NURSING JURISPRUDENCE

BY: ATTY DEIRDREE CODAMON- GALLMAN, RN

NURSING JURISPRUDENCE

department of law which comprise all legal rules and principles affecting the practice of nursing.

NURSING LEGISLATION


the making of laws, or the body of laws already affecting the practice of nursing.

LAW


a rule of civil conduct prescribed by the supreme power in a state commanding what is right and prohibiting what is wrong.

LEGAL RIGHT


a claim which can be enforced by legal means against a person whose duty is to respect it.

 

COURT MECHANISM: LAWSUIT-

proceeding in court for a purpose.  Purpose: 1. to enforce a right 2. to redress a wrong

Q:If you think that a person has done something seriously wrong to you, the correct action to do get redress for the injury received is to:


A. systematically plan on how to have a vindication for the damage done B. file a lawsuit against the person for damage C. hire someone to take revenge for you

Parties to cases:
 

Civil case- Complainant/ defendant Criminal case- Plaintiff/ accused

Q: The person who institutes legal proceeding is called:

   

A. Plaintiff B. respondent C. defendant D. Accused

Q:A hospital filed a case of damages against nurse for breach of contract. Who is the nurse in the case? A. complainant B. accused C. defendant D. plaintiff

  

STATUTE OF LIMITATIONS
- the length of time following the event during which the plaintiff may file a suit.  Example: negligence- filed within 2-3 years from occurrence.

DUE PROCESS


is a fair and orderly process which aims to protect and enforce a person s right.

FUNDAMENTAL REQUIREMENTS OF DUE PROCESS:

1. Right to be informed

2. Right to remain silent

3. Right to a competent counsel

4. No use of violence, threat, torture

PRE-TRIAL- eliminate matters not in dispute, agree on issues or settle procedural matters. TRIAL- facts are presented and determined; law applied at the end.

SUMMONS- is a writ commanding an authorized person to notify a party to appear in court to answer a complaint made against him. WARRANT- presented by an arresting officer

SUBPOENA- is an order that requires a person to attend at a specific time and place to testify as a witness. SUBPOENA DUCES TECUM- is a subpoena that requires a witness to bring documents/ papers in his possession.

A process whereby the BON only compel the personal attendance of a witness to bring with him to the court books, papers and the like to elucidate the matters in issue:

a. b. c. d.

Warrant Subpoena Subpoena duces tecum Summons

WITNESS- person giving necessary details

Nurses as witness:
Could not divulge PRIVILEGED COMMUNICATION in a civil case- means that the nurse is incompetent to testify on the communications made to him by the patients, all the device given and all the information gathered by observation during the seal of secrecy. Exceptions:1. criminal case 2. with the patient s consent 3. patient sued doctor for damages


Q:For privileged communication in the doctor, the nurse and the patient, the seal of secrecy:

a. forever remains until removed by patient b. may be broken upon death of the patient c. may be disclosed when the patient is insane d. all of the above

 

Testimonies of Facts- factual information no opinion unless an expert witness PERJURY- is the willful telling of a lie under oath.

HEARSAY EVIDENCE- rumors, not admissible in evidence DYING DECLARATION or ANTE MORTEM STATEMENTS- considered hearsay unless the dying person is a victim of a crime.

APPEALS- review of the case by appellate court and when decided by it, the final judgment results and matter is ended. EXECUTION OF JUDGMENT


Failure to comply means contempt of court

FELONIES
acts or omissions punishable by law.  Elements: 1. Deceit-( dolo) 2. Fault-(culpa) due to imprudence, negligence or lack of foresight/ skill


Q: A crime can be committed with the element of culpa if:



A. the person committed the crime because of ignorance of the law B. the person knows the action is a crime and he chooses to do it C. the person committed the crime because he lacked the competency to act correctly

Stages of felonies
1. Consummated all elements executed, with successful result all elements executed but no successful result not all elements executed, no successful result

2. Frustrated

3. Attempted

Degree of Felonies degree penalty fine

Capital above P6k punishment or >6yrs & 1 day Less grave 1 month and 1 not > P 6 K day to 6 years but not <P200

grave

Light felony 1 day to 30 days

fine not > P 200

Q: If the penalty is the death penalty, what is the degree of the felony?

  

A. grave B. less grave C. light felony

Q: If the fine is exactly P200., what is the degree?

