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APA style 7th edition and Originality SafeAssign submission are required.Please see document attached.
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Student PowerPoint Presentation: Chapter 7, 8, 9
Objectives: The presentation assignment has several goals. It requires students to apply concepts
from Corporate Structure and legal issues, Medical Staff organization and Physician Liability.
The process to identified and review cases focused on the legal risk for nurses it is a great skill
they will be using as Healthcare Administrator. In addition, the student will be able to identify a
variety of negligent errors by allied health professionals. .
Format and Guidelines: The student will create a Power Point Presentation from Chapter 7,8,9
of the Textbook to Week 3 (Choose your desire topic form these chapters). The Presentation
should have a minimum of 12 slides, including Title Page, Introduction, Conclusion, and
References.
The student must use other textbooks, research papers, and articles as references (minimum 3).
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Title Page: Topic Name, Student Name
2. Introduction: Provide a brief synopsis of the meaning (not a description) of the topic you
choose, in your own words
3. Content Body: Progress your theme, provide Material, illustrations and Diagram to
explain, describe and clarify the Topic you choose.
4. Conclusion: Briefly summarize your thoughts & conclusion to your critique of the
articles and Chapter you read.
5. References: The student must use other textbooks, research papers, and articles as
references (minimum 3).
Chapter 7
Corporate
Structure
and Legal Issues
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LEARNING OBJECTIVES
▪ Describe how a corporation derives its authority.
▪ Discuss corporate organization & committee structure.
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▪ Explain what is meant by fiduciary responsibility.
LEARNING OBJECTIVES – II
▪ Explain the terms corporate negligence, respondeat superior, &
independent contractor.
▪ Describe the various corporate duties of healthcare organizations.
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▪ Describe the Sarbanes–Oxley Act & the purpose of corporate
compliance programs.
HEALTHCARE CORPORATIONS
▪ Corporations have governing bodies.
▪ Governing body has ultimate responsibility for operation of the
corporation.
▪ Authority creates certain duties and liabilities for governing boards and
their individual members
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▪ Incorporated under state law as freestanding for-profit or not-for-profit
corporations.
HEALTHCARE CORPORATIONS – II
▪ Tax-exempt status of healthcare corporations is coming under increased
scrutiny as they diversify their activities.
▪ Governing Boards Duties Include:
▪ holding meetings, establishing policies, being financially scrupulous,
providing adequate insurance, & paying taxes where required by law.
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▪ Not-for-profit healthcare organizations are usually exempt from federal
taxation.
Fiduciary Responsibility
▪ Board members (trustees, directors) are responsible for overseeing
fulfillment of the organization’s mission.
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▪ Governing body has ultimate responsibility for the operation of the
organization.
Authority of Corporations
▪ Implied
▪ Authority not expressed by written words
▪ Ultra Vires Acts
▪ Acting beyond scope of authority
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▪ Express
▪ Authority designated by statute . . . .
CORPORATE COMMITTEES
Executive Committee
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▪ Liaison between management & full board.
▪ Review & make recommendations on management
proposals.
▪ Performing special assignments as may be delegated by
full board.
▪ Business transacted should be reported at regular
sessions of the governing body & ratified.
▪ Committee generally has all the powers of the governing
body.
Bylaws Committee
▪ Reviews & recommend bylaw changes to the governing body.
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▪ Bylaws generally are amended or rescinded by a majority vote of the
governing body.
Finance Committee
▪ Overseeing financial affairs of the organization
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▪ Direct & review preparation of financial statements, operating budgets,
major capital requests . . . .
Joint Conference Committee
▪ A forum for discussion of matters of policy and practice pertaining to
patient care.
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▪ Composed of an equal number of representatives from the executive
committees of the governing body & medical staff, along with
representation from administration and nursing.
Nominating Committee
▪ Develop & recommend criteria for governing body membership.
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▪ Recommend appt’s for new board members.
Planning Committee
▪ Periodic review of org’s mission & vision statements.
▪ Develop strategic plans & ongoing monitoring.
▪ Develop of short-term & long-range goals.
▪ Maintenance of the organization’s physical facilities.
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▪ Conduct of community health needs assessments.
Planning Committee – II
▪ Preparation of capital budgets.
▪ Acquisition of major equipment.
▪ Addition of new services based on identified community need.
▪ Downsizing & closing services.
▪ Planning progress reports to the full board.
▪ Program development.
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▪ Oversight of expansion programs.
Patient Care Committee
▪ Identify patient & family needs & expectations.
▪ Determine methodology for reviewing data.
