Criminal Liabilities and Legal Responsibilities of a Nurse A.

DOCTRINE Of RES IPSA LOQUITUR

 As Nurses starts to practice their profession, Nurses liability has increased.  “the thing speaks for itself”
 Assuming authority, responsibility, accountability for their professional practice,  injury could not have happened if someone was not negligent
professional nurses increasingly are being subjected to scrutiny by Boards of Nursing that no further proof is required.
representing the law, the scope of nursing practice to protect the public welfare. Example: forceps left inside the abdominal cavity after a TAHBSO procedure
 Nurses are also increasingly being subjected to malpractice lawsuits. When nurses Malpractice
become defendants in legal actions,  Improper or unskillful care;
 Other nurse serves as expert witnesses both for the defense (representing the  also denotes stepping beyond one’s authority with
practitioner) and the prosecution (representing the plaintiff). serious consequences
 Expert witnesses testify to the standard of care required of the health care provider and  Term of negligence of professional personnel
whether it was met. For this reasons, professional nurses need basic knowledge of the of (Professional Negligence)
the legal aspects of nursing.  Used properly only when it refers to a negligent act
Responsibility and Accountability for the practice of Professional Nursing committed in the course of professional performance
 Professional nurses undertake to practice their profession, they are held responsible and Example: Giving of Anesthesia by a nurse/ prescribing medicines.
accountable for the quality of performance of their duties. Once they are employed in any A. DOCTRINE OF FORCE MAJEURE
institution, or hospital are directly responsible to their immediate supervisors.  irresistible force, one that is unforeseen or inevitable.
 Private duty nurses, being independent practitioners, are held to a standard of conduct  Under Civil Code of the Philippines-no person shall be responsible for those events
that is expected of reasonably prudent nurses. A standard is the desired and achievable  except in cases expressly specified by law.
level of performance against which actual practice is compared. Standards serve as Example: floods, fire, earthquakes and accidents fall
benchmark against which to plan, to implement and assess quality of services and to
show that nursing is accountable to society, to consumers of nursing services and to B. DOCTRINE OF RESPONDEAT SUPERIOR
governments as well as to the profession of nursing and individual members, Venson,  “Let the master answer for the acts of the subordinate.”
(2016).  liability is expanded to include the master as well as the employee and not a shift of
PROFESSIONAL NEGLIGENCE AND MALPRACTICE liability from the subordinate to the master.
Standard Example:
 Desired and achievable level of performance against which actual practice is compared. hospital will be held liable, if effort to cut down on expenses if decides to hire
 Serves as benchmark against which to plan, to implement and assess quality of services underboard nurses or midwives in place of professional nurses, and these persons
Intentional Wrongs prove to be incompetent.
 Tortuous/ pagsang ayon acts surgeon will be held responsible in case a laparotomy pack is left in a patient’s
 nurse liable which arise in performance of her duties abdomen.
Negligence Note: Private duty nurses, however, are considered independent contractors. They
 An act commission or omission (pagkukulang) are liable for their own negligent actions.
 pursuant to a duty, Incompetence
 that a reasonably prudent person in the same circumstances would/ would not do,
 acting/ non-acting cause of injury to another person or his property  Lack of ability, or legal qualifications and being unfit to discharge the required duty.
Example:  It is a ground for the revocation and suspension of her certificate of registration.
1. she meets this standard then there is no negligence or carelessness. Example: A nursing assistant giving an IV medication to the
But if defendant’s action fails meet standard-negligence patient.
A. LIABILITY FOR WORK OF NURSE TRAINEES AND NURSE VOLUNTEERS
 Nurses are responsible and accountable for their practice, nurse volunteers should
exercise utmost caution, critical thinking and independent judgment to prevent incurring
liabilities which may be hard to get out of.
B. LIABILITY OF NURSES FOR THE WORK OF NURSING AIDES
Nurses should not delegate their functions to nursing aides since the Philippine
nursing act specifies the scope of nursing practice of professional nurses.
Nurses are enjoined to supervise their subordinates and see to it that they perform
only those which they been taught to do and those which they are capable of doing.
