Medico-legal Issues or Medico-legal case (MLC) applies to any case of injury or medical condition in which law enforcement agencies seek to investigate and fix the responsibility regarding the said injury or medical condition.
The nurse and the law
The law is a system of rules a society sets and maintains in order to protect property and prevent persons from harm.
Importance of law to the nurses.
- Protect the public from persons unqualified to practice nursing.
- To define the scope of the nurse e. what s/he is expected by law to do and not to do.
- To protect patients from legal risks
- To deal with legal threats effectively.
- To issue licenses for practice and revoke or suspend a license incase of gross incompetence or negligence.
Categories of Law in Medico-legal Issues
Criminal law: It encompasses conduct considered offensive to the public or society as a whole. Prosecution is brought by the state against an individual for breaking the law known as a crime.
Example; a nurse is arrested for stealing drugs, s/he will be charged and brought before the court to handle the case which is prosecuted by the government of Uganda (Uganda vs. the nurse/criminal)
Civil law: It deals with the rights and responsibilities of private individuals. The civil law is designed to compensate individuals for the harm caused by the health workers. Example; if the nurse negligently administers treatment to a patient which results in to harm, the patient can sue that nurse for his/her negligence and seek compensation for the harm caused. Or the employer of that nurse meets the consequences of the negligence.
Tort Liability/Crimes: These are crimes that are punishable by law. There are two types of tort i.e. intentional and non-intentional. Intentional tort is punishable by law (criminal or civil law.)
Intentional Torts
Assault- threatening or attempting to treat a person with out his/her consent. Example;
- Administering an injection to a patient who had refused Patients have aright to refuse care or withdraw consent at any time.
- Sexual assault; where find the health worker harasses the patient/client
False detention- restraining another person with out legal justification or his/her consent. An example;
- Medical asylums or isolation centers for the presumed mentally
Fraud- purposeful misrepresentation that causes harm to another person. Example;
- Misrepresenting qualifications when applying for licensure.
Negligence- deviation from standard of care that results in HARM to the patient. Example;
- Administering treatment negligently and contrary to the professional standards e. wrong medication, wrong route of administration, wrong dosage and concentration.
- Mistaken identity i.e. preparing a wrong patient for an operation, to exchange babies in the labour room/suit, to exchange dead bodies in the mortuary.
- Failure to communicate verbally or in written concerning the patient’s condition.
- Poor or no maintenance of patient’ records.
- Failure to count sponges and instruments during surgery leading to retaining of some in the patient’s body.
- Loss or damage to patient’s property and fame.
- Breach of duty (negligent action/omission that violates the standard of care expected.)
- Physical or psychological damage of the patient.
- Failure to report and protect victims e.g. child abuse, sexual assault, patients restrained by law, mentally incompetent and infectious disease exposure.
Abandonment- termination of a patient’s care with out assuring the continuation of care at the same level or higher.
Euthanasia (mercy killing) – taking positive step to kill a person in order to end his/her suffering is murder.
Breach of scope of practice- failure to follow the range of activities and limitations of a given medical provider as defined by the state legislation, references national curricula or may be enhanced by medical direction, protocols and standing orders.
Breach of confidentiality- failure to keep privileged information i.e. patient’s history, assessment findings, treatment rendered etc.
RIGHTS OF A PATIENT.
Optimal care of a patient requires harmonious collaboration between the patient and the care provider.
Purpose of the rights
- Help the patients feel more confident in the health care setting.
- To stress the importance of a strong relationship between the patients and their health care givers.
- To indicate the key roles patients play in staying healthy.
The following are the rights of a patient;
- A patient has a right to accurate and clear information relevant to his/ her health care plan except in emergencies.
- The patient has a right to know the identity of medical personnel involved in their care.
- Patients have a right to fully participate in decision making related to their health care.
- A patient has a right to refuse any recommended treatment or care plan.
- They have a right to be informed of the consequences of any action.
