[Legal aspects of the supervision of nosocomial infection]

Hospital infections are a serious epidemiological problem since hospital departments have been established. Through many years the problem of hospital infections was unsatisfactorily recognized and not until 1970 appeared in Poland publications concerning hospital infections and suggesting systems of control as well as inspection. In the same time acts and instructions were issued defining principles and procedures in case of nosocomial infections. The aim of this paper was to show changes in legislation concerning the incidence, registration and action against hospital infections.

[Restraining measures in the hospital and nursing home]

Time and time again, physicians and nursing staff are confronted with a need to apply compulsory fixation measures to hospital patients or nursing home residents. This may be necessary to protect the physical integrity either of the patient himself or of others. When applying coercive measures, careful consideration must be given to the respective hazard potential. The care-providing physician must exercise great care with regard to the selection, implementation and documentation of the measures to be employed.

Errors in compliance with federal rules and regulations relating to healthcare benefits programs: the University of Washington Department of Neurological Surgery experience

✓ This article details the errors in compliance with federal rules and regulations relating to the healthcare benefits programs at the University of Washington Department of Neurological Surgery from 1996 through 2002. University faculty members, regardless of the organization to which they belong, will be identified by the federal government as the individual responsible in healthcare finance inquiries. A full understanding of all regulations and an active compliance program are necessary to avoid problems, including criminal prosecution.

[Indicators for quality evaluation of inpatient patient care in an ENT clinic]

According to the law (Section 137 SGBV) in Germany, hospitals have to implement quality-assurance (QA) programs, which are now of particular importance in times of ongoing structural change in health care. External as well as internal methods of QA are well established and can serve as parameters for single processes and outcomes in most cases. However, there is still an urgent need for methods measuring the quality of total hospital performance. Indicators are powerful instruments for this purpose. They reliably reflect clinical outcome, physicians' and nurses' activities, administration and can be regarded as instruments for general hospital performance in otorhinolaryngology. We describe the process of definition, development and application of quality indicators for measuring quality in health care. Furthermore, we present a critical overview of selected indicators in otorhinolaryngology, general medical indicators and indicators concerning administrative problems. Because of current developments in German health care the application of quality assurance methods similar to the system of indicators presented is strongly recommended.

Effect of regulations and guidelines on gastroenterology programs

This paper reviews the standards of practice, regulations, and guidelines that govern gastrointestinal endoscopy and their effect on space and equipment, staff and physician quality of care, and educational programs. It also examines how all these considerations have affected the growth of an endoscopy center and describes the processes that have been instituted to ensure compliance with all relevant standards, regulations, and guidelines.

Ramifications of the Family and Medical Leave Act of 1993

Six months ago, the Family and Medical Leave Act of 1993 was signed into law, and key provisions of the act became effective on August 5, 1993. This article examines the main provisions of the act, explains how employee leaves will be granted in compliance with the act, outlines the consequences of noncompliance with the act, analyzes the operational ramifications of the act, quantifies the financial implications of the act, and discusses the role of the healthcare financial manager in assisting with the formulation of a hospital policy to comply with the act.

Review exclusive contracts in light of recent challenges

Many hospitals hold exclusive physician contracts, primarily with hospital-based specialists such as pathologists, radiologists, emergency physicians and anesthesiologists. But some physicians are beginning to view exclusive contracting as a form of economic credentialing, and have begun challenging such contracts in the courts in a number of states.

Safety in health care facilities

Safety plays an important role in the daily operation of any health care facility. Effective safety management not only assures employees that they have a safe working environment, but also allows patients to enjoy an atmosphere that is free from unnecessary risks and hazards. Having an effective safety program that addresses pertinent safety issues within the facility, as well as within the community will give the administration confidence that the facility is delivering the highest quality of patient care.

Liability issues for radiology managers

This article on legal issues is structured in two parts--the first details the fictitious case of a routine pyelogram in which the patient had an allergic reaction to the contrast media. In the second section, Mr. Hollingsworth gives up-to-date information on liability issues and precautionary measures for managers.

Virginia legal battle highlights unrest between hospitals, physicians

A bitter dispute over a proposed management-services contract has ended a decades-old business alliance between Culpepper (Va.) Memorial Hospital and Virginia Radiology Associates.

Liability for medical record disclosure is real but rare

The most recent public concern for patient confidentiality has centered on the medical records of AIDS patients. However, a new confidentiality concern is the liability of the self-insured hospital that reviews medical claims internally. Also, the sometimes conflicting demands of protecting patient confidentiality and being reimbursed in a timely fashion are setting off sparks between the medical records department and the business office.

