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medicolegal

medico-legal issues in the ED

general issues

drugs, poisons and controlled substances

legislation

Pharmaceutical Benefits Scheme (PBS)

Therapeutic Goods Administration (TGA)

  • 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.
  • 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.

medical certificates

  • 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.

death certificates, Coroner's issues

jury duty

  • 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.

registration

Victoria

medicolegal.txt · Last modified: 2018/08/16 02:28 by gary1