Chapter 3: Legal Issues

1 COMMON LAW
1.1 MNAGHTEN RULE

People who dont understand the nature and implications of murderous

actions because of insanity cannot be held legally accountable for murder

1.2 WYATT V. STICKNEY

Confirmed a right to treatment

1.3 ROGERS V. OKIN

Determined right to refuse treatment

1.4 TARASOFF V. THE REGENTS

OF THE UNIVERSITY OF CALIFORNIA

Ruled that mental health professionals have a duty to warn of threats of harm
to others

2 CIVIL LAW
2.1 NEGLIGENCE

Failure to do or not to do what a reasonably careful person would do under

the circumstances
Careless; departure from the standard of conduct generally imposed
Four elements that must be present:
o Duty to care
o Obligation of reasonable care
o Breach of duty
o Injury caused by breach of duty

2.2 DUTY

TO CARE
A legal obligation of care, performance, or observance imposed on a person
who is in a position to safeguard the rights of others

2.3 REASONABLE CARE

The degree of skill, care, and knowledge ordinarily possessed and exercised
by other nurses in the care and treatment of patients

2.4 BREACH

OF DUTY
Failure to conform to or the departure from a required duty of care owed to a
person

2.5 PROXIMATE CAUSE

Reasonable connection exists between the negligent conduct and the

resulting damages
Negligence must be a substantial factor causing the injury
Foreseeability: the reasonable anticipation that harm or injury is likely to
result from an act or omission to act

2.6 MALPRACTICE

Professional negligence
Failure to take measures to prevent harm to patients or a failure to maintain
the standard of care

2.7 NURSING DELEGATION

Nurse should know and follow local hospital procedures within scope and
authority
Ensure the UAP assigned has been fully trained and is qualified
Know the limitations and responsibilities of nursing practice in the state

2.8 DUTY

TO WARN OTHERS
A nurse who is aware of a patients intention to cause harm to self or others
must communicate this information to other professionals
Should be discussed with the clinical team before taking action to ensure
that patients rights are balanced
Documentation in the patients record is crucial for effective communication

2.9 ASSAULT

The deliberate threat coupled with the apparent ability to do physical harm to
another
No actual contact
Verbally threatening to force the patient to take meds against the patients
will

2.10BATTERY

Intentional touching of another person

Violates the physical security of another
Force used in the unlawful detention of a patient

2.11FALSE IMPRISONMENT

The unlawful restraint of an individuals personal liberty

Unlawful restraint or confinement
Necessity: a person who is physically confined to a given area experiences a
reasonable fear that force will be sued to detain or intimidate him or her

3 COMMITMENT ISSUES

Patients must admit to themselves and others that self-management is no

longer an option

3.1 VOLUNTARY PATIENTS

People or therapists request admission and they sign documents for consent
to treatment
When they are ready to leave, they sign themselves out
Grace period of 48 to 72 hours to assess patients before they leave

3.2 INVOLUNTARY PATIENTS

A person who has the legal capacity to consent to treatment refuses to do so

People who are considered dangerous to self or others due to a mental
disorder can be involuntarily treated
State must produce clear evidence to prove a person is mentally ill and
dangerous
Three types:
o Emergency care: dangerous to self, to others, or gravely disabled
48 72 hours
o Short term observation and treatment
o Long term commitment (3, 6, or 12 months)
People who need prolonged psychiatric care but refuse to seek
such help voluntarily
Usually brought before a hearing officer

3.3 NURSING IMPLICATIONS

Must adhere to legal time constraints

Must be aware of the point at which the emergency treatment is over and
prepare the patient for discharge
Patients must be released when no legal basis exists for confinement in the
hospital

3.4 COMMITMENT

OF INCAPACITATED PEOPLE
Once judged incompetent, the person loses rights such as right to marry,
vote, drive a car, and enter into contracts

Gravely disabled: the inability to provide food, clothing, and shelter to oneself
because of a mental illness
Conservators and guardians: legally obligated to act in the best interest of
the incapacitated patient

4 PATIENT RIGHTS
4.1 RIGHT TO TREATMENT
ENVIRONMENT

WITH THE

LEAST RESTRICTIVE

Least restrictive environment using the least restrictive means (without

restraints, seclusion)
Nurse can be held liable if the patient does not receive adequate treatment

4.2 RIGHT

TO CONFIDENTIALITY OF RECORDS
Patient information should be treated confidentially
Voluntary and involuntary patients are granted this right

4.3 HEALTH INSURANCE PORTABILITY

(HIPAA)

AND

ACCOUNTABILITY ACT

Gives patients more control over their medical records

Right to be educated about HIPAA
Right to access their own medical records
Right to correct or add to their medical records
Right to demand their authorization before medical records are disclosed to
others
To release info about patients, a consent form must be signed first
Doctrine of privileged communication: a psychiatrist is not obliged to reveal
the contents of sessions with the patient

4.4 RIGHT

TO FREEDOM FROM RESTRAINTS AND SECLUSION

Restraint: broad term used to characterize any form of limiting a persons
movement or access to his or her own body
o Physical holds, bed rails, medications, or restraint devices
Seclusion: isolating a person in a room in which he is physically prevented
from leaving

4.5 NURSING IMPLICATIONS

Intervention are aimed at preventing a patients escalation in behavior and

loss of control
Staff members involved in decision to restrain or seclude must have special
training and demonstrate competency

Alternatives must be considered first

Physicians order is required within 1 hour
Least restrictive method or device possible must be chosen
Document events leading to the intervention and justification
Orders must have the type of restraint, rationale for use, and time limits
PRN orders not permitted
Used for shortest possible time
Must tell the patient what behaviors are expected before release
Reevaluate patients at least every 2 hours
Patients must be observed constantly during restraint and seclusion, at least
every 15 minutes
Patients must be debriefed after restraints
Patients have right to request notification of a family member in the even
that restraints or seclusion are implemented
Death of a patient while in restraints is required to be reported to the FDA,
even if the restraints did not contribute to the death

4.6 RIGHT

TO GIVE OR REFUSE CONSENT TO TREATMENT

Right of voluntary patients to refuse treatment
Involuntary patients do not lose their right to give informed consent of
psychotropic drugs
After the court decides a person is not competent to understand the need for
treatment, medications can be imposed
If psychiatric emergency, medications can be given without consent to
prevent harm to the patient or to others
Nurses must ensure that coaxing does not escalate to the point of forcing
medication on a patient
Never hid meds in food or liquid when a patient refuses

4.7 SUSPENSION

OF PATIENTS RIGHTS
Suspension of rights for the protection of patients or others
For therapeutic purposes
No units have unlimited telephone privileges, for example
Requires the nurse to document clearly that allowing the patient to continue
to exercise the specific right might result in harm

5 PSYCHIATRIC ADVANCED DIRECTIVES

5.1 PATIENT SELF-DETERMINATION ACT

Requires all health care facilities that serve Medicare and Medicaid patients
to provide their patients with written info about their right to make decision
about their medical care

5.2 DURABLE POWER

OF ATTORNEY
Written document in which one person authorizes another person to act on
the principals behalf in the event the principal becomes unstable to act on
his own behalf secondary to a physical or mental disability

5.3 ADVANCE DIRECTIVES

FOR MENTAL HEALTH TREATMENT

Use of specific meds, including dose and route
Use of specific treatment options
Behavior management
List of the people who are to be notified and allowed to visit
Consent to contact health care providers
Willingness to participate in research studies