“Professional Legal Issues with Medical and Nursing Professionals” Please respond to the following: •* From the scenario, analyze the different and overlapping general roles of physicians and nurses as they apply to professional credentialing and subsequ

HAS 515, Lecture 5, Medical Staff Privileges and Nursing and the Law

Slide #

Scene/Interaction

Narration

Slide 1

Scene 1: Exterior Strayer University Building/Classroom

Slide 2

Scene 2

Professor Charles enters classroom and introduces the topics for today’s lesson and begins the lecture.

HSA515_5_2-PC-1.mp3: Hello everyone! Welcome back to class. Today, we are going to discuss an overview of medical ethics, the credentialing process, physician legal issues, and finally, nurses and the law with the context of health services organizations.

Keep in mind that a physician must bear the responsibility to patients first and foremost, as well as society, other health professionals, and themselves. These ethical principles have been adopted by the American Medical Association.

Furthermore, the medical staff organization of a hospital is defined by its hospital bylaws. The medical staff is formally organized with officers, committees, and bylaws. At regular intervals, the various committees of the medical staff review and analyze their responsibilities, clinical experiences, and opportunities for improvement.

The responsibilities of the various committees including:

The Quality Improvement Council;

Executive Committees;

Tissue Committee;

Medical Records Committee;

Credentialing Committee; and

The Infection Committee includes patient care standards and practices;

Management functions;

Administrative duties; and

Credentialing of its members.   

Let’s first discuss the role of the Hospital Medical Director. What do you think are some of the Medical Director’s duties?

HSA515_5_2-C-2.mp3:  The Medical Director is a liaison between the medical staff and the Board of Trustees or Directors and senior management.

HSA515_5_2-D-1.mp3: I agree with Casey, but would I’d like to add to the Medical Director’s duties with the enforcement of the medical staff bylaws and governing body.

HSA515_5_2-C-3.mp3: In addition to what has already been noted, I would say that the Medical Director is certainly a physician who monitors the quality of medical care in the hospital.

HSA515_5_2-PC-2.mp3: Absolutely.  What are some of the liabilities of the Medical Director?

HSA515_5_2-C-4.mp3: The patient care monitoring is critical and any failure by the Medical Director to fulfill their duties can hold the hospital and him or herself liable for patient injuries.

HSA515_5_2-PC-3.mp3: What is an example of such liability?

HSA515_5_2-D-2.mp3: I remember there being a case where a nursing home was indicted by a grand jury for the death of several residents. The Medical Director was also indicted. They explained that they merely signed papers and attended meetings; however this did not absolve them of their responsibility to ensure the adequacy and the appropriateness of the medical services in the organization.

HSA515_5_2-PC-4.mp3: Great job, Donald!  Now let’s take a closer look at how medical staff privileges are restricted to those professionals who fulfill the requirements as described in a hospital’s medical staff bylaws.

Slide 3

Check Your Understanding

Which of the following is a code of medical ethics?

A. Physicians shall uphold the standards of financial collection of patient bills.

B. Physicians shall support access to medical care for all people.

C. Physicians shall respect only the rights of paying patients.

Correct Feedback:

B. Physician shall support access to medical care for all people.

Incorrect Feedback:

A. Physicians shall uphold the standards of financial collection of patient bills.

C. Physician shall respect only the rights of paying patients.

Slide 4

Scene 3

Discussion between Prof Charles and students. 

HSA515_5_3-PC-1.mp3: Appointments to the medical staff, and medical privileges should be granted only after there has been a thorough investigation of the applicant. 

The delineation of clinical privileges should be discipline specific and based on appropriate predetermined criteria that adhere to national standards. 

The privileging and credentialing process is to evaluate the competency of the physician applicant to determine whether he or she is qualified for appointment to the medical staff. Previous memberships on hospital medical staffs and residency training and education are scrutinized carefully; along with any licensing or malpractice problems.As a former hospital CEO, I am very familiar with the arduous and time consuming vetting conducted of every applicant. The hospital’s duty and legal responsibility is to provide a safe environment for the patient.