  

A. grave B. less grave C. light felony

CLASSIFICATION OF PERSONS CRIMINALLY LIABLE: 1. PRINCIPAL a. By direct participationdoer of the act

b. By inducement-directly force or induce others c. By cooperation- indispensable

2. ACCOMPLICE
-a person who cooperates accessory before the fact - absent at the time crime is committed.

3. ACCESSORY
accessory after the fact a. Profits b. Conceals/ destroys evidence c. Assists in the escape of the principal

Situation: Danaya is two-months pregnant. Her parents do not know this. Danaya informed her friend Alena about the problem. Alena referred Danaya to Pirena , an abortionist. Danaya had an abortion.

If those involved will be charged legally, who is considered as the principal? a. Danaya b.Alena c. Pirena d. None of them

Who is considered as an accomplice? a. Danaya b.Alena c. Pirena d. None of them

If during the investigation, the pieces of evidence were not found because Gurna the maid of Pirena burned it. Gurna is consider as: a. accomplice b. accessory c. principal d. co-principal

A nurse is liable as an accomplice in an abortion if she:

a. Assist in the escape of the offender b. Refers the pregnant mother to the abortionist c. Conceals the evidence of the crime d. None of these

Circumstances affecting criminal liability

J-E-M-A-A

JUSTIFYING


 

SELFSELF-DEFENSE  Unlawful aggression  Reasonable necessity  Lack of sufficient provocation Fulfillment of Duty Obedience to an order from superior  Order must be lawful  Superior acting within the scope of practice

EXEMPTING
 

Insane/imbecile Performance of a lawful act causes

injury by mere accident

 

Under 9 y/o Under compulsion of uncontrollable

force

 

Under impulse of uncontrollable fear Failure to perform an act required by

law when prevented by some lawful cause

MITIGATING
   

  

Under 18y/o or over 70 y/o No intention to commit so grave a wrong Sufficient provocation/threat preceding the act Immediate vindication of a grave offense Voluntary surrender Deaf & dumb/ with physical defect Suffer from such illness that diminishes willpower

AGGRAVATING


Treachery/taking advantage of superior strength or position  Price, reward, promise  Use of fire, poison, explosion  Calamities  Craft, fraud or disguise employed  Evident Premeditation  Cruelty

ALTERNATIVE


May increase/ decrease criminal liability depending on the nature and effects of the crime

Relationship Intoxication Degree of instruction/ education

DRILLS
1. Under compulsion of uncontrollable force 2. There is sufficient provocation 3. Act is committed with abuse of confidence 4. Fulfillment of a duty 5. Offender is over 70 years old

6. Voluntary surrender 7. Disguise be employed 8. Defense of a stranger 9. Acts under the impulse of an uncontrollable fear 10. Offender is insane

Q: Premeditating to commit a crime is considered as:

   

A. justifying B. mitigating C. aggravating D. exempting

Q: When the defendant kills someone accidentally:

   

A. justifying B. exempting C. aggravating D. mitigating

CRIMES CONCERNING THE NURSE

     

-the victim or offender is the 1. father 2. mother 3. brothers/sisters 4. ascendants 5. descendants 6. spouse

The killing of another human being

-The killing of another human being with

any of the aggravating circumstances provided by law.

treachery

- the killing of an infant less than three days or 72 hours.

ACTS OF LASCIVIOUSNESS

MALICIOUS MISCHIEF

PHYSICAL INJURIES
1.

Serious Physical Injuries

2. Less Serious Physical Injuries 3. Slight Physical Injuries

ANTI- RAPE LAW (RA 8353)

I.
 

A. MARITAL RAPE B. STATUTORY RAPE

II. Anyone who inserts his penis into the oral orifice of another by force is liable under this law.

III. Anyone who inserts anything into the anal orifice or genitalia of another is liable under this law.

ROBBERY
-

Anyone who gets the personal property of another with the use of force,violence or intimidation.

THEFT
-anyone who gets the personal property of another without the latter s permission.

ASSAULT
-

imminent threat of harmful/ offensive body contact

BATTERY
-

intentional, unconsented touching of another person.

ILLEGAL DETENTION/ FALSE IMPRISONMENT

-

Deprive another of his freedom of movement or space.

Patient restraint

SIMULATION OF BIRTH


1. Pretend that a woman gave birth

2. Substitution or exchanging of babies in the nursery

3. intentionally putting wrong information in the birth registration form

DEFAMATION
1. Slander- oral

2. Libel- written

Q: The nurse writes the following note in the client s chart The physician is incompetent because he ordered the wrong drug dosage .This statement may lead to a charge of: a. Assault b. slander c. libel d. Invasion of privacy

INVASION OF PRIVACY
THE RIGHT TO BE LEFT ALONE, FREE FROM UNWARRANTED PUBLICITY, RIGHT TO LIVE ONE S LIFE * Nurses liable if they divulge any information from patient s chart to improper or unauthorized persons.

