MIDTERM-RDT 105
MIDTERM— RDT 105: ETHICS
Lesson 2:
ETHICAL AND LEGAL ISSUES IN HEALTH CARE
● TOP 5 MOST COMMON LEGAL HEALTH ISSUES
1. Patient Confidentiality
- anyone legally authorized to make healthcare decisions for a person lacking such capacity has the
same right of access to the person’s personal medical information.
- health care practitioners should routinely disclose their practices regarding privacy of personal medical
information.
2. Patient Relationship
- having relationship with the patient
3. Malpractice
- a dereliction of professional duty or a failure to exercise an ordinary degree of professional skill or
learning by one (such as a physician) rendering professional services which results in injury, loss, or
damage.
■ Common Types of Medical Malpractice
- Failure to diagnose a serious condition
- Surgical errors
- Incorrect treatment of a medical condition
- Birth injuries
- Cancer misdiagnosis
- Medication errors
- Bedsores
- Anesthesia errors
- Dental mistakes
- Failure to prevent or treat infections
4. Negligence
- a failure to behave with the level of care that someone of ordinary prudence would have exercised
under the same circumstances.
- the behavior usually consists of actions, but can also consist of omission when there is some duty to
act.
■ Common Medical Negligence
- Incorrect medication prescriptions or administration of drugs. This can occur when a patient is
prescribed the wrong drug for their illness, receives another patient’s medication or receives an
incorrect dosage of medication.
■ Examples of Medical Negligence
1. Failure to Diagnosis
2. Providing Low-grade Treatment
3. Negligence in Providing Care
■ Different Types of Negligence
1. Gross Negligence
- severe form of negligence
- theft, murder
2. Comparative Negligence
- giving percentage to both casualties
3. Contributory Negligence
- legal doctrine: injured person has contributed to the negligence
4. Vicarious Negligence/ Imputed Negligence
- one person is held for the negligence of another
:
- liable of the superior to protect the worker
5. Informed Consent
- is the process in which a healthcare provider educates a patient about the risks, benefits, and
alternatives of a given procedure or intervention.
- The patient must be competent to make voluntary decisions about whether to undergo the procedure
or intervention.
- Informed consent is both an ethical and legal obligation of medical practitioners.
■ Types of Informed Consent
1. Signed/Written Consent
2. Online Consent
6. Access to Quality Health Care
- health care access is the ability to obtain healthcare services such as prevention, diagnosis, treatment,
and management of diseases, illness, disorders, and other health-impacting conditions.
- For healthcare to be accessible it must be affordable and convenient.
PARAMETERS OF LEGAL RESPONSIBILITY
● CRIMINAL LIABILITY
- simplest terms— when you are “criminally liable”, it mean you may be held legally responsible for breaking the
law.
- this can be potential or actual responsibility— meaning that you actually committed the crime, or that you are
simply suspected of committing it.
- If the liability is proven in court, you will be held responsible for the crime and sentenced accordingly
- In cases of criminal liability, the government believes you may have committed a criminal act, and the
government prosecutes the case in court.
● WHAT DETERMINES CRIMINAL LIABILITY?
- In order to prove that you are criminally liable, the prosecution must prove “beyond a reasonable doubt“ not only
that you committed the crime, but that you intended to do it. However, certain exceptions exist where “strict
liability” is enforced, meaning that you can be held liable for the crime regardless of your intentions.
- For example, you may be convicted of selling alcohol to a minor whether or not you knew the person’s age.
- You can also be ticketed for speeding even though you didn’t know you were exceeding the speed limit. Your
experienced criminal defense attorney can advise you on whether your alleged offense is a strict liability offense.