▪ Identify patterns of concern.
▪ Forward information to those responsible for implementing
change in the org.
▪ Review, evaluate, & implement plans for improving
organizational performance.
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▪ Corporate development.
Audit & Regulatory
Compliance Committee
▪ Develop corporate auditing policies & procedures.
▪ Review credentials of IAs & facilitating change in auditors as appropriate.
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▪ Recommend independent auditors (IA).
Audit & Regulatory
Compliance Committee – II
▪ Review with IAs scope & extent of their audit duties & responsibilities.
▪ Set, oversee, review, & act on recommendations of internal audit staff.
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▪ Review scope & results of annual audit
Audit Committee Responsibilities
▪ Reviewing & evaluate financial statements.
▪ Promote prevent, detect, deter, & report fraud.
▪ Review means for safeguarding assets.
▪ Ensure financial reporting functions comply with accepted
accounting principles.
▪ Review reliability & integrity of financial & operating
information.
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▪ Review internal accounting practices of corporation.
Safety Committee
▪ Reviews & acts on reports involving”
▪ emergency preparedness
▪ equipment management
▪ fire safety
▪ risk management
▪ utilities management
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▪ Responsibility for overseeing organization’s safety management
program.
Corporate Ethics
▪ Develops a Code of Ethics
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▪ Describes ethics of an organization & how it responds to internal or
external circumstances affecting the organization’s mission & values
Sarbanes-Oxley Act
• Act contains 11 titles, or sections, ranging from
additional Corporate Board responsibilities to criminal
penalties, & requires Securities & Exchange
Commission to implement rulings on requirements to
comply with SOX.
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• Sarbanes-Oxley Act (SOX) was signed into law by
President Bush on July 30, 2002 in response to the
Enron debacle & high profile cases of corporate
mismanagement.
Major provisions of SOX – I
▪ Certification of Financial Reports
▪ Accelerated Reporting of Trades by Insiders
▪ Prohibition: Insider Trades during Pension Fund Blackout Periods
▪ Public Reporting of Compensation & Profits
▪ Inside Audit
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▪ Ban on Personal Loans
Major Provisions of SOX – II
▪ Criminal & Civil Penalties
▪ Increased Criminal Penalties
▪ Code of Ethics & Standards of Conduct
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▪ Internal Audit Certified by External Auditors
Sarbanes-Oxley Act of 2002
Promoting Due Diligence
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▪ SOX is about self-regulation:
▪ Selecting leader with morals & core values
▪ Examining incentives
▪ Monitoring organization’s culture
▪ Building a strong knowledgeable governing body
▪ Searching for conflicts of interest
▪ Focusing attention on the right things
▪ Having courage to speak out
Corporate Compliance Program
▪ Compliance Officer
▪ maintains confidentiality & privacy rights of employees
▪ satisfying expectations of management & governing
▪ adheres to applicable laws, rules, & regulations
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▪ Internal mechanisms for preventing, detecting, & reporting criminal
conduct.
Corporate Negligence
▪ Corporation treated no differently than individual
▪ Liability to injured party
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▪ Doctrine under which hospital is liable if it fails to uphold required
standard of care
Benchmark Case Facts – I
Darling v. Charleston Comm. Mem. Hosp.
▪ 18 Yr. Old Football Player injured
▪ Leg casted by General Practitioner in ED
▪ Patient complains of pain
▪ No specialist called for consultation
▪ Two weeks later – student transferred
▪ Eventually leg amputated
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▪ Fracture of tibia & fibula
Benchmark Case Trial – II
▪ No expert testimony presented
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▪ Documentary Evidence included
▪ Medical records
▪ Hospital’s bylaws, rules & regulations
▪ Illinois Hospital Licensing Act
▪ JCAHO standards
Benchmark Case – III
▪ Hospital, as a corporate entity, liable for:
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▪ Negligent act of nurses
▪ Negligent acts of physicians
Benchmark Case Lessons:
Provide Competent Staff
▪ Verify licensure, as appropriate
▪ Provide procedures for credential & privileging
▪ Monitor quality of care
▪ Require consultations
▪ Alert supervisor of care concerns
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▪ Verify training & experience
DOCTRINE OF RESPONDEAT SUPERIOR
▪ “let the master respond”
▪ Also referred to as vicarious
liability, whereby an employer is
answerable for the torts
committed by employees.
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▪ Legal doctrine holding employers
liable for the wrongful acts of their
employees.
Respondeat Superior – II
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▪ To impute liability to the employer:
▪ Master-servant relationship between employer & employee must
exist.
