Fluent Essays

Assignment:  answer either 1 and 2, or 3 and 4, or 5 and 6? Almuayrifi 1 Lesson five The government and the doctor patient relationship READ: 1. Hippocratic oath http://www.nlm.nih.gov/hmd/greek/greek_oath.html 2. AMA view on ethics and confidential read section 3.1.1 and 3.2.1 https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-3.pdf 3.Kentucky statue on reporting child abuse has been in place for many years. In 2020 the law was amended to include subsection four on female genital mutilation. That provision become effective on April 2, 2020. The guts of the statute are in section one.Note the absence of exceptions. 620.030 Duty to report dependency, neglect, abuse, human trafficking, or female genital mutilation -- Husband-wife and professional-client/patient privileges not grounds for refusal to report -- Exceptions -- Penalties. (1) Any person who knows or has reasonable cause to believe that a child is dependent, neglected, or abused shall immediately cause an oral or written report to be made to a local law enforcement agency or to the Department of Kentucky State Police, the cabinet or its designated representative, the Commonwealth's attorney, or the county attorney by telephone or otherwise. Any supervisor who receives from an employee a report of suspected dependency, neglect, or abuse shall promptly make a report to the proper authorities for investigation. If the cabinet receives a report of abuse or neglect allegedly committed by a person other than a parent, guardian, fictive kin, person in a position of authority, person in a position of special trust, or person exercising custodial control or supervision, the cabinet shall refer the matter to the Commonwealth's attorney or the county attorney and the local law enforcement agency or the Department of Kentucky State Police. Nothing in this section shall relieve individuals of their obligations to report. (2) Any person, including but not limited to a physician, osteopathic physician, nurse, teacher, school personnel, social worker, coroner, medical examiner, child-caring personnel, resident, intern, chiropractor, dentist, optometrist, emergency medical technician, paramedic, health professional, mental health professional, peace officer, or any organization or agency for any of the above, who knows or has reasonable cause to believe that a child is dependent, neglected, or abused, regardless of whether the person believed to have caused the dependency, neglect, or abuse is a parent, guardian, fictive kin, person in a position of authority, person in a position of special trust, person exercising custodial control or supervision, or another person, or who has attended such child as a part of his or her professional duties shall, if requested, in addition to the report required in subsection (1) or (3) of this section, file with the local law enforcement agency or the Department of Kentucky State Police, the cabinet or its designated representative, the Commonwealth's attorney, or county attorney within forty-eight (48) hours of the original report a written report containing: (a) The names and addresses of the child and his or her parents or other persons exercising custodial control or supervision; (b) The child's age; (c) The nature and extent of the child's alleged dependency, neglect, or abuse, including any previous charges of dependency, neglect, or abuse, to this child or his or her siblings; (d) The name and address of the person allegedly responsible for the abuse or neglect; and (e) Any other information that the person making the report believes may be helpful in the furtherance of the purpose of this section. (3) Any person who knows or has reasonable cause to believe that a child is a victim of human trafficking as defined in KRS 529.010 shall immediately cause an oral or written report to be made to a local law enforcement agency or the Department of Kentucky State Police; or the cabinet or its designated representative; or the Commonwealth's attorney or the county attorney; by telephone or otherwise. This subsection shall apply regardless of whether the person believed to have caused the human trafficking of the child is a parent, guardian, fictive kin, person in a position of authority, person in a position of special trust, or person exercising custodial control or supervision. (4) Any person who knows or has reasonable cause to believe that a child is a victim of female genital mutilation as defined in KRS 508.125 shall immediately cause an oral or written report to be made by telephone or otherwise to: (a) A local law enforcement agency or the Department of Kentucky State Police; (b) The cabinet or its designated representative; or (c) The Commonwealth's attorney or the county attorney. This subsection shall apply regardless of whether the person believed to have caused the female genital mutilation of the child is a parent, guardian, or person exercising custodial control or supervision. (5) Neither the husband-wife nor any professional-client/patient privilege, except the attorney-client and clergy-penitent privilege, shall be a ground for refusing to report