Discussion: Patient Bill of Rights

Chapter 3 Legal Principles  63 Discussion: Patient Bill of Rights  Procedure 3.1 Apply the Patient’s Bill of Rights Name _________________________________________________ Date ______________ Score ___________ Tasks: Apply the patient’s bill of rights in scenarios related to choice of treatment, consent for treatment, and refusal of treatment. Demonstrate sensitivity to patient rights. Scenario 1 (Choice of treatment): Julia Berkley (DOB 7/5/1992) was a patient of Dr. Angela Perez during her entire pregnancy. Julia is experiencing some complications. Dr. Perez explained the choices Julia had for delivery. She stated with the complications, a C-section may be the best option. You are working with Dr. Perez and prepared the consent form for the C-section. You go into the exam room to have Julia sign the consent form. As you discuss the form, Julia tells you that she is fearful of a C-section and wants a vaginal delivery. Scenario 2 (Consent for treatment): Ken Thomas (DOB 10/25/61) saw Jean Burke N.P. before leaving on a week-long trip out of the country. He is leaving in 3 days and wants a hepatitis A vaccine injection. The area he is traveling to has a high risk for hepatitis A. Jean Burke orders immunoglobulin for Ken, which will provide immediate protection against hepatitis A. Discussion: Patient Bill of Rights

You prepare the injection and enter the exam room. As you are telling Ken about the side effects of the medication, he asks, “What is immunoglobulin?” You reply that it is a sterile medication made of antibodies from blood. Ken states that he is a Jehovah’s Witness and cannot receive blood products. Scenario 3 (Refusal of treatment): Aaron Jackson (DOB 10/17/2011) was in for his well-child check. His records indicate that he is due for his first varicella vaccine. You bring the Varicella (Chickenpox) Vaccine VIS (vaccine information statement) and the Vaccine Authorization form to the exam room. As you start discussing the vaccine, Aaron’s mother, Patricia, interrupts you and tells you she is not interested in having Aaron get his chickenpox vaccine. Equipment and Supplies: • Patient health records • Patient’s Bill of Rights (Figure 3.3) • Discussion: Patient Bill of Rights

General Procedure Consent form (Figure 3.4) • Varicella (Chickenpox) VIS (available at www.cdc.gov) • Vaccine Authorization form (Figure 3.5) Standard: Complete the procedure and all critical steps in _______ minutes with a minimum score of 85% within two attempts (or as indicated by the instructor). Scoring: Divide the points earned by the total possible points. Failure to perform a critical step, indicated by an asterisk (*), results in grade no higher than an 84% (or as indicated by the instructor). Time: Began_________ Ended_________ Total minutes: _________ Copyright © 2020, Elsevier Inc. All Rights Reserved. 64  Chapter 3 Legal Principles Steps: 1. Review the Patient’s Bill of Rights. Apply the Patient’s Bill of Rights as you role-play each of the three scenarios. 2. Using Scenario #1, role-play the situation with a peer. You are the medical assistant. Discussion: Patient Bill of Rights

Demonstrate how a medical assistant should handle the situation. Apply the Patient’s Bill of Rights to the situation by remembering the rights of the patient. a. Show sensitivity to the patient by being respective and professional. (Refer to the Checklist for Affective Behaviors.) b. Ask the patient if she has any questions about the procedures. Let the provider know if the patient has questions. c. Ask the patient what she would like to do. Based on her answer, follow up as necessary. d. Using the health record, document the patient’s decision and the name of the provider notified. 3. Using Scenario #2, role-play the situation with a peer. You are the medical assistant. Demonstrate how a medical assistant should handle the situation. Apply the Patient’s Bill of Rights to the situation by remembering the rights of the patient. a. Discussion: Patient Bill of Rights