Four Elements Nursing aids are responsible for their actions
1. Existence of a duty
Nursing aides perform selected nursing activities under the direct supervision of
2. Failure to meet the standard of due care
nurses.
3. Foreseeability of harm
C. LIABILITY FOR THE WORK OF NURSING STUDENTS
4. Injury/ failure to the plaintiff
Examples: RA 9173 – nursing students do not perform professional nursing duties.
1. Failure to report observations to attending physicians Nursing students should be under supervision of their clinical instructors.
2. Failure to exercise degree of diligence which the circumstances particular case demands In order that the errors committed by nursing students will be avoided or minimized,
Mistaken identity the following measures should be taken:
Wrong medicine, wrong concentration, wrong route, wrong dose Nursing students should always be under supervision of their clinical instructors.
Defects equipment such as stretchers/ wheelchairs lead to falls thus injuring the pt They should be given assignments that are their level of training experience and
3. Admin. of meds w/o a doctor’s prescription competency.
4. Errors due to family assistance They should be advised to seek guidance if they are performing a procedure for the
A. Civil Code, Article 19 first time.
 act with justice give every man his due, observe honesty and good faith. They should be oriented to the policies where they are assigned.
B. Civil Code, Article 20 Their performance should be assessed frequently to determine their strength and
 performance obligations tru negligence cause any injury to another, liable for damages. weaknesses.
Three conditions required to establish a defendant’s negligence Legal Defense in Negligence
 When nurses know and attain the standard of care in giving service and that they have
Injury was of such nature not normally occur-unless negligent act on the part of someone
documented the care they give.
Injury was caused by an agency w/in control of the defendant
 If the patient’s careless conduct contributes to his own injury.
Plaintiff himself did not engage in any manner that would tend to bring about the injury
ADVOCACY
Example:
 Helping others grow and self-actualize by informing them of their rights and ascertaining that
1. pt came in walking to the out-patient clinic for injection. Upon adm. the injection to his
they have the right information on which to base their decisions.
buttocks, the patient experienced extreme pain. His leg felt weak and he was
 The Code of Ethics for Registered Nurses, Sec. 8 and Sec.
subsequently paralyzed. His sciatic nerve was injured.
2. presence of sponges in the patient’s abdomen after an operation. Guidelines to be Observed:
3. Fracture on a newly-delivered baby born by breech presentation. 1. Registered nurses are the advocates of the patients.
2. Nurses should be able to advocate for themselves and the profession.
 MEDICAL ORDERS, DRUGS, AND MEDICATIONS RA 6675
CRIMES AFFECTING NURSING PRACTICE/ REGISTERED NURSES
According to manner of Commission
. DOLO (deceit) with criminal intent
CULPA (fault) without criminal intent, negligent
 A nurse may be held liable for intentional wrongs, intentional
INTENTIONAL tortuous acts may arise in the performance of her duties.
WRONGS TORT
 legal wrong, committed against a person or property independent of
a contract which renders the person who commits it liable for
damages in a civil action.
Examples:
Only validly registered medical, dental and veterinary practitioners, whether in private A. Assault/atake
institution, corporation or in the government, are authorized to prescribed drugs.  imminent verbal threat of a harmful or offensive bodily contact.
Requires that the drug be written in their generic names. Ex. nurse threatens geriatric pt take meds
Only when these orders are legal writing and bear the doctor’s signature thus the nurse B. Battery
have the legal right to follow them.  Intentional, unconsented touching of another person.
The nurse must not execute an order if she is reasonably certain it will result in harm to Ex. Pt refuses IM injection but give it anyway
the patient. C. False Imprisonment/ Illegal Detention
PHARMACY ACT RA 5921  Unjustifiable detention of a person without legal warrant / violation of duty intended to
result in such confinement.
All prescriptions must contain the following information: Name of the  Ex. Pt insists leaving hos, but he is still allowed to go home against medical advice
prescriber order not to be charged with false imprisonment
Office address  However, if patient has a communicable disease, hospital cannot be charged with false
imprisonment in order to protect the public.
