Ethics Ch. 4 and 5
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. What would you like to do?
When was the Hippocratic Oath developed and by who?
Confiedentiality is not only ethical but mandated by________.
- (includes specific treatments and conditions. Also, can not legally say the pt was there)
Who does the Privacy Act of 1974 apply to?
Only US citizens and permanent residents
Who signed the Privacy Act of 1974 into law?
President Gerald Ford
What was the forefather to HIPAA?
Privacy Act of 1974
- It is not exclusive to medical information
- Addresses a variety of information including how social security numbers are shared.
Why is confidentiality important?
- Because a person's healthcare information is private and personal.
- because a person might be more likely to seek healthcare if assured of privacy.
Give examples of breach of confidentiality.
- Receptinist asking why patient is seeing dr in waiting room
- Sign in list in drs. office that contains personal into such as phone and address
- Nurse and dr. discussing pt info in the hall before going into seeing the next pt.
- Insurance clerks leaving computers unattended
- Night shift custodianreading records when clearing at night
Who signed HIPAA into law and in what year?
The federal law (HIPAA) was enacted to do what?
- To address privacy issues
- And continuation of health insurance coverage
What does the HIPAA legislation give to the pt?
Gives pt. more control over personal medical information and how it is used or released.
What are the five different forms that are requited to protect pt information(HIPAA)?
- The privacy notice
- The signature of the pt indicating reception of the privacy notice
- The pt's. permission to provide medical information to other people or entities
- A trading partner agreement specifying the parties involved (ex. physician and pt.)
- A contractual statement b/w the physician or facility and the pt.
One of the goals of HIPAA when individuals change health insurance progrmas is to improve conditions, including portability. What does portability mean?
Means that no lapse of healthcare coverage occurs when a person changes from one job to another even if insurace carriers change.
One of the goals of HIPAA. Provided there is no lapse of coverage, to cover preexisting conditions. What is the meaning of preexisting conditions?
Preexisting conditions are ailments or diseases that the pt has before health insurance coverage begins.
The preexisting allowance in the law permits continuous coverage through_______________________.
The Consolidated Omnibus Budget Reconciliation Act (COBRA), 1985
The goals of HIPAA is the protections of_____________________.
Private medical information, standardization and simplification of forms, and strategies to prevent fraud, waste, and abuse.
What is the 1st overall goal of HIPAA?
To protect and enhance the rights of consumers by providing them access to their health information and controlling the inappropriate use of that information.
What is the 2nd overall goal of HIPAA?
To improve the quality of health care in the US by restoring trust in the healthcare system among consumers, health care professionals, and the multiple organizations and individuals committed to the delivery of care.
What is the 3rd overall goal of HIPAA?
Improves the efficiency and effectiveness of healthcare delivery by creating a national framework for health privacy protections that builds on efforts by states, health systems, and the individual organizations and individuals.
HIPAA has added _____ and _______ to issues regarding electronic personal healthcare information.
HIPAA requires that only the _______ necessary information for the purpose of disclosure be ________, rather rhan the entire record as was assumed in the past.
Under HIPAA, does the pt have the right to inspect and copy records?
Under HIPAA, does the pt have the right to ask for info to be amended if believed to be incorrect?
Under HIPAA, does the pt have the right to ask what disclosures have been made?
Under HIPAA, does the pt have the right to request restriction of information disclosure?
Under HIPAA, does the pt have the right to request the method of communication?
Under HIPAA, does the pt have the right to a paper copy of the privacy notice of the institution?
What year was HIPAA written into law?
How many implementations were there of HIPAA? What were they and what were there years?
- insurance claims AND clearinghouse of electronic and medical claims (2002)
- federal privacy regulations (2003)
What are two main ways for the healthcare professional to achieve confidentiality for the pt?
- professional silence
- secure data management(ex. having access to a pt's medical record does not involve automatic permission to view the record)
How many primary components of HIPAA are there?
- Title 1-Insurance Portability
- Title 2- Administrative Simplification
- Title 3- Medical Savings and Tax Deduction
- Title 4- Group Health Plan Provisions
- Title 5- Revenue Offset Provisions
It is mandated that businesses with ____ of more employees must provide employees who leave that business health insurance for up to ____ months, usually paid for by the employee. Under ________ law.
When was the Privacy Rule implemented and in what year did it go into effect?
