Here is Part 3 of the legal information provided by Barbara G. Graybill, Esq., of Schutjer Bogar LLC, located in Harrisburg, PA. I've reprinted the information directly below so I don't get in trouble.
The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.
My own notes are in italics. They may or may not be as accurate as the information provided by Barbara.
FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY – Part 3
GUIDELINES FOR BEING LEGALLY DEFENSIBLE AS A HEALTH MINISTRY PARTICIPANT
1. Understand the scope of your responsibilities. Negotiate and educate your parish supervisor and boards regarding what you can and can't do. If you are a parish nurse, it does not mean that you function as a "free" home nurse to every member of the community but this misconception widely persists. Education of your congregation is extremely important.
2. Put it in writing. You should have a written job description which identifies your major goals and objectives; who is your "supervisor" and what reporting and accountability standards are being implemented; how you will report time; how you will keep case notes; who owns case notes; a description of your required reporting requirements; the number of hours expected; and the opportunities you will have to educate the parish on your role. Make sure you have notes when there could be obvious legalities involved, such as gun shot wounds, child abuse, elder abuse, etc.
3. Know the chain of command in your parish; have a good grasp of the guiding rules, practices, and cultural backgrounds. Use your denominational guidance. If you aren't sure if your denomination or church has them, investigate (example - The United Methodist Church has a Book of Discipline, which contains Social Principles. These can serve as guidance in certain situations.)
4. Avoid the appearance of impropriety. Many times, two are better than one, expecially in certain instances. For example, it is best to have another person around when you are placing an individual's narcotics in a med box for him to take, to avoid possible accusations of stealing medications.)
5. Do not take gifts or money directly from parishioners. Notify your supervisor of any attempts to give you money or other items. A gift given with the full knowledge of your supervisor may be okay, but don't accept "gifts in the dark." A good policy among all church employees is to not accept gifts or to report all gifts through your church channels.
6. Network and educate yourself. Realize that you may often run into conflicts; i.e., the wife who may be responding angrily to her sick husband because she is exhausted—and because she is exhausted, she is abusive or neglectful of her husband's needs; a wife being abused by her husband, an elder in the church; a teenager being sexually active with an older member of the church; an unwanted pregnancy; admission of pedophilia, alternate lifestyles against which your church may take a moral stand, etc. Plan for conflicts and think through them before you encounter them so you are prepared.
7. Educate the parish about your responsibilities and the information and referral services you provide.
8. Know your liability carrier and the situations you are required to report to them. BE SURE THERE IS LIABILITY COVERAGE. There are situations where, even if nothing "happens," it is best to report an insident. One example is: You take a blood pressure Sunday morning during your routine blood pressure screening and later you find they were admitted to the hospital. Though you followed protocol, it might be best to report the incident to your insurance company. Check with them to find out what incidents they want reported.
9. Plan your office space to avoid compromising situations.
10. Plan your filing process to protect confidentiality.
11. Individuals who assume this role are often nurturers who want to "fix things." Realize what your role is—your obligation to the welfare of your parishioners equally — and realize that you can't be the one to fix things. Realize that you can refer out.
Monday, September 15, 2008
Legal Issues in Health Ministries - Part 2
Here is Part 2 of the legal information provided by Barbara G. Graybill, Esq., of Schutjer Bogar LLC, located in Harrisburg, PA.
The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.
My own notes are in italics. They may or may not be as accurate as the information provided by Barbara.
FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY – Part 2
THE ROLE OF THE PARISH HEALTH MINISTRY PERSONNEL
Generally, health ministry personnel who are employees of a church may not practice nursing duties (if licensed as such), such as administering medications, starting IV's, dressing open wounds, etc. Since few parish nurse programs have a physician as a supervisor, the practice of nursing functions per se does not occur in an employment setting. Rather, the function of the nurse is one of information, education and referral in the parish. However, the church itself, if it encourages such actions, may face great liability unless a doctor becomes an "agent" of the church and assumes supervisory functions.