Legal review: AIDS patient records--legal issues of access and disclosure

All 50 states require AIDS cases to be reported to the department of health. Many jurisdictions require HIV and ARC reporting, as well. Many states have also enacted confidentiality provisions that prohibit health care providers from releasing HIV-related information without the patient's consent, although exceptions to the statutes authorize disclosure without consent to other health providers, spouses, and other persons under certain conditions set forth in the legislation. In addition, the patient may obtain access to his or her own records and may authorize release to third parties. Providers who violate the provisions are subject to liability. The patient usually has a private cause of action for damages and costs; in addition, the state may impose fines and jail terms for more egregious violations. Finally, courts may authorize disclosure of confidential HIV information in certain situations. In the absence of a statutory provision governing court-ordered disclosures, courts will balance the patient's privacy interest against the plaintiff's need to know and the public interest involved. Several states have enacted statutes that modify this traditional balancing approach, although it is unclear whether these statutes provide additional protection for health care providers and patients seeking to prevent disclosure of information. Health record practitioners should keep abreast of legislative and regulatory developments in their states that affect use and disclosure of AIDS patient records. Careful discussion with the health institutions' legal counsel of any situation not covered clearly by applicable statue or regulation is strongly recommended.

Health care litigation: managing an appeal

This is the third in a series of articles on health care litigation. This article illustrates how unfavorable appellate precedent can occur and proposes techniques for preventing such adverse results.

Guidelines on product liability for the hospital blood bank. The British Committee for Standards in Haematology

This report aims to clarify the position of the hospital blood bank in the light of product liability legislation contained in the Consumer Protection Act of 1987. Blood has been defined a 'product' under this Act. The potential for the blood bank to be seen in the role of 'supplier', 'keeper' or even 'producer' in the chain of product supply to the patient is explained and advice given on the resulting implications for blood bank practice. It will be necessary to define, adopt and implement standard operating procedures (SOP) for all blood bank activities. Guidance is given on the format, preparation and content of SOPs and specimen examples offered. The fundamental importance of quality assurance is emphasized.

Automated medical records: legal questions and risks

Automation of medical records poses special legal questions and creates some unique legal risks. However, legal barriers to automation can usually be overcome and legal risks managed in such a way as to permit a provider to take advantage of the efficiencies and the information gain of automating medical records.

Search and "civil" issues for security officers

While security officers have a great deal of latitude to conduct searches, employees are becoming more willing to challenge employers who order these searches. The author presents a solution to the problem--vesting officers with police powers.

Avoiding administrators' liability

Radiology administrators have been mostly untouched by the medical liability crisis, but legal experts warn that lawsuits could be targeted at health care administrators. Consequently, administrators should take several precautions to limit their changes of being drawn into a lawsuit.

Apparent agency: how can hospitals combat the appearance?

This article examines one of the newer theories of liability which courts are using to hold hospitals liable for the negligence of their physicians. The authors suggest possible ways in which a hospital, including its medical record department, can attempt to avoid, or at least minimize, this liability risk.

Informed consent: Part II

Although the legal responsibility to inform and obtain the patient's consent lies with the surgeon, the agency may have a duty to ensure that the patient's consent has been obtained. Agency liability is limited to those cases in which the agency knew (or should have known) that informed consent was not obtained. It is still unclear whether agencies have an affirmative duty to ensure that consent has been obtained. If this duty does exist, it appears that a policy requiring documentation in the medical record of the patient's consent meets this requirement. It is clear that whatever the extent of the agency's duty, it does not include the duty to give the patient information or assess his or her level of understanding. Court opinions discourage anyone but the physician from doing so. A nurse's legal responsibility is limited to following agency policy. Courts have not recognized any independent nurse duty beyond that which accrues to them as employees of the agency. Perioperative nurses often provide the final checkpoint that consent has been obtained and documented before the procedure begins. This unique position raises additional legal concerns if the agency's policy is not followed or if the premedicated patient arrives without proper consent documentation in the record. Perioperative nursing concerns will be discussed next month in Part III.

"Medical records--legal implications for the hospital."

There are compelling legal reasons for the hospital to maintain an effective medical record service. This article is concerned to highlight those reasons and to provide guidelines to hospitals and associated health professionals as to what constitutes a sufficient and proper medical records service.