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Legal Aspects of

Nursing
Nelia B. Perez RN, MSN
PCU - MJCN

Legal Terms
• Negligence
• A general term that refers to conduct
that does not show due care
• Occurs when someone fails to do
something that a reasonably prudent
person would do in a similar
situation
• Four essential characteristics



Duty
Breach of duty
Harm
Causation

Civil Code, Article 19
• One shall act with justice, give
every man his due, observe
honesty and good faith.

Civil Code, Article 20
• Those who, in the performance
of their obligations through
negligence cause any injury to
another, are liable for damages.

Common Acts of Negligence
• Burns
• Objects left inside the patient’s
body
• Falls of elderly
• Falls of children
• Failure to observe and take
appropriate action as needed

Specific Examples
• Failure to report observations to
attending physicians
• Failure to exercise the degree
of diligence which the
circumstances of the particular
case demands
• Mistaken identity
• Wrong medicine, wrong
concentration, wrong route,
wrong dose

Conditions for Res ipsa loquitor
• That the injury was of such nature that it
would normally occur unless there was a
negligent act on the part of someone
• That the injury was caused by an agency
within control of the defendant
• That the plaintiff himself did not engage in
any manner that would tend to bring about
the injury

Legal Terms
• Duty
• Duty of a professional toward an
individual
• That duty is established when the
nurse patient relationship is started
• Breach of duty
• Nursing care fell below acceptable
standards or the nurse was
negligent

Legal Terms
• Harm
• The patient has been injured in some
way
• Causation
• The breach of duty caused the harm

Legal Terms
• Malpractice
• Specific type of negligence
• Applied to professionals who fail to
follow a standard of care prevalent
for the profession and thereby
harms another person
• Ranges from being negligent when
caring for a patient to betraying a
confidence

MEDICAL ORDERS,
DRUGS and
medications.

RA 6675
• Only validly registered
medical, dental and
veterinary practitioners,
whether in private institution,
corporation or in the
government, are authorized
to prescribed drugs.

RA 5921 (PHARMACY ACT)
• All prescriptions must contain the following
information:
• Name of the prescriber
• Office address
• professional registration number
• Professional tax receipt number
• Patient’s/client’s name, age , sex
• Date of prescription.

RA 6675
• Requires that the drug be written in their
generic names.
• Only when these orders are legal
writing and bear the doctor’s signature
thus the nurse have the legal right to
follow them
• The nurse must not execute an order if
she is reasonably certain it will result in
harm to the patient.

INTRAVENOUS THERAPY AND LEGAL
IMPLICATIONS
• Philippine nursing act of 1991 section 28
• “ in the administration of intravenous
injections, special training shall be
required according to protocol
established”.
• Basis of nurses legal right to give IV
injection.
Board of nursing resolution no. 8 states
that any registered nurse without such
training and who administers IV
injections to patients should be held
liable, either criminally or
administratively or both.

TELEPHONE ORDERS
• Only in an extreme emergency and when
no other resident or intern is available
should a nurse receive telephone orders.
• The nurse should read back such order to
the physician to make certain the order
has been correctly written.
• Such order should be sign by the
physician on his next visit within 24 hours.

MEDICAL RECORDS
• Supplies rich material for medical and
nursing research
• Serves as a legal protection for the
hospital, doctor, and nurse by reflecting
the disease or condition of the patient and
his management.
• “if it was not charted, it was not observed
or done”.

CONTINUATION..
• Nurses are expected to record fully,
accurately, legibly and promptly their
observations from admission to the time of
the patient’s discharge.
• Nurses are legally and ethically bound to
protect the patient’s chart from
unauthorized person.

CHARTING DONE BY STUDENT
NURSES
• When a nurse or clinical instructor counter
signs the charting of the nursing student,
he/she has personal knowledge of
information and that such is accurate and
authentic.
• Anyone who countersigns without
verification commits herself to possible
legal risks.

Liabilities of nurses for the work of
nursing aides
• Nurses should not delegate their
functions to nursing aides since the
Philippine nursing act specifies the
scope of nursing practice of
professional nurses.
• Nurses are enjoined to supervise
their subordinates and see to it that
they perform only those which they
been taught to do and those which
they are capable of doing.