Show sensitivity to the patient regarding his right to refuse. Be accepting of his beliefs and his refusal. (Refer to the Checklist for Affective Behaviors.) b. When the patient refuses the medication, be respectful in your body language and words. Notify the provider. c. Using the health record, document the patient’s decision and the name of the provider notified. 4. Using Scenario #3, role-play the situation with a peer. You are the medical assistant. Demonstrate how a medical assistant should handle the situation. Apply the Patient’s Bill of Rights to the situation by remembering the rights of the patient. a. Show sensitivity to the mother of the patient by being respectful and professional. (Refer to the Checklist for Affective Behaviors.) b. Ask the mother if she has any questions about the vaccine. Let the provider know if the mother has questions. c. Ask the mother what she would like to do. Based on her answer, follow up as necessary. d. Using the health record, document the mother’s decision and the name of the provider notified. Total Points Copyright © 2020, Elsevier Inc. All Rights Reserved. Point Value 10* Attempt 1 Attempt 2 0 0 10* 10 10* 5 10* 10* 5 10* 5 10* 5 100 Chapter 3 Legal Principles Discussion: Patient Bill of Rights 65

Checklist for Affective Behaviors Affective Behavior Sensitivity Directions: Check behaviors observed during the role-play. Negative, Unprofessional Behaviors Attempt 1 2 Positive, Professional Behaviors Poor eye contact Proper eye contact Distracted; not focused on the other person Judgmental attitude; not accepting attitude Focuses full attention on the other person Nonjudgmental, accepting attitude Fails to clarify what the person verbally or nonverbally communicated Fails to acknowledge what the person communicated Rude, discourteous Uses summarizing or paraphrasing to clarify what the person verbally or nonverbally communicated Acknowledges what the person communicated Pleasant and courteous Disregards the person’s dignity and rights Other: Maintains the person’s dignity and rights Other: Grading for Affective Behaviors Does not meet • Response lacked sensitivity. Expectation • Student demonstrated more than 2 negative, unprofessional behaviors during the interaction. Discussion: Patient Bill of Rights

Needs • Response lacked sensitivity. Improvement • Student demonstrated 1 or 2 negative, unprofessional behaviors during the interaction. Meets • Response was sensitive; no negative, unprofessional Expectation behaviors observed. • More practice is needed for behavior to appear natural and for student to appear comfortable and at ease. Occasionally • Response was sensitive; no negative, unprofessional Exceeds behaviors observed. Expectation • At times student appeared comfortable and at ease; but more practice is needed for behavior to become natural and consistent with a professional medical assistant. Always • Response was sensitive; no negative, unprofessional Exceeds behaviors observed. Expectation • Student’s behaviors appeared natural and comfortable. Discussion: Patient Bill of Rights Behaviors are consistent with a professional medical assistant. Point Value Copyright © 2020, Elsevier Inc. All Rights Reserved. 0 0 10 10 10 Attempt 1 Attempt 1 2 Attempt 2 66 Discussion: Patient Bill of Rights Chapter 3 Legal Principles Documentation – Scenario 1 Documentation – Scenario 2 Copyright © 2020, Elsevier Inc. All Rights Reserved. Chapter 3 Legal Principles  67   Documentation – Scenario 3 Comments CAAHEP Competencies Steps X.P.4.a. Apply the Patient’s Bill of Rights as it relates to: choice of treatment 1, 2 a-d X.P.4.c. Apply the Patient’s Bill of Rights as it relates to: refusal of treatment 1, 4 a-d X.P.4.b. Apply the Patient’s Bill of Rights as it relates to: consent for treatment X.A.1. Demonstrate sensitivity to patient rights Copyright © 2020, Elsevier Inc. All Rights Reserved. 1, 3 a-c 2 a, 3 a, 4 a