● FOUR ELEMENTS OF CRIMINAL LIABILITY
1. ACTUS REUS
- guilty of act
2. MENS REA
- guilty of mind
3. CONCURRENCE
- actus reus + mens rea
4. CAUSATION
- severe cause of the act
● CIRCUMSTANCES WHICH AFFECT CRIMINAL LIABILITIES
○ JUSTIFYING
- under which the law justifies a person from criminal liability for the commission of a crime
- self defense
○ EXEMPTING
- circumstances under which the law exempt a person from criminal liability for the commission of a
crime
- with mental health condition or below 9 years old
○ MITIGATING
- those which do not constitute a justification or excuse of the offense in question, but which, in fairness
and mercy, may be considered as extenuating or reducing the degree or normal culpability
:
○ AGGRAVATING
- those attending the commission of a crime which increase the criminal liability of the offender or make
his guilt more severe
LEGAL ASPECT AND THE RADIOLOGIC TECHNOLOGIST
● DOCTRINE OF FORCE MAJEURE
- force majeure— act of God
- an irresistible force, one that is unforeseen or inevitable
● DOCTRINE OF RESPONDENT SUPERIOR
- let the master answer for the acts of the subordinate
● IGNORANTIA JURIS NON EXCUSAT
- ignorance to the law is not an excuse
● DURA LEX SED LEX
- the law is harsh but it is the law
● NULLUM CRIMEN, NULLA POENA SINE LEGE
- no crime, no punishment without the law
● FELONIES— acts or omission punishable by law and they may be committed not only by means of deceit but also
by fault
● CLASSIFICATION OF FELONIES ACCORDING TO MEANS BY WHICH THEY ARE COMMITTED
○ INTENTIONAL FELONIES— Deceit (Dolo)
- the act is performed or the omission incurred with deliberate intent or malice to do an injury
- crimes or offenses that are intentionally carried out to cause harm and injury to others
○ CULPABLE FELONIES— Fault/Guilt (Culpa)
- the act is performed without malice
- there is no intention to harm others but the harm was still done either through negligence, lack of skill,
or even through the ignorance of the law
FIRST BOARD OF RADIOLOGIC TECHNOLOGY
● HISTORY
- The Board of Radiologic Technology was created on February 27, 1992 by virtue of Republic Act No. 7432 also
known as the "Radiologic Technology Act of 1992." The first Board was composed of Fortunato C. Gabon Jr. as
Chairman with Jose T. Gaffud, Editha C. Mora, Dexter R. Rodelas and Dr. Eulinia M. Valdezco as Members. The
Rules and Regulations governing the examination, registration, licensure and practice of radiologic and x-ray
technology was promulgated on September 20, 1993.
- The Board conducted its first fully computerized licensure examinations on December 27, 1993, the results of
which were released on April 9, 1994.
● 1ST CHAIRMAN— Fortunato C. Gabon (001)
● RADIOLOGIC TECHNOLOGISTS:
○ Dexter Rodelas (002)
○ Editha C. Mora (003)
● RADIOLOGIST— Jose T. Gaffud
● PHYSICIST— Eulina M. Valdezio
Lesson 3: TORTS— Intentional and Unintentional
● TORTS
- wrongful actions that can cause harm to others
- through tort law, society seeks to compensate those who have suffered injuries as a result of the wrongful
conduct of others
- aims to provide the compensation to those who suffered because of someone else’s action
- for the victim not to be (lugi)
- Product liability is a major area of tort law under which sellers can be held liable for defective products
- CEO’s should find ways or seeks to compensate for the ones who suffered from their products
(victims)
- A growing body of law (purpose or aim) is designed to protect the health and safety and the credit of
consumer
- tort law and different body of laws
:
● THE BASIS OF TORT LAW
○ Goal of Tort Law
■ To provide compensation to someone who has been harmed
■ In torts cases, one person sues another to get money or other relief for the harm suffered
■ Main purpose— is to protect people’s right and provide remedies when those rights are violated (Ex.
One person or group brings suit against another)
○ Wrongs and Compensation
○ One Person or Group brings Suit Against another
■ Obtain Compensation (money damages)
■ other relief for harm suffered
○ Purpose of Tort Law is to Provide Remedies
■ Invasion of protected interests or rights
■ provide remedies to compensate for the wrongful actions
○ Elements of a Tort
■ Points that plaintiff(injured person or victim) must prove to succeed
● INTENTIONAL TORTS
○ Requires Intent
- actions are intended or you are knowledgeable, or aware of the specific wrongful action
- the wrongful action is within your 100% capacity of knowledge
○ Tortfeasor— the person accused
- intended the consequences of an act
- knew or should have known that certain consequences would result from an act
○ Fall into Two Categories:
■ AGAINST PERSONS
- problems within individuals
1. ASSAULT
- act is intended to cause an apprehension of harmful or offensive contact
- act caused apprehension in the victim that harmful or offensive contact is imminent
- when someone’s action make another someone afraid, they are about to get harmed
- mentally or emotionally afraid without physical contact
- example: threatening
2. BATTERY
- an intent to cause an unwanted contact
- there’s a specific contact involved
- example: when someone intentionally makes harmful physical contact with another person
without their consent
- the unwanted harmful contact
- compensation
- defense to assault and battery:
- consent— ask
- self-defense
- defense of others
3. FALSE IMPRISONMENT
- intent to confine or restrain a person without their consent or against their will
- actual confinement in boundaries not of the plaintiff’s choosing
4. INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS
- causing harm to one’s emotional or mental health
- severe anxiety or depression
- outrageous conduct by the defendant
- intent
- severe emotional distress suffered by the plaintiff with the emotional distress being caused by
