Paramedic 1.25 – Medical/Legal and Ethics: Statutory Responsibilities

Paramedic 1.25 – Medical/Legal and Ethics: Statutory Responsibilities

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Welcome to this module in which we will be
discussing statutory responsibilities that often apply to EMS providers within the prehospital
environment. Once completed with this module, you should
be able to discuss the Medical Practice Act, discuss the legal implications of medical
direction, and describe the concept of a statutory duty to act. This module addresses principles of statutory
responsibilities as applied to EMS agencies and providers. In providing this information, nothing in
this presentation should be construed as legal advice. Rather, the information provided is merely
a broad overview of this legal subject as denoted within the national paramedic educational
standards. Please be aware that every state has different
laws that impact EMS agencies and providers, and these laws may change over time by application
of legislative action or court decisions. Federal, state, and local laws and other legal
provisions not discussed within this presentation may also impact EMS agencies and providers. Additionally, information that was current
or applicable at the time this presentation was produced may not be at the time you are
watching this presentation and new laws may have been added as well. Lastly, the legal topics and doctrines discussed
within these presentations are not the totality of all laws that apply to EMS agencies and
providers. There are numerous other laws and provisions
that impact diverse aspects of providing EMS. If you or any other EMS provider has questions
related to the laws that apply within the realm of providing EMS, additional guidance
and assistance should be obtained from a licensed attorney within your area who has subject
matter expertise in the specific area of law in question. Without delving too deep into concepts of
Constitutional law, states have the authority to legislate for the safety, health, and well-being
of its populace. These so-called “police powers” allow
states to write laws and regulations governing a wide array of topics. Within the scope of this discussion, the Tenth
Amendment allows states to write laws governing the practice of medicine within the state. These laws are commonly referred to as medical
practice acts within each respective state. While every state has its own laws governing
the practice of medicine, it is not unusual for these laws to regulate healthcare professions
to ensure competency of those practicing medicine within the state. Within Wisconsin, state statute 448 governs
medical practices generally, with the state Department of Health Services promulgating
additional rules to further define requirements that apply to physicians, physical therapists,
podiatrists, dietitians, athletic trainers, and occupational therapists. There are other laws as well that govern other
areas of healthcare, such as state statute 441, which regulates nursing. As far as EMS is concerned, the law designed
to directly govern EMS in Wisconsin is state statute 256. Under the authority granted in this statute,
the Department of Health Services also promulgated Administrative Rule DHS 110, which specifically
covers EMS services and providers within the state. These laws governing EMS typically define
specific requirements for physicians serving as medical directors for EMS agencies. Tasks such as competency assurance, providing
internal training, ensuring provider skill competencies, and performing quality assurance
through run reviews are all common requirements within these laws. In many states, specific liability for the
EMS medical director is also defined, whether that physician is directly supervising EMS
providers through on-line medical control, or by off-line, indirect supervision through
the use of standing orders and protocols. In a somewhat related vein, some states also
recognize the applicability of the borrowed servant doctrine when EMS providers are directed
by an on-scene paramedic (who should be functioning under on-line or off-line medical direction). This commonly applies when interfacing with
other agencies and the paramedic at one agency directs the actions of a lower-level provider
(such as an EMT or AEMT) on the scene. The person with the highest level of licensure
on the scene often bears greater responsibility for the patient than others who are also participating
in patient care. Therefore, the paramedic must be diligent
and competent while overseeing all aspects of patient care within his or her watch, so
to speak. At this point, we do not want to delve too
deeply into concepts of legal liability for civil torts (including negligence and medical
malpractice). Therefore, the important concept to understand
here is that each state has laws governing EMS in general, EMS agencies, and EMS providers. As a paramedic student, you hopefully already
have a basic understanding of the EMS laws that apply in your state. Once you are licensed to practice as a paramedic,
any ignorance of the laws that apply to your practice of EMS is no excuse as it will be
your responsibility to understand those various laws and comply with their provisions. We discussed duty to act in a previous presentation,
so we will not spend too much time discussing it here. Where duty to act can become confusing is
when a paramedic is not functioning within his or her formal role as an EMS provider. Stopping at the scene of an accident or rendering
care to an injured party while you are off-duty are both examples of instances where your
state’s Good Samaritan law may apply. Typically, most states do not require off-duty
EMS personnel to act in the event of an emergency that just so happens to pop up nearby that
off-duty EMS provider. If that off-duty EMS provider decides to stop
and help, however, he or she may be obligated to continue rendering aid until relieved by
an on duty EMS or other healthcare provider (as the law commonly does not tolerate leaving
a party in a worse situation then when you discovered them if that party begins rendering
aid). Beyond that, if the off-duty provider does
render aid, many states have Good Samaritan laws that protect the person who stopped to
help from being civilly liable for the results associated with the aid that was rendered. Within Wisconsin, state statute 895.48 is
our Good Samaritan law that protects people who render emergency care at the scene of
an emergency or accident in good faith from civil liability for acts or omissions in rendering
that care. (This assumes, however, that the person was
not a healthcare provider acting pursuant to his or her usual and customary employment.) When a duty does exist for an EMS provider
to render care, ceasing that care without the consent of the patient or without transferring
the patient to another appropriate healthcare provider with the same or higher level of
licensure is routinely considered to be abandonment of the patient, which can obviously lead to
legal liability for the provider. When that duty is created can depend on the
facts of the particular scenario. For an on-duty EMS provider, that duty typically
begins when a call for service is received and the provider is dispatched. If someone stops by the station on a still
alarm, a duty arguably begins. If the provider is on a lunch break and comes
across an accident, or is dispatched to a call and comes across the same accident while
driving to the first call for service, whether or not a duty exists may depend upon local
protocols and operating guidelines. Regardless, if a duty exists, the paramedic
must fulfill his or her duty to avoid allegations of abandonment. While we did not delve too deeply into the
statutory responsibilities that apply to paramedics given the unique nature of each state’s
laws as they apply to EMS, you should now have at least a cursory understanding of medical
practice acts, how medical direction is impacted by the law, and statutory duty to act. For more information on any of these topics,
it is recommended that you reach out to your paramedic instructor or your agency’s service
director or medical director. This presentation was prepared by Waukesha
County Technical College in Pewaukee, Wisconsin and is distributed with an attribution, non-commercial,
share alike 4.0 international Creative Commons license. Copyright 2019, Waukesha County Technical
College. For information on WCTC’s numerous fire
and EMS educational offerings, please visit us online at WCTC.edu.

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