In parishes where a nurse performs nursing functions, not only is the church liable for her actions, but problems arise with the confidentiality of records issues, e.g., what may you tell a supervisor (minister, priest, etc.) about the individual receinging services. Generally, in a nursing situation, that information would be confidential. But the minister or priest has an obligation to oversee the functions of all actions taken officially on behalf of the church. His or her failure to do so can render the church liable with little or no defense.
In some situations, particularly poorer communities, parish nurses often provide nursing services. In this case the nurse, parish and insurance carrier must be very clear about the chain of command, supervisory responsibilities, and adherence to the nurse practice act with its attendant regulations, case law and statements of policy. In such a case, the nurse may feel compelled, because of a generous nature, to go beyond what is logically called for. If she does, it is at the risk of her license and subjects the church to greater liability. This is true whether or not the nurse functions as an employee or volunteer.
It should be understood that the role of the parish nurse is not the same as that of a home health nurse. The parish and the nurse must educate the community as to her appropriate role.
CONFIDENTIALITY ISSUES
The concept of confidentiality of information gleaned during the practice of parish health ministry raises some uncomfortable questions. For instance, if the parish nurse learns that a husband is abusing his wife, must that information be shared with the minister? What if the wife dislikes the minister and feel the minister theologically feels that a husband is obligated to control his wife? What if the wife doesn't care if the minister knows, but the minister, upon learning of it, accidentally releases that information in the course of a conversation in which another parish member is nominating the husband for office in the church?
It is very important that both the parish and the nurse understand the need for confidentiality and work out an acceptable plan for handling such situations. The health ministry provider will need to keep records of her work for purposes of liability, but what happens to those records upon her leaving the church? Are they the records of the church or the individual? And should the minister have access to those records? What if the church has a committee handling personnel matters—are the entitled to know anything more than the number of hours the individual is working? What standards can be in place to assure that the program and its personnel can be adequately evaluated?
The best rule of thumb for records is that the health ministry personnel log visits and time spent on such visits as the official record for personnel matters and reporting issues. Separate notes should be kept in the individual's file and should be the property of the health ministry personnel unless the church member specifically permits access to the file by any other individual. However, for the safely of everyone involved, it is important to set forth the understanding that the employing/supervising entity has with the health ministry personnel and PUT IT IN WRITING to avoid potential problems in the future.
SUPERIVSION OF VOLUNTEERS
The supervision of volunteers (for driving, delivering meals, etc.) often falls to the parish health ministry coordinator or falls under his or her purview. Where the parish health coordinator has such responsibility, authority and accountability follows. It is the supervisor's responsibility to take responsible steps to educate and inform the volunteers of any rules, policies or procedures of the church with regard to parish health ministry. Volunteers must understand the rules of confidentiality, the scope of the activities permitted, and the issue of liability. For example, does the parish's insurance cover volunteers who drive parishioners to appointments or deliver meals? That information needs to be clarified; in many cases, the volunteer is expected to have his or her own insurance. By supplying volunteers, has the church made sure that such volunteers are licensed and capable of driving? While volunteers are generally covered by the Good Samaritan statute, case law has not developed sufficiently to clearly define the role of the church.
The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.
My own notes are in italics. They may or may not be as accurate as the information provided by Barbara.
FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY – Part 2
THE ROLE OF THE PARISH HEALTH MINISTRY PERSONNEL
Generally, health ministry personnel who are employees of a church may not practice nursing duties (if licensed as such), such as administering medications, starting IV's, dressing open wounds, etc. Since few parish nurse programs have a physician as a supervisor, the practice of nursing functions per se does not occur in an employment setting. Rather, the function of the nurse is one of information, education and referral in the parish. However, the church itself, if it encourages such actions, may face great liability unless a doctor becomes an "agent" of the church and assumes supervisory functions.
In parishes where a nurse performs nursing functions, not only is the church liable for her actions, but problems arise with the confidentiality of records issues, e.g., what may you tell a supervisor (minister, priest, etc.) about the individual receinging services. Generally, in a nursing situation, that information would be confidential. But the minister or priest has an obligation to oversee the functions of all actions taken officially on behalf of the church. His or her failure to do so can render the church liable with little or no defense.