▪ Wrongful act of employee must occur within scope of employment.
Independent Contractors
▪ Responsible for their own negligent acts.
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▪ Principal must not have right to control agent’s work.
Governing Body Responsibilities
▪ Licensure
▪ CEO Code of Ethics
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▪ Appointment of CEO
Governing Body
Responsibilities – II
▪ Appointment of Competent Staff
▪ Application requirements for privileges
▪ Process for granting emergency staff privileges
▪ Requirements for medical staff consultations
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▪ Medical staff bylaws
Governing Body
Responsibilities – III
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▪ Peer-review process
▪ Process auditing medical records
▪ Process for addressing disruptive physicians
▪ Process for disciplinary action
Governing Body
Responsibilities – IV
▪ Ensure a Safe Working Environment
▪ Comply with Accreditation Standards
▪ Provide timely treatment
▪ Avoid self-dealing & conflict of interest situations
▪ Provide adequate staff
▪ Provide adequate insurance
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▪ Comply with the laws & regulations
Governing Body
Responsibilities – V
▪ Be financially scrupulous
▪ Provide adequate facilities, equipment & supplioes
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▪ Require competitive bidding
Governing Body
Responsibilities – VII
▪ Properly Maintain Equipment
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▪ Provide a safe environment
▪ Toxic Fumes
▪ Fire Hazards
▪ Prevent Falls
Review Questions – I
2. List some of the major provisions of SOX
3. Describe the meaning of the legal doctrine respondeat superior.
4. Describe the term corporate negligence.
5. Why is the Darling case described as a benchmark case?
6. Does the legal doctrine respondeat superior apply to an independent
contractor? Explain your answer.
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1. Describe the organization, responsibilities, duties, and legal risks of a
governing body.
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Chapter 9
Nursing and the
Law
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LEARNING OBJECTIVES
▪ Explain the process of obtaining nurse licensure.
▪ Discuss the various categories of nursing staff.
▪ Describe a variety of the legal risks nurses encounter in the practice of
nursing.
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▪ Describe why and how the role of nurses continues to evolve and
expand.
Scope of Practice
▪ Role of nurse continues to expand due to
▪ shortage of primary care physicians
▪ ever-increasing specialization
▪ improved technology
▪ public demand
▪ expectations within the profession itself.
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▪ Permissible boundaries of practice for health care professionals,
defined in state statutes, which define the actions, duties, & limits
of nurses in their particular roles.
NURSING DIAGNOSIS
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▪ Various states recognize that nurses can render a nursing diagnosis.
▪ e.g., Section 335.01(8) of the Missouri Revised Statutes (1975)
authorizes an RN to make an assessment of persons who are ill and
to render a nursing diagnosis.
Nurse Licensure
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▪ Requirements for Licensure
▪ Reciprocity
▪ agreement between states whereby a nurse licensing board in
one state recognizes licensees of another state.
▪ Endorsement
▪ boards determine if out-of-state nurses’ qualifications are
equivalent to their own state requirements at the time of initial
licensure.
Nurse Licensure – II
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▪ Waiver
▪ When applicants do not meet all the requirements for licensure
but have equivalent qualifications, the specific prerequisites of
education, experience, or examination may be waived.
▪ Examination
▪ Some states will not recognize out-of state licensed nurses &
make it mandatory that all applicants pass a licensing
examination.
Suspension & Revocation
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▪ Violations may include
▪ procurement of a license by fraud
▪ unprofessional, dishonorable, immoral, or illegal conduct
▪ performance of specific actions prohibited by statute
▪ malpractice.
Practicing without a License
▪ Health care orgs are required to verify each nurse’s license is current.
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▪ Mere fact that an unlicensed practitioner is hired will not generally in & of
itself impose additional liability unless a patient suffered harm as a result
of an unlicensed nurse’s negligence.
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Classification of Nurse
Staff
Nurse Managers
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▪ Chief nursing officer has responsibility for:
▪ maintaining standards of practice
▪ maintaining current p & ps
▪ recommending staffing levels
▪ coordinating & integrating nursing services with other patient care
services
▪ selecting nursing staff
▪ developing orientation and training programs.
Nurse Managers – II
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▪ Failure to supervise
▪ can lead to disciplinary action
Registered Nurse
▪ Graduation from accredited nursing program
▪ National Council Licensure Examination
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▪ Pass national licensing exam
LPNs & LVN
▪ Graduation from accredited nursing program
▪ Routine nursing care
▪ vital signs, injections, assist patients, etc.