CHAPTER 3 Legal Principles 61 a let the provider know. After all the questions have been answered, then the informed consent form can be signed. Do not have the pacient sign if he or she: Does not understand the treatment. Cannot legally give consent. Has questions. . . PATIENT’S BILL OF RIGHTS Congress has attempted to create laws effecting a patient’s “bill of rights related to patient care and services, but none of the proposed bills has passed. The Affordable Care Act’s Patient’s Bill of Rights focuses on rights related to insurance. With no federal laws to follow, the American Hospital Association created a patient’s bill of rights for its members. Since then, many health care facilities have created their own patient’s bill of rights. Many agencies title theirs as “Patient’s Rights and Responsibilities” Discussion: Patient Bill of Rights (Fig. 3.3). Discussion: Patient Bill of Rights The patient’s bill of rights Information on the Informed Consent Forms Patient’s name, date of birth, and health record number • Name of hospital or facility • Name of provider(s) performing treatment(s) • Risks and benefits of the treatment(s) • Alternative treatment(s) and risks • Risk if treatment(s) is delayed or not done • Statement indicating the treatment was explained to the patient or guardian Signature of patient or guardian Signature and name of person who explained the treatment options • Signature of the witness • Date and time consent form was completed WALDEN-MARTIN FAMILY MEDICAL CLINIC 1234 ANYSTREET I ANYTOWN, ANYSTATE 12345 PHONE 123-123-1234 I FAX 123-123-5678 Patient Bill of Rights RIGHTS 1. Medical Care and Dental Care. Discussion: Patient Bill of Rights

The right to quality care consistent with available resources and accepted standards. The right to refuse treatment to the extent permitted by law and Government regulations, and to be informed of refusal consequences. When concerned about care received the right to request review of care adequacy. 2. Respectful Treatment. The right to considerate and respectful care, with recognition of personal dignity. 3. Privacy and Confidentiality. The right, within law and military regulations, to privacy and confidentiality concerning medical care. 4. Identity. The right to know, at all times, the identity, professional status, and professional credentials of health care personnel, as well as the name of the health care provider primarily responsible for his or her care. 5. Explanation of Care. The right to an explanation concerning diagnosis, treatment, procedures, and prognosis of illness in terms the patient can understand. When it is not medically advisable to give such information to the patient, information should be provided to appropriate family members or, in their absence, another appropriate person. 6. Informed Consent. The right to be advised in non-clinical terms of information (significant complications, risks, benefits, and alternative treatments) needed to make knowledgeable decisions on treatment consent or refusal. 7. Discussion: Patient Bill of Rights

Research Projects. The right to be advised if the facility proposes to perform research associated with care. The right to refuse to participate in any research projects. 8. Safe Environment. The right to care and treatment in a safe environment. 9. Medical Treatment Facility (MTF) or Dental Treatment Facility (DTF) Rules and Regulations. The right to be informed of facility conduct rules and regulations. The patient should be informed about smoking rules and should expect compliance with those rules from other individuals. Patients are entitled to information about the MTF or DTF mechanism for the initiation, review, and resolution of patient complaints. RESPONSIBILITIES 1. Providing Information. The responsibility to provide, to the best of his or her knowledge, accurate and complete information about complaints, past illness, hospitalizations, medications, and other matters relating to his or her health. A patient has the responsibility to let his or her primary health care provider know whether he or she understands the treatment and what is expected of him or her. 2. Discussion: Patient Bill of Rights

Respect and Consideration. The responsibility for being considerate of the rights of other patients and MTF and DTF health care personnel and for assistance in the control of noise, smoking, and the number of visitors. The patient is responsible for being respectful of the property of other persons and of the facility. 3. Compliance with Medical Care. The responsibility for complying with medical and nursing treatment plans, including follow-up care, recommended by health care providers. This includes keeping appointments on time and notifying the MTF or DTF when appointments cannot be kept. 4. Medical Records. The responsibility for ensuring that medical records are promptly returned to the medical facility for appropriate filing and maintenance when records are transported by the patients for the purpose of medical appointment or consultation, etc. Discussion: Patient Bill of Rights

All medical records documenting care provided by any MTF or DTF are the property of the U.S. Government. 5. MTF and DTF Rules and Regulations. The responsibility for following the MTF and DTF rules and regulations affecting patient care conduct. Regulations regarding smoking should be followed by all patients. 6. Reporting of Patient Complaints. The responsibility for helping the MTF or DTF commander provide the best possible care to all beneficiaries. Patients’ recommendations, questions, or complaints should be reported to the patient contact representative. FIGURE 3.3 Patient’s Bill of Rights .