2012) Commonwealth v. Twitchell. Retrieved From: http://www.casebriefsummary.com/commonwealth-v-twitchell/

Shin K.; Shin C.; Blanchette P. Health and Health Care of Korean –American Elders. Retrieved From: http://web.stanford.edu/group/ethnoger/korean.html

Diaries of the Medical Professional

Assume the voice of a medical professional, employed by your physician, writing in his or her diary. Reveal the character's personal beliefs on cultural, social, and ethnic diversity in health care, as well as the individual's ethical stance on a particular issue that is on his or her mind. 

My character is a Jewish nurse her personal beliefs on cultural, social and ethnic diversity in health care are: that human life is of infinite value and that preservation of life supersedes almost all other consideration. (Reform Judaism.org 2015) She also beliefs that God endowed humanity with the understanding and ability to become one with God in making a better world for all, she feels obligated to provide health care regardless of one’s social statues.(Reform Judaism.org 2015)

The physician she works for is not Jewish and has a belief if one cannot pay for his services he will not see them after a point, as his thought is no payment equals no paycheck. The nurse has an ethical issue with this, she completely understands that paying patients equals a paycheck and the paycheck is needed, her religious beliefs are; “if a doctor withholds services it is considered as shedding blood” she beliefs everyone is equal and entitled to treatment per her religion. (Reform Judaism.org 2015)

Allow this entry to serve as a case study. Recount a workday for this individual and the ethical dilemma the person was faced with. 

2/23/2015

Monday morning is always crazy in the office, and this Monday was no different other than the heart break I am stuck with. How will I sleep tonight as I feel I have disobeyed my faith? Today a young boy was turned away from seeing the doctor as he had an outstanding balance his mom had not paid and it is extremely past due. Why didn't I just pay the balance for them, I could have? I have failed you God and my community, why can’t I get the provider to see all are B’tselem Elohim in the image of God? My confusion runs rapid tonight, and I feel as I need to not just say a prayer as a remainder for my failure but for understanding for the provider I work for; Prayer for Peace.

How did the individual deal with the situation? What was his or her rationale for doing so?   

She stood by doing nothing during the process even though she felt brokenhearted. Her rationale for doing nothing appears to be the need for a paycheck and her faith lead her to pray for understanding of the provider.

Step out of this "diary" entry and return to your own writing voice. Did this individual assess his or her situation accurately? Why or why not? 

Yes, I feel she assessed her situation accurately as she felt her personal beliefs to be everyone deserves healthcare regardless and it is clear that the doctor refuses care if bills are in collections.

How did this individual's personal ethics influence his or her job performance? 

I don’t think the nurse’s personal ethics influences her job performance, however I think it influenced her emotional which may have led her to feel anger with herself or the provider as she feels she broke her beliefs.

Relate the person's case to the broader issues facing medical professionals every day, and some of the effective and ineffective approaches there are to dealing with ethically challenging scenarios related to cultural, social, and ethnic sensitivities.  

Cultural diversity can strengthen and broaden the health care delivery systems, examples of alternatives services and treatment modalities can be provided by other cultures. Most cultural both the patient and the provider use health care that is identified with in their cultural group and is a part of the cultural beliefs system. Nurses need to realize how each cultural understands and processes life, what each cultural considerers to be illness, health and maintenance of wellness, understand what causes certain cultural to think  illness are caused for a reason and understand that how to heal or find a cure can be different across the board. Nurses also bring their own beliefs and cultural and by putting ones cultural aside can sometimes make a difference to response of service. Policies and procedures need to be put in place to accommodate all backgrounds and beliefs as cultures differ and I believe a nurse is in a position to respond to cultural diversity and influence policies in her work place.

Reform Judaism.org. (2015) Jewish Life in Your Life: Jewish Views on Healthcare. Retrieved From: http://www.reformjudaism.org/jewish-views-health-care

Fremgen B. (2012) Medical Law and Ethics. Fourth Edition. Retrieved From: Pearson Education, Inc.

Get Your Moral Hands Off My Ethics Laws!

