About Health Care Law

An earlier post was made here a month ago regarding the beta testing of Google’s Health and surely, as predicted, a test run would be available after a month or so.

Now, Google has chosen its partner in making the test run possible: the Cleveland Clinic. The said hospital, ranks as one of the best in America according to U.S News and World Report. Cleveland Clinic patients can put their medical profiles on the internet (Google’s database) so that their medical history will be available for search via Google Health.

A certain Pam Dixon of the World Privacy Forum questioned the process since this concerns the privacy of the individuals who will join the test run.

It is but important to note that the putting up of medical profiles on Google Health is on a voluntary basis.

Photo taken from

In the race of becoming the world’s number 1 free web service provider, Google has once again made it to the headlines.

It was accidental really. Computer geeks were able to get a glimpse of a screenshot of a webpage that says, “Google Health Beta”. Perhaps Google found out about the website and they immediately removed it from their server but the said computer geeks were able to take a short tour of the log in page. It features a handful of services like you can create your own online health profile, obtain records from doctors and pharmacies as well, find competent medical professionals online and many more.

Since it is in “beta” mode, I am sure that about a month from now, Google will be doing a public test run on it.

Photo taken from http://blogoscoped.com

A month ago, a brief introduction about HIPAA was made (click here to read it). After the 9/11 attacks in WTC and Pentagon, there was a sudden increase of people who want to be under the HIPAA’s roof, perhaps due to the fear the attacks imposed upon the people.

But in the past years (not more than 3 years - present), the said sudden increase of HIPAA clients that were seen after the 9/11 attacks, aren’t anymore as evident as it was before. In fact, it is dwindling. Some experts say that this is due to the worries of the people regarding technology.

Technology, as we all know, advances every minute. Just as you were buying a new phone in the cell shop, another company is manufacturing a new one that’s better, bigger and more hip than the one you’re holding now. People fear that the technology might be abused and used against them since they are already “identified” with an alphanumeric combination (the national security vs. civil rights debate).

Photo taken from http://lovesagame.com

HIPAA, or the Health Insurance Portability and Accountability Act, has been ratified by the United States Congress 12 years ago to protect and administer the health insurance of all the residents of the United States. The first target of the said act is to protect the health insurance of those who lose and/or change their occupations. Employers and insurance service providers could be very tricky this time and HIPAA is there to protect them from any con these companies might pull off on them.

Second, is that of the national identifiers card. This card will umbrella all the insurance companies (even Medicare, Medicaid etc.) and will provide an alphanumerical system of identification.

Although it has been ratified 12 years ago, it was only made effective in 2006 and has been running since then.

Photo taken from http://healthcare.zdnet.com

The code of ethic in the Philippines is formulated by the Philippine Medical Association promulgated or known as Republic Act 4224. This Code of Ethics includes the duties, responsibilities, obligations of Filipino Physicians to the recipient of their care.

The Code of Ethics of Physicians is subdivided into two Articles. Article I, in which in states the General Principles. There are six Sections in this article. Meanwhile, in Article II, it states the duties of the physician to their patients or to the recipient of their care.
Here is the Code of Ethics in Medical field in the Philippines (pinoy.md - a website for Filipino Doctors)

Article I
GENERAL PRINCIPLES

Section 1. The primary objective of the practice of medicine is service to mankind irrespective or race, creed or political affiliation. In its practice, reward of financial gain should be a subordinate consideration.

Section 2. On entering his profession a physician assumes the obligation of maintaining the honorable tradition that confers upon him the well deserved title of “friend of man”. He should cherish a proper pride in his calling, conduct himself as a gentleman, and endeavor to exalt the
standards and extend the sphere of usefulness of his profession. He should adhere to the generally accepted principles of the International Code of Medical Ethics adopted by the Third General Assembly of the World Medical Association at London, England in October, 1949 as part of his professional conduct.

