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Medical Legal Issues and Definitions

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This page consist of online training for EMS personnel.  The subject of training is "Medical Legal Issues and Legal Definitions".  To see more training topics,  Click Here!


Medcial Legal Considerations and Definitions


In any position of responsibility, potentials for liabilities must be expected. The position of the EMS Professional includes numerous responsibilities. The public and our patient's expect us to perform appropriately in any given situation. Therefore, in any given situation, the EMS Professional should be thoroughly informed not only of their obligations, but also of the potential legal consequences.

This page will cover some of the Legal Issues EMS Professionals may encounter.   This page is in no way intended to mislead the EMS Professional from their own states Legal Guidelines, please be sure you follow your Policies and Procedures.

Criminal Law:

The Conduct or offenses that have been codified in statues by the Legislature as "public wrongs" or "crimes against the state."   Therefore this type of conduct is prohibited and any such wrong is considered to have been committed against the public in general.    The prosecuting party for such offenses would be the "state" or another "public governmental entity".

Civil Law:

Refers to private law.   As between two recognizable parties.   Civil Law includes actions based on contract or  "tort."

Tort:

A legal term that refers to any wrongful act or injury done by a private person in negligent or in a willful manner against another person or property, thereby causing injury or damage.   A claim or personal injury or malpractice would be a "tort" action.

Administrative Law:

This is another area of Civil Law.   "Administrative Law" pertains to the government's authority to enforce the rules, regulations, and pertinent statues of governmental agencies.   i.e. EMS Professionals are granted a Certification by the State,  any violations of the conditions and provisions of this Certification would be conducted as an Administrative proceeding.

Medical Practices Act:

Legislation that governs the practice of medicine,  may vary from state to state.   These statues identify the aspects of medical practice that may be delegated by a physician to the EMS Professional.    Acting beyond or in violation of these statutory provisions may constitute practicing medicine without a license.    The EMS Professional should be familiar with the "acts allowed" section of the state medical practices act.

State Emergency Medical Services Legislation:

Every state has enabling legislation that provides for the practice of Pre-hospital Care in that state.   This legislation would define the "Scope of Acts" allowed to be performed by the EMS Professional.    These acts may also be defined in rules and/or regulations promulgated by a council or a board.    This would usually address the prerequisites to certification or licensure, the basis for maintaining such,   i.e.  continuing education requirements, and the disciplinary action that may result on loss of the license or certification.

Motor Vehicle Laws:

EMS Professionals are prone to another source of law.   This would be the "motor vehicle code".   As with any other law, this law varies from state to state.   The operation of emergency vehicles brings a huge concern of dangers even under the best circumstances, the EMS Professional may be liable for injuries to a patient or another person if the injury is due to a violation of a state staute while driving on an emergency call.   Lights and sirens are not a defense against liability.    More important is the fact that EMS Professionals who drive negligently or carelessly defeat the the primary goal of Pre-hospital care if they never get to the patient or never get the patient to the hospital.   The frequency of accidents that involve emergency driving indicates poor observance of the motor vehicle statues that govern emergency vehicle operation.

Scope of Practice:

EMS Professionals have acquired special skills and knowledge that enable them to render emergency care in the time of need to the sick or injured.   With this knowledge comes significant legal responsibilities.   We have legal responsibilities to our patient's, our Medical Director, and to the public.   It is essential to be familiar with our "scope of practice" no matter our certification level.    We should never attempt to perform skills we are not certified to perform in accordance with state statues.    Our ability to function is contingent on "medical direction."  Medical Direction can be accomplished in several ways.

On-Line Medical Direction:

This is accomplished via telephone or radio.   i.e.  Direct voice contact during the course of providing Pre-hospital emergency care.

Off-line Medical Direction:

This is accomplished via "approved medical protocols"  and  "standing orders".   Protocols and/or Standing orders makes the EMS provider responsible to the Medical Director for any treatment that is provided or omitted in the Pre-hospital setting.

