HONG KONG LEGAL NURSE CONSULTANTS

香 港 法 護 顧 問 學 會

HONG KONG LEGAL NURSE CONSULTANTS (香港法護顧問學會) accredited by the “ Nursing Council of Hong Kong ” as a Provider of Continuing Nursing Education (CNE) since the year 2006 .

『香港護士管理局』授權本會舉辦之 CNE 課程、均可獲發認可之 CNE 學分。

HONG KONG LEGAL NURSE CONSULTANTS

香 港 法 護 顧 問 學 會

HONG KONG LEGAL NURSE CONSULTANTS
(香港法護顧問學會) accredited by the “ Nursing Council of Hong Kong ” as a Provider of Continuing Nursing Education (CNE) since the year 2006 .

『香港護士管理局』授權本會舉辦之 CNE 課程、
均可獲發認可之 CNE 學分。

課程簡介 Course Introduction

Part 1: BASIC MEDICO-LEGAL ISSUES ALL NURSES SHOULD AWARE

Part 1: BASIC MEDICO-LEGAL ISSUES ALL NURSES SHOULD AWARE
Lecture A of Part 1:
Conspiracy to defraud(串謀詐騙) Section: 159A The offence of conspiracy / (1) Actus reus 犯罪行為 / (2) Mens rea 犯罪心意 / VIR-Video Interview Recording / Sick leave certificates case /Smith-town Hospital [1996] case / Conspiracy to steal drugs and medications from Government Hospital (Case study) / Principles of defence (辯護原則) / Negligent act of the Professional people such as doctors, Nurse; / "roadside emergency” - A Good Samaritan Law – volunteer;/ Health care providers and Patients relationship / This treatment is “necessary for live saving”/ Patient with Mental Disorder (DAMA)/ R v Hallstrom [1986] / Mental Health Ordinance: Section 31(Form 1, 2 AND 3) and Section 45;/ Personal Data (Privacy) Ordinance Cap 48 / To "make a data access requests"-Patients Medical Record./“Credibility”(誠信)-Improper alteration of Nursing record(醫療紀錄) for the purpose of concealment (cover-up)/ Incident Report –copies ; General Principle :- Report the “fact”/ Consent for Treatment - Case study : Re C and PPH Case [2018] – “Informed Consent”/ (Jehovah’s Witness Case[1987]) / Nurses or Doctor’s signature in the Consent Form ?/ Consent: 18 years and Gillick Consent (Gillick v West Norfolk & Wisbech Area Health Authority [1985] case) /Guardianship Order(監護令) / Limitation Ordinance (時效條例) / Hospital Staff injury - issue of liability (Wong WM case and Wagon Mound case [1967])/ Nursing staff occupational hazard (風險)/ Master and servant -Vicarious liability / Burden of Proof (舉證責任) – Patients / Res Ipsa Loquitur (The thing speaks for itself). 「事實本身即是証明」; /不誠實取用電腦 Section 161 - (c) with a view to “dishonest gain” for himself or another目的在於使其本人或他人不誠實地獲益; / Verbal order; Telephone orders; Standing Orders - R v Salisbury [8 November 2005] – Nurse sentenced to 4 years imprisonment
Lecture B of Part 1:
Can I search the locker of the patient ? / Obligation to report crime;/ Police searching power ; / Report child abuse ; / Report maltreatment of an elderly patient in the geriatric ward / Ombudsman’s Office 申訴專員.

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Part 2:DISCIPLINARY PROCEDURE FOR NURSES AND ABUSIVE PATIENTS MANAGEMENT/ ORGAN TRANSPLANTATION / LIVING WILLS / CORONERS ORDINANCE/ DEATH INQUEST.