Professional registration number D. Invasion of Right to Privacy and Breach of Confidentiality
Professional tax receipt number pt/name, age, sex  The right to be left alone, right to be free of unwanted & exposure to public view
Date of prescription  Privacy relates to a person or identity.
Ex: curtains are used during bed bath procedure to provide privacy of the patient
INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS  Confidentiality relates to data or information about an
 Philippine nursing act of 1991 section 28 individual.
Adm. IV, special training shall be required according to protocol established Ex: pt charts not shared w nurses who have not have direct involvement in the care
1. Basis of nurses’ legal right to give IV injection E. Defamation
2. Board of nursing resolution no. 8 states that any registered nurse without such training  Character assassination/ pagpatay, be it written or spoken.
and who administers IV injections to patients should be held liable, either criminally or  Slander – oral or spoken defamation
administratively or both.  Libel – written defamation (cartoon characters, words written or essay)
SCOPE OF DUTIES AND RESPONSIBILIRIES IN INTRAVENOUS THERAPY  There must be a third person who hears or reads
1. Interpretation of the doctor’s orders for intravenous therapy CRIMES, MISDEMEANORS, AND FELONIES
2. Performance of venipuncture, insertion of needles, cannulas except TPN and cutdown Crime
3. Preparation, administration, monitoring and termination of intravenous solution such as  act committed or omitted in violation of the law
additives, intravenous medications, and intravenous push elements:
4. Administration of blood/blood products as ordered by physicians 1. criminal act
5. Recognition of solution and medicine incompatibilities 2. evil or criminal intent
6. Maintenance and replacement of sites, tubing’s, dressings in accordance with Conspiracy to commit a crime
established procedures 2 or more persons to commit a crime or felony
7. Establishment of flow rates of solutions, medicines, blood and blood components be classified as:
8. Utilization of thorough knowledge and proficient technical ability in the use/care, 1. Principal
maintenance, and evaluation of intravenous equipment
 committed a direct part in the execution of the act.
9. Nursing management of TPN, outpatient intravenous care and Maintenance of
 directly force or induce others to commit the act.
established infection control and aseptic nursing interventions
10. Maintenance of appropriate documentation associated with the preparation,  Considered as the mastermind of the crime
11. administration and termination of all forms of intravenous the therapy 2. Accomplices
TELEPHONE ORDERS  Cooperates in the execution of the offense by previous
Only in an extreme emergency and when no other resident or  Not being principal
 simultaneous act and has knowledge of the criminal intention of the principal
intern is available should a nurse receive telephone orders. 3. Accessory
The nurse should read back such order to the physician to make  Have knowledge of the commission of the crime
certain the order has been correctly written.  Take part subsequent to its commission by profiting themselves or assisting the
offender to profit from the effects of the crime
Such order should be sign by the physician on his next visit
 Provides exit strategy
within 24 hours. Criminal Actions
MEDICAL RECORDS  Deals with acts/ offenses against public welfare.
Supplies rich material for medical and nursing research 1. Misdemeanor
Serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or  general name for a criminal offense which does not in law amount to felony?
condition of the patient and his management.  Punishment is usually fine or imprisonment in less than one year
“if it was not charted, it was not observed or done”. 2. Felony
Nurses are expected to record fully, accurately, legibly and promptly their observations  Public offense for which a convicted person is liable to be sentenced to
from admission to the time of the patient’s discharge.  death or to be imprisoned in a penitentiary or prison?
Nurses are legally and ethically bound to protect the patient’s chart from unauthorized  committed with:
person.  Deceit -exists when the act is performed with deliberate/sinasadya intent
CHARTING DONE BY STUDENT NURSES  fault -wrongful acts result from imprudence, negligence, or lack of skill/foresight.