In some situations, particularly poorer communities, parish nurses often provide nursing services. In this case the nurse, parish and insurance carrier must be very clear about the chain of command, supervisory responsibilities, and adherence to the nurse practice act with its attendant regulations, case law and statements of policy. In such a case, the nurse may feel compelled, because of a generous nature, to go beyond what is logically called for. If she does, it is at the risk of her license and subjects the church to greater liability. This is true whether or not the nurse functions as an employee or volunteer.
It should be understood that the role of the parish nurse is not the same as that of a home health nurse. The parish and the nurse must educate the community as to her appropriate role.
CONFIDENTIALITY ISSUES
The concept of confidentiality of information gleaned during the practice of parish health ministry raises some uncomfortable questions. For instance, if the parish nurse learns that a husband is abusing his wife, must that information be shared with the minister? What if the wife dislikes the minister and feel the minister theologically feels that a husband is obligated to control his wife? What if the wife doesn't care if the minister knows, but the minister, upon learning of it, accidentally releases that information in the course of a conversation in which another parish member is nominating the husband for office in the church?
It is very important that both the parish and the nurse understand the need for confidentiality and work out an acceptable plan for handling such situations. The health ministry provider will need to keep records of her work for purposes of liability, but what happens to those records upon her leaving the church? Are they the records of the church or the individual? And should the minister have access to those records? What if the church has a committee handling personnel matters—are the entitled to know anything more than the number of hours the individual is working? What standards can be in place to assure that the program and its personnel can be adequately evaluated?
The best rule of thumb for records is that the health ministry personnel log visits and time spent on such visits as the official record for personnel matters and reporting issues. Separate notes should be kept in the individual's file and should be the property of the health ministry personnel unless the church member specifically permits access to the file by any other individual. However, for the safely of everyone involved, it is important to set forth the understanding that the employing/supervising entity has with the health ministry personnel and PUT IT IN WRITING to avoid potential problems in the future.
SUPERIVSION OF VOLUNTEERS
The supervision of volunteers (for driving, delivering meals, etc.) often falls to the parish health ministry coordinator or falls under his or her purview. Where the parish health coordinator has such responsibility, authority and accountability follows. It is the supervisor's responsibility to take responsible steps to educate and inform the volunteers of any rules, policies or procedures of the church with regard to parish health ministry. Volunteers must understand the rules of confidentiality, the scope of the activities permitted, and the issue of liability. For example, does the parish's insurance cover volunteers who drive parishioners to appointments or deliver meals? That information needs to be clarified; in many cases, the volunteer is expected to have his or her own insurance. By supplying volunteers, has the church made sure that such volunteers are licensed and capable of driving? While volunteers are generally covered by the Good Samaritan statute, case law has not developed sufficiently to clearly define the role of the church.
Legal Issues in Health Ministries - Part 1
Finding information regarding legal issues in health ministry is like looking for half a needle in a silo of hay. Every state may have variations to any theme, but I obtained permission from Barbara G. Graybill, Esq., a lawyer with Schutjer Bogar LLC of Harrisburg, Pennsylvania, to publish the following information regarding Pennsylvania law that she put together for a parish nursing seminar I attended recently. She did request that I include the following:
The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.
I will probably publish this legal information in several blog entries so if you are interested, follow the blog titles to get all the information. I will place my own notes in italics to provide more information and as a "warning" that the information may not be as "accurate."
So here you go.
FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY (September 2008)
REALITY. There is no single answer for the same questions posed in different churches.
The question, "Can I be sued if…:" will always be answered "Yes." The real issue is, "Are we defensible?"
CHURCH STRUCTURE AND BELIEFS. Churches range from independent to connectional, conservative to liberal. Both structure and theology, as well as the personality of the minister, can affect how the parish health ministry is maintained and run. Additionally, parishioner expectations can impact the ministry. Before attempting to answer questions about how the parish health ministry is affected by legal issues, it is important to define the structure of the church and identify the key decision makers. A review of the insurance coverage is also critical.
Issues include:
1. Who has the ultimate decision-making power in your church?
2. What power does the governing board have, if any?
3. Are there religious/theological constraints on health care issues in your church regarding end of life decisions, birth control, family structure, etc.?