Part 2:DISCIPLINARY PROCEDURE FOR NURSES AND ABUSIVE PATIENTS MANAGEMENT/ ORGAN TRANSPLANTATION / LIVING WILLS / CORONERS ORDINANCE/ DEATH INQUEST.
Lecture A of Part 2:
Incident Reports admissibility / Defamation Ordinance /and Patient Fall (the Physio’s case )./ Chapter 8 EVIDENCE ORDINANCE (證據條例) / Incident reporting system In Hospital / Slander (短暫形式誹謗) and Defamation (誹謗) /“Prompt” reporting – mistake of colleague (?)/Patient’s Fall case studies (Lamarca case) /An error of judgment Vs Negligence / Judicial Review 司法覆核 / Internal Disciplinary Procedure for Nurses- “The Committee of Inquiry (審查委員會)”/ Nursing Disciplinary Procedure under the Nurses Registration Ordinance ( Cap. 164 )/ Section 17 DISCIPLINARY PROCEEDINGS AND OFFENCES管理局的紀律處分權力 / “Unprofessional Conduct”不專業行為 / 4 Fields of accountability for professional nurses and doctors/The Bogus Nurse Case -Removal from the Register/ Balamoody case / Abusive Patients Management and the Law (+Violent patients)/ “duty of care” owned by Hospital for discharged patients / DAMA “violent patients./ HUMAN ORGAN TRANSPLANT ORDINANCE(人體器官移植) Cap.465 / Ethical and moral issues / Court of Criminal Appeal(R v Donovan [1934]) / Four conditions for surgery / Strunk v Strunk Case [1969] / Statutory requirements for disclosure of the risks involved in transplantation /Brain death/
Lecture B of Part 2:
Ombudsman Complaint [ 2001 ] : Form 1,2,3 “right to see the on-call judge”/ Duty of care / foreseeable risk of healthcare providers : (The “jump case” )/ Restraint Of Patient in Hong Kong / Care of the dying/force feeding/right to choose death/and “Living Wills” /“DNR order” (or No code order )/ [1] Autopsies ( 屍體剖驗 );[2] Reportable death;[3]Coroners Ordinance (死因裁判官條例); [4] Death Inquest.

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PART 3: NURSING MALPRACTICE

PART 3: NURSING MALPRACTICE
【真實個案/案例】由於急症室醫生不理會護士之臨床評估而叫病人出院回家,因而令病人要做下肢切除手術,醫院醫生護士 因而被控專業疏忽。作為僱主需要負的〝間接法律責任〞。護士無保留地/盲目地/遵守醫生的指令做事,所產生的法律責任。 護士應有的專業決定。【真實個案/案例】做手術後,病人腹腔內遺下紗布,是護士責任而不是醫生的責任。醫生在簽手術紙 之前,沒有解釋給病人知道全部手術的風險/ C0NSENT FORN 的問題。【真實個案/案例】虐待兒童及護士對這方的法律責任/ 控告專業疏忽。保護兒童組(英國)。兒童猝死於嬰兒床上之案例(2004 年)。【Munchausen Syndrome by Proxy 〝MSBP〞】。靜脈注射血管找來找去找不到,護士因而被控專業疏忽,(醫院守則 / 規則反而在法庭對護士不利)。專家証人的作用。醫生和護士下班後當義務急救員,因而被起訴。醫院保險亦不能給護士作出保障。助產士在醫院以外,給危急臨盆孕婦接生- 助產士委員會的專業守則。救路邊交通意外的傷者,醫護人員所產生的法律問題。【命令就是命令!】。ER 醫生沒及 時作出將病人轉往 ICU 的決定因而護士被控專業疏忽。【真實個案/案例】醫生給予〝明顯錯誤及危險〞的指示,護士盲目地 遵從所產生出來的法律責任。〝情況危急時〞和〝情況不危急時〞/法律責任之不同。 第四課: 病人跌斷腳是護士之責或是病理學的骨折?護理人員撰寫〝護理記錄及報告〞。(4B)護士主管須知的〝職業安全及健康條例〞 (CAP 509)。 第五課:(5A)護士因勸病人家屬考慮另找醫生,護士因此被醫院解僱-上訴庭案例(1999)。護士指出上司犯錯,指出同事犯錯,及報告醫 生犯錯所產生的問題。病人知情權。醫生根據【私隱條例】所擁有的豁免權(S.59)。警員拘捕權之問題。市民主動舉報罪案之法律問題,及護理人員之應用。(5B)病人不依時去診, 護士沒有主動跟進,因而護士被控專業疏忽。【真實個案/案例】/病人沒有前往醫院注射第二針 ATT,護士被起訴及作出賠償。

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Part 4 : CODE OF ETHICS AND PROFESSIONAL CONDUCTS FOR NURSES IN HONG KONG AND PATIENT CONFIDENTIALITY

PART 4: MAINE THEME: Code of Ethics and Professional Conduct for Nurses in Hong Kong
(香港護士淪理及專業守則) ; Part 4
Code of Professional Conduct for Nurses / be reasonably regarded as disgraceful (不名譽) or dishonorable (敗壞名譽) by a RN / Code of Ethics and Professional Conduct for Nurses in Hong Kong. / 1. [P.5] Respect the dignity of the Patients; 2. [P.5] Safeguard the Patient’s right to self-determination; 3. [P.6] Hold in confidence of Patient’s data; 4. [P.7] Report to an appropriate person or authority when safe care cannot be provided; 5. [P.7] Play their right roles; 6. [P.7] Maintain standards of the profession; 7. [P.9] Uphold the image of the nursing profession: stealing, dishonesty; criminal convictions; 8. [P.9] Maintain clean boundaries between themselves and the Patients; 9. [P.10] Actively up-date their professional knowledge; 10. [P.16] Guide: Administration of Medication (Right dose, right patient, right drug; / knowledge of allergies, / any doubt about the medication? ) / HONG KONG BILL OF RIGHTS ORDINANCE [香港人權法案條例]
Cap. 383 Section 8 / Failed to obtain informed consent from the Patient before performing the Stapled Haemorrhoidopexy (“the Operation”)/ “How much supervision the patient should have been given”?/ Disclose Patient’s information to close relatives? - Medical-privilege / Standard of care of Student Nurse / Gold v. Essex County Council [1942]/ Guide: Infection control (Proactively to upkeep the Infection Control standard;/ Nursing Documentation / Restraint Of Patient
in Hong Kong / Judicial Review 司法覆核.