under this section or for excluding evidence regarding a dependent, neglected, or abused child or the cause thereof, in any judicial proceedings resulting from a report pursuant to this section. This subsection shall also apply in any criminal proceeding in District or Circuit Court regarding a dependent, neglected, or abused child. (6) The cabinet upon request shall receive from any agency of the state or any other agency, institution, or facility providing services to the child or his or her family, such cooperation, assistance, and information as will enable the cabinet to fulfill its responsibilities under KRS 620.030, 620.040, and 620.050. (7) Nothing in this section shall limit the cabinet's investigatory authority under KRS 620.050 or any other obligation imposed by law. (8) Any person who intentionally violates the provisions of this section shall be guilty of a: (a) Class B misdemeanor for the first offense; (b) Class A misdemeanor for the second offense; and (c) Class D felony for each subsequent offense. Effective: April 2, 2020 History: Amended 2020 Ky. Acts ch. 74, sec. 7, effective April 2, 2020. -- Amended 2019 Ky. Acts ch. 33, sec. 9, effective June 27, 2019. -- Amended 2013 Ky. Acts ch. 25, sec. 2, effective June 25, 2013. -- Amended 2008 Ky. Acts ch. 72, sec. 4, effective July 15, 2008. -- Amended 2007 Ky. Acts ch. 85, sec. 330, effective June 26, 2007. -- Amended 1988 Ky. Acts ch. 258, sec. 2, effective July 15, 1988; and ch. 350, sec. 43, effective April 10, 1988. -- Created 1986 Ky. Acts ch. 423, sec. 64, effective July 1, 1987. Legislative Research Commission Note. The 1988 4.The Kentucky law on reporting elder abuse --an edited version KRS 209.030- Reports of adult abuse, neglect, or exploitation -- Cabinet actions -- Status and disposition reports. (1) . . . (2) Any person, including but not limited to physician, law enforcement officer, nurse, social worker, cabinet personnel, coroner, medical examiner, alternate care facility employee, or caretaker, having reasonable cause to suspect that an adult* has suffered abuse, neglect, or exploitation, shall report or cause reports to be made in accordance with the provisions of this chapter. Death of the adult does not relieve one of the responsibility for reporting the circumstances surrounding the death. (3) An oral or written report shall be made immediately to the cabinet upon knowledge of suspected abuse, neglect, or exploitation of an adult. *the term “adult” in this statute does not have its common meaning. Instead the term is defined in another section of chapter 209 as follows: "Adult" means a person eighteen (18) years of age or older who, because of mental or physical dysfunctioning, is unable to manage his or her own resources, carry out the activity of daily living, or protect himself or herself from neglect, exploitation, or a hazardous or abusive situation without assistance from others, and who may be in need of protective services; (4) Any person making such a report shall provide the following information, if known: (a) The name and address of the adult, or of any other person responsible for his care; (b) The age of the adult; (c) The nature and extent of the abuse, neglect, or exploitation, including any evidence of previous abuse, neglect, or exploitation; (d) The identity of the perpetrator, if known; (e) The identity of the complainant, if possible; and (f) Any other information that the person believes might be helpful in establishing the cause of abuse, neglect, or exploitation. (5) Upon receipt of the report, the cabinet shall conduct an initial assessment and take the following action: (a) Notify within twenty-four (24) hours of the receipt of the report the appropriate law enforcement agency. If information is gained through assessment or investigation relating to emergency circumstances or a potential crime, the cabinet shall immediately notify and document notification to the appropriate law enforcement agency; (b) Notify each appropriate authorized agency. The cabinet shall develop standardized procedures for notifying each appropriate authorized agency when an investigation begins and when conditions justify notification during the pendency of an investigation; (c) Initiate an investigation of the complaint; and (d) Make a written report of the initial findings together with a recommendation for further action, if indicated. (6) (a) The cabinet shall, to the extent practicable, coordinate its investigation with the appropriate law enforcement agency . . (7) Any representative of the cabinet may enter any health facility or health service licensed by the cabinet at any reasonable time to carry out the cabinet's responsibilities under this chapter. Any representative of the cabinet actively involved in the conduct of an abuse, neglect, or exploitation investigation under this chapter shall also be allowed access to financial records and the mental and physical health records of the adult which are in the possession of any hospital, firm, financial institution, corporation, or other facility if necessary to complete the investigation mandated by this chapter. These