EMS Professionals also have an ethical responsibility to the patient's we treat and to the public.   We provide the physical and emotional needs of the patient as well as the family.   EMS providers have responsibilities of practice, skills must be practised to the point of "mastery".   Attendance at regular continuing education and refresher courses ensures up-to-date knowledge and adequate skill performance.   All levels, including, the Director, Medical Director, and providers should participate in critical review sessions to identify areas of weaknesses, or to improve such things as:

  • Response times.
  • Patient outcomes.
  • Communications.
  • Documentation.
  • Communications.
Ethical considerations is an ongoing process and should never be overlooked by any level of provider.

The Patient's Rights:

Patient's have rights under the law.   The rights to our patient's are liberties that all people expect to be guaranteed by the United States Legal System.

Do Not Resuscitate (DNR):

Laws and protocols govern DNR orders.   These laws may vary from state to state.   DNR's are the request of the patient or by the patient's surrogate decision maker, a person legally designated to make decisions for the patient.   If the patient cannot make a decision regarding his/her own care and a surrogate decision maker has not been named, two physicians must agree the performance of CPR would be contrary to accepted medical standards.   To withhold efforts in the field setting, a written  "DNR"  from a physician is required.   If a written order is not immediately available to the provider, or if some doubt as to the existence of a  "DNR"  order, the provider should not withhold resuscitation efforts.

The Right to Refuse Care:

The patient has the right to refuse treatment.   Providing emergency care when the patient does not consent could result in charges against the provider.   The liability for treating a patient who refuses care can be either  "assault", or "battery",  explained in the definition section of this page.   The laws allowing a patient to refuse care come from a fundamental concept that all adult humans of sound mind have the right to determine what is to be done to their bodies.   Laws that govern when a provider can begin treatment will be covered on this page in definitions.   The patient may withdraw from treatment at any time they choose.    i.e.  an unresponsive patient who regains consciousness and refuses transport.   To refuse care however, this patient must be of legal age and be mentally competent.    Below you will find  "Legal Terms" along with the "Definitions".

Abandonment:

Failure to provide care for the patient once care has been initiated.   Abandonment can take many forms.   Abandonment can also result in the provider being subject to liability for "negligence".   Some different forms of abandonment as follows:

  • Initiates care and leaves the patient, or turns the patient over to someone who has a lower level of training.
  • The patient is left unattended for a period of time and his/her condition worsens or additional injuries are sustained.
  • The provider fails to relay information to the receiving facility regarding the patient's history, treatment, or current condition.
  • The provider fails to respond to or finish an ambulance call.
  • Once the responder responds, something happens that stops the response, such as equipment failure or a change in the providers own health status and the incident is not immediately reported.

    Assault:

    If your actions put the patient in immediate fear of harm.

    Battery:

    To touch another person without his/her consent, even if the provider justifiably believes that the action is necessary to save the patient's life.

    Breach of Duty:

    Can be shown by providing evidence that the provider did not perform to the Standard-of-Care  (the level of care that would have been provided by another provider of the same certification level acting in the same type of situation).

    Confidentiality:

    Privacy that is afforded to patient-related information.

    Duty to Act:

    Implies a contractual or legal obligation to provide patient care.

    False Imprisonment:

    Intentional and unjustifiable detainment of a person.

    Expressed Consent:

    When a patient of legal age and ability to make a rational decision gives permission to be treated.

    Implied Consent:

    The consent implied when a patient is unable to give expressed consent  the law assumes that such a patient would want to have life-saving treatment administered.

    Negligence:

    Failure to exercise the degree of care that a reasonable person would exercise under the same circumstances.

    In order to prove "negligence",  the complaining person must be able to prove the following four elements.

    • The provider had a Duty to Act.
    • A Breach of the Duty to Act Occured.
    • The patient experienced a Physical or Psychological Injury as a Result of the Breach of Duty.
    • The providers Actions or Failure to Act Was the Proximate  (or immediate)  cause of the patient's Injury.



    This Site Designed and Maintained by:Lee Sampson/Flight Paramedic