- Implemented in 2003
- Went into effect in 2001
A portion of HIPAA that refers to personal data, known as protected health information (PHI)
The Privacy Rule
A specific medical information pertaining to the pt, such as name, date of birth, and social security number.
PHI (protected health information)
Health insurance companies (vendors) may obtain medical information about a pt only if the pt signs a ______________.
release of information form
Health information records includes:
pharmacy records and mental health records and is not limited to the confines of a hospital or dr.'s office
Is information shared with law enforcement officials kept private by HIPAA?
Is information maintained by the CIA kept private by HIPAA?
No, outlined in the Privacy Act of 1974(US Department of Justice, 2003)
Can financial documents (bankers or creditors) be shared?
Can insurance representatives information be shared?
Can educational records be shared?
Yes (teachers and administrators, including vaccinations and other info)
Can info be shared if a subpoena for medical records, needed in court cases is given?
Is this an exception to HIPAA, electronic database files of private companies?
Can employee records be shared?
- includes any employer sponsored health program in which you may participate or information needed by your employer for the Family and Medical Leave Act.
A company that is self-insured for medical coverage of employees, the handling of insurance claims and other health-related info is covered by HIPAA.
the Family and Medical Leave Act.
Exceptions to HIPAA include:
- suspected abuse
- certain contagious diseases
- (may vary according to state law)
- may be overridden when the life or safety of the pt is endangered such as when knowledgeable intervention can prevent threatened suicide or self injury
- the moral obligation to prevent substantial and foreseeable harm to an innocent 3rd party usually is greater than the moral obligation to protect confidentiality
Which other legislations can cover personal records?
- the Family and Medical Leave Act (FMLA)
- the Gramm0-Leach-Bliley Act (GLB)
Who should you visit for more info on medical information, safety records, and medical leave records?
- The US Department of Labor
A national data bank (under HIPAA) to prevent fraud/abuse by practitioner and suppliers.
Healthcare Integrity and Protection Data Bank HIPDB)
When did the HIPDB become operational?
Prevents fraudulent and/or abusive healthcare practitioners and suppliers from being able to practice.
Centralized data bank designed to improve not just the ethical standards and practices of the healthcare industry, but also to provide a go-to place to prevent unethical persons from being allowed to serve pts.
like the "Better Business Bureau of Healthcare"
List the areas being monitored by the HIPDB
- Licensure and certification actions
- Exclusion from participation in federal and state healthcare programs (ex. Medicare)
- Civil judgments related to healthcare
- Criminal convictions
- Revocation or suspension of lab certification
There are rules about accessing information. Why is this?
To protect a pts medical info under HIPAA
A document that allows the healthcare provider to share certain info, but not necessarily the whole record.
Release of Information Form
In addition to pt.'s medical info, confidentiality laws can protect _______ to ensure better pt. care.
the healthcare provider
When was the Patient Safety and Quality Improvement Act (PSQIA) published? When was it implemented?
- published in 2005
- implemented in 2009
Provides a confidential reporting system for violations of pt safety by creating an environment where providers can report and examine pt safety events without fear of increased liability risks. Identities of people who file reports are kept private.
- the Patient Safety and Quality Improvement Act (PSQIA)
- published in 2005, implemented in 2009
Harm to a person younger than 18 years old who is not an emancipated minor.
Every _______ there is a report of child abuse, not to count unreported cases.
Who are legally required to report child abuse?
- Medical health professionals
- social workers
- day care workers
- law enforcement personnel
In some states, clergy, foster parents, attorneys, and camp counselors are require
In ____ states, any person who suspects abuse is required to report it.
Who should you report a child abuse to?
the county's Department of Human Services AND the police department
Reports can be made to the 24 hour Child Abuse National Hotline at 1-800-4-A-CHILD
What happens to many elder abuse cases?
they go unreported
What is the legal definition of age of elder abuse?
varies from state to state. Generally 50 or 60 and above
Harmful treatment of elderly can include:
- sexual abuse
- financial exploitation
- self abuse
According to _____________-"it has ben estimated that _________ Americans 65 years or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection"
the National Research Council Panel to Review Risk and Prevalence of elder Abuse and Neglect(2003)
between 1 and 2 million
Where should you report elder abuse?
the local Department of Human Services AND the police department.
In how many states is elder reporting mandated?
What could result in not reporting elderly abuse?
How many Americans are affected by mental illness?
1 in 5
Which healthcare professionals have a legal obligation to report suspicion of self-harm of one who is harming others?