Section 3. In his relation to the state and to the community, a physician should fulfill his civic duties as a good citizen, conform to the laws and endeavor to cooperate with the proper authorities in the due application of medical knowledge for the promotion of the common welfare.

Section 4. In his relation to the state and to the community, a physician should fulfill his civic duties as a good citizen, conform to the laws and endeavor to cooperate with the proper authorities in the due application of medical knowledge for the promotion of the common welfare.

Section 5. With respect to the relation of the physician to his colleagues, he should safeguard their legitimate interests, reputation, and dignity-bearing always in mind the golden rule “whatever ye would that man should do unto you, do you even so to them.”

Section 6. The ethical principles actuating and governing a clinic or a group of physicians are exactly the same as those applicable to the individual physician. Specialties in the various fields of medical sciences are not exempt from the application of these principles

Article II
DUTIES OF PHYSICIANS TO THEIR PATIENTS

Section 1 A physician should attend to his patients faithfully and conscientiously. He should secure for them all possible benefits that may depend upon his professional skill and care. As the sole tribunal to adjudge the physician’s failure to fulfill his obligation to his patients is, in most cases, his own conscience, and violation of this rule on his part is discreditable and inexcusable.

Section 2 A physician is free to choose whom he will serve. He may refuse calls, or other medical services for reasons satisfactory to his professional conscience. He should, however, always respond to any request for his assistance in an emergency. Once he undertakes a case, he should not abandon nor neglect it. If for any reason he wants to be released from it, he should announce his desire previously, giving sufficient time or opportunity to the patient or his family to secure another medical attendant.

Section 3 In cases of emergency, wherein immediate action is necessary, a physician should administer at least first aid treatment and then refer the patient to a more qualified and competent physician if the case does not fall within his particular line.

Section 4 In serious cases which are difficult to diagnose and treat, or when the circumstances of the patient or the family so demand or justify, the attending physician should seek the assistance of his colleagues in consultation.

Section 5 Physicians must exercise good faith and strict honesty in expressing his opinion as to the diagnosis, prognosis, and treatment of the cases under his care. Timely notice of the serious tendency of the disease should be given to the family or friends of the patients and even to the patient himself if such information will serve the best interest of the patient and his family. It is highly unprofessional to conceal the gravity of the patient’s condition, or to pretend to cure or alleviate a disease for the purpose of persuading the patient to take or continue the course of treatment, knowing that such assurance is without accepted basis. It is also unprofessional to exaggerate the condition of the patient.

Section 6 The medical practitioner should guard as a sacred trust anything that is confidential or private in nature that he may discover or that may be communicated to him in his professional relation with his patients, even after their death. He should never divulge this confidential information, or anything that may reflect upon the moral character of the person involved, except when it is required in the interest of justice, public health, or public safety.

Section 7 The medical profession not being a business and service its primary concern, a physician should not charge exorbitant or excessive fees. In determining the amount of the fee, he should always consider the financial status of the patient, the nature of the case, the time
consumed, his professional standing and skill and the average fees charged by physicians of the same standing in the same locality.

There are actually 7 types of Health Insurance in which an applicant can apply for in US. But usually, it depends on the status or occupation of the applicant. The types of Health Insurance are as follows:

1. Group Health Plans – This kind of insurance provides health care coverage for employers, student organizations, professional associations, religious groups and the like.

2. Individual Plans – This kind of plan is sold directly to individuals that avail of the insurance plan by applying personally to have one.

3. Fee-For-Free Insurance Plans – This is actually a way of some companies to compensate with the access of their employees to health care service. This plans offer reimbursements or refunds for their paid bills on hospitals from their company.