▪ under direction of an RN or physician
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▪ Pass a licensing exam approved by the state
Float Nurse
▪ Nurse who rotates from unit to unit based on staffing needs.
▪ If a patient is injured due to floater’s negligence, standard of care
required will be that required of a nurse on the assigned patient care unit.
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▪ Can benefit understaffed unit but also may present a liability as well if
they are assigned to work in an area outside their scope of expertise.
Agency Nurse
▪ Risk for negligent conduct of agency staff.
▪ Case: Resuscitation of Choking Child Fails
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▪ Agency workers must have necessary skills & competencies to carry out
duties & responsibilities assigned.
Special-Duty Nurse
▪ If a master-servant relationship exists between the org & special-duty
nurse, doctrine of respondeat superior may be applied to impose liability
on the org for nurse’s negligent acts.
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▪ A health care professional employed by a patient or patient’s family to
perform nursing care for the patient.
Traveling Nurse
▪ Opportunities that include higher wages.
▪ Skills enhanced with exposure to intriguing assignments.
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▪ Nurse who travels to work in temporary nursing positions in different
cities and states.
▪ independent contractors or
▪ elect to work with one or more recruitment agencies
Student Nurse
▪ Students are personally liable for their own negligent acts, & the facility is
liable for their acts on basis of respondent superior.
▪ Student nurse are held to the standard of a competent professional
nurse when performing nursing duties
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▪ Student nurses are entrusted with the responsibility of providing nursing
care to patients.
Nurses
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Advanced Practice
The Role of Nurses Extends Beyond the
Hospital Ward
–Consumers Union of United States Inc., The Washington Post, May 30, 2011
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A nurse is a doctor’s best friend, according to Marvin M. Lipman,
Consumers Union’s chief medical adviser. This advice was given to him
by a hospital ward’s head nurse when he was a third-year medical
student making contact with patients for the first time, along with the
suggestion that he’d do well not to forget it.
Nurse Practitioners
▪ Trained in delivery of primary health care & assessment of psychosocial
& physical health problems such as the performance of routine
examinations & ordering of routine diagnostic tests.
▪ NP Negligence
▪ Responsible for negligent acts
▪ Can imputed to physician
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▪ RNs who have completed education to engage in primary health care
decision making.
The Role of Nurses Extends Beyond the
Hospital Ward
–Consumers Union of United States Inc., The Washington Post, May 30, 2011
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Nurse practitioners . . . Studies have found that their ability to diagnose
illnesses, order and interpret tests, and treat patients is equivalent to that
of primary-care physicians. They also tend to spend more time with
patients during routine office visits than physicians, and they are more
likely to discuss preventative health measures. As of 2010, 140,000 NPs
were working in the United States.
Clinical Nurse Specialist
▪ CNS acts as a resource for the management of patients with complex
needs and conditions.
▪ The CNS participates in staff development activities related to his or her
clinical specialty & makes recommendations to establish standards of
care for those patients.
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▪ Clinical nurse specialist is a professional RN with an advanced academic
degree, experience, and expertise in a clinical specialty (e.g., obstetrics,
pediatrics, psychiatry).
Clinical Nurse Specialist – II
▪ CNS collaborates with other members of the health care team in
developing and implementing the therapeutic plan of care for patients.ard
of care
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▪ CNS functions as a change agent by influencing attitudes, modifying
behavior, & introducing new approaches to nursing practice.
Certified Nurse Anesthetist
▪ Education and Certification
▪ Major risks include
▪ improper placement of an airway
▪ failure to recognize significant changes in a patient’s condition
▪ improper use of anesthetics
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▪ Oversight of an anesthesiologist often required
Certified Nurse Midwife
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▪ Provide
▪ delivery for patients at low risk for complications
▪ often manage normal prenatal, intrapartum, & postpartum care.
Certified Nurse Assistant
▪ Help with positioning, turning, lifting & performing a variety of tests *
treatments.
▪ Case: Failure to follow policy & safe practices
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▪ Aide who has been certified & trained to assist patients with activities of
daily living under the direction & supervision of an RN or LPN.
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Legal Risks of Nurses
NURSING LEGAL RISKS
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▪ Patient Assessments
▪ Failure to Conduct a Proper Examination
▪ Failure to Take Vital Sign
▪ Failure to take vital signs.
