R U Reasonable?
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The document discusses several key concepts regarding medical legal issues: 1) It describes the reasonable person theory of tort law and what is required for appropriate informed consent. 2) It lists three common charting pitfalls: too little documentation, too much documentation, and illegible documentation. 3) It discusses the landmark case establishing informed consent requirements, noting that patients have the right to determine what is done with their own body and must be informed of treatment options, risks, and alternatives.
R U Reasonable?
- 1. Basis Behind Medical Legal Issues NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 2. Describe the Reasonable Person Theory ofTort Law What is required for Appropriate Informed Consent ListThree Charting Pitfalls NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 3. Statutory Law Law is passed (i.e.) Nurse Practice Act Common Law Legal Precedent NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 4. Criminal Intentional Civil Unintentional NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 5. Duty Medical Legal—Duty to care Breech Not acting within your standard of care Harm Actual or imagined Causation Did the breech cause the harm NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 6. Negligence Law Each member of society has a duty to behave as to avoid unreasonable risks of harm to others We Must Act: As a reasonable person of ordinary prudence in similar circumstances NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 7. Considers Personal Characteristics Similar age, intelligence, experience Similar circumstances ▪ Emergencies require less of a standard Similar physical disabilities Mental Disabilities do not relieve a person from conforming to Reasonable Person Standard ▪ Same is true of intoxication NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 8. Used as a judgment: Did a persons conduct fall below this standard… ▪ Was there a breech of Duty? NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 9. Objective for two reasons Hypothetical Person ▪ Ideal attributes Focused of behavior ▪ Rather than the subjective mental state NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 10. Flexible Tailored to the facts of the case ▪ Reasonable Foreseeablity ▪ Magnitude ▪ Social Utility ▪ Avoidance ▪ Context NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 11. Could a reasonable person predict the foreseeable risk of harm NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 12. As the seriousness of the risk increases the duty to avoid the behavior increases NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 13. The more valuable the conduct to society, the less likely the breech Good Samaritan Laws NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 14. Emergencies do not need the same cautiousness and deliberation as planned events NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 15. Diagnosis Purpose of Procedure Risks involved Success Rate Failure to Act Alternative treatments NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 16. Landmark case for informed consent handed sown in USAppeals Court Washington District NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 17. 1959 – 19 y/o clerk in DC with back pain sought tx and found to have bulging disc @T4 Surgeon called and talked to mother inWV. No record of consent during conversation Surgery performed and mom arrived after surgery, consent signed. On PO day 2 pt assisted OOB to void and was left unattended and fell in process of voiding Lower extremity paralysis Months later, crutch walking with no bowl or bladder function NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 18. “every human being of adult years and sound mind has a right to determine what shall be done with his own body” Right to Self Determination NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 19. Must be able to trace: Knowledge of options Risks of each Magnitude of Risk Risk of failure to act NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 20. Required to communicate this to the patient Medical training enables providers to a self-satisfying course of action Prerogative is of the patient not the physician NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 21. Justices found: This is doctrinal emphasis not an addition to malpractice law Settled the rule: ▪ Therapy not authorized equaled a tort – Common Law Battery ▪ CriminalTort (intentional) not a CivilTort (unintentional) NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 22. Degree of care which a reasonable prudent person with like training would have experienced under similar circumstances Physician performs at a higher level than a non-physician Same of similar location/setting NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 23. Are but an adaptation of general standards Required to act as reasonable men possessing their medical talents would NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 24. Unwilling to adopt full disclosure Unrealistic to expect disclosure of every risk no matter how remote What a reasonable practitioner would bare More importantly: What a reasonable person would expect ▪ Patient prerogative ▪ Self-determination shapes duty to reveal NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 25. Two exceptions to the rules: Incapable of consenting and failure to treat would harm ▪ Unconscious patient in the ED Disclosure poses threat to the patients care NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 26. Not Duress but undue influence Duress Induced by threat No reasonable alternatives Undue Influence A relationship exists ▪ Trust and Confidence ▪ Domination Unfair persuasion NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 27. Healthcare Insurance PortabilityAssuranceAct NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 28. Too little Too Much Illegible NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD
- 29. NCANA Dist. I & II Mtg. 2015 JerryCoy, CRNA, PhD