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.
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