 When a nurse or clinical counter signs the charting of the nursing student, he/she has Criminal Negligence
personal knowledge of information and that such is accurate and authentic  classified into:
 instructor Anyone who countersigns without verification commits herself to possible legal 1. Reckless Imprudence
risks  act or fails to do it voluntarily but without malice, from which material damage
 results immediately.  There is force majeure
2. Simple Imprudence  Mastermind of a crime- considered as principal
 did not use precaution and the damage was not immediate or the impending 3. Mitigating circumstances
danger was not evident or manifested immediately.  Decreases criminal liability
Criminal Intent  Because of equity in the law/ justice (fairness and mercy)
 State of mind of a person at the time of the  Examples
criminal act is committed.  Age of convict- <18 years old or >70 years old
 person is aware that the act is unlawful but  Voluntary surrender (adm. Correct med to wrong pt but immd.. report to superior)
commits it anyway.  deaf and dumb, blind
Deliberate intent  rape victim agrees to marriage
 two elements without which can be no  Note: Lack of education is not mitigating in:
crime.  Rape
 freedom and intelligence  Forcible abduction
 person offers evidence of insanity,  Arson
necessity, compulsion or accident or  Treason
infancy,  In crimes against chastity like seduction and acts of lasciviousness
 Court will decide if he is not guilty of the  Those acts committed in a merciless or heinous manner
criminal offense. 4. Aggravating circumstances
According to degree of the acts  increase the criminal liability of the offender or make his guilt or more severe
Consummated/ natapos na  if present- murder
 all the elements necessary for its execution and accomplishment  if absent- homicide
 Ex. The nurse wanted to commit euthanasia and  Examples
had given an overdose of morphine that leads to  Abuses
patient’s death 1. Cruelty/ malupit
Frustrated/ nabigo 2. Abuse of authority
 offender performs all the acts or execution which will produce the felony as a  Treachery/ pagtataksil
consequence but which nevertheless, do not produce it by reason of causes  Premeditation/ paligsahan
independent of the will of the perpetrator. 5. Alternative circumstances
 Ex. Nurse was hired to give poison to a geriatric patient by a relative for inheritance.  aggravating or mitigating according to the nature and effects of the crime
However, the patient was revived after the poison was given.  aggravating in physical injuries inflicted by a descendant upon as ascendant.
Attempted  mitigating when accused aided his/her brother in the fight against the offended party
 When the offender commences the commission of the same  degree of Intoxication- RA 9165) habitual, it can be aggravating circumstance.
directly by overt (open or manifest) acts due to unforeseen  Illiteracy is mitigating if there is lack of sufficient intelligence and knowledge of the full
circumstances there was no complete execution to produce the significance of one’s act.
desired felony.  Lack of education is not mitigating in: rape, force abduction, arson, treason, crimes against
 Ex. Respiratory Physiotherapist planned to poison a geriatric patient with an overdose of chastity like seduction and acts of lasciviousness and acts committed in merciless or
inhaled anesthetic but due to lack of available supply, pt. not comatose or dead. heinous manner
Felonies classified according to the degree of punishment MORAL TURPITUDE
Grave felonies  act of baseness, vileness or depravity in social or public duties which a man owes to his
fellow man or to society in general. It is contrary to the accepted and customary right and
 punishment death/penalties from 6 years and 1 day to life
duty between men
imprisonment or fine not exceeding php6,000.00.
MURDER
Less Grave felonies
 unlawful killing of a human being with intent to kill
 Law punishes with penalties which in their maximum period are correctional. . Ex. Euthanasia and abortion
 Imprisonment from 1 month and 1 day to 6 years Fine not exceeding php6,000.00 HOMICIDE
Light felonies  killing of a human being by another..
 Those infractions of law for the commission of which the penalty of arrestor menor ABORTION
 Imprisonment for 1 day to 30 days/ Fine not exceeding php200.00.  expulsion of a product of conception before the age of viability
 punishable only when they have been consummated, with the exception of those committed NFANTICIDE
against a person or property.  killing of child less than 3 days of age.
Criminal Liability  Mother- penalty of imprisonment 2 years- four months and one
 Nurse subject herself to criminal prosecution either by committing a felony or by performing day to 6 years.
an act which would be an offense against person or property. PARRICIDE
 Ignorance of the law is not an excuse for failure to comply therewith.  crime committed when one kills his/her father, mother or child
 Violators of the criminal law cannot escape punishment on the ground of ignorance of the whether legitimate or illegitimate,
law  shall be imposed of penalty for life imprisonment (reclusion
CIRCUMTANCES AFFECTING CRIMINAL LIABILITY perpetua) to death.