• Nursing aids are responsible for
their actions.
• Nurses should not delegate their
functions to nursing aides.
• Nursing aides perform selected
nursing activities under the direct
supervision of nurses.

LIABILITY FOR THE WORK OF
NURSING STUDENTS
• RA 9173 – nursing students do not
perform professional nursing duties.
• Nursing students should be under
supervision of their clinical instructors.
• In order that the errors committed by
nursing students will be avoided or
minimized, the following measures should
be taken:
• Nursing students should always be
under supervision of their clinical
instructors.

• They should be given assignments that
are their level of training experience and
competency.
• They should be advised to seek
guidance if they are performing a
procedure for the first time.
• They should be oriented to the policies
where they are assigned.
• Their performance should be assessed
frequently to determine their strength
and weaknesses.

Legal Terms
• Standard of Care
• Level of care a reasonably prudent
nurse would have maintained
• Standards of care change with
each new medical advance
• Must keep up with the latest
information in your field
• Must read journals, attend
conferences
• Be familiar with the policy and
procedure manuals and clinical
pathways in your facility

Legal Terms
• Liability
• And obligation or debt that can be
enforced by law
• In cases of malpractice a person
found guilty of a tort is considered
legally liable, or legally responsible
for the outcome

Liability
• Common sources of liability
• Most malpractice claims come from
routine functions








Falls
Medication errors
Burns
Failure to observe
Failure to notify MD
MDs failure to respond
Violation of policies and procedures
Defective equipment
Improper pt teaching

Liability
• Falls
• Identify pt who is at risk for a fall and
take action
• Blind
• Elderly
• Sedated
• Dizzy
• Confused
• Immediately post-op

Liability
• Document use of
• Restraints
• Side rails
• Monitoring of pt

• Use care with restraints
• Side rails are considered a restraint
• May be chemical or physical
• Should use the least restrictive
method
• Continually monitor the pt
• Careful documentation

Liability
• Medication errors
• Perhaps 98,000 Americans dies each
year from med errors
• Remember the five rights
• Right patient, drug, dose, time, route
• Check the med label three times before
administering the med
• Know the correct dose
• Know the correct route
• Know the potential side effects
• Clarify any order with the physician who
ordered the drug

The 5Ps of Incident Reporting
among Filipino Nurses




Policy
Probity
Peril
Punishment
Preservation

Liability
• Burns
• Hot water
• Heating pads
• Heating lamps
• Sitz bath

Liability
• Failure to observe
• Keep monitors on the pt
• Monitor vital signs after
administration of pain meds
• Monitor pt closely and report any
complications

Liability
• Failure to notify the physician
• Must communicate any pertinent
information to the pt’s MD in a timely
manner
• Must speak with MD, not leave
messages
• Should go up the chain of command
if unable to get MD
• Notify MD if there is a change in the
pt’s condition

Liability
• Physician's failure to respond
• If you feel that the MD does not
respond in a satisfactory manner,
must notify the supervisor, hospital
administrator, or medical director

Liability
• Violation of policies and procedures
• You are responsible for knowing
them
• Defective equipment
• Must select the appropriate
equipment for a particular pt or
procedure
• Maintain that equipment
• Use the equipment properly
• Report any problems immediately

Liability
• Improper patient teaching
• Liable for what you teach or fail to
teach
• Give written instructions to reinforce
the verbal instructions
• Document teaching in the chart
• Must provide it in the patient’s
primary language

Incident Reports
• Allows hospital administration to
identify problems within the
hospital system
• Alert administration of an event
that may end up in a lawsuit
• Important to fill out one to identify
problematic situations and create
a safe environment
• Keep statements factual,
objective, do not draw
conclusions
• Do not mention incident report in
charting
• May or may not be allowed into
court

• Remember that patients who feel that
doctors and nurses have done their
best are not as likely to sue as a patient
who feels ignored or neglected
• A little kindness goes a long way!

TORT

Definition
• A tort is a legal wrong,
committed against a person or
property independent of a
contract which renders the
person who commits it liable for
damages in a civil action.

