To be an effective manager
It is critical to understand the fundamental ethical and legal concepts that govern the workplace, including the legal relationship between the consumer and the organization—the patients and healthcare providers. Since the healthcare profession has complex situations that involve ethical difficulties, ethical action is believed to be the appropriate thing to do, not only what is proper in law. Furthermore, the healthcare industry, like many others, is heavily regulated in the United States. These laws govern those who receive, pay for, provide, and control health care services. The health care services and care which people are receiving our offer are affected by a number of moral, ethical concepts and the regulation set by the state. These factors are critical in protecting the quality of care that is being rendered to the patients as they are the guiding principles of delivering services, and as well as providing order in our health care system by protecting the health care system as well by applying laws and regulations to protect every entity.
Health Care Ethics
Health care ethics are defined as moral beliefs, values and principles that direct nurses and doctors in making choices regarding medical care. At the center of the health care is a sense of right and wrong and our beliefs about the rights people have and the duties people owe to the others in the society. It is only through thinking rationally about ethical aspects of the health decisions that people or nurses would be able to make the right choices which are just, fair and good. Some of the ethical and moral laws that would be discussed in this paper include;
Patient Self-Determination and Autonomy
The respect for the patient independence is the often talked-about concept or principle in the medical ethics. In the medical practice autonomy is expressed as the right of competent adults to be able to make informed decisions regarding their own medical care. This principle underlies the specific requirement to seek informed agreement of the patient prior to any investigation taking place. The law requires that any patient matured enough who is not mentally incapacitated has the right to be able to decide whether to assent to the treatment to be administered to him or her (Pantilat, 2014). The two clauses which must exist before a decision is termed as autonomous include. He or She should have relevant internal capacities for self-government and must be free from external constraints. In any medical context, the decision is considered as autonomous in cases where the person has the overall capacity to be able to make relevant decisions and that he or she has enough information to make such decision voluntarily.
Beneficence
Beneficence is defined as the activity that is done in order to assist the others. These actions are always undertaken to help in preventing or removing harms of others. Physicians working in different organization are expected to desist from causing harm, in addition, they have an duty to assist their patients (Wilkens University, 2015). The physicians are never expected to live up the ideal beneficence, however, the main goal of medicine is to promote the welfare of the patients. They should have knowledge and skills which assist them to accomplish their duties. Due to the nature of the relationship which exist between the physicians and the patients, the doctors have the obligation to remove and prevent, in addition to weighing the balancing the possible benefits against the likely risks of any action undertaken. Beneficence also includes protecting and defending the rights of the others, helping those in danger get saved in whatever they are doing.
Fiduciary Duty
Fiduciary duty is the obligation to be able to act in the best interest of a person or even an organization. The health care managers or professionals as well as the managers in the various industries struggle with the dilemma of whether or not to admit harmful mistakes to the unsuspecting patients and customers. But the health care professionals and the other medical ethicists do agree that the problem of the medical mistakes always requires immediate attention. The members of the public deserve to feel confident that when the patients enters any health care system, they should be assured of the medical care they are getting. Therefore, the medical professionals have the fiduciary duty to act in the best interest of the patients.
Non-maleficence
Non-maleficence simply means to "do no harm." The medical professional must abstain from providing treatment which are not effective, or acting with total malice toward the patients. They should not do anything that would be able to purposely harm the patients without such actions being balanced by proportional benefit (Wilkens University, 2015). All the medical treatment actions that are being undertaken by the medical team should have some benefits to the patients. The patients must also be in a position to decide whether the likely benefits outweigh the potential harm.
Fidelity
This is the principle which stands for many things which includes loyalty, advocacy, dedication, fairness and truthfulness to the patients. All medical professionals are required to keep their commitments based on caring as a virtue. The principle also supports the fact that confidentiality is important in the medical profession (Wilkens University, 2015).
Health Care Laws and Regulations
Healthcare profession could be a rewarding career field, but it could be intimidating as well. Not only one is required to know the important medical information, but also one is responsible for keeping up with the complicated regulations and laws related to this field. The federal laws and regulation keep on changing, the healthcare professionals are required to be updated on all changes instituted by the state or the federal government.
Criminal, Civil and Malpractice Law
As mentioned previously, healthcare career is a very complex industry. Hence, the medical professionals should be able to understand that criminal, civil and malpractice law play also a critical role in the industry and that they should carry out their duties diligently to avoid breaking these laws. There are a number of disputes that the government should be in place some regulations and laws to limit those disputes from harming the patients as well as the medical professionals. In the healthcare profession and any other profession, criminal law relates to the violation of the statutes which pertains to the public offenses or the acts committed against the members of the public. For instance, health care professional or organizations can be prosecuted for criminal behavior such as battery, abuse, fraud and assault.
Criminal law refers to the law guarding crime committed against the legal statute. Some cases where the medical professional can be charged for breaching criminal law includes making false statements to the state or federal government, engaging in conspiracy to defraud the state or federal government or presenting fictitious, fraudulent or false claims to the government. Civil law always covers the noncriminal disputes which include negligence and tort. It is contained in the branch of legislation which deals with the rights and duties of the citizens rather than with the criminal acts. Some of the civil laws in the healthcare sector include;
Tort and Negligence
It is defined as a civil wrong, or tort committed by a person to another person or property. The wrong always result from the breach of one's legal duty of care. Negligence in health care setting was developed in the English law under the well known common law (Griffith, 2016). For tort and negligence to be well-established on a nurse or medical professional, three elements must be established by the jury, they include;
Duty of care
Breach of duty of care
Breach of duty causes loss or harm to the plaintiff
There is proximate cause or causal connection exist between the breach and the patient's injury
Medical professionals should understand that they have a duty of care to the patients who are under their care at any given time. Therefore, it is important that they should carry out their duties and responsibilities with due diligence. It is important that they exercise a certain degree of care which any other ordinary person would have done under the same circumstance to protect the patient under their care (Griffith, 2016). If a nurse is not able to carry out such ordinary duties it results in the breach of care on the part of the patient. Nurses or doctors should never be careless whenever they are carrying out their duties since this result in malpractice which is another form of negligence. Malpractice is defined as the failure by a professional to act in a professional manner and yet he/she has the requisite knowledge, training and skills to act in a prudent manner.
Federal Regulation in Health care
Federal regulation plays a very critical role in the health care industry. The different regulatory bodies protect the members of the public from the various health risks, besides providing a number of programs for the public welfare and health. All these regulatory agencies protect and also regulate the public health at each and every level. These regulations are developed and implemented by all levels of government, also private organizations play a role in development and implementation. The health care standards and regulations are important since it ensures compliance, in addition to providing safe health care to every person who uses health care facility. The health care regulatory agencies are tasked with the duty of monitoring facilities and practitioners to ensure that they are providing quality services and products to the members of the public. Some of the federal regulations regulating the health care sector include;
"Health Insurance Portability and Accountability Act" (HIPAA) of 1996
This is the act which provides protections for the employees and their families whenever they lose their jobs. It provides additional opportunities to be able to enroll in a group health plan if one loses other coverage or experience in certain life events. The regulation also forbids discrimination against workers and their dependents based on health factors which they have such as prior medical conditions, genetic information and previous claims experience (United States Department of Labor, 2014). The act also preserves the role of the state in regulating health insurance, including the state authority to provide more protections than under the already available federal law.
Emergency Medical Treatment and Active Labor Act (EMTALA)
The EMTALA is a federal law which requires that anybody coming to the emergency department need to be stabilized and treated. The treatment should be carried out regardless of their ability to pay, or insurance status. The problem with the act is that since its enactment it has never been funded by the state (American College of Emergency Physicians, 2016). Therefore, the burden of the uncompensated care has been over the years hence causing a number of emergency department to be closed, reducing the resources for everybody, besides threatening the ability of the emergency department to provide medical care for all the patients. The act was also meant to oversee how the patients move from one facility to the other. A patient is deemed to be stable and ready to be transferred if the treating doctor determines that no substantial deterioration will take place in the process of transfer between the facilities (Campbell, 2005).
Medicare and Medicaid Fraud Prevention
Some of the Medicare and Medicaid Fraud Prevention Acts that have been put in place to reduce the cases of fraud in health care system include;
Federal False Claims Act (FCA)
This is the law which protects the federal government from being sold substandard or overcharged for goods and services. It imposes civil liability to any person or organization who knowingly submit or cause submission of fraudulent or false information or claim to the federal government. For instance, if a physician knowingly submits claims to the Medicare for a higher level of the medical services than actually provided, he/she would be penalized for violating the FCA (Centers for Medicare & Medicaid Services, 2016).
Physician Self-Referral Law (Stark Law)
This is the law which prohibits the physician from making a referral for some designated health services payable by Medicaid or Medicare to any entity in which the physician has an investment interest or which she or he has a compensation arrangement unless exception cases applies.
Criminal Health Care Fraud Statute
This is the statute which prohibits willfully and knowingly executing, or even attempting to execute, a scheme in connection with a delivery of health care benefits to either defraud any health care benefit scheme or obtain by means of false pretenses any property or money owned by or control by health care benefit program (Centers for Medicare & Medicaid Services, 2016). For instance a number of medical clinics and doctors conspire in well coordinated scheme to swindle the Medicare Program, by just submitting claims for the power wheelchairs that are unnecessary medically for the patient.
Conclusion
The health care industry is an important industry, which has a number of players which include patients, medical professionals and the government. Maintaining an appropriate working relationship among these players is very important for the efficient and effective operation of the industry.The ethical and the moral principles combined with the state and federal laws and regulations are very important in maintaining the needed balance among these players.
References
American College of Emergency Physicians. (2016). Emergency Medical Treatment and Active Labor Act . Retrieved from Acep.org: https://www.acep.org/news-media-top-banner/emtala/
Campbell, C. (2005). Legalese. Emergency Medical Treatment and Active Labor Act (EMTALA). . Journal Of Legal Nurse Consulting, 31-34.
Centers for Medicare & Medicaid Services. (2016). Medicare Fraud & Abuse:. New York: Centers for Medicare & Medicaid Services. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf
Dreachslin, J. L. (2007). Diversity management and cultural competence:research, practice and the business case. Journal of Healthcare Management, 79-86.
Griffith, R. (2016). Repercussions of negligence in community nursing practice. . British Journal Of Community Nursing, 155-158.
Pantilat, S. (2014). Beneficence vs. Nonmaleficence. Retrieved from ucsf.edu: http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_bene_nonmal.htm
United States Department of Labour. (2014). Employee Benefits Security Administration. Retrieved from dol.gov: https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/hipaa-consumer
Wilkens University. (2015). 6 Key Ethical Principles of Nursing. Retrieved from Onlinenursing.wilkes.edu/: http://onlinenursing.wilkes.edu/key-ethical-principles-of-nursing/