4. Who oversees the parish health ministry?
5. What is the relationship between health ministry personnel and the church?
EXPLORING ISSUES
VOLUNTEER. A volunteer is an individual who provides services without pay. Depending upon the type of work done and the amount of supervision, as well as any licensure the volunteer holds, liability issues may vary. A licensed individual providing services for which he or she is licensed is still held to the same standard of care as thought they were working for pay. However, under legislation passed to protect volunteers, the actions of the volunteer have to be extremely outrageous before they give rise to liability.
EMPLOYEE. An employee is defined as a person who works at the direction of, and for the benefit of, the employer. The employer has the right to supervise or set parameters for your work. Because of the concept of Respondeat Superior (the master is liable for the actions of his or her employee), an employee surrenders part of his or her autonomy in exchange for employment. However, a licensed professional still remains responsible to maintain the professional standards required by licensure; failure to do so may result in the revocation of your license.
INDEPENDENT CONTRACTOR. An independent contractor is a person who contracts with the provider to do certain services by virtue of the independent contractor's skills or licensure. The IC performs certain duties, but is ultimately responsible for the outcome of their own work. The employer generally does not have control of the work times and work process involved in the tasks, but only in the outcome. An IC must maintain his or her own liability insurance and worker's compensation and must submit proof of the same upon demand. Generally, the concept of IC can be resolved by looking at the degree of control the provider has with the independent contractor. Generally, parish health ministry workers do not fit into this category.
AGENT. An agent is someone who is authorized to act on behalf of the church or institution. The agent can be a volunteer, an independent contractor or employee. The scope of the agent's activities should be clearly delineated in writing; however, the appearance of authority often leads other entities to rely upon the agent's actions. This is a situation congregations need to have defined clearly in writing.
SCOPE OF EMPLOYMENT vs. SCOPE OF PRACTICE. An employer may limit the scope of practice of a licensed professional but may never enlarge it. An employer may not require you to do acts outside your scope of practice. And while the employer may limit the scope of your practice, it cannot limit the duty imposed upon you by virtue of your licensing. Therefore, it is critical to know both the scope of your practice and the actual duties of your employment. A job description is key to fully understanding the expectations of your responsibilities and liabilities.
The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.
I will probably publish this legal information in several blog entries so if you are interested, follow the blog titles to get all the information. I will place my own notes in italics to provide more information and as a "warning" that the information may not be as "accurate."
So here you go.
FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY (September 2008)
REALITY. There is no single answer for the same questions posed in different churches.
The question, "Can I be sued if…:" will always be answered "Yes." The real issue is, "Are we defensible?"
CHURCH STRUCTURE AND BELIEFS. Churches range from independent to connectional, conservative to liberal. Both structure and theology, as well as the personality of the minister, can affect how the parish health ministry is maintained and run. Additionally, parishioner expectations can impact the ministry. Before attempting to answer questions about how the parish health ministry is affected by legal issues, it is important to define the structure of the church and identify the key decision makers. A review of the insurance coverage is also critical.
Issues include:
1. Who has the ultimate decision-making power in your church?
2. What power does the governing board have, if any?
3. Are there religious/theological constraints on health care issues in your church regarding end of life decisions, birth control, family structure, etc.?
4. Who oversees the parish health ministry?
5. What is the relationship between health ministry personnel and the church?
EXPLORING ISSUES
VOLUNTEER. A volunteer is an individual who provides services without pay. Depending upon the type of work done and the amount of supervision, as well as any licensure the volunteer holds, liability issues may vary. A licensed individual providing services for which he or she is licensed is still held to the same standard of care as thought they were working for pay. However, under legislation passed to protect volunteers, the actions of the volunteer have to be extremely outrageous before they give rise to liability.
EMPLOYEE. An employee is defined as a person who works at the direction of, and for the benefit of, the employer. The employer has the right to supervise or set parameters for your work. Because of the concept of Respondeat Superior (the master is liable for the actions of his or her employee), an employee surrenders part of his or her autonomy in exchange for employment. However, a licensed professional still remains responsible to maintain the professional standards required by licensure; failure to do so may result in the revocation of your license.
INDEPENDENT CONTRACTOR. An independent contractor is a person who contracts with the provider to do certain services by virtue of the independent contractor's skills or licensure. The IC performs certain duties, but is ultimately responsible for the outcome of their own work. The employer generally does not have control of the work times and work process involved in the tasks, but only in the outcome. An IC must maintain his or her own liability insurance and worker's compensation and must submit proof of the same upon demand. Generally, the concept of IC can be resolved by looking at the degree of control the provider has with the independent contractor. Generally, parish health ministry workers do not fit into this category.
AGENT. An agent is someone who is authorized to act on behalf of the church or institution. The agent can be a volunteer, an independent contractor or employee. The scope of the agent's activities should be clearly delineated in writing; however, the appearance of authority often leads other entities to rely upon the agent's actions. This is a situation congregations need to have defined clearly in writing.
SCOPE OF EMPLOYMENT vs. SCOPE OF PRACTICE. An employer may limit the scope of practice of a licensed professional but may never enlarge it. An employer may not require you to do acts outside your scope of practice. And while the employer may limit the scope of your practice, it cannot limit the duty imposed upon you by virtue of your licensing. Therefore, it is critical to know both the scope of your practice and the actual duties of your employment. A job description is key to fully understanding the expectations of your responsibilities and liabilities.
Sunday, September 14, 2008
Connecting Faith and Daily Life
"Connecting my faith with my daily life simply means that no matter where I am or what I do, I'm on assignment for God. I'm there for God. I'm God's hands. I'm God's feet. I'm God's ears. I listen with the ear of my heart to all that goes on. When God puts me in charge, God asks me to be there all ways and always."
Pat Miles, nurse
Pat Miles, nurse
Twelve Beatitudes for a Parish Nurse
Parish Nurses are blessed with a variety of gifts that make them uniquely supportive of congregations.
1. Blessed be the parish nurse for she is caring.
2. Blessed be the parish nurse for she is available and accessible to congregations.
3. Blessed by the parish nurse for she is knowledgeable about community resources and process of referral.
4. Blessed be the parish nurse for she is cost effective.
5. Blessed be the parish nurse for she has a high tolerance for ambiguity.
6. Blessed be the parish nurse for she has had a generalist education and previous employment that have resulted in a broad variety of skills.
7. Blessed be the parish nurse for she is process oriented.
8. Blessed be the parish nurse for she is possessed with a generosity of spirit, both of time and talent.
9. Blessed be the parish nurse for she focuses on priorities.
10. Blessed be the parish nurse for she is committed, dependable and persevering.
11. Blessed be the parish nurse for she has a heritage and tradition of pioneering.
12. Blessed be the parish nurse for she is a believer...in God, clients, nursing, and in a better world--here and in the hereafter.
Adapted from Parish Nursing: The Developing Practice. Solari-Twadeli, A. and M.A. McDermott, ed. Park Ridge, IL: National Parish Nurse Resource Center, 1991.
1. Blessed be the parish nurse for she is caring.
2. Blessed be the parish nurse for she is available and accessible to congregations.
3. Blessed by the parish nurse for she is knowledgeable about community resources and process of referral.
4. Blessed be the parish nurse for she is cost effective.
5. Blessed be the parish nurse for she has a high tolerance for ambiguity.
6. Blessed be the parish nurse for she has had a generalist education and previous employment that have resulted in a broad variety of skills.
7. Blessed be the parish nurse for she is process oriented.
8. Blessed be the parish nurse for she is possessed with a generosity of spirit, both of time and talent.
9. Blessed be the parish nurse for she focuses on priorities.
10. Blessed be the parish nurse for she is committed, dependable and persevering.
11. Blessed be the parish nurse for she has a heritage and tradition of pioneering.
12. Blessed be the parish nurse for she is a believer...in God, clients, nursing, and in a better world--here and in the hereafter.
Adapted from Parish Nursing: The Developing Practice. Solari-Twadeli, A. and M.A. McDermott, ed. Park Ridge, IL: National Parish Nurse Resource Center, 1991.
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