records shall not be disclosed for any purpose other than the purpose for which they have been obtained. (8) Any representative of the cabinet may with consent of the adult or caretaker enter any private premises where any adult alleged to be abused, neglected, or exploited is found in order to investigate the need for protective services for the purpose of carrying out the provisions of this chapter. If the adult or caretaker does not consent to the investigation, a search warrant may be issued upon a showing of probable cause that an adult is being abused, neglected, or exploited, to enable a representative of the cabinet to proceed with the investigation. (9) . . . (10) In the event the adult elects to accept the protective services to be provided by the cabinet, the caretaker shall not interfere with the cabinet when rendering such services. (11) . . . (12) . . . . Effective: June 20, 2005 5.Kentucky laws on when to and when not to report domestic violence KRS209A.130 Educational materials to be provided suspected victim of domestic violence and abuse or dating violence and abuse -- Availability of online materials. (1) If a professional has reasonable cause to believe that a victim with whom he or she has had a professional interaction has experienced domestic violence and abuse or dating violence and abuse, the professional shall provide the victim with educational materials related to domestic violence and abuse or dating violence and abuse including information about how he or she may access regional domestic violence programs under KRS 209A.045 or rape crisis centers under KRS 211.600 and information about how to access protective orders. (2) A nonprofit corporation designated by the cabinet pursuant to KRS 209A.045 as a primary service provider for domestic violence shelter, crisis, and advocacy services in the district in which the provider is located shall make the educational materials required under this section available on its Web site or in print form for professionals to provide to possible victims of domestic violence and abuse or dating violence and abuse. Effective:June 29, 2017 KRS 209A.100 Report by professional of act of domestic violence and abuse or dating violence and abuse to law enforcement. (1) Upon the request of a victim, a professional shall report an act of domestic violence and abuse or dating violence and abuse to a law enforcement officer. (2) A professional who makes a report under this chapter shall discuss the report with the victim prior to contacting a law enforcement officer. Effective:June 29, 2017 KRS 209A.110 Report by professional to law enforcement concerning belief that client's or patient's death is related to domestic violence and abuse or dating violence and abuse. (1) A professional shall report to a law enforcement officer his or her belief that the death of a victim with whom he or she has had a professional interaction is related to domestic violence and abuse or dating violence and abuse. (2) Nothing in this chapter shall relieve a professional of the duty pursuant to KRS 620.030 to report any known or suspected abuse, neglect, or dependency of a child. (3) Nothing in this chapter shall relieve a professional of the duty pursuant to KRS 209.030 to report to the cabinet any known or suspected abuse, neglect, or exploitation of a person eighteen (18) years of age or older who because of mental or physical dysfunction is unable to manage his or her own resources, carry out the activity of daily living, or protect himself or herself from neglect, exploitation, or a hazardous or abusive situation without assistance from others. Effective:June 29, 2017 KRS 209A.130 Educational materials to be provided suspected victim of domestic violence and abuse or dating violence and abuse -- Availability of online materials. (1) If a professional has reasonable cause to believe that a victim with whom he or she has had a professional interaction has experienced domestic violence and abuse or dating violence and abuse, the professional shall provide the victim with educational materials related to domestic violence and abuse or dating violence and abuse including information about how he or she may access regional domestic violence programs under KRS 209A.045 or rape crisis centers under KRS 211.600 and information about how to access protective orders. (2) A nonprofit corporation designated by the cabinet pursuant to KRS 209A.045 as a primary service provider for domestic violence shelter, crisis, and advocacy services in the district in which the provider is located shall make the educational materials required under this section available on its Web site or in print form for professionals to provide to possible victims of domestic violence and abuse or dating violence and abuse. Effective:June 29, 2017 6. compare to the way Ohio treats the domestic violence problem in Ohio Revised Code 2921.22 (F) ORC 2921.22 (F) (1) Any doctor of medicine or osteopathic medicine, hospital intern or resident, nurse, psychologist, social worker, independent social worker, social work assistant, licensed professional clinical counselor, licensed professional counselor, independent marriage and family therapist, or marriage and family therapist who knows or has reasonable cause to believe that a patient or client has been the victim of domestic violence, as defined in section  3113.31  of the Revised Code, shall note that knowledge or belief and the basis for it in the patient's or client's records. 