Examples

• Assault and Battery.
• Assault is the imminent threat of a
harmful or offensive bodily contact.
• Battery is an intentional,
unconsented touching of another
person.
• False Imprisonment or Illegal
Detention.
• It means that the unjustifiable
detention of a person without legal
warrant within boundaries fixed by
the defendant by an act or violation
of duty intended to result in such
confinement.

• Defamation.
• Slander is oral defamation of a
person by speaking unprivileged
or false words by which his
reputation is damaged.
• Libel is defamation by written
words, cartoons or such
representations that cause a
person to be avoided, ridiculed, or
held in contempt or to tend to
injure him in his work

CRIMES

Crime defined
• It is an act committed or omitted
in violation of the law. It is
composed of two elements: (1)
criminal act and (2) evil/criminal
intent

Conspiracy to commit a crime
• A conspiracy to commit a crime
exists when two or more
persons agree to commit a
felony and decide to do it.

Criminal Liability

nurse may incur criminal liability or subject
herself to criminal prosecution either by
committing a felony or by performing an
act which would be an offense against
person or property.

• Ignorance of the law is not an
excuse for failure to comply
therewith.
• Violators of the criminal law cannot
escape punishment on the ground
of ignorance of the law

Circumstances affecting criminal liability
• Justifying circumstances are those where
the act of a person is said to be in
accordance with law, so that such person
is deemed not to have transgressed the
law and is free from both criminal and civil
liability.
• These circumstances, enumerated in
Article 11 of the Revised Penal Code, are
(1) self-defense; (2) defense of relatives;
(3) defense of a stranger; (4) avoidance of
greater evil or injury; (5) fulfillment of duty
or lawful exercise of right or office, and; (6)
obedience to an order issued for some
lawful purpose.

• Exempting circumstances
- an imbecile or insane person, unless
the latter has acted during a lucid interval.
-below 9 years old
-over 9 years of age and under fifteen
unless he/she acted with discernment

- causes an injury which is merely an
accident without fault or intention or
causing it
-acts under the compulsion of an
irresistible force
-acts under the impulse of an
uncontrollable fear of an equal or
greater injury

• Mitigating circumstances
Are those which do not constitute
justification or excuse of the offense in
question, but which in fairness and
mercy, may be considered as
extenuating degree of moral culpability.

• Aggravating circumstances

• Are those attending the commission of
crime and which increase the criminal
liability of the offender or make his guilt
or more severe.
• Some of the ff circumstances:
• When the offender takes advantages of
his public position.
• When the crime is commited in place of
worship
• When the act is committed with evident
premeditation or after an unlawful entry.

• Alternative circumstances
-are those which must be taken into
consideration as aggravating or mitigating
according to the nature and effects of the
crime and other conditions attending in
commission.
Should be taken consideration when the
offended party is the spouse, ascendant
or descendant, legitimate, natural or
adopted or relatives.

Points in order to avoid criminal liability:
1. Be very familiar with the Philippine nursing
law.
2. Beware of laws that affecting nursing
practice
3. At the start of employment, get a copy of
your job description, the agency’s rules,
regulations and policies.
4. Upgrade you skills and competence

5. Accept only such responsibility that is within the
scope of your employment and your job description.
6. Do not delegate your responsibilities to others.
7. Determine whether your subordinates are competent
in the work you are assigning them.
8. Develop good interpersonal relationships with your
co-workers, whether they be your supervisors, peers
or subordinates.

9. Consult your superior for problems that maybe too
big for you to handle.
10. Verify orders that are not clear to you or those that
seem to be erroneous.
11. The doctors should be informed about the patients
conditions
12. Keep in mind the values and necessity of keeping
accurate and adequate records
13. Patients are entitled to an informed consent.

Examples liabilities of Nursing:




Liability for injury to patient
Liability for sponge left in the patient’s abdomen
Liability for a safety pin left in patient’s abdomen
Liability for defective equipment
Liability for death for patient who jump from window
of his room

Liability for negligence of surgical nurse
Liability for rapture of surgical wound.
Liability for burns for suffered by patient
Liability for burns from hot water bags
Liability for negligence of nurse
employees
• Liability fro death of infant resulting from
injection of digitalis
• Liability of nurse performing
administrative work




Principals
• Are those who take a direct part in the
execution of the act; who directly force or
induce others to commit; or who cooperate
in the commission of the offense by
another act without which it would not
have been accomplished.

Accomplices
• Are those persons who, not being
principals, cooperate in the execution in
the offense by previous or simultaneous
act.

Accessories
• Are those who, having knowledge of the
commission of the crime, either as
principals or accomplices, take part in the
subsequent to its commission by profiting
themselves or assisting the offender to
profit from the effects of the crime.

Criminal Actions

• Deal with acts or offenses
against public welfare.

Misdemeanor

• Is a general name for a
criminal offense which does
not in law amount to felony.

Felony

• Is a public offense for which
a convicted person is liable
to be sentenced to death or
to be imprisoned in a
penitentiary or prison.
• Is committed with deceit and
fault.

Criminal negligence
• Reckless imprudence – when a person
does an act or fails to do it voluntarily but
without malice, from which material
damage results immediately.
• Simple imprudence means that the person
or nurse did not use precaution and
damage was not immediate or the
impending danger was not evident or
manifest.

Criminal intent

• Is the state of mind of a
person at the time the
criminal act is committed.
• Two elements of deliberate
intent: freedom and
intelligence

Criminal Negligence, mala
in se and mala prohibita
• Criminal Negligence – committed by
means of faulty (culpa); deceit (dolo) (mala
in se) and those which are punished by
special law (mala prohibita).

Kinds of criminal negligence
• Reckless imprudence – doing or failing to
do an act resulting to injuries or death due
to an inexcusable lack of precaution.
• Simple imprudence - mere lack of
precaution in a situation where threatened
harm is not immediate or the impending
danger is not openly visible or manifest.

• Culpa Contractual (breach of Contract) – when a nurse
is contractually obligated to perform a particular health
service or intervention to a patient and he/she causes
death or injuries to the latter.
• Culpa aquiliana a tortous liability which arises from the
breach of a professional duty to any person fixed by the
laws and such breach constitutes violation of a private
legal right, not created by any contract.

End of Life Decisions and the
Law




Do Not Resuscitate Orders
Advance Directives
Contracts/ wills/ testaments
Durable Power of Attorney
Incident Report

LEGAL BASES OF
NURSING EDUCATORS,
NURSING REGULATION
AND NURSING PRACTICE

R.A. 9173
• AN ACT PROVIDING FOR A MORE
RESPONSIVE NURSING PROFESSION,
REPEALING FOR THE PURPOSE
REPUBLIC ACT NO. 7164, OTHERWISE
KNOWN AS "THE PHILIPPINE NURSING
ACT OF 1991" AND FOR OTHER
PURPOSES

R.A. No. 9173 – Nursing Law
• Aims to provide a sound general
and professional foundation for the
practice of nursing through quality
nursing education.
• The first policy encourages nursing
schools and colleges to implement
some standards for admission,
qualifying exams for 3rd year level
promotion and quality part indices
for the continuance of nursing
student in their respective nursing
degree programs to ensure the
quality of their nursing graduates.

R.A. No, 9173 – Nursing Law (cont)
• The 2nd policy – total quality education can
only be achieved when the government
makes it accessible to all who are fit and
prepared for it.
• Uplift standard of nursing education for this
country to produce quality nursing
graduates and ultimately globally
competitive Filipino Nurses.
• Not to discriminate against student where
spirits are willing but in intellectual, they are
wanting.
• Every Filipino has the right to education
however; every Filipino has the
responsibility to know his limitation and to
change the course for which he is suited.

• Nursing Education and nursing
practice are constantly interacting
while in the process of rapid
change to adopt to the existing
demands and condition of the
health care delivery system.
• They are complimenting each
other.
• The success of nursing practice
rest upon a sound educational
foundation of the nurse.
• The goal of nursing education is
to prepare the nursing student for
nursing practice.

• Goal of nursing practice is to
provide quality nursing service
and improve nursing care.
• This is when nursing regulation
comes into play.
• Everyone has a right to nursing
education as a constitutionally
guaranteed right.

Art. XIV, Sec. 1 of the 1987
Constitution
• To protect and promote the right
of all citizen to quality education
at all level and to take all
appropriate steps to make such
education accessible to all.