▪ Failure to Monitor Vital Signs
▪ Delay in Monitoring Fetus
▪ Untimely Reassessment
▪ Failure to Repeat Vital Signs
NURSING LEGAL RISKS – II
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▪ Treatment
▪ Delay in Treatment
▪ Failure to Follow Physician’s Orders
▪ Burns from Bovie Machine
▪ Failure to Note Patient’s Airway Became Dislodged
▪ Treating Wrong Patient
NURSING LEGAL RISKS – III
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▪ Infections
▪ Failure to follow proper infection-control procedures
▪ proper hand-washing techniques
▪ Cross contamination of patients
NURSING LEGAL RISKS – IV
▪ Negligent Care Causes Laceration
▪ Failure to Follow Instructions
▪ Delay in Reporting Patient’s Condition
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▪ Negligent Amputation of Infant’s Finger
NURSING LEGAL RISKS – V
▪ Failure to Note Change in Patient’s Condition
▪ Failure to Report Deteriorating Condition
▪ Delay in Reporting a Patient’s Condition
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▪ Failure to Verify Orders
NURSING LEGAL RISKS – VI
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▪ Discharge
▪ Failure to Act: Swollen Beyond Recognition
▪ Discharge: Infants Switched
CASE: Nursing Diagnosis
Court’s Decision
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▪ Defendant physicians ignored nurse’s assessment of patient’s diagnosis,
which contributed to delay in treatment & injury to the patient. Nurse
testified that she told the physician that patient’s signs & symptoms were
not those associated with indigestion. Defendant physician objected to
this testimony, indicating that such a statement constituted a medical
diagnosis by a nurse. The trial court permitted the testimony to be
entered into evidence.
What do you think happened on appeal?
CASE: Nursing Diagnosis
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▪ Missouri Court of Appeals affirmed lower court’s ruling, holding that
evidence of negligence presented by a hospital employee, for which an
obstetrician was not responsible, was admissible to show events that
occurred during patient’s hospital stay.
▪ See text case: Cignetti v. Camel
Medications Errors
▪ Failure to Identify Correct Patient
▪ Administering the Wrong Medication
▪ Administering the Wrong Dosage
▪ Failure to Clarify Orders
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▪ Failure to administer Medications
Medications Errors – III
▪ Administering wrong dosage
▪ Failure to discontinue a drug
▪ Failure to note a change order
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▪ Administering Drugs by the Wrong Route
Infections
▪ Cross Contamination
▪ Failure to follow established procedures
▪ Infection control
▪ Sterile technique
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▪ Failure to Notify Physician
CASE STUDIES
1. Negligent Care Causes Laceration
3. Failure to Question Discharge
4. Chance of Survival Diminished
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2. Failure to Follow Instructions
Case 1a:
Negligent Care Causes Laceration
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▪ Plastic cup as arm guard?
▪ Morris alleged from personal observation that the laceration to her
daughter’s arm was caused by the jagged edges of a plastic cup that
had been split & placed on her arm to guard an IV site.
▪ Text case: Morris v. Children’s Hospital Medical Ctr.
▪ Was this a breach of the standard of care for nurses?
CASE 1b:
Negligent Care Causes Laceration
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▪ A nurse, in her affidavit, who stated her qualifications as an expert,
expressed her opinion that the practice of placing a split plastic cup over
an IV site as a guard constituted a breach of the standard of nursing
care.
CASE 2a:
Failure to Follow Instructions
▪ Heart monitor was connected incorrectly & resulted in an electrical shock
to the infant.
▪ Dangers of electric cords are within the realm of common knowledge.
▪ Record showed the nurse failed to exercise ordinary care in connecting
the infant.
▪ Text Case: Cafiero v. North Carolina Board of Nursing
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▪ Failure of a nurse to follow the instructions of a supervising nurse to wait
for her assistance before performing a procedure can result in revocation
of the nurse’s license.
CASE 3a:
Failure to Question Discharge
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▪ Premature Discharge
▪ A nurse has a duty to question the discharge of a patient if he or she
has reason to believe that such discharge could be injurious to the
health of the patient.
▪ See text case: Koeniguer v. Eckrich
CASE: 3b
Failure to Question Discharge
▪ The evidence presented a woman conscious of her last days on earth,
swollen beyond recognition, tubes exiting almost every orifice of her
body, in severe pain, and who deteriorated to the point where she could
not verbally communicate with loved ones.
▪ See text case: NKC Hosps., Inc. v. Anthony
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Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ The hospital’s negligence is based on acts of omission, by failing to have
the patient examined by a physician and by discharging her in pain.
CASE 4a:
Chance of Survival Diminished
Ard v. East Jefferson Gen. Hosp.
▪ Husband was having difficulty breathing
▪ Code eventually called
▪ Patient did not survive
© 2014 Jones and Bartlett Publishers
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearn