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Part 5: CARE OF ELDERLY PATIENT AND ADVANCE DIRECTIVE AND EPA (Enduring Power of Attorney)

Part 5
Maine Theme: Specific legal issue in elderly Patients Care:
Advance Directive (提前醫療指示);【安樂死】(Euthanasia);Enduring Power Of Attorney(持久授權書);and / Code of Ethics and Professional Conduct for Nurses in Hong Kong Case law related to common legal issue for Nurses:
[1] 放棄救年長病人政策是否合乎法律原則?【DNR 】。自願入院的病人,病人自主權(CAP 136 S,30)。醫院歧視老年人政策。病 人病況前景極差- 醫生決定不進行救之法律問題。病人家人選擇 DNR 的法律權利。家人及醫護人員之“串謀緘默”。年長病人 間歇性理解治療同意書內容所簽之治療同意書的法律問題。九十歲病人反對進行某項重要手術(非危急情況)該如何處理。病人 親屬替病人簽治療同意書是否合法?【安樂死】(Euthanasia)之法律問題。病人提前指示及(LIVING WILL)。 [2]:醫護人員應如何處理年長病人拒絕出院及親屬拒絕接年長病人出院事宜。病霸的問題。社康護士對獨居長者病人之專業疏忽。【安 全出院問題】。 [3]:對年長病人所施的束縛及適當武力是否構成刑事毆打?人權法第三條對護士處理年長病人的制肘。有關案例之研討。監護令的運用, 監護令的香港案例研討(共 6 個)。 [4]:年長病人拒絕藥物,護士可否改變形式給予藥物(包括將藥磨碎混入食物哄其進食)是否違法?病人跌落床,夜更護士疏忽匯報及 導致以後發生的一連串問題。年長病人患褥瘡(BEDSORE)致死,護士被控誤殺(英國案例)。阻止年老病人離開病房。強逼年長病 人接受藥物。 [5]:病人自主權的局限。病人要求將呼吸維生機器移開而選擇死亡。精神病院的病人,選擇不服從醫生的做手術勸告,精神病人自主權 的局限。合法監護人對年長病人的法律權利。病況資料及病人精神健康資料- 醫生擁有的法定豁免權。

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PART 6 Employment Law for Nurses (僱傭條例基本知識)

第一課:僱傭條例基本知識。護士破壞合約,護士在入職前未有誠實申報特別醫療情況及刑事紀錄,可否用作解僱藉口/護士在入職前未透 露癲癇症醫療紀錄,可否用作解僱護士藉口/護士工作岡領(J0B DESCRIPTION)是否/並非合約條文一部份?/工作情況如:更期,時間,補 假,工作地點等;此等條文可否成為合約內容的一部份/護士長勒令 ICU 護士超時工作-ICU 護士可不可以拒絕/護士可不可以拒絕護士長分 配(REALLOCATE)到另一病房/另一工作單位/損壞或遺失僱主的貨品或設備/護士便期 NURSES SCHEDULE 須在事前至少 48 小時通知僱員。 第二課:即時解僱(S.9)。無須給予對方通知或代通知金。故意不服從合理的命令 – 真實個案研討。行為不當(MISCONDUCTS);【護士不專業行為】(CAP 164)及案例研討。慣常疏忽職守。根據普通法理由而終止合約。政府人員行為不當案例。不當地終止合約(WRONGFUL TERMINATION)。/Employment at will。即時辭職(S.10)。醫生証明永久不適合工作。法律規定,每 7 天可亨有一天休息日(REST DAYS)。 法定假日 – 至少 48 小時通知。要求僱員在法定假日工作 – 60 日內安排補假。以工資代替法定假日。無能力繼續從事工作而即時辭職 (MEDICAL GROUND)。寬恕(CONDONATION)。病假(4/5 正常工資)。有薪年假的計算方法。申索補償(REMEDY)。不合理及不合法解僱。僱 員要求復職(REINSTITEMENT)。 第三課:不當地終止合約之案例研討/ 審查委員會調查結果 – 護士行為不當。舉証標準及舉証責任。護士缺席審判。要求律師代表出席。 護士勒令離席;向法庭上訴的權利。 第四課:勞資審裁處(LABOUR TRIBUNAL)。連續性的僱傭合約/ 兼職長散工。交通津貼及加班費。計算年終酬金。終止僱傭金的判給(TERMINAL PAYMENTS)。僱員缺勤時間 – 扣除工資。職員損壞或遺失工具或設備– 扣除工資。【通知期】或【代通知金】之計算方法。工資扣除,作 為紀律處分之 7 項法定原則。暫停僱用作為紀律處分。

