MISSISSIPPI GULF COAST COMMUNITY COLLEGE

RADIOLOGIC TECHNOLOGY PROGRAM

RGT 2132 ETHICAL AND LEGAL RESPONSIBILITIES CHAPTER TWO: PRINCIPLES OF BENEFICENCE AND NONMALEFICENCE

Society expects health care professionals to do good and thereby help patients. This good encompasses proper behavior within law, custom, relationship, and contract. State and federal laws may give the health care professional defined guidelines within which to do good as society sees matters. Principle of Double Effect: A person may perform an act that has evil effects or risk such effects as long as four certain conditions are met. These conditions include: 1) The action must be good or morally indifferent in itself 2) The agent must intend only the good effect and not the evil effect 3) The evil effect cannot be a means to the good effect 4) Proportionality must exist between good and evil effects In order to determine proportionality the following questions may be employed: Are alternatives with less evil consequences available? Could another procedure produce the same diagnosis without pain? What are the levels of good intended and evil risked? What will be gained from the procedure? What is the probability that the good or evil intended will be achieved? What action and influence do the health care team and patient have? What gains to the patient are possible? Beneficence- performance of good acts It requires the action of an imaging professional to do good or prevent harm. Nonmaleficence- the avoidance of evil; hinges on a system of weighting A vital consideration in the practice of imaging is in doing good and not causing harm in doing so. So the stronger of the two actions in Nonmaleficence; However, beneficence is an active process, whereas Nonmaleficence is passive. Difference Between Nonmaleficence and Beneficence Nonmaleficence Beneficence Goal is to do no harm Goal is to do good Achieved through passive omission Achieved through active process Primary responsibility of the health care Secondary in importance to nonmaleficence provider

Towsley-Cook 2009

For imaging professionals, justice (the principle of fairness) requires the performance of an appropriate procedure only after informed consent has been granted. Patient autonomy is complicated when a surrogate is making the health care decisions. In a determination of the best interests of the patient, the surrogate must consider what the patient would do if they were competent enough to make their own decisions. Maintaining a high quality of patient care and technologic skills helps ensure that procedures achieve good for the patient, and practicing protective measures aids in the avoidance of harm. Patients participate in protecting themselves by gathering information and understanding the procedures they are undergoing. Standard of Care- the degree of skill or care practiced by a reasonable professional practicing in the same field The most basic legal parameter in health care is the standard of care, which encompasses the obligation of health care professionals to do no harm and their duty to provide reasonable patient care. Each profession establishes standards of care to define the parameters within which that profession is obligated to practice. Practice standards, educational requirements, and curricula developed for the medical imaging sciences all help to establish the standard of care to which imaging professionals must hold themselves. National professional organizations set the practice standards for health care specialists and are recognized as the authorative basis of a profession. Practice standards may be used to define what radiologic technologists do and how they do it. They can be used to: Develop job descriptions Develop department policies Develop performance appraisals Define job duties Standards for accreditation for educational programs in radiologic sciences as defined by the Joint Review Committee on Education in Radiologic Technology (JRCERT) or other regional accreditation agencies with similar standards must be met for graduates to be recognized by the American Registry of Radiologic Technologists (ARRT). Standards of care are determined by other sources than national agencies. One source is institutional and departmental policies and procedures. If written guidelines exist, professionals need to be aware of them and follow them. Liability can be found based on the failure to follow the written policies of the institution. Other sources of standards of care are federal and state statutes (such as HIPAA) and the Joint commission on Accreditation of Healthcare Organizations (JCAHO).

