4. Module 2 - Legal Aspects and Risk Management

4.1. Module 2-1: Violence and aggression - legal aspects

This module on the “SAFEMEDIC” platform includes:

•       Coursebook "Legal Issues of Medical Personnel in dealing with Aggressive or Agitated Patients"

•       Video lecture “Legal Issues of Medical Personnel in dealing with Aggressive or Agitated Patients” by dr Iveta Vitkuté-Zvezdiniené, University of Applied Sciences, Kaunas, Lithuania

•       Audio lecture “Legal Issues of Medical Personnel in dealing with Aggressive or Agitated Patients – Irish Perspective”

•       Questions and Answers session for Lecture 2-1

•       Material to download

•       Test

 

 

LEGAL ISSUES OF MEDICAL PERSONNEL IN DEALING WITH AGGRESSIVE OR AGITATED PATIENTS


Course summary

The framework for the course Legal Issues of Medical Personnel in Dealing with Aggressive or Agitated Patients is based on 4 pillars that can be divided into several individual blocks.

 

1) the subject-matter of a person's right to adequate, safe and healthy working conditions;

2) the regulation of rights and obligations of the medical staff providing personal health care services under the national legislation;

3) analysis of the legal content of the patients' rights and obligations;

 4) legal requirements for the use of violence in the medical staff performance of duties against aggressive or agitated patients and/or when defending against illegal or violent actions of the patients.

The aim of the course is to develop guidelines for health service workers/ hospital personnel/ health care practitioners (ambulance crews, emergency room staff), who have primary contact with patients, to be able to correctly evaluate dangerous situations created by an aggressive or agitated patient from a legal point of view and, in this regard, apply legal measures.

The training course focuses on human rights and patient rights as well as the rights of medical personnel, taking into account the state of legislation de lege lata and de lege ferenda, as well as juridical decisions.

 

Upon completion of the course, the course participant will have knowledge of the following:

•       the subject-matter of a person's right to appropriate, safe and healthy working conditions;

•       the rights and responsibilities of the patient;

•       the rights and responsibilities of the medical personnel providing health care services;

•       the legal liability forms for non-compliance;

•       legal remedies against aggressive or excited patients.


Upon the completion of the course, the course participant will be able to:

•       determine the relationship between legal and moral standards in providing personal health care services;

•       legally define forms of aggression;

•       ensure that the provision of personal health care services meets the specific needs of patients without prejudice to their rights.


Specification of the output knowledge and professional competences and skills

The graduate of the course Legal Issues of Medical Personnel in Dealing with Aggressive or Agitated Patients in health care will be able to:

1.  Remember: the graduate identifies and defines the legal concept of violence, legal liability forms for actions of violence.

2.  Understand: the graduate explains the concept of individual rights, identifies the rights and responsibilities of individuals providing health care, and identifies the specific needs of patients without prejudice to their rights.

3.  Apply: the graduate is able to put the learned subject-matter into practice. The graduate is able to apply appropriate legal remedies against violent patient behaviour, to properly perform the duties of healthcare without violating patients' rights. 

4.  Analyse: The graduate is able to properly assess a violent patient’s behaviour.  

5.  Synthesize: The graduate is able to summarize the right to proper, safe and healthy working conditions, to draw up a handbook of the patient’s responsibilities. 

6.  Evaluate: The graduate is able to recognize a specific form of violence and assess the situation by legal requirements.

 

Contents of the course:

1.   The concept of violence and forms of legal responsibility for violent behaviour

2.   A health care provider's right to adequate, safe and healthy working conditions.

3.   The rights and obligations of the medical staff providing personal health care services.

4.   The patients' rights and obligations: legal content analysis.

5.   Legal requirements for the use of violence against aggressive or excited patients in the exercise of their duties as medical staff and / or in defending against illicit, violent patients.

 

Review, model situations  

During the final block, participants will prepare a legal analysis of a specific case based on their own choice or instructor assignment, to demonstrate their theoretical knowledge individually or in small groups. 