All healthcare professionals
Sometimes the best interest of the ______ outweighs the protection of a pt.'s private medical info.
The precedent setting case that imposes a duty to warn third parties regarding psychiatric dangerousness.
Tarasoff vs. Regents of the University of California
*all states except Texas and Virginia accept the duty imposed by Tarasoff
HIPAA does not provide a right to sue but instead provides:
a requirement to file a written complaint with the Secretary of Health and Human Services (HHS) through the Office of Civil rights.
A conformance with fact or reality.
The obligation to tell the truth and not to lie or deceive others.
A falsehood told to another who has a reasonable expectation of the truth.
What are components of reasonable expectations of the truth:
- Place of communication
- Rules of Communicators
- Nature of the truth involved
A pt has the right to _____ during the informed consent process, when making decisions about treatment, and when making important non-medical decisions.
Knowledge a person has a right or obligation to conceal.
A confidence or secret that will result in harm if it is revealed.
What are the three types of obligatory secrets?
- Natural-a secret that by its nature would be harmful if revealed
- Promised-a secret the receiver has promised to conceal.
- Professional- A secret maintained to protect the pt, society, and profession.
What are some exceptions to confidentiality?
- communicable diseases
- automobile accidents
- birth defects
- industrial accidents
- family's need to know
- public's need to know
- third-party payers
Don't discuss pt info where it can be overheard even if you are not using their name.
All papers, reports, and computer printouts should be kept in a secure place. They should be appropriately disposed of (shredded or torn). Confidential papers should be picked up as soon as possible from copiers, conference rooms, fax machines, etc.
Sensitive info should be released only through:
- The information department of the department such as:
- communication b/w pt and psychotherapist or social worker
- sexually transmitted disease test results or visit notes
- HIV test results and related information
- sexual assault treatment records
Sets minimum wage limits, regulates overtime pay standards, and establishes guidelines for youth employment.
The Fair Labor Standards Act (FLSA) of 1938
All employers must comply with FLSA except...
small, independently owned construction, retail, and service businesses
Prohibits sex-based wage differences; it does not mean that men and women will receive the same pay because other factors can determine an employees pay rate. Ex. education
the Equal Pay Act
Requires employers in qualifying circumstances to allow employees up to ____weeks of unpaid job protected leave each year after ___ year(s) of employment.
- the Family Medical Leave Act
- 12 weeks
- 1 year
An act that includes the requirement that employees provide reasonable break time for new mothers to pump breast milk.
Patient Protection and Affordable Care Act
______ oversees these laws, except the _____ that is overseen by the _____.
- US Department of Labor
- the Equal Pay Act
- the Equal Employment Opportunity Commission (EEOC)
Which laws does the EEOC oversee?
- the Equal Pay Act
- the Civil Rights Act of 1964
- the Age Discrimination in Employment Act of 1967
- the Rehabilitation Act of 1973
- the Pregnancy Discrimination Act of 1978(amends Title 7 of the Civil Rights Act)
- the Americans with Disabilities Act of 1992 (extends the Rehabilitation Act)
The US Department of Labor oversees which laws?
- the Equal Pay Act
- the Family Medical Leave Act
- the Patient Protection and Affordable Care Act of 2010
Prohibits discrimination based on sex and race in hiring, promoting, and firing processes. Title 7 prohibits discrimination on the basis of race, color, religion, sex, or national origin.
the Civil Rights Act of 1964
Prohibits discrimination on the basis of race, color, religion, sex, or national origin.
Title 7 of the Civil Rights Act
Prohibits employment discrimination against individuals 40 years or older.
the Age Discrimination in Employee Act of 1967
Requires minimum accommodations to oppose discrimination against qualified individuals based on disability. The act applies to organizations receiving financial assistance from the federal government.
the Rehabilitation Act of 1973
Amends Title 7 of the Civil Rights Act to prevent an employer refusing to hire or firing a woman because she is pregnant.
the Pregnancy Discrimination Act of 1978
Prohibits discrimination of individuals with physical or mental disabilities. It extends the ____ to employees with 15 employees or more.
- the Americans with Disabilities Act of 1992
- extends the Rehabilitation Act
What is the time restriction to file a discrimination complaint with the EEOC?
Administered by the Occupational Safety and Health Administration (OSHA)
the Occupational Safety and Health Act
Responsible for regulating the safety and health conditions of most private and public work environments.
OSHA reports that more workers are injured in which industry?
Healthcare and Social Services
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