Emergency Legal Preparedness for Hospitals and Health Care Personnel

Centers for Law and the Public's Health: A Collaborative at Johns Hopkins and Georgetown Universities, USA.
Disaster Medicine and Public Health Preparedness (Impact Factor: 1.14). 07/2009; 3(2 Suppl):S37-44. DOI: 10.1097/DMP.0b013e31819d977c
Source: PubMed

ABSTRACT During the past decade, hospital emergency preparedness has become a focus of local, state, and federal governments seeking to address emergencies or disasters that affect the public health. Integral to hospital emergency preparedness are numerous legal challenges that hospitals and their health care personnel face during declared states of emergencies. In this article, we evaluate legal requirements for hospital emergency preparedness, key legal concerns that hospitals should consider in emergency preparedness activities, and how the changing legal landscape during emergencies necessitates real-time decision making. We then analyze legal issues including negligence, discrimination, and criminal culpability that may arise during or after medical triage. Finally, we examine the legal risks of evading preparedness, specifically asking how a hospital and its personnel may be held liable for failing to plan or prepare for an emergency.

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    ABSTRACT: Documentation of the patient encounter is a traditional component of health care practice, a requirement of various regulatory agencies and hospital oversight committees, and a necessity for reimbursement. A disaster may create unexpected challenges to documentation. If patient volume and acuity overwhelm health care providers, what is the acceptable appropriate documentation? If alterations in scope of practice and environmental or resource limitations occur, to what degree should this be documented? The conflicts arising from allocation of limited resources create unfamiliar situations in which patient competition becomes a component of the medical decision making; should that be documented, and, if so, how? In addition to these challenges, ever-present liability worries are compounded by controversies over the standards to which health care providers will be held. Little guidance is available on how or what to document. We conducted a search of the literature and found no appropriate references for disaster documentation, and no guidelines from professional organizations. We review here the challenges affecting documentation during disasters and provide a rationale for specific patient care documentation that avoids regulatory and legal pitfalls. (Disaster Med Public Health Preparedness. 2013;0:1-7).
    Disaster Medicine and Public Health Preparedness 08/2013; 7(4):354-360. DOI:10.1017/dmp.2013.76 · 1.14 Impact Factor
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    ABSTRACT: Introduction:Significant legal challenges arise when health care resources become scarce and population-based approaches to care are implemented during severe disasters and pandemics. Recent emergencies highlight the serious legal, economic, and health impacts that can be associated with responding in austere conditions and the critical importance of comprehensive, collaborative health response system planning. This article discusses legal suggestions developed by the American College of Chest Physicians (ACCP) Task Force for Mass Critical Care (MCC) to support planning and response efforts for mass casualty incidents involving critically ill or injured patients. The suggestions in this chapter are important for all of those involved in a disaster or pandemic with multiple critically ill or injured patients including front line clinicians, hospital administrators and public health or government officials. Methodology:Following the ACCP Guidelines Oversight Committee's methodology, the Legal Panel developed 35 key questions for which specific literature searches were then conducted. The literature in this field is not suitable upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process resulting in seven (7) final suggestions. Results:Acceptance is widespread for the health care community's duty to appropriately plan for and respond to severe disasters and pandemics. Hospitals, public health entities and clincicians have an obligation to develop comprehensive, vetted plans for mass casualty incidents involving critically ill or injured patients. Such plans should address processes for evacuation and limited appeals and reviews of care decisions. To legitimize responses, deter independent actions, and trigger liability protections, MCC plans should be formally activated when facilities and practitioners shift to providing MCC. Adherence to official MCC plans should contribute to protecting hospitals and practitioners, who act in good faith, from liability. Finally, to address anticipated staffing shortages during severe and prolonged disasters and pandemics, governments should develop approaches to formally expand the availability of qualified health care workers, such as through using official foreign medical teams. Conclusions:As a fundamental element of health care and public health emergency planning and preparedness, the law underlies critical aspects of disaster and pandemic responses. Effective responses require comprehensive advance planning efforts that include assessments of complex legal issues and authorities. Recent disasters have shown that while law is a critical response tool, it can also be used to hold health care stakeholders that fail to appropriately plan for or respond to disasters and pandemics accountable for resulting patient or staff harm. Claims of liability from harms allegedly suffered during disasters and pandemics cannot be avoided altogether. However, appropriate planning and legal protections can help to facilitate sound, consistent decision-making and support response participation among health care entities and practitioners.
    Chest 08/2014; 146(4). DOI:10.1378/chest.14-0741 · 7.13 Impact Factor
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    ABSTRACT: The global rise of Ebola viral diseases in 2014 necessitates legal responses that promote effective public health responses and respect for the health and human rights of populations. Compulsory public health interventions, approval and administration of experimental drugs or vaccines, and allocation of finite resources require difficult choices in law and policy. Crafting legal decisions in real-time emergencies is neither easy nor predictable, but it is essential to controlling epidemics and saving lives.(Disaster Med Public Health Preparedness. 2014;0:1-4).
    Disaster Medicine and Public Health Preparedness 10/2014; DOI:10.1017/dmp.2014.96 · 1.14 Impact Factor