Highlight a specific case, such as the Baby M Case, and identify the legal, ethical, and moral issues presented in the case.
Surrogate Denied Custody of Child

 

Santa ANA, Calif. in 1990 there was a case where a woman agreed to be a surrogate for a couple and after delivering a baby boy she then wanted to keep him as her own or at least wanted parental rights. (Mydans S. 1990) This case made it to a superior court judge and her parental rights where denied, judge stated “two parents are better than three”.  (Mydans S. 1990)

The surrogate felt she had a legal right as she carried the baby boy for a full pregnancy; another aspect is there is a contract that both parties entered into and are required to uphold. (Mydans S. 1990) The ethical and moral points were no matter where a baby grows the genetics of this said baby is who he/she is. (Mydans S. 1990) This case along with similar ones brings to light the Baby M case from New Jersey in this case the surrogate was both a home and a genetic parent to the baby. (Mydans S. 1990)

Explain what criteria you used to determine whether the issues were legal, ethical, or moral or a combination of the three.

Back to the Calvert case the egg was from Mrs. Calvert and it was fertilized with Mr. Calvert sperm through Vitro and the only reason they could not conceive and carry a baby without a surrogate was Mrs. Calvert had a hysterectomy however her ovaries stilled functioned normally. (Mydans S. 1990)  The biggest thing is the young lady who became the surrogate did so under a contract which paid her for a service she agreed to provide. (Mydans S. 1990)

This case to me is a combination of legal, ethical and morals all wrapped into one. Who has the rights to the baby and under what circumstance warrants that right? The fact that a contract was written and signed not to mention the surrogate was paid, by her trying to gain any rights shouldn’t that be consider a breach of contract; she knew what she signed and she agreed to the terms by accepting payment.  (Mydans S. 1990)

The ethical and morals combination comes into play with the debate regarding nature versus nurture, because of today’s advances in medicine; what role does genetics play? Was the judge in the right by stating “the role of genetics plays a decisive role”? (Mydans S. 1990) 

 This case to me brings to light all the ways a baby or child becomes part of a family, be it by natural birth, surrogacy or adoption; is it genetics or environment? Is there a difference between being a surrogate or foster parent? For me the answer is they are the same; as a mom myself. I do not doubt that you can bond with a baby you carry for 9 months even if it is not yours biologically: no different than a foster parent I am sure does, however both have enter into a contract and understand it is in the purpose to help a family have a baby or take care of said baby or child after they are here.

Examine the common misconceptions of ethical values versus moral principles.  Clearly define the characteristics of each and provide real life examples to help students better relate.     

Ethical values: is a set of established principles governing behavior. (The Free Dictionary 2015)

An example of ethical values is not treating people differently because of their religions, ethnic backgrounds, genders, ages or disabilities.

Moral principles: are the principles of right and wrong that are accepted by an individual or social group. (The Free Dictionary 2015)

 An example of moral principles is; you should not take what does not belong to you.

Mydans S. (1990) The New York Times: Surrogate Denied Custody of Child. Retrieved From: http://www.nytimes.com/1990/10/23/us/surrogate-denied-custody-of-child.html

The Free Dictionary (2015) Retrieved From: http://www.thefreedictionary.com/

Highlight a particular medical news story from the last 10 years that posed both ethical and legal dilemmas, such as the Terri Schaivo case.  

 I have chosen a case of intersex babies, which is when a baby is born with XY male chromosomes but ambiguous genitals.

Reflect on the outcome of the case. With which side of the case did you agree with? What was the ethical and legal basis for your position?  

  

I agree with the activists on intersex infants. I also believe the outcomes are unclear and would encourage the parents and medical staff to educate everyone involved regarding the risks and possible negative outcomes of performing gender assignment surgery on an infant.

The ethical basis of my position on intersexuality is, when trying to define feminine or masculine anatomy, even if you use the word “ambiguous genitalia” instead of intersexuality you still have to decide how small a baby’s penis should be to be considered “ambiguous”.

The legal basis for my position is it is the parent’s decision to make and they should have all the proper information including both short term and long term risks and negative outcomes.

Present both sides of the case and objectively debate the ethical and legal issues being presented. 

Doctor’s side: by six weeks gestation both female and male embryos develop undifferentiated gonadal tissue and can produce either female or male genitalia. Intersex occurs because somewhere along the way an abnormality happens that affects the complete masculinization or with a female some virilizing influence that acts on the developing embryo. Intersex is a condition which affects about one out of every two thousand babies. Most are easy to identify through physical exam and the parents of a baby usually wants to know if it is a boy or girl when baby is born.

Activist side: There are many reasons why when doing gender assignment surgery the wrong gender could be picked. Some conditions to consider are; hypospadias, clitoromrgaly, Complete Androgen Insensitivity Syndrome, Congenital Adrenal Hyperplasia, micropenis, True Hermaphroditism. Studies show that recipients of early gender assignment are dissatisfied with the outcomes there are also many examples in both psychological and medical literature describing the problems linked to this type of procedure.