Jurisprudence and Legal Liabilities in Nursing What is liability in the practice of nursing in the Philippines? A liability is a penalty of sanction suffered by a nurse if found guilty of violation of any of the existing laws in the Philippines and their implementing rules and regulation. Kinds of Liabilities 1. Administrative Liability 2. Civil Liability 3. Criminal Liability I. ADMINISTRATIVE LIABILITY Definition: is that which is occurred for a violation of any administrative or regulatory law in the Phil. Ex: nursing act, Med. tech Law, etc. The nursing act or law is a kind of administrative or regulatory law that regulates of governs practice of nursing in the Phil. It provides for grounds of reasons for reprimand, suspension or revocation of a license to practice nursing in the Phil. The nursing act, however, is applicable only in the Phil. And is not recognized anywhere in other countries. Where the complaint is filed: the complaint is called administrative complaint and is filed with the board of nursing which under the PRC. Nature of Liability: the liability under and administrative case is purely personal to the respondent nurse. In other words, the license of the hospital is not affected by the guilty verdict on the supposed negligent nurse. II. CIVIL LIABILITY Definition: the civil liability of the nurse is that which impose a penalty of damages in the form of payment or compensation. The basis of the damage suffered by the aggrieved party, on the account of the supposed negligence of the nurse.
The law: the law existing and applicable to this kind of liability is the civil code of the Phil. It is the law that governs private relationship between the nurse and the patient. It imposes a liability of amount in money representing the supposed damages suffered from the patient Penalty: the penalty imposed under the civil code of the Phil is called civil liability. The penalty represents the sufferings or expenses incurred by the patient. On account of the supposed negligence or wrongdoing of a nurse. It compensates the aggrieved party for his or her supposed misery in being a victim of a nurse. Kinds of Damages: As a civil liability. There are different kinds of damages that the nurse may incur. These are the one that is most popular: 1. Actual damages 2. Exemplary damages 3. Moral damages 4. Lost of income
There is also law that, if violated, imposes a civil liability on the supposed negligent nurse. This is family code of the phil. this law provides for the at the at which the patient can sign consent and that is at 18 yrs of age. It is the nurse secure consent for a 15 yrs old pt. Then a civil liability may be incurred by the nurse. Nature of civil liability: a nurse may be found guilty of negligence in a civil case and may be ordered to pay damages to the pt. However, in civil cases there is what called primary liability and secondary liability. This is by virtue of the employer-employee relationship between the nurse and the hospital. This is also called Doctrine of Vicarious liability in civil cases. The civil code provides that the employer may be liable for the negligent act of its employee. III. CRIMINAL LIABILITY Definition: is that incurred by a guilty nurse with imprisonment and or fine as penalty imposed. After trial or hearing. If found guilty of
the crime charged the judge reads a verdict of guilty of and imposes a penalty of imprisonment and or fine. The laws and penalty: The main existing law that imposes a criminal liability in the practice of nursing is the revised penal code of the phil. it provides a various crimes charging a nurse with criminal or penal offense. Nursing Jurisprudence -Defined as the department of law that comprises all the legal rules and principles affecting the practice of nursing. It includes not only the study but also the interpretation of all these rules and principles and their application in the regulation of the practice of nursing. It deals with: 1. All laws, rules and regulations. 2. Legal principles and doctrines governing and regulating the practice of nursing. 3. Legal opinions and decisions of competent authority in cases involving nursing practice. Sources of Nursing Jurisprudence in the Philippines: The sources are the following: 1. The Constitution of the Republic of the Philippines, particularly the Bill of Rights. 2. Republic Act No. 7164 otherwise known as the Philippine Nursing Law of 1991. 3. Rules and regulations promulgated by the Board of Nursing and/or Professional Regulation Commission pertaining to nursing practice. 4. Decisions of the Board of Nursing and/or Professional Regulation Commission on nursing cases. 5. Decisions of the Supreme Court on matters relevant to nursing. 6. Opinions of the Secretary of Justice in like cases. 7. The Revised Penal Code. 8. The New Civil Code of the Philippines. 9. The Revised Rule of Courts.
