medico-legal issues in the ED

see also:

• your hospital policies relating to medicolegal issues
• medical indemnity
• forensic medicine, crimes and prisoners
• left at own risk / absconding patient / missing patient / competence
• managing violence or the aggressive patient in the ED
• searching patients, suspicious behaviour, unknown substance, weapons or crime within the ED
• professional health care bodies and registration boards
• ethical issues in emergency medicine
• consent
• patient privacy and confidentiality
• 2018: To Err Is Homicide in Britain: The Case of Dr Hadiza Bawa-Garba
  • BMJ article on the Bawa-Garba case
  • BMJ article of use of medical records in the Bawa-Garda case

• Vic. Working With Children Check - accreditation
  • staff working on “paediatric wards” (may include EDs) are required to obtain a formal police check - application form from Australian Post outlets
  • Vic. Medical Practice Act 1994 (pdf)
• Australasian College for Emergency Medicine (ACEM)
  • ACEM - patients' rights to access emergency department care (pdf)
  • ACEM - privacy (pdf)
  • ACEM - provision of ED telephone advice (pdf)
  • ACEM - responsibility of care in EDs (pdf)
• Simon Bolch's Fellowship Exam notes - legal issues (2008)
  • DLA Phillips Fox - Regular Bulletins providing the latest Information on the law as it relates to health

• Vic. legislation - drugs, poisons and controlled substances regulations 2006 (pdf)

• PBS - prescribing medicines - information for prescribers
• PBS - approved medications search

• TGA website for health professionals

• Medical Treatment Planning & Decision Act 2017 (Vic) commenced 12th March 2018
  • Allows a person with decision making capacity to make Advance Care Directives in relation to their care.
    • There are two types of ACDs:
    • Instructional Directive: A directive that allows people to refuse or allow particular treatment in the event that they lose capacity.
    • Values Directive: A general statement regarding preferences and values to be taken into account in the event that a person loses capacity. Health Practitioners must still seek consent for treatment from the patient’s Medical Treatment Decision Maker (the MTDM). The MTDM must take a values directive into account in determining whether or not to consent to treatment.
  • Provides a framework for medical decision making for people without decision making capacity.
    • allows for people to appoint to appoint a MTDM (formerly known as a Responsible Person or Power of Attorney). If no MTDM has been appointed, in order to determine who the MTDM is, practitioners should follow the default list set out in the Act. The first of the following people with a close and continuing relationship with the patient, who is willing and available:
      • spouse or domestic partner
      • primary carer
      • the eldest adult child
      • a parent of the patient
      • the eldest adult sibling
    • If there is a no MTDM available, a health practitioner may administer “Routine Treatment”. If the Treatment is “Significant” and no MTDM is available, the Health Practitioner must seek consent from the Office of Public Advocate.
    • Powers of attorney made prior to 12 March 2018 will remain valid until revoked or expired. They will be considered MTDMs under the new Act.
  • see also: WH intranet only resources
  • Vic. Medical Treatment Act 1988 - forms for rights of patients to refuse treatment but is now superseded by Medical Treatment Planning & Decision Act 2017 (Vic)
• Vic. govt - Residential services Practice Manual 2007 - consent for residential care patients
• Aust. Govt - age of consent, mature minor's rights to privacy and confidentiality regarding parents access to medical care

• doctor must:
  • consider patient's right of consent
  • respect patient's dignity and privacy
    • thus photographs, particularly, sensitive photographs should NOT be shown to third parties who are not involved in the patient's care unless the patient has consented to this, and preferably, all identifying features have been removed.
• see clinical photography consent

• it is NOT acceptable to provide certificates for time off work just on request (employers may lodge a complaint if their employee is found working elsewhere or involved in recreational activities when they have been certified as being sick!) - the doctor should feel confident that the patient's medical condition warrants time off work. If the condition does not warrant time off work, the doctor can offer to write a letter detailing reported symptoms or encourage the patient to write a statutory declaration.

• see death and the potentially dead

• in the past, doctors were excused from jury duty but legislation has now changed so that all occupations are represented.
• if you respond to the summons and list sufficient and logical reasons for being excused you may be excused.
• to be excused as an ED doctor, you would need to show that you are an essential member of the emergency department on that day and cannot be replaced and that your absence will significantly impair the functioning of the department and add risk to patients. It would be prudent to obtain a letter confirming this from the Director of the ED.

• see also Medical registration boards

• Vic. Health Professions Registration Act 2005 (pdf)

• Victorian legislation - search for Acts, Statutes, etc