Nursing
education

NURSING EDUCATION
• R.A. 7164
Required a certification by the school that the
applicant belong to the upper 40% of the
graduating class, as a general requirement to
the nursing degree course.
• R.A. 9173
> deletion of said admission requirement
> one high school performance is not an
accurate basis for college admission and
students’ mental competence and
psychological preparedness for college
education.
> More nursing students because more
graduating students will be eligible to enroll in
nursing degree program and more nursing
schools will be opened and offer the degree of
BSN.

NURSING EDUCATION (Cont)
• R.A. 7722 – CHED
Provide standard or minimum
requirement for the operation
and regulation of educational
institution offering tertiary
courses such as BSN.

• Duly authorized government agency that
approves the opening and regulates the
operation of nursing schools all over the
country.
• Created through R.A. 7722, May 18, 1994
CHED Memo Circular No. 30, s. 2001
• Updated policies and standards for nursing
education.
• New policy directing the CHED to regulate
the establishment and operation of review
center.

CHED Policy on Nursing schools and
colleges
• Nurses are needed in every
part of the world, with the
tremendous global demand,
nursing schools and colleges
are sprouting everywhere like
mushrooms.
• Authority to open and close
nursing schools / colleges

CMO No. 30
• The authorization to open a nursing school
shall be based upon:
1. written recommendation of BON,
PRC and NSA (National Student
Affiliation), DOH
2. approval of CHED
• The power of BON as to authorization of
opening or closing nursing schools is
recommendatory pursuant to COM No. 30
and RA 9173.

B. ADMINISTRATION AND FACULTY
• Fulltime Dean and Faculty
Qualification of Dean
• Perform vital role and function in nursing
school, required to work fulltime because
she is in charge to administer and manage
the nursing school, faculty and staff, the
nursing student and degree program.
• Filipino Citizen
• Currently registered nurse in the
Philippines
• Holder of Master’s Degree in Nursing
• 5 years of competent teaching and
supervisory experience in college or
institute of nursing.
• Member of good standing (ADPCN) and
accredited national nursing organization
(PNA)

Qualification and Rank of Faculty Members
A Filipino Citizen
Currently RN in the Philippines
Holder of Master’s degree
At least 3 years of Clinical
experience
• Member of good standing
accredited national nursing
organization.



R.A. 10609
• AN ACT PROTECTING THE RIGHT OF
STUDENTS ENROLLED IN COURSES
REQUIRING PROFESSIONAL
LICENSING EXAMINATIONS TO
ENROLL IN REVIEW CENTERS OF
THEIR CHOICE AND PROVIDING
PENALTIES FOR VIOLATIONS
THEREOF.

NURSING REGULATION

NURSING REGULATION
• Professional Regulatory Board of Nursing
* created under new nursing law (RA
9173)
* Primary agency responsible for the
regulation of the admission, registration
and practice of nursing profession in the
Philippines.
* Composition of BON
* one Chairperson
* Six Members
* Appointed by the President of
the Philippines

Qualification of Chairperson
and Members of BON
• Representative of 3 areas of nursing
(education, service and community health
nursing)
• Natural born citizen and resident of the
Philippines.
• Member of good standing accredited
professional organization of nurses.
• Registered nurses and holder of Master’s
Degree
• 10 years of continuous practice of the
profession prior to appointment
• No conviction of any offense involving
sound turpitude.

Powers, Duties and
Responsibilities of the BON
• Conduct licensure examination for nurses
(R.A. 8981)
• Prepare adopt and issue the syllabi or
tables of specification of the subject for
examination in consultation with the
academe.
• Determine and prepare the questions
for the licensure examinations which
shall strictly be within the scope of
syllabi or table of specification of the
subject for examination.

Conduct licensure examination
for nurses (R.A. 8981)-Cont
• To score and rate the examination papers
with the name and signature of the board
members concerned appearing thereon
and sublit the result in all subjects duly
signed by the members of the board to the
commission within 10 days from the last
day of examination unless extended by the
commission for justifiable cause and
subject to the approval of the commission.
• Determine the appropriate passing general
average rating in an examination if not
provided for in the law regulatory thru
profession.

Our duty is to be useful,
not according to our
desires but according to
our powers.