HSA515_5_3-PC-2.mp3: Disruptive physicians have a negative impact on the organization and eventually the quality of patient care. The hospital should have a Wellness Committee to enforce the right policies as they relate to conflict resolution and professional misconduct among caregivers. The behavior of the privileged physician must be monitored as well as having been thoroughly vetted by the hospital before being credentialed to be on the hospital medical staff. The hospital must provide a safe patient environment and disruptive behavior by the physician can jeopardize effective treatment. A disruptive physician can be counseled by the Wellness Committee and dismissed from the medical staff, if necessary, to prevent harm to the patient and also, interfering with hospital patient care.

HSA515_5_3-C-1.mp3: So, Professor Charles, can you tell us about failing to meet ethical standards?

HSA515_5_3-PC-3.mp3: Absolutely! The Credentialing Committee, for instance, has the choice of enforcing ethical standards and denying privileges based on disruptive patterns of behavior by the physician and interference with the delivery of quality patient care. 

I was the hospital CEO in which a physician was denied privileges by the governing board based on unethical behavior as shown through patterns of rude, abusive, and disruptive behavior. The specific instances were temper tantrums, condescending remarks about women, and several instances of throwing a scalpel.

HSA515_5_3-D-1.mp3: Just to be clear, The board was concerned that the physician’s behavior would continue until a patient was injured as a result of his actions?

HSA515_5_3-PC-4.mp3: Yes, and much of such instances can be detected, not just by hearsay, but through the hospital Wellness Committee.

Misdiagnosis is the most frequently cited injury in malpractice suits against physicians. Although diagnosis is a medical art and not an exact science, early detection can be critical to a patient’s recovery.

HSA515_5_3-C-2.mp3: I am still not quite clear on how wrong site surgery occurs. Can you help me understand it better, Professor Charles?

HSA515_5_3-PC-5.mp3: Sure….I was involved in a case in Florida, as the hospital corporate negligence expert, where the surgeon amputated the wrong leg. The hospital practiced corporate negligence when the operating room nurses allowed the operating room blackboard to be covered with chalk dust so that it could not be clearly determined whether the patient’s “right” or “left” leg was checked to be amputated. Of course, the surgeon and operating room nurses should have reviewed the patient’s chart to confirm the leg to be amputated and the wrist ID band to identify the patient.

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Slide 5

Check Your Understanding

The hospital board determines the competency of a physician applicant to be on the medical staff through _________.

A. Credentialing

B. Privileging

Correct Feedback:

A. Credentialing is the correct answer. It’s when the Credentialing Committee and the board vet or screen the physician for competency

Incorrect Feedback:

B.  Privileging is determined after a physician is credentialed. Privileges are the particular procedures the physician is allowed or not allowed to perform in the hospital.

Slide 6

 Check Your Understanding

A physician who repeatedly misrepresented his/her credentials by claiming to be Board Certified in Internal Medicine can be brought before the state medical licensing board and  _____________ .

1.  Place physician on probation.

 B. Permanently revoke the physician’s license.

C. Suspend the physician’s license.

       D. Reprimand

Correct Feedback:

B. Permanently revoke the physician’s license. Physicians who repeatedly misrepresent their credentials damage their credibility and present a potential danger to the public. The state licensing board duty is to protect the public from deceitful physicians and harm.

Incorrect Feedback:

A. Incorrect.  Probation is of no consequence to the physician who deceives the public.

C. Incorrect.  Please try again. Suspension still allows the physician to practice medicine again and deceive the public.

D. Incorrect.  Please try again.  Remember, the physician can still practice medicine with a suspension.

Slide 7

Scene 4

Discussion of nursing and the law

HSA515_5_4-PC-1.mp3: Now let’s discuss nursing and the law.

Can anyone explain what the state nursing practice act does?

HSA515_5_4-C-1.mp3:  I think I can. Through state law, the nurse practice act oversees the actions, duties, and limits of nurses in their particular roles. Nursing continues to change in response to advances in technology, changes in patterns of demand for health services, and the evolution of professional relationships among nurses, physicians, and other health professionals.

HSA515_5_4-PC-2.mp3:  Very good Casey!  That is an excellent explanation.

HSA515_5_4-D-1.mp3: Prof. Charles, what about nurse licensure?

HSA515_5_4-PC-3.mp3: Donald that is a great question! Each state has a nurse licensing board organized and operated within guidelines of specific legislation to license all professional and practical nurses. A nurse must graduate from a nurse-approved school and pass a state licensing exam before being licensed.