MISDEMEANOR


An act less than a felony.

Q: A person uses the license of another person to practice nursing. Liable for What?
   

A. negligence B. malpractice C. misdemeanor D. invasion of privacy

DRILLS
1. A student nurse is overheard talking in the cafeteria about a client and his suicidal tendencies. 2. A nurse asks a client why he chose Dr. Smith for her physician when this doctor is always rude to the staff.

3. A client is told he must pay the remainder of his medical bill before he can leave the facility. 4. A nurse told the client that she will inject her with sedatives if he does not cooperate. 5. A nurse forcibly opened the mouth of a pedia patient and gave his medication.

6. A nurse takes the wallet of the patient while the latter is sleeping. 7. A nurse takes the wallet of the patient with the use of violence and intimidation.

8. A nurse gives a potent injection of morphine to a patient causing his death. 9. A nurse poisons his client to end his life. 10. A patient died because of wrong medication given.

GUIDELINES TO PREVENT CRIMINAL LIABILITY:

1. Be very familiar with the Philippine Nursing law 2. Be familiar with the laws affecting nursing practice 3. Know agency rules, regulations, policies 4. Upgrade skills and competence

Q:To upgrade your skills, you must:

   

A. enrol in the graduate school B. be a member of the PNA C. attend seminars and trainings D. renew license

5. Develop good IPR with co-workers 6. Consult superior as needed 7. Verify vague/ erroneous orders 8. Always keep doctor updated regarding patient 9. Ensure accurate recording and reporting 10. Get informed consent 11. Do not delegate responsibilities to others

LEGAL CONSIDERATIONS IN CHARTING:

1. Don t tamper with medical records(ARD)adding, rewriting and destroying original record 2. Observe agency s standards on documentation  complete, concise, specific, use standard abbreviation

TELEPHONE ORDERS

TIPS FOR AVOIDING LEGAL PITFALLS:

1. Patient Falls  do proper assessment  appropriate assistance  use protective measures  document all nursing interventions

2. Medication errors
  

observe 7 R s of drug administration Check dr s order Understand the medication you will administer Consult drug handbook/ pharmacy Not exempt from liability for following dr s order

a.

b.

c.

d.

A co-nurse confided that she has given a medication to the wrong patient. What will you do? advise her to report the incident to the head nurse advise her to keep quiet about what happened accompany her to the head nurse to report the incident report her immediately to the head nurse

3. Equipment injuries
refuse to use a device not know how to operate  report adverse events to superiors  monitor patient regularly  bring questionable orders to the attention of the doctor or superior


Failure to communicate


promptly report changes in the patient s symptoms and signs of distress to the Dr

proper documentation of all assessments and telephone conversations with the Dr

NURSES AND CONTRACTS

CONTRACT- agreement between at least two parties which create an obligation recognized by law.

Elements of a valid contract:

1. given freely/ voluntarily- no coercion/ pressure 2. competent parties- 18 yrs old, sound mind 3. lawful object- within the bounds of law 4. valid consideration- has monetary value

Essential requisites:
1. Consent 2. Object certain 3. Cause of the obligation

Types of Contract:
1. Implied- terms are inferred from actions of contracting parties. 2. Expressed- verbal/ written, terms are specified/ given at the time the contract is made.

3. Void or inexistent- inexistent from the very beginning therefore may not be enforced. Ex: contrary to law. 4. Illegal - expressly prohibited by law like obtained through fraud, undue influence or duress. 5. Voidable/annullable- one of the parties is incapable of giving consent

5. Formal- agreement among parties and is required to be in writing by special laws. Ex: marriage, Deed of sale 6. Informal- concluded as a result of a written document where the law does not require the same to be in writing.

Q: A person entered the clinic of a doctor for treatment.What type of contract?

   

A. formal B. implied C. informal D. expressed

Q: A nurse and a pregnant woman agreed that the nurse will do home delivery for a fee. What type of contract?
   

A. informal B. implied C. expressed D. formal

BREACH OF CONTRACT- failure without legal excuse to perform any promise which forms the contract.

The following constitute breach of contract for nursing service:

1. 2.

3. 4.

Prevention of performance Failure of performance because of inconvenience or difficulty Abandonment of duty Substitution of performance

Legal excuses in refusing or failure to perform a contract:

1. Discovery of material misrepresentation 2. Where performance will be illegal 3. Impossible by reason of illness 4. Impossible by death of patient or nurse 5. Made for other reasons 6. Contract is insufficient

Will


an act whereby a person is permitted with formalities of law to control to certain degree the disposition of a state to take effect after his death.