10. The National Internal Revenue Code as amended Laws, Resolutions, Proclamations and Executive Orders Affecting the Practice of Nursing in the Philippines ON NURSING RA 9173 An act Providing for a more Responsive Nursing Profession repealing for the purpose RA 7164, otherwise known as Philippine Nursing Act of 1991 RA 7164 Philippine Nursing Act of 1991 BON Resolution No. 110 of 1998 Adoption of a Guide to Evaluate Compliance with Standards for Safe Nursing Practice BON Resolution No. 14 S 1999 Adoption of the Nursing Specialty Certification Program and Creation of the Nurse Specialty Certification Council BON Resolution No. 118 S. 2002 Guidelines for the Implementation of Board Resolution No. 14 S 1999 BON Resolution No. 425 S 2003 Implementing Rules and Regulations of RA 9173 BON Resolution No. 08 S 1994 Special Training on Intravenous injections for RN Proc #539 Nurses Week- Every last week of October LOI 1000 Members of accredited professional organizations given preference in hiring attendance to seminars ILO Convention #149 Improvement of life and work conditions of nursing personnel (ILO Recommendation #157) RA 8344 Hospitals/ doctors to treat emergency cases referred for treatment ON CHILDREN, WOMEN AND FAMILY EO 209
Family Code of the Philippines PD 48 Four (4) children with maternity leave privilege PD 69 Four (4) children for personal tax exemption PD 491 Nutrition Program PD 603 Child and Youth Welfare Code PD 651 Birth registration within 30 days following delivery PD 965 Family planning and responsible parenthood instructions prior to issuance of marriage license PD 996 Compulsory Immunization for children below eight (8) years old against preventable diseases PD 791 Revised Population Act as implemented by POPCOM (Commission on Population) EO 51 Philippine Milk Code Proc. #6 United Nations Goal on Universal Child Immunization by 1990 RA 6725 Prohibition of Discrimination against Women RA 7600 Rooming- in and Breast feeding Act of 1992 RA 7610 Special Protection of women against Child abuse, Exploitation and Discrimination RA 7432 Senior Citizens Act RA 9262
Violence against women and Children RA 7877 Anti- sexual harassment Act of 1995 RA 8187 Paternity Leave Act of 1995 RA 7192 Women in Development and Nation Building COMMUNITY RA 7160 Local Autonomy (Government) Code RA 7305 Magna Carta of Public Health Workers PD 825 Anti- improper garbage disposal PD 856 Code of Sanitation LOI 949 Legal basis of Primary Health Care RA 1082 Creation of rural health units all over the Philippines RA 3573 Reporting Communicable Diseases RA 4073 Treatment of Leprosy at Government skin clinic, rural health unit or by a duly licensed physician RA 6972 Day care center in every barangay RA 7883 Barangay health Workers benefits and Incentive Act of 1992 RA 8749 Clean Air Act ON EMPLOYMENT
PD 442 New Labor Code PD 626 Employee Compensation and State Insurance Fund PD 851 13th month pay PD 1519 Medicare Benefits to all Government Employees PD 148 Amending RA 679 (Woman and Child Labor Law) EO 180 Guidelines on the right organize of government employees RA 1080 Civil Service Eligibility RA 6713 Code of Conduct and Ethical Standards for Public Official and Employees RA 6727 Wage Rationalization RA 6758 Salary Standardization of Government employees RA 6741 New Retirement Law of employees in the Private Sector RA 7875 National Health Insurance Act of 1995 RA 8282 Social Security Law of 1997 (amended RA 1161) RA 8291 Government Service Insurance System Act of 1997 (amended PD 1146) Legal Problems in Nursing Practice I. Crime - Act committed in violation of social law. a. Tort (fraud, negligence & malpractice) - Legal wrong committed against a person, his rights & property
1. 2. 3. Negligence Definition:
Fraud misrepresentation of fact with intentions for it to be acted Negligence Malpractice
on by another person ( such as falsifying graduate nursing programs)
- Unintentional failure of an individual person to perform an act or omission to do something that a reasonable person would do or not do. - Most common unintentional tort - Failure to observe the protection of ones interest, the degree of care, and vigilance of circumstances. Example: a. burns: heating pads ,solutions & steam vaporizers b. failure to take & observe appropriate actions forgetting to take vital signs to a newly post operative client. c. Falls: side rails left down, baby left unattended d. mistaken identity, wrong medicine, dose & route Malpractice Definition: any professional misconduct which involves any conduct that exceeds the limits of ones professional standards means going beyond the context or scope of allowed nursing practice resulting to injurious or non-injurious consequences. - stepping beyond ones authority Example: a. prescribing drugs b. giving anesthesia c. doing surgery Elements of Negligence Lawsuit plaintiffs injury Elements of Malpractice Lawsuit is required
B- breach of duty was the cause of the P- professional SPECIFIC standards of care
R- Real or actual proof injuries to the standards of care O- owed specific nursing duty standards of care D- defendant breach the duty Intentional Torts Assault -Mental or physical threat
R- required obedience E- exceeds the limits of the
Battery -physical harm through willful touching of person or clothing without consent.
