Análisis de datos

The state Supreme Court hears appeals from the state appellate courts. Unless an important federal issue or a constitutional right is involved, the state supreme court is the final authority for state issues. Decisions from the state supreme court are bind-ing on all other courts in that state.

The United States Supreme Court is the court of final decision for both the federal system and the state system in matters involving constitutionally protected rights, such as freedom of speech. Appeals are brought to the Supreme Court under a writ of certiorari, which is a written petition by the unsuccessful party requesting that the Supreme Court hear the case. Because the Supreme Court receives requests from thousands of cases annually, only those involving questions of substantial federal importance are selected for review. Once the United States Supreme Court hears a case, the decision becomes binding in all state and federal courts in the nation.

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 The state legislature creates the nurse practice act and grants authority for a Board of Nursing to administer and enforce the act.

 The nurse practice act creates the legal boundaries for the scope of profes-sional nursing practice.

 Both substantive law and procedural law affect the legal process.

 Substantive law defines specific rights, duties, obligations, or prohibitions that are imposed by authorities.

 Procedural law determines the method or process for legally enforcing these rights and obligations.

 Civil law refers to the law relating to relationships between private persons.

 Criminal law violations are brought by a governmental entity.

 The two areas of torts are: (1) unintentional (such as negligence) and (2) inten-tional (such as battery).

 Health care fraud includes: upcoding, unbundling charges, receiving kick-backs, inflating bills, and billing for services not rendered.

I N A N UTSHELL

The legal system in the United States is a complex combination of laws, rules, and regulations that are created at both the federal and state levels. Nurses must stay informed of the legal scope of their nursing practice as society and the profession changes. A basic knowledge of the law and how it works helps nurses avoid litigation while giving them the confidence to practice more competently.

A

1. Describe the four major sources of law.

2. What effect do societal values and customs have on the development of laws?

3. How does civil law differ from common law and from criminal law?

4. Discuss the steps in a criminal trial process.

5. Explain the concept of precedent, or stare decisis.

6. Explain the functions of the trial courts, appellate courts, and supreme courts at the state and federal levels.

7. Discuss the differences between a misdemeanor and a felony. Give examples of each.

8. Explain the types of torts.

9. List the elements of negligence that must be present to prove liability for malpractice.

A C ^{ASE IN} P ^OINT

Nursing Malpractice The Facts

Evidence supported the claim that a labor and delivery room nurse failed to observe or recognize signs and symptoms of fetal distress from 8:30 PM to 9:00 PM. The court rejected the defense claim that any negligent conduct of the nurse prior to 8:50 PM was a remote cause of the infant’s injuries. The evidence showed that the nurse left the labor room for approximately 10 minutes and should have been in the patient’s room doing one-to-one care. The physician testified that the nurse’s failure to take action or notify him delayed delivery of the compromised infant and caused and contributed to the infant’s damages.¹¹

Jury Award

A jury awarded $3.5 million, which was reduced to the applicable statutory cap on damages.

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10. Discuss the differences that exist between intentional tort and a tort based on negligence.

11. Explain the difference between ordinary negligence and professional negli-gence and give examples.

12. List several types of fraud that may have an impact on a nurse’s license.

13. Describe the possible ethical conflict with managed care and patient’s right to treatment.

14. What is the statute of limitations in your state?

15. Find and discuss a case of patient abuse by a health care provider in your area of practice.

16. Discuss a recent case of Medicare or Medicaid fraud in your area of practice.

17. How has the current economic environment affected patient care and the delivery of care by health care providers?

18. Give an example of professional negligence using the elements of negligence.

19. Obtain a copy of your state’s nurse practice act. List the reasons why a nurse’s license may be revoked, suspended, or reprimanded.

20. Discuss the two recent cases involving nursing malpractice and negligent homicide.

Negligent Homicide The Facts

Over the course of 3.5 weeks, 13 patients in one intensive care unit (ICU) had violent seizures followed by cardiac and respiratory arrest during the night shift.

Nine died. In another incident, the same nurse was on duty at a different facil-ity and a patient died with the same symptoms.

The nurse was arrested and charged with murdering a total of 12 patients. He was tried and convicted of killing 12 patients by injecting them with massive doses of lidocaine.