- Patients who are unable to participate have a right to be represented by parents, guardians or other family members.
- Patients have a right to respect and non-discrimination from all members of the health care team at all times and under all circumstances.
- The patients have a right to every consideration of privacy concerned with case discussion and consultation. Examination and treatment should be conducted in a manner that protects the patient’s privacy.
- All communications and records pertaining the patient’s care must be treated as confidential by the hospital or health care team.
- Patients have a right to review the records pertaining to their medical care and to have the information explained or interpreted as necessary except when information is restricted by law.
- The patients have a right to choose health care providers who will ensure access to appropriate high quality of care.
- The patients have a right to complain about the care or appeal for proper care internally or externally (an independent system)
- A patient has a right to know the policies of a hospital regarding their care.
HEALTH CARE TEAM AND THEIR ROLES & RESPONSIBILITIES
Medical staff
Physician Assessment
- Performing complete health assessments including: Taking a full medical history including presenting complaint, past illnesses, social history, family history, and performing a complete physical examination
- Screening patients at risk for hereditable conditions and potentially preventable disorders.
- Assessment, diagnosis, primary medical treatment and advice for management of acute medical conditions and injuries.
- Assessment of the exacerbations and complications of chronic medical problem.
Treatment/Management
- Provision of continuous care to patients over their lifetime based on the delivery of the following services:
- Acute medical treatment for a range of medical problems from minor ambulatory care visits to severe life threatening illness presenting to emergency rooms, in hospitals, in the home and in long term care facilities.
- Provide primary reproductive care including maternal and newborn care.
- Provide screening for and treatment of sexually transmitted diseases (STDs.)
- Provide primary mental health care.
- Provide palliative care.
- Provide hospital care where required.
- Provide early intervention and counseling to reduce risk or development of harm from disease.
- Provide appropriate immunizations.
- Provide care and monitoring of chronic illnesses, including patients with complex co-morbidities.
- Provide early access for assessment of episodic illness or injury with provision of diagnosis, primary medical treatment and advice on self-care and prevention.
- Maintain and keep safe the medical record of each patient.
- Perform surgeries where required.
Education/Advocacy
- Provide counseling on many health and health care issues including but not limited to birth control, prevention of STDs, prevention of disease and issues related to the effects of disease on family members.
- Perform the role of advocate to assist patients to navigate through a complex health care system in order to obtain the best care in the most expeditious way in a cost effective manner.
- Identify and meet the needs of the individual patients, the practice population and the community in general by working with a variety of partners throughout the public health, community, and hospital sectors.
Referrals/Collaboration
- Assist with discharge planning, rehabilitation services, out- patient follow-up and home care services.
- Coordinate referrals to other health care providers and agencies, including specialists, rehabilitation and physiotherapy services, home care and palliative care services, and diagnostic services, as required.
- Collaborate with other mental health care providers when required.
- Coordinate referrals to secondary and tertiary facilities based on patients’
- Report births, deaths, and contagious and other diseases to governmental authorities.
- Collaborate with necessary public health initiatives.
Dentist
The general dentist (DMD or DDS) is a primary care professional for patients in all age groups. Dentists take responsibility for the diagnosis, treatment management and overall coordination of services to meet the oral health needs of patients.
Registered Nurses-(PNO, SPNO)
Assessment
- Assess holistically and provide services to patients in all developmental stages, and to families and communities.
- Complete health assessments, including a health history and physical examination.
- Formulate and communicate medical diagnoses.
- Synthesize information from patients to identify broader implications for health within the family.
- Use family assessment tools to evaluate family strengths and needs.
- Determine the need for, and order from, an approved list of screening and diagnostic laboratory tests and interpret the results.
- Determine the need for, and order and interpret reports of X-rays, ECGs and diagnostic ultrasounds for diagnosis
- Assess patient
Treatment/Management
- Initiate and manage care of patients with diseases or disorders.