 

DECEDENT- person whose property is transmitted through succession. TESTATOR- a decedent who left a will HEIR- a person called to succession

TYPES OF SUCCESSION: 1. Testate- a person dies leaving a will. 2. Intestate- a person dies without leaving a will.

TWO KINDS

1. Notarial will- acknowledged before a notary public, with attestation clause 2. Holographic will- entirely written, dated and signed in the handwriting of the testator

Who makes wills:

1. those not expressly prohibited by law 2. 18 yrs old 3. sound mind

Who could be witnesses:

1. sound mind 2. 18 and above 3. not blind, deaf or dumb 4. able to read and write

a. b. c. d.

Bakekang, 59 years old, is suffering from a debilitating disease but of sound mind. She has asked you to help her make a will. How should you respond to the situation? let her dictate and write for her call her intended beneficiaries as witnesses assist patient to consult a legal officer refuse request since it is not your duty

NURSE S OBLIGATION IN THE EXECUTION OF A WILL:

1. Note the soundness of client s mind and to ensure that there is freedom from fraud/ undue influence.

2. Note that the will is signed by the testator.

3. Note that the witnesses shall be present at the time and sign in the presence of testator.

GIFTS MORTIS CAUSA



disposing of gifts by a person in anticipation of death/ belief in approaching death.

Limitations: 1. limited to personal properties 2. acceptance by the recipient 3. gifts are revocable and subject to the claims of creditors without proof of intent of defrauding them

BOARD QUESTIONS: 1. The nurse out of pity unhooked the patient from a respirator. The patient died after 15 minutes. This type of felony is: a. consummated b. frustrated c. attempted


2. Circumstances which are said to be in accordance with the law are said to be: a. Justifying b. Exempting c. Mitigating d. Aggravating

3. All of the following are exempting circumstances except: a. Imbecile b. 8 year old c. performance of a lawful act d. offender is deaf and dumb

4. When a politician takes advantage of his power in the performance of unlawful actions, this is considered as: a. justifying circumstance b. exempting circumstance c. mitigating circumstance d. aggravating circumstance

5. When one alters a record to conceal possible evidence of negligence, she can be charged as: a. accomplice b. accessory c. principal d. co-principal

BOARD QUESTIONS: 1. A client in a long term care facility refuses to take his oral medications. The nurse threatens the client and tells him that, if the medication isn t taken, restraints will be applied. The nurse s statement constitutes which legal tort? a. assault b. battery c. negligence d. right to refuse treatment


2. The nurse is at risk for lawsuit. Which of the following actions will shield her from possible lawsuits? 1. knowledge and implementation of standards of care 2. documentation of actions accurately and concisely 3. document outcome of care 4. following all doctor s order a. 1,2,4 b. 2 & 3 c. 1,2,3 d. 2,3,4

3. One of the midwives in the health center injected Cotrimoxazole to a 5 year old patient without the consent of the parents. Which of the following can the midwife be possibly accused of? a. malpractice b. battery c. negligence d. assault

4. If that nurse divulges the information that she is caring for the child of a patient with sexually transmitted disease, she can be liable for: a. libel b. slander c. tort d. invasion of privacy

5. Two janitors were having a heated argument as to who shall dispose the waste of a patient with typhoid fever. The first one called the other lazybone and pain in the neck within the hearing of the rest of the nurses.The case is: a. libel b. invasion of privacy c. slander d. negligence

6. Should the accusation be written in the newsletter of the hospital, such liability is a: a. assault b. libel c. slander d. battery

7. The nurse observed that in the hospital where she worked, it is a practice to accept medical orders by telephone. In this aspect, she should remember the following: a. T.O should be countersigned by the attending physician at the first opportunity to make it legal order b. T.O are risky and should not be accepted c. The nurse could write on the the doctor s order sheet the exact date, time and full name of the dr giving the order d. The nurse can sign for the doctor on the order sheet  a. 1,4 b. 1,2 c. 3 only d. 1, 3

8. The nurse noticed that restraining patients is a common practice. Which of the following should she remember? a. Restraints are necessary so that the nurse could do more work for patients b. Use of restraints is an effective intervention c. Restraints require a physician s order d. Refusal to be restrained is a ground for terminating the nurse-patient relationship

 

 

9. Patient records are very important in court litigations. Which of the following safeguards should be adopted by the nurse? A. follow standard charting b. photocopy pt s chart before submitting to the medical records Office c. maintain a logbook of potential legal case all of the above