4. Managed Care Plans – These are sold to either group or individual clients. This insurance is manage by an insurance company wherein it has 2 subdivisions:
a. Health Maintenance Organization (HMO) – This is a prepaid plan in which people who avails this kind of insurance will pay a premium every month.
b. Preferred Provider Organization- This is a combo of fee-for-free insurance plans plus health maintenance organization plans

5. Government Health Plans – There are actually two types of Health insurance plans US offers:
a. Medicare – The coverage of this insurance is hospital insurance where it aides in paying for hospital stays and other bills consumed during hospitalization.
b. Medicaid – is designed to provide help with the beneficiaries of the person who applied for it. It covers lab test, consultation fee and x-rays
•TRICARE – health insurance plans for military

6. Supplemental Insurance – this covers the expenses that an individual failed to pay using the regular insurance

7. Worker’s Compensation – this is a kind of insurance in which the basis is if the injury is job related this insurance will cover it.

It is the nursing care for aged client or patient given in a nursing home, hospital, even at home. In geriatric nursing, the health care provider, usually a geriatric nurse will do assessments of the patients. Usually, the assessment is about the physical, mental and physiologic functioning of an older person to evaluate and identify what nursing intervention to implement for the patients. This includes some activities that can reinvigorate or refresh the older people. Older people are known to be slow and easily to get tired. Henceforth, the health care provider should consider the capabilities and limitations of his or her aged patients in order to prevent untoward incidence such as overtiring the patient may lead to any vascular accident or high blood pressure. As a person gets older, many conditions will occur as an effect on how the person dealt with his or her lifestyle when he or she is still young. Some diseases or conditions are normally occurring when someone reached the old age. For an instance, the brittleness of the bones, this is just normal for aging people because interstitial fluid in the bond that moistens it will dry up when a person gets older. Some conditions are Alzheimer’s disease, hearing impairment, hypertension and so forth. There is a certain therapy appropriate for geriatric patients. It is the geriatric therapy also known as gerontherapy. This therapy treats the disease of the geriatric patients. It is a useful therapy that improves the health of the patient. This is the standard therapy that most of the geriatric nursing are practicing.

If there is Patient’s bill of rights, nurses are no exception to that. Nurses have also rights in practicing his or her profession to avoid misconduct or abuse from any patient. Usually, some patients violate the rights of a nurse because they are not aware of those. However, ignorance to the facts is not an excuse, because if someone ignores a fact, he or she does not actually changing that fact. Here is the nurses’ bill of rights according to the American Nurses Association:
1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice.
3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses with Interpretive Statements.
4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and for their patients.
7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.
If one of the above mentioned rights is violated, the person who committed violation shall be held liable in a law suit which is punishable by the law.

Patients also known as clients have basic rights in accessing on health care services. However, many people are not aware of it because of some reasons, and one is the literacy level that they have. Here are some of the basic rights of a patient:
1. Right to considerate and respectful care
2. Right to know
3. Right to obtain from his or her physician complete current information about diagnosis, treatment, and prognosis in easily understandable terms.
4. Right to obtain consent before any procedure whether it is verbal or written consent.
5. Right to refuse certain procedures as well as in participation in clinical research
6. Right to be transferred to another facility
7. Right to routine services whenever hospitalized at the Clinical Center
8. Right to privacy concerning the medical care program
Using these rights, health care providers who will violate it are held liable or subjected to a lawful suit if found to be guilty on exploiting any of the above mentioned patient’s bill of rights.

As said in the earlier post, there are special considerations when handling a psychiatric patient. Since psychiatric patients are not able to think like a normal person does, second is their unawareness of what will or not harm them and other person. Here are some tips to consider when handling a psychiatric patient observing at the same time their rights.

1. be placed in treatment against their will
2. pose a risk to themselves
3. have been judged to have committed a crime while legally insane
4. be unable or unwilling to consent treatment
5. be incapable of fully understanding medication risks
6. require restraints for their safety or that of others
7. make threats that obligate their caretakers to warn potential victims
8. undergo forensic evaluation that requires the nurse to testify in court

These hints are to be observed in handling psychiatric patients in order to achieve the goal of rehabilitation and full recovery of these patients. Though obviously, the patient’s rights and the interest of society may collide and meet conflict, each party should be subjected to respect the interest to avoid issues that are not needed in the progress of the people who are in this kind of condition or illness.