the defendant’s conduct
5. DEFAMATION
- giving false information against a specific person that can degrade their identity
:
- wrongfully harming a person’s good reputation
- Slander— breaching this duty orally
- Libel— breaching this duty in writing
- the publication requirement- proof
- defense against defamation
- truth
- privileged communications
- made without actual malice
6. INVASION OF THE RIGHT TO PRIVACY
- use of person’s name, picture, or likeness for commercial purposes without permission
- intrusion into person’s affairs or seclusion
- publication of information that places person in false light
- Public disclosure of private facts about individual that ordinary person would find
objectionable
7. APPROPRIATION
- use by one person of another person’s name, likeliness, or other identifying characteristic
without permission and for the benefit of the user
- scamming
8. MISINTERPRETATION (FRAUD)
- intentional deceit for personal gain
- elements of fraud
- misinterpretation of facts or conditions with knowledge that they are false or with
reckless disregard for the truth
- intent to induce another to rely on the misinterpretation
- justifiable reliance by the deceived party
9. WRONGFUL INTERFERENCE
- wrongful interference with a contractual relationship
- valid, enforceable contract exists between two parties
- third party knows that this contract exists
- third party intentionally causes either of the two parties to breach the contract
■ AGAINST PROPERTY
1. TRESPASS TO LAND
- trespass criteria, rights and duties
- enter or invaded one’s land without permission
- defense against trespass to land
2. TRESPASS TO PERSONAL PROPERTY
3. CONVERSION
● UNINTENTIONAL TORT
- refers to an act that is unintended but causes injury, losses, and damages to the victim.
- when an unintended accident occurs, it can lead to body injury, damage of property or even material loss, such
an unintended accident is an unintentional tort
○ NEGLIGENCE
- most common unintentional tort that can be proven in court
- If a plaintiff files a lawsuit against the defendant for negligence, the plaintiff is required to prove
three factors in the court. These are:
1. Duty of Care: the plaintiff must be able to prove that the defendant owed the duty of care by
avoiding careless actions that could result into harm
2. the plaintiff must also be able to prove that the defendant provide standard care that a
‘reasonable’ person would have provided
3. the plaintiff must be able to prove that their injuries or losses were caused by the
defendant’s actions
Lesson 4: Legal Doctrines—Professional Standard and Medical Records
:
● LEGAL DOCTRINES
A. PROFESSIONAL STANDARD
- set of practices, ethics, and behaviors that members of a particular professional group must adhere to
- pertains to perfection
- these sets of standards are frequently agreed to by a governing body that represents the interests of
the group
- the main purpose of professional standards is to direct and maintain safe and clinically competent
nursing(all professionals in the hospital) practice.
B. MEDICAL RECORDS
- legal document providing a chronicle of a patient’s medical history and care
- physicians, nurse practitioners, nurses and other members of the health care team may make entries
in the medical record.
- it includes a variety of types off “notes” entered over time by health care professionals, recording
observations and administration of drugs and therapies, orders for the administration of drugs and
therapies, test results, x-rays, reports, etc.
● 10 COMPONENTS OF A MEDICAL RECORD
1. IDENTIFICATION INFORMATION
- one of the first important components
- medical records need to have information to help identify who the history belongs to
- ex. date of birth, name, marital status, and social security number
- personal information of the patient
- must be input correctly and accurately
2. MEDICAL HISTORY
- previous history
- considered for everyone, even those who have never been to a doctor or hospital
- most people in the US do have at least some form of medical history, whether large or small
- includes:
- allergies
- treatments
- medical care
- present and past diagnosis
3. MEDICATION INFORMATION
- medicines that a patient is ingesting need to be documented in their medical record as it could affect
their course of treatment
:
- whether they have tried herbal remedies, illegal substances, or OTC medication, everything should be
included
4. FAMILY HISTORY
- can play an important role in their health
- many health concerns can be genetic, making them important to add to the file
- some health problems of family members (immediate—first family) may not be worrisome, however,
some hereditary diseases and cancers that may be passed down should be documented
- thus, if it is accessible, a patient’s family’s medical history is often added to their medical record
5. TREATMENT HISTORY
- another vital part of the patient’s medical record
- it encompasses all treatments they have ever undergone and their results
- some things include:
- chief complaints
- history of illness
- vital signs
- physical examination
- surgical history
- obstetric history
- medical allergies
- family history
- immunization history
- habits (diet, alcohol intake, exercise, drug use/abuse, smoking, etc.)
- developmental history
6. MEDICAL DIRECTIVES
- crucial documents to outline directions by the patient regarding what they want or do not want in case
they cannot communicate their medical care
- direction of medical applications or decisions
- these include the DNR, knows as the ‘do not resuscitate’ order, and their will
7. LAB RESULTS
- different lab results that the patient has received are all added to the record
- these can be results on lab results related to cells, tissues, or body fluids.