1. Justifying circumstances ROBBERY
 No criminal liability  crime against person or property of taking personal property of
 Act itself justified as reasonable another person.
 Examples Ex. Nurse takes patient’s cash or jewelry while patient is sleeping.
 Self-defense Elements: if incomplete becomes Mitigating Circumstances CONTROLLED SUBSTANCES
1. unlawful aggression  RA 6425 (Dangerous Drugs Act of 1972) covers administration
2. necessity for the means employed and regulation of manufacture, distribution and dispensing of
3. lack of sufficient provocation controlled drugs. Authorized persons to prescribe or dispense
 Fulfillment of a duty or lawful order (police shooting drug addict to defend) these drugs require to register and have special license for this
2. Exempting circumstances purpose. Controlled drugs are kept in locked cabinets and are
 Deceases criminal liability documented and counted every shift
 exempted SIMULATION OF BIRTH, SUBSTITUTION OF ONE CHILD FOR
ANOTHER OR ABANDONMENT OF LEGITIMATE CHILD
 Examples
 Simulation of birth – one who enters in a birth certificate a birth that
 Imbecile or insane (unless the latter has acted during a lucid interval)
did not occur. It is a crime against the civil status of a person.
 Person <9 years old
 Substitution of one child for another or concealing or abandoning
 Lacks of intelligent
any legitimate child with intent to cause such a child his/her civil
 Person over 9 years of age and under fifteen (unless acted pagkilala/ discernment)
status shall be punishable for simulation by birth, prison mayor and
 Natural calamity causes injury
 a fine not exceeding one thousand pesos
Things to remember in order to avoid criminal liability
A. Be very familiar with the Philippine nursing law.
B. Beware of laws that affecting nursing practice
C. At the start of employment, get a copy of your job description, the agency’s rules,
regulations and policies.
D. grade your skills and competence
E. Accept only such responsibility that is within the scope of your employment and your job
description.
F. Do not delegate your responsibilities to others.
G. Determine whether your subordinates are competent in the work you are assigning them.
H. Develop good interpersonal relationships with your co-workers, whether they be your
supervisors, peers or subordinates.
I. Consult your superior for problems that maybe too big for you to handle.
J. Verify orders that are not clear to you or those that seem to be erroneous.
K. The doctors should be informed about the patients’ conditions.
L. Keep in mind the values and necessity of keeping accurate and adequate records
M. Patients are entitled to an informed consent.
Action performance of something in a certain way.
a. Abortion any person who, with the intention of prematurely ending a pregnancy, willfully and
unlawfully does any to act to cause the same is guilty of procuring abortion. In the
Philippines abortion is illegal.
b. Criminal law the division of the law dealing with crime and punishment
c. Controlled Substances Dangerous Drugs Act of 1972 covers the administration medication,
regulation of the manufacture, distribution, and dispensing of controlled drugs. Damage loss,
injury or deterioration caused to one’s person or property by the design, negligence or
accident of another.
d. Homicide Killing of a human being by another.
e. Infanticide killing of a child less than three days of age.
f. Law a rule of conduct pronounced by a controlling authority which may be enforced. It
commands what is right and prohibits what is wrong.
g. Moral Turpitude an act of baseness, vileness or depravity in social or private duties which a
man owes to his fellow man or to society in general, an act contrary to the accepted and
customary rule of right and duty between men.
h. Motive inner impulse drive or intention that causes a person to do something or act in a
certain way.
i. Murder Unlawful killing of a human being with intent to kill. It is a very serious crime.
j. Parricide committed by one who kills his/her father, mother or child whether legitimate or
Illegitimate, descendants, or his/her spous
k. Revocation annulment of the professional status and privileges of a registered nurse;
license to practice is confiscated which may be temporary or permanent.
l. Robbery crime against a person or property.
m. Simulation of Birth, Substitution of One Child for Another, or Abandonment of a Legitimate
Child