Towsley-Cook 2009

Negligence- an unintentional tort involving duty, breach of duty, injury, and causation Reasonable care- the degree of care a reasonable person, similarly situated, would use Medical negligence- a breach of the health care providers duty to follow the applicable stand of care, which results in harm to the patient A deviation from the accepted guidelines for a procedure that causes harm to a patient may form the basis for a judgment of liability. In order to prove medical negligence, a plaintiff must provide evidence establishing an applicable standard of care, demonstrate that the standard of care has been violated, and prove a casual relationship between the violation and the alleged harm. Written documentation is extremely important; attorneys, judges, and juries may take the position that if an event was not documented, it did not happen. Medical imaging professionals have an obligation to perform examinations in a manner consistent with policies and procedures, never vary from accepted standards of care, and provide appropriate documentation. Res Ipsa Loquitur- Latin term meaning the thing speaks for itself. It is a legal concept invoked in situations in which a particular injury could not have occurred in the absence of negligence. When res ipsa loquitur is claimed in a lawsuit, all parties involved in the procedure are defendants because obviously one of them is negligent. Therefore they all must try to prove that they were not negligent. From a legal perspective, certain information is mandated by statutes, regulations, and institutional requirements. Proper documentation creates a medical record that accurately and completely reflects the patients care. Poorly maintained, incomplete, inaccurate, illegible, or altered records create questions as to the treatment given to the patient. The Code of Ethics adopted by the ASRT and the ARRT requires that the technologist act as an agent through observation and communication to obtain pertinent information that will aid in the diagnosis and treatment of the patient. JCAHO regulations require that pertinent patient histories be taken before all procedures performed in the department. Departmental policies generally mandate that this information be recorded on every patients medical record. Written and radiographic documentation is a great aid in the defense of a medical negligence case. Technologists have the opportunity and obligation to document thoroughly.

Towsley-Cook 2009

Items that should be included on patient data sheet: Basic patient identification information Pertinent patient history Answers to questions regarding pregnancy and last menstrual period Signature line Time of patient arrival and departure Name of technologist performing examination Comment section The comment section can be used to note any variance from standard procedure such as the patients refusal or inability to cooperate during part of all of the procedure. Can also use this section to document why a procedure was not repeated. Medical records are business documents. They must reflect only factual information regarding patients and their care and treatment. Documenting personal opinions or derogatory statements regarding the patient is inappropriate and may result in liability for the technologist, the medical facility, or both. Incident reporting is a valuable risk management tool that allows the facility to immediately investigate the incident and, if need be, institute corrective action to prevent future occurrences. Events that require incident reports: Sudden death Falls Drug, contrast, and radiopharmaceutical errors and reactions Injuries caused by faulty equipment Injuries to employees and visitors Threats of legal action Unexplained requests from attorneys for medical records The ultimate goal in incident reporting is to improve patient care by helping to prevent future errors and injuries. Any procedure performed in an imaging department that requires the use of intravenous (IV) administration of contrast material carries with it the risk of allergic reaction. This risk is great enough to mandate extensive documentation. Items that should be included in the data sheet for introduction of contrast material and radiopharmaceuticals: Documentation of obtaining of informed consent Allergies Material used Amount (volume and radioactivity, if applicable) Time of administration Path of administration (oral, IV, through catheter, rectal) Injection sites(s) Name of person administering material

Towsley-Cook 2009

Reaction Time of reaction Symptoms of reaction Treatment of reaction Physician treating Time and condition on leaving department

A notation should always be placed in every blank, especially allergies. If the patient has no allergies then NKA (no known allergies) should be noted. Any drugs given must be properly charted in the patients medical record by authorized personnel. Liability has been imposed in cases based on the incorrect identification of films and mix-ups of films. Film identification includes not only the patients identity, but also right and left orientation. The technologist has the sole responsibility for ensuring that this is done. Use of a uniform, consistent system to identify films will help eliminate errors that can lead to litigation in this area. The delay or failure of a report to get to the appropriate physician is a common source of litigation in the radiology area. The most effective way to decrease risk in this area is documentation of when the report is delivered, to whom, and a copy of the report itself. The NCRP states, The primary goal is to keep radiation exposure of the individual well below a level at which adverse effects are likely to be observed during the individuals lifetime. Another objective is to minimize the incidence of genetic effects. Because any exposure is a risk, an important task for the technologist is the use of proper radiation protection to provide high-quality patient care and reduce litigation risk. Methods of radiation protection are use of proper exposure factors, filtration, collimation, and shielding devices. Preventative maintenance and calibration of equipment should be performed routinely to ensure that the radiation dose emitted is accurate and appropriate. JCAHO guidelines exist for safety programs, and institutional policies and procedures generally follow these guidelines. Imaging professionals should know their facilitys programs and be familiar with policies and procedures.

Towsley-Cook 2009