- other results such as x-ray and imaging tests produced through mammograms, scans, x-rays, and
ultrasounds are all added as well
8. CONSENT FORMS
- patients should be able to make informed decisions about their care
- physician should let the patient know all important information about all medical procedures
- information includes:
- diagnosis
- recovery chances
- recommended treatment
- benefits and risks of the treatment
- risks if the treatment is not not taken
- success probability if treatment is taken
- length of recovery time and challenges
9. PROGRESS NOTES
- made by physicians if changes or new information come up during the course of the treatment
- some information included within these notes are:
- bowel and bladder functions
- observation of the mental and physical condition of the patient
- sudden changes taking place
- food intake
- vital signs
10. FINANCIAL INFORMATION
- an important part of patient’s medical records
- cards, SSS, PhilHealth, contact number, emergency contact
- backup information
- some of the information included is:
- subscriber name
:
- policy number
- name, phone number, and address of insurance payer
- relationship of the patient to the one insured
- phone number, address, and name of the responsible party
- occupation, employer phone number, and employer of the responsible party
● USE OF MEDICAL RECORDS
○ To document the course of patient’s illness and treatment
○ Communicate between attending doctors and other healthcare professionals providing care to the patient
○ Collection of health statistics
○ Legal matters and court cases
○ Insurances cases
● COMPONENTS OF MEDICAL RECORD
○ Front sheet or identification summary sheet
○ Consent treatment
○ Legal documents like referral letter, request for information etc.
○ Discharge summary, referral slip
○ Admission notes, clinical progress notes, nurses progress note
○ Operation report if operation has been performed
○ Investigation reports like, x-rays, pathology etc
○ Orders for treatment and medication forms listing daily medication ordered and given with signatures of the
doctor prescribing the treatment and the nurse administering it
● LABELING OF MEDICAL RECORD FOLDER
- the following should be written on the medical record folder:
○ patient’s name
○ patient’s medical record number
○ year of last attendance
● ISSUE OF MEDICAL RECORD NUMBER/UID NUMBER
- medical record numbering systems are how we give a number to medical records
○ MANUAL SYSTEM
- MRN should be issued in straight numerical order from the number register commencing with the
number 1.
- For example, if the last number given to a patient were 342, the number issued to the next patient
would be 343 and the next 344 and so on.
○ COMPUTERIZED SYSTEM
- UID/ MR Number is auto generated and there is OPD visit numer and IPD Visit Number
- UID Number is permanent but OPD/IPD Visit Number may change
● SEQUENCE OF MEDICAL RECORD
○ Information and identification sheet
○ Clinical notes
○ Diagnostic reports
○ Blood transfusion notes
○ Nurse notes
○ Informed consent
- x-ray films are stored separately
● COMPLETION OF MEDICAL RECORDS
○ The consent form for treatment has been signed by the patient;
○ Patient identification details (name and medical record number) are correct and entered on all forms
○ Doctors have recorded all essential information
○ Doctors have signed and dated all clinical entries
○ The front sheet has been completed and signed by the attending doctor
○ Nurses have recorded and signed all daily notes regarding the condition and care of the patient
○ All the orders for treatment have been recorded in the medication form and signed
○ Medication administration has been recorded and signed
○ The anesthetic form (if any) has been completed and signed
:
○ The operation form (if any) has been completed and signed
○ The main condition/principle diagnosis has been recorded on the front sheet
○ Operations and/or procedures have been recorded on the front sheet
○ Diagnostic reports have been attached
○ Discharge/referral summary is duly filled and signed
● RADIOGRAPHIC IMAGES AS LEGAL DOCUMENTS
- Medical imaging developed rapidly to play a central role in medicine today by supporting diagnosis and
treatment of a disease.
- Medical imaging encompasses technologies like ultrasonography, mammography, computed tomography (CT
scans), and nuclear medicine
- Medical imaging is crucial in a variety of medical settings and at all major levels of health care
- the use of diagnostic imaging services is essential in confirming, assessing and documenting the course of
many diseases and response to treatment
- Many low and lower-middle income countries cannot afford imaging equipment, adn often there is a shortage of
healthcare workers trained to use such equipment
- the WHO collaborates with partners and manufactures to develop technical solutions for improved diagnostic
imaging services in remote locations.
- in addition, WHO and partners provide training programs in the use and management of medical imaging with
emphasis on patient safety
● CT SCAN PATIENT HISTORY FORM
● MAMMOGRAPHY PATIENT HISTORY FORM
● X-RAY FILM
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