 

Tools and equipment:

A static video camera, a GoPro camera (if available), restrictive means, documentation, chairs, mattresses, hospital bed.


Course notes:

1. THE CONCEPT OF VIOLENCE AND LEGAL LIABILITY FOR VIOLENT BEHAVIOUR

 

From a legal point of view, violence is an act prohibited by law and characterised by certain features:

(a) illegality,

(b) the intentional nature of the act,

(c) targeting another person,

(d) physical or mental influence on the perpetrator or victim.


Review questions:

  1. What are the necessary judicial features of violence?
  2. Is the healthcare provider treated as a civil servant and subject to special statutory protection against violence?

 

2.CONTENT OF THE RIGHT OF THE HEALTHCARE PROVIDER TO DECENT, SAFE AND HEALTHY WORKING CONDITIONS

 

The right of workers, including healthcare workers, to safe and healthy working conditions is guaranteed by international and national legislation. This section includes the analysis of the content of the positive duty of the state and employer to create safe and healthy working conditions for employees in all work-related aspects.  

 

Review questions:

  1.  What is the legal content of the principle of 'safe and healthy working conditions'?
  2. What are the recommended measures to ensure that the worker has the right to decent and fair working conditions?
  3. In what cases can the employer be held legally liable for failure to comply with the positive obligation to ensure safe and healthy working conditions for the employee?

 

3. CONTENT OF THE RIGHTS AND OBLIGATIONS OF MEDICAL PERSONNEL PROVIDING PERSONAL HEALTH CARE SERVICES

The right of the individual to health care, both, nationally and internationally, is emphasized in adopted papers as one of the fundamental rights of the individual, without which the individual would not be able to exercise his or her other economic, political and social rights. It also embraces the right to have and maintain the best possible physical and psychical state of health. This part includes conditions and criteria for the quality of personal health care.

 

Review questions

1.  What is the content of an individual's right to health?

2.  What are the different types of personal healthcare services?

3.  What does the duty of care mean when providing personal health care?

4.  What does the maximum effort standard mean?

5.  What is the legal treatment of the actions of a person's health care provider in addressing patient anxiety resulting from aggressive behaviour towards himself or herself or the environment?

6.  What does informed patient consent mean?

7.  In what cases is patient consent not required for the provision of personal health care?

  

4.THE PATIENTS’ RIGHTS AND RESPONSIBILITIES: LEGAL CONTENT ANALYSIS

This section covers the prevention of the manifestation of consumer-oriented rights and obligations in the context of equality between the parties involved in health care relations. Since the legal status of a person as a patient arises from the moment of referral to a health care institution, the exercise of rights as well as the performance of duties are an integral part of the provision and receipt of healthcare services. This section covers a range of rights and obligations, their legal content, and, consequently, problems related with the implementation and application of legal norms. 

Review questions:

1.   What does the principle of unity of rights and duties mean and what are the legal problems that are reflected in the concept of rights and obligations in the field of healthcare?

2.   What are the obligations of patients and what are the legal requirements for such duties?

3.   What are the legal consequences of the patient's failure to perform his / her duties?

 

5. LEGAL REQUIREMENTS FOR THE USE OF COERCION AGAINST AGGRESSIVE OR AGITATED PATIENTS 

IN THE PERFORMANCE OF MEDICAL DUTIES AND / OR IN THE DEFENCE OF UNLAWFUL, VIOLENT PATIENT ACTS

 

This section includes legal requirements for limiting patients' freedom, requirements for legal protection in order to protect patient / staff safety. 

 

Review questions:

1.      What is the meaning of a mental and behavioural disorder?

2.      In what cases is physical restraint possible?

3.      What are the types of physical restraint and the elements that characterise it?

4.      Which entities are entitled to apply physical restraint?

5.      What can be the duration of physical restraint?

6.      What is the legal requirement for a physical restraint proceeding?

 


6. REVIEW, MODEL SITUATIONS  

Legal analysis of a specific case based on the course participants’ choice or instructor’s assignment, to demonstrate their theoretical knowledge individually or in small groups.