Evidence showed the following:

 The nurse was on the unit and assisted in the patients’ care before the seizures.

 He exhibited unusual behavior on the nights the patients had the seizures and died.

 The patients’ deaths were consistent with administration of large doses of lidocaine.

 Patients’ blood or tissue samples had high concentrations of lidocaine.

 Lidocaine was found at the nurse’s home.

 Evidence at trial did not convey that the killings were “mercy killings.”

The Court Decides

The nurse was convicted of first-degree murder.¹²

 

E

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Mrs. J., 84 years old, was an active member of a local senior citizens group. One day at a group-sponsored picnic, Mrs. J. experienced an episode of acute chest pain, followed by collapse and cardiac arrest. A member of the group who had taken a cardiopul-monary resuscitation (CPR) course performed CPR on Mrs. J. for approximately 20 minutes, during which time an ambulance was called and the paramedics arrived. Mrs.

J. never regained consciousness, although a cardiac rhythm was re-established by the paramedics. She was admitted to the ICU of a local hospital, intubated, and connected to a ventilator. Her two daughters and a son, all of whom lived out of state, were noti-fied of her condition.

Over the several days it took her children to arrive at the hospital, Mrs. J.’s condition gradually deteriorated to the point at which vasoactive medications were required to maintain her blood pressure and urinary output. Although she did not meet all the criteria of brain death, as a result of some reflex reactions that remained, her primary physician believed that because of the extended period of anoxia she had suffered before she was intubated by the paramedics, she had suffered irreversible brain damage.

When the situation was explained to her children, Daughter A and the son agreed that to attempt any further resuscitation on their mother would be futile and cruel.

Daughter B, however, disagreed and demanded that “everything” be done to keep her mother alive. After a rather spirited discussion involving the three children, the physi-cian, and the head nurse of the ICU, a compromise was reached. Mrs. J. was to be assigned a “medication-only” code, which meant that antiarrhythmic, vasopressor, and cardiotonic agents would be used to keep the heart beating. The family signed the appropriate form for this procedure, and the physician wrote a medication-only code on the physician order sheet.

The following day, with the family members at the bedside, Mrs. J. went into a sustained episode of ventricular fibrillation. The nurse who was caring for Mrs. J. gave the appropriate medications for the condition. Without chest compressions to circulate the medications, however, there was no change in her cardiac pattern. Approximately 5 minutes into the medication-only code, Daughter B began to yell loudly, “You better do something else, or I’m going to sue you and this hospital for everything you’re worth!”

What should the nurse do at this point? Start chest compressions? Tell the family that she cannot do so because of the order? Would Daughter B actually be able to file a lawsuit in this situation?

References

1. National Council of State Board of Nursing: About NCSBN—Overview, Nursing Regulation.

http://www.ncsbn.org, accessed December 2002.

2. Creighton, H: Law Every Nurse Should Know, ed 5. WB Saunders, Philadelphia, 1986, p 1.

3. Cazales, MW: Nursing and the Law. Aspen, Germantown, Md, 1978, p 3.

4. Catalano, JT: Ethical and Legal Aspects of Nursing. Springhouse, Springhouse, PA, 1991.

5. Bernzweig, EP: The Nurse’s Liability for Malpractice, ed 6. St Louis, Mosby, 1996.

6. Sermchief v. Gonzales, 660 S.W.2d 683 (Mo. 1983).

7. State of Utah v. Warden, 813 P.2d 1146 (Utah 1991).

8. State of Louisiana v. Brenner, 486 So. 2d 101 (La. 1986).

9. People of the State of Illinois v. Johnson, 595 N.E.2d 1381 (Ill. App. 2d 1992).

10. The People v. Diaz, 834 P.2d 117 (Cal. 1992).

11. Fairfax Hospital System, Inc. v. McCurly, 419 S.E. 2d 621 (Va. 1992).

12. People v. Diaz, ll Cal Rptr. 2d 353 (Cal. 1992).

Resources

National Council of State Boards of Nursing 676 N. St. Clair Street

Suite 550

Chicago, IL 60611-2921 1-312-787-6555 http://www.nscbn.org

Office of the Inspector General Medicaid and Medicare Fraud Hotline 1-800-HHS-TIPS (1-800-447-8477)