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Part 7: CONSENT FOR TREATMENT AND GUARDIANSHIP

PART 7 - MAIN THEME: RECENT UPDATING ON HOSPITAL AUTHORITY INFORMED CONSENT FOR OPERATION/PROCEDURE/TREATMENT AND GUARDIANSHIP (HA VERSION:2.0 @26/02/2018). RELATED LEGAL PRINCIPLE AND MOST UPDATING CASE LAW WILL BE DISCUSSED.
[A]
(1) The need for Informed Consent – Criminal liability and civil liability on the part of the treating doctors and the Hospital Authority(HA).(2) Emergency treatment without consent.(3) Valid informed consent.(4) Procedures for obtaining consent(5) The need for a witness;(6) Competences to give consent;(7) Formal assessment of capacity;(8) Providing “sufficient information”;(9) “Refusal” and “consent”;(10) Refusal to receive blood transfusion;
(11) Children under 18 and adult;(12) Refusal by a competent minor;(13) Unreasonable refusal by parent of incompetent minor;(14) Competent minor and his request on confidentiality;(15) Parental responsibility in a divorce situation;(16) Part IVC Mental Health Ordinance – MIPO consent or refuse consent for treatment;(17) “Guardianship Board” – Power of a Guardian and application of Guardianship;(18) The best interest of the patient Vs. medical interest;(19) Two MO Emergency treatment under Section 59ZF(1) MHO;
(20) Common Law Position – Assessment of competence for Medical Treatment;(21) MIP refusal of consent for treatment;(22) Psychiatrist’s involvement;(23) Gillick Competent cases;
(24) Frequently asked questions on consent;(25) What is “in the best interests” under the Law?(26) Valid period of a “Consent Form” and “reconfirmation of consent Form”?
(27) Witten consent, oral consent and implied consent?(28) Documentation and consent;(29) Withdrawal of consent by patients;(30) Providing “sufficient information” to patients;(31) Refusal by a competent minor;(32) Explanation and providing information to patient by “intern”? by “nursing staff” or by other MOs?
[B]:Guardianship (監護令)
[C]:Current case law study. 【真實個案/案例】

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護理記錄及事故報告證書課程CERTIFICATE COURSE ON INCIDENT/ACCIDENT REPORTING AND DOCUMENTATION FOR NURSES

CERTIFICATE COURSE ON INCIDENT/ACCIDENT REPORTING AND DOCUMENTATION FOR NURSES 護理記錄及事故報告證書課程
(4小時由2:00 p.m. 至 6:00 p.m.):
以法庭案件及護士局聆訊等討論加強學員了解護理文件的法律地位、護理專業的重要性、護理文件指引和原則的之法律精神探討、護理文件及報告常出現的錯誤、護理文件語言、書寫技巧、護理標準之釋義、風險預見能力的重要性、專家意見、文件證據之探討、刑事與民事責任問題、舉證標準、事故報告、供詞書寫技巧格式及示範與討論。
(4小時由2:00 p.m. 至 6:00 p.m.):
護理專業之責任和疏忽問題探討、疏忽的構成等探討、謹慎責任與護理責任、證明疏忽與護理專業、轉嫁責任的理解、人權法與護理專業探討,約束病人事的法律責任、攻擊與毆打罪、非法拘禁定義、法庭案件討論:精神有問題病人自殺與護理責任、同意書之合法及有效性、見證人的責任問題探討,人權法與約束、DNR、DAMA等事故報告討論,法庭案件及護士局聆訊討論等。

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星期三「830專題視像講座」

星期三「830專題視像講座」
(1.5 CNE課程:1.5小時課程、廣東話授課)
上課方法: 視像學習形式(Zoom)
每次討論大都是發生在醫護人員及(香港)醫院之真實案例;
從法官的判詞及雙方律師的辯論理據,中高層之醫護人員,可以將自己代入其中,從而學到在同一處境中,可以作出正確,合法的決定,繼而可以避免很多法律風險。

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