7. Finally compare what Ohio requires of doctors and others who become aware of gunshot wounds. Ohio Revised Code 2921.22 ORC 2921.22 (B) Except for conditions that are within the scope of division (E) of this section, no person giving aid to a sick or injured person shall negligently fail to report to law enforcement authorities any gunshot or stab wound treated or observed by the person, or any serious physical harm to persons that the person knows or has reasonable cause to believe resulted from an offense of violence.   8. In 2005 the Canadian province of Ontario passed a law requiring physicians in that province to report gunshot wounds. The law was controversial read the following articles about that law. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC385356/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC385357/ http://www.cmaj.ca/content/173/3/242.2.full.pdf+html Spousal abuse and domestic violence Prior to June 29, of 2017, Physicians in Kentucky who had “reasonable cause to suspect” that a patient had ben the victim of spousal abuse were required to report that event to the state. Failure to do so subjected the physician to criminal penalties. The potential penalty for not promptly notifying the state included up to 90 days in jail for the offending physician. This put doctors in a difficult spot when the patient would ask the physician “please don’t tell anyone”. The old law made Kentucky the only state to require doctors to report all types of spousal abuse when the patient specifically didn’t want the report to be made. The old law, passed in the late 1970’s, was designed to protect spouses, mostly women, in the same way that children were protected. The 2017 changes to the law** were supported by the Cabinet for Health and Family Services, the branch of the government that had the responsibility for following up on reports made by physicians. Other supporters included the Kentucky Medical Association, the Kentucky Coalition of Nurse Practitioners and Midwives, the Kentucky Coalition Against Domestic Violence, the Kentucky Commonwealth Attorneys Association, and the Kentucky Association of Criminal Defense Lawyers, The new law requires health care professionals who “have reasonable cause to believe” that a patient who they are caring for has been a victim of domestic abuse** to: 1. Provide the patient with educational materials about a. How to obtain a protective order from the courts; and b. Regional shelters; and or rape crisis centers 2. Report the Belief to the law enforcement if the patient requests a report to be filed 3. Discuss with the patient the report that the healthcare professional will be filing with law enforcement. The new law contains the same immunities and protections for those that make reports good faith and in compliance law that are available to those that make good faith reports of child abuse. With the changes in the law Kentucky has gone from “you must report” to “you must not report unless asked to report”. The penalties that were in place for not reporting continue to be in place, in instances where a healthcare professional fails to report an incident that a patient has asked them to report. The same penalties also apply to professionals that fail to provide the necessary counseling and information called for in items 1 and 3 above. *for those that are curious, the new law can be found in chapter 209A of the Kentucky revised statutes **the new law expands the scope of the law to include protection for not only spouses, but also former spouses, intimate partners, and dating partners Assignment: five answer either 1 and 2, or 3 and 4, or 5 and 6 1. Is there any practical reason for the distinction between gunshot wounds and evidence of other illegal violence, (fist fights, stab wounds etc.) and 2. Similar legislation did not pass in Canada until 2005 at which time it was very controversial among doctors. Why was it controversial and what was their hesitancy about the law? (eventually all of Canada’s provinces passed comparable legislation). OR 3. If you were a patient and you read all of these statutes would you be more likely or less likely to go to the doctor, and more or less likely to have frank open discussions with your doctor? Would this be your answer if you were a pregnant drug abuser, spouse of an abuser, gunshot wound victim etc.? and 4. Is society better served or worse served by legislation calling for mandatory reporting of medical information to the government. ? OR 5. Why do you think Kentucky now approaches the reporting of child abuse differently than it approaches the reporting of domestic violence? and 6.Are the changes to Kentucky’s laws regarding the reporting of domestic violence changes for the better? If yes, why? If no, why not?