Example a. threatening or attempting to do violence to another b. forcing a medication or treatment when the patient doesnt want it c. threatening children to take the medication
Example a. actually touching or wounding a person in offensive manner b. hitting or striking a client c. immediately injecting a surgical needle without informing the patient about the said procedure
False Imprisonment - occurs when the person is not allowed to leave a health care facility when there is no legal justification to detain the client. - occurs when restraining devices are used without an appropriate clinical need. - The intentional confinement without authorization by a person who physically constricts another using force , the threat of force or confining structures and or clothing , even without force or malicious intent to detain another without consent in a specified area constitutes grounds or a charge of false person
from harming self or others if it is necessary to confine to define one self , others or property or to effect a lawful arrest. Example: A Hispanic American patient undergoes TAHBSO and has no Medicare or HMO card or any cash to pay hospital bills. The nurse put the patient in a room until the relatives of the former arrive to pay the bills. Legal aspect regarding Restraints Restraints are protective devices used to limit the physical activity of a client or to immobilize a client or an extremity. Physical restraints: restrict client movement through the application of a device. Chemical restraints: Medications given to inhibit a specific behavior or movement. Under Omnibus Budget Reconciliation Act: any client or patient has the right to be free from Physical (such as restraint jackets) and chemical (sedation, psychotropic drugs) restraints Imposed for the purpose o discipline or convenience and should not be required to treat medical or psychiatric symptoms. Lawful Requirements & Nursing Actions for Using Restraints According to (JCAHO) Joint Commission on ACCREDIATATION OF HEALTHCARE ORGANIZATIONS 1. RESTRAINTS SHOULD NOT BE USED PRN!!! 2. Informed consent and a Doctors order is needed to use restraints. 3. Doctors orders for restraints should be renewed within a specific time frame according to the agencies policies. 4. Restraints should not interfere with any treatments or affect the clients health problems. 5. Document the following: Reason for the restraints
Method of restraints Date and time of application Duration of use and clients response Release from the restraints (every 30 minutes) with periodic exercise and Circulatory, neurovascular and skin assessment Evaluation of clients response 6. DONT ASK PERMISSION IF THE PATIENT HAS AN ALTERED LEVEL OF CONSCIOUSNESS!!! 7. If the client is unable to give consent to a restraint procedure, then consent of proxy must be obtained AFTER FULL DISCLOSURE OF ALL RISK AND BENEFITS. 8. Use a clove hitch knot so that restraint can be changed and release easily and ensure that there is enough slack on the straps to allow some movement o the body part. 9. Never secure restraints to bed rails or mattress. Secure restraints to parts of the bed or chair that will move with client & not constrict movement. Writing an Incident Report - A tool used as a means of identifying and improving client care. They are usually made immediately after its occurrence and validated immediately by co-workers. - the real purpose is to provide accurate documentation of occurrences affecting the client as to have basis for its intervention. - it is usually made as a comprehensive & accurate report on any unexpected or unplanned occurrence that affects or potentially affects his family or other members of the health team.
The following are common situations that require an incident report: MOST OF THEM ARE NEGLIGENT NURSING ACTS a. Falls , Burns & medication error b. Break in the aseptic technique
c. Incorrect sponge count during surgery d. Failure to report the clients condition Rules in Incident Report Dont use the word error or include lawful judgment or inflammatory words Legal Rules on Documentation, Charting & MDs Order Documentation - Legally required by accrediting agencies, state licensing laws and state nurse and medical practice acts. -required for insurers reimbursement - legal documentation that signifies proper communication about the patients condition Organ Donation Requirements: a. Any person 18 years of age or older may become an organ donor by written consent. b. Informed choice to donate an organ can take place with the use of a written document signed by the client prior to death, a will, or a donor card or an advance directive. c. In the absence of appropriate docum...