- Monitor the ongoing therapy of patients with chronic stable illness by providing effective pharmacological, complementary or counseling interventions.
- Prescribe drugs from an approved list.
- Use nursing strategies arising from the best available evidence and consistently incorporate patient’s perspectives in care.
Education/Advocacy
- Determine the need for, and implementation of, health promotion, and primary and secondary prevention strategies for individuals, families, and communities, or for specific age and cultural groups.
- Provide health education to individuals and groups.
- Identify community needs and resources and develop age and culturally sensitive community program.
Referrals/Collaboration
- Consult with a physician in accordance with the standards for consultation with physicians, and/or refer the patient to another health care facility.
Registered Nurses & other nursing staff
Depending on the population health needs and the mix of other providers, the Family Health Team may choose to integrate an RN, RPN, or both into the interdisciplinary team.
Assessment
- Assessment of patient health care needs (physical, emotional, psychological, and spiritual )
- Analysis of the findings of a health assessment.
- Interpret patient health records.
- Observe and record outcomes.
- Collect data through a therapeutic relationship with a patient.
Treatment/Management
- Determine the appropriate service or treatment, the appropriate care provider or the appropriate equipment.
- Provide nursing care and treatment (including complementary therapies and/or counseling) for health problems.
- Help patients to identify and use health resources.
- Involve patients in decisions about their own health.
- Encourage patients to take action for their own health.
- Initiate health education and other activities that assist, promote and support patients as they strive to achieve the highest possible level of health.
- Develop learning resources for nurses and other health care providers.
- Develop and deliver health education programs for patients, or communities.
Referrals/Collaboration
- Collaborate with other health care providers.
- Coordinate patient care.
Midwives
Assessment
- Assess and monitor women during pregnancy.
- Provide pre-natal education.
- Order tests if necessary
Treatment/Management
- Deliver babies.
- Administer some medications during delivery if necessary.
- Manage labour and conduct spontaneous normal vaginal deliveries.
- Perform episiotomies and amniotomies and repairing episiotomies and lacerations, not involving the anus, anal sphincter, rectum, urethra and periurethral area.
- Administer, by injection or inhalation, a substance designated in the regulations (Midwifery Act, 1991, c.31, s. 4.)
- Take blood samples from newborns by skin pricking or from women from veins or by skin pricking.
- Insert urinary catheters into women.
- Prescribe drugs designated in the regulations (Midwifery Act, 1991, c. 31, s.4)
- Monitor women in post partum period.
- Assess/monitor new babies.
Education/Advocacy
- Assist women in making informed decisions about their care and choice of birthplace.
Referrals/Collaboration
- Arrange consultation or transfer to physician if necessary
- Assist in complicated deliveries.
- Report births to governmental authorities.
Dietitian
The Registered Dietitian (R.D.) is a health care professional trained in the single specialty of nutrition science. Their goal is to promote health and fight illness by fostering the practice of proper nutrition to individuals and groups.
Assessment
- Work with individual patients to determine nutritional needs.
- Conduct nutritional and weight assessments.
Treatment/Management
- Develop nutritional plans based on comprehensive needs assessment.
- Provide nutritional counselling.
- Provide weight management counselling.
Education/Advocacy
- Promote behaviour change related to food choices, eating behaviour and preparation methods to optimize health.
- Promote patient independence and autonomy in decision- making for patient to achieve health.
- Conduct patient workshops and seminars.
- Identify community capacities and facilitate community skill- building, health advocacy, and social action.
Referrals/Collaboration
- Work with physicians on medication monitoring plans as they relate to nutrition.
- Communicate relevant nutritional information to other health care providers.
Pharmacists
Assessment
- Ensure appropriate patient information is gathered and recorded.
- Review patient profile including known patient risk factors for adverse drug reactions, drug allergies, known contraindications to prescription drugs, nonprescription drugs, natural health products, and complementary or alternative medicines.
- Evaluate patient drug therapy and identify potential and actual drug-related problems and determine appropriate therapeutic options to resolve or prevent them.