HSA515_5_4-C-2.mp3: So is it safe to say that nurses who transfer to other states may be licensed by reciprocity, waiver, examination, and endorsement?

HSA515_5_4-PC-4.mp3: Yes, Casey, I believe that is a pretty good distinction.

HSA515_5_4-D-2.mp3: I do know that the discussion on nurse licensure has really clarified some questions for me.  Now, a little more clarification on the law would really help.

HSA515_5_4-PC-5.mp3: Well, that is a great lead-in to the next topic, which is the law and practice of nursing.

Slide 8

Scene 5

Discussion on the law and the practice of law.

HSA515_5_5-PC-1.mp3: The nurse manager is a qualified RN or registered nurse who has the authority, responsibility, and accountability for the function, activities and training of the nursing staff.

A manager who knowingly fails to supervise an employee’s performance or assigns a task to an individual whom he or she knows or should have known is not competent to perform the task can be held personally liable if injury occurs to the patient. The employer will be held under the doctrine of respondeat superior as the employer of both the manager and the individual who performed the task in a negligent manner. The nurse manager is not relieved of responsibility even though the employer is liable under respondeat superior.

In determining whether a nurse manager has been negligent, the nurse is measured against the standard of care of a competent and prudent nurse in the performance of supervisory duties.

Who can tell us the role of agency or temporary nurses who work in the hospital but are not employees of the hospital?

HSA515_5_5-C-1.mp3: I would say that the hospital is equally responsible for contract nurses as it is for nurse employees. Hospitals have a duty to ascertain the competency of contract nurses as they do for employee nurses.  

HSA515_5_5-PC-2.mp3: Exactly! It is so important to remember that the organization’s responsibility to the patient cannot be delegated to others.

If the hospital retains a contract nurse to care for its patients the hospital still has the same duty to provide a safe patient environment as it does employing its own nurse employee.

HSA515_5_5-D-1.mp3: Professor, in our discussion, you have provided us with a significant amount of information about nurses. It seems as though the nurse is between a rock and a hard place if a physician’s orders jeopardizes the well-being of a patient.

HSA515_5_5-PC-3.mp3: Donald, nursing guidelines in place but not followed, in spite of the doctor’s orders, are of no value and can fail to protect the patient from harm. The nurses have a duty to report the problem to the supervising nurse and take appropriate action to safeguard the patient.  

A nurse, who fails to report a patient’s condition or symptoms to the attending physician resulting in injury to the patient, is negligent and thus the hospital is also negligent under the doctrine of respondeat superior.

HSA515_5_5-C-2.mp3:  So anytime any caregiver deviates from the standard of care resulting in harm to the patient, the caregiver and employer are held liable?

HSA515_5_5-PC-4.mp3: Exactly. Among the common acts for which nurses can be found negligent include:
Improper or inappropriate administration of medications;
Negligent injections;
Failure to follow physician orders;
Departure from acceptable practice;
Burns;
Infections;
Delay in treatment;
Failure to correctly transcribe telephone orders;
Patient falls and so on.

Slide 9

Scene 6

Summary

Picture of Casey and Donald as they speak.

HSA515_5_6-PC-1.mp3: We are just about out of time.  Let’s go over what we learned in this lesson. 

We discussed medical ethics, medical staff organization, the credentialing process, legal risks of physicians and nurses, and the nurse practice act.

We learned that the corporate negligence doctrine states that hospitals have a duty to provide an adequately trained medical and nursing staff and a safe environment for the patient. We then noted that hospitals have a responsibility to ensure the competency of their medical, nursing staff and all caregivers, and to evaluate the quality of medical treatment rendered on the premises. We also discussed that the medical staff and nurses have ascribed to a body of ethical statements developed primarily for the benefit of the patient. The main theme of our lesson is that nurses and physicians must recognize responsibility to patients first and foremost, as well as to society.

Before we adjourn, are there any questions?

HSA515_5_6-D-1.mp3: I have no questions; I think that the information was clearly presented, Professor.

HSA515_5_6-C-1.mp3: No further questions for me.

HSA515_5_6-PC-2.mp3: Well, if there are no further questions, please take some time to complete the threaded discussions for this week. Take care and see you again soon!