- Conduct patient assessments for medication problems.
Treatment/Management
Pharmacists dispense drugs and medications prescribed by physicians, physician assistants, nurse practitioners, and dentists. They also advise healthcare professionals and patients on the use and proper dosage of medications, as well as expected side effects and interactions with other prescription and nonprescription medicines. These professionals also order and maintain supplies of medications and various medical supplies required for use in the clinical setting.
- Manage medication.
- Monitor patient compliance.
- Home follow-up.
Education/Advocacy
- Patient education to facilitate patient’s understanding of her/his drug therapy and ability to comply with the therapy regimen.
Referrals/Collaboration
- Refer the patient to appropriate health care providers within the Family Health Team if necessary.
- Communicate with physicians to help the patient achieve maximum benefit from drug therapy and to prevent medication errors or potential significant adverse reactions.
Orthopedists
Assessment
- Complete health assessment through information gathering, lower extremity physical examination, patient health history and relevant clinical findings.
- Evaluation of overall lower extremity foot and ankle function relating to activities of daily living.
- Examination and review of lab tests, diagnostic tests and consulting medical and surgical notes.
- Assessment of the impact of an injury, disability or disease (rheumatoid arthritis/diabetes/sprains/strains) on foot function.
Treatment/Management
- Perform surgery by cutting into subcutaneous tissues of the foot.
- Administer, by injection into feet, a substance designated in the regulations.
- Prescribe drugs designated in the regulations.
- Perform surgery by cutting into bony tissues of the forefoot if the required training has been completed.
- Communicate a diagnosis identifying a disease or disorder of the foot as the cause of a person’s symptoms.
- Take x-rays under the Healing Arts Radiation Protection Act.
Education/Advocacy
- Educate and advise patients about the prevention and care of morbid conditions relating to chronic diseases (e.g., diabetes and peripheral vascular disease. )
Referrals/Collaboration
Chiropodists and podiatrists work as key interdisciplinary practitioners in hospitals, community health care centres, and nursing and retirement homes. In private practice, they receive referrals from medical and other health care practitioners and consult with these referring practitioners to provide timely and optimal care for their patients.
Community health worker
Community Health Workers (CHW) can be broadly defined as individuals who connect health care consumers and providers, promoting health particularly among groups who have traditionally lacked access to care. The CHW is a member of the community and play an important role in identifying a community’s problems and in developing solutions. Examples of successful uses of the CHW include: using ex-addicts to educate intravenous drug users about AIDS risks and increasing breast, cervical, and colon cancer screening in minority communities.
CHWs may play critical roles in improving community health status by providing cultural and technical linkages between community members, primary care providers, and the health care delivery system.
Assessment
- Intake Assessment.
Treatment/Management
- Facilitate coordinated access to services in areas such as assistance with daily living, housing, crisis intervention, treatment, health promotion and
- Facilitate linkages with appropriate services, supports, and prevention.
- Provide crisis intervention and intensive/short-term resources.
- Evaluate achievement of patient goals.
Financial management: budgeting, banking.
- Nutrition: menu planning, grocery shopping, food preparation.
- Personal effectiveness: problem-solving, decision making, communication and interpersonal skills, goal- setting, time structuring and management.
- Community integration: use of transit, social/recreational, peer support and other services.
- Health and wellness: support clinical plan including medication, appointments, healthy choices and
- Employment/service: support maximum involvement in volunteer, community service or paid employment.
- Personal care: hygiene grooming, self-care skills, clothing management.
- Household management: such as laundry and house cleaning.
- Housing support: finding and maintaining adequate housing, liaison/support to landlord, utilities.
Education/Advocacy
- Advocacy: support appropriate use of available community public services and program.
- Advocate for patient’s civil and legal rights. Referrals/Collaboration
- Collaborate with other professionals regarding after care plan and follow-up activities.
- Refer to community programs and mental health services.