Assault or battery, or both, may be either criminal or tort (civil). Assault is placing an individual without consent in a situation in which he or she fears immediate bodily harm. Battery is the touching of a person without his or her consent. Battery can also occur with the touching of anything connected with a person (clothing, purse, jewelry) without consent. ^3,4 Damages for battery may be punitive or nominal as well as compensatory. ^8,20

Other types of intentional torts are, briefly, false imprisonment, the unjustifiable detention of a person without his or her consent, and invasion of privacy, a key concept in issues related to confidentiality. The patient has the right to privacy of medical information. Photographs may not be taken and information may not be released without consent. Some situations are newsworthy, and the public’s right to know can exceed the patient’s right to privacy. ⁸ Obviously, knowledge of statutes and knowledge of relevant laws related to consent is vital. Defenses used against intentional torts are consent (discussed later in this chapter), self defense, defense of others, and necessity. ^8,20

A quasiintentional tort protects an individual’s interest in a person’s reputation, privacy, and freedom from legal action that is unfounded. ¹ It is a legal action that arises from damages inflicted on a person’s reputation or privacy. Examples of such a tort include defamation of character, libel, and breach of confidentiality. Tort law does not actually protect a person; it just provides an avenue through the courts to seek compensation for damages done.

Vicarious liability is defined as one party being responsible for the actions of another. The doctrine of respondeat superior, “let the master respond,” has been used frequently when nurses are accused of malpractice. As a result of this doctrine, the employer has an obligation to ensure that employees perform duties in a competent safe manner. Two elements must be shown: (1) the injured party must prove that the employer had control over the employee; and (2) the negligent act occurred in the scope and course of the employment. ⁶ Vicarious liability can be found with either malfeasance or nonfeasance of the employee.

Recently courts have attached judgments directly against institutions for corporate negligence. Hospitals have found themselves accountable as an entity when the duty is owed directly to the patient and not through employees. Types of corporate duties attached directly to the institution are outlined in Box 36-2. ^{13141516 and 17}

The principles related to abandonment are important to flight nurse practice. Abandonment occurs with unilateral termination of the nurse-patient relationship without consent from the patient. ⁷ Abandonment can also occur if the care of the patient is transferred to someone less qualified. ^7,9 Questions may arise regarding abandonment any time there is a demonstration of disregard for the patient’s welfare, unreasonable practices, or both. ⁷ The various types of air medical transports should be reviewed by each program and evaluated to ensure that potential abandonment issues are addressed. George⁸ suggested that the act of dispatching an ambulance was presumptive of voluntary assumption of a duty to a patient. This assumption should be considered in development of communication center protocols.

Many medical tort claims are related to consent issues. ⁵Informed consent requires more than a patient’s signature on a consent form. The suggested treatment must be presented to the patient with a discussion of all material risks, consequences, and available alternatives. ^1,5 If the patient refuses the first treatment option, other treatment options should be explained. Informed consent requires understanding on the part of the patient.

Consent can be written or oral. Nurses are frequently asked to obtain signatures on consent forms. Before the patient signs, the nurse should determine that the patient understands the purpose of the consent. Expressed consent occurs with written or oral acknowledgment. Implied consent occurs when a patient is compliant with a request (extending arm for phlebotomy, allowing placement of nasal prongs, and so on). Implied consent is frequently operational in emergency situations. Most consent statutes allow for treatment of life-threatening emergencies if the patient is unable to consent because it is the reasonable thing to do. ⁵ One should be cautious, however, not to exceed the limits of implied consent. If the patient is physically or mentally incapable of consenting, implied consent is operative in the case of a true emergency. In the absence of a true emergency, consent should be obtained before treatment from a person who is authorized to consent. ⁵

Consent for treatment of minors is reserved for a parent or legal guardian. Implied consent is used for minors with life-threatening emergency conditions. The parents or legal guardian should be contacted as soon as possible for notification and consent. Most states have laws related to emancipated minors who can consent before the age of majority. In addition, minors may be allowed to consent for treatment of certain conditions such as sexually transmitted diseases, pregnancy, and substance abuse. ⁵

Refusal to consent or withdrawal of consent is sometimes a murky question. A common issue is the refusal of a blood transfusion because of religious beliefs. If the treating physician believes that a blood transfusion is necessary and the patient refuses, an attempt can be made to obtain a court order. However, in the field, the competent patient’s wishes must be respected. The court uses a balancing test to weigh one right against the other. The court leans to the right of the patient to make a knowing choice in refusing consent. The exception is in the case of minors. If the court is convinced a child needs life-saving measures, compelling state’s interest in the child usually overrides the parent’s interest.

The purpose of documentation is to document care and treatments given, assist with continuity of care between health professionals, establish a record of patient care so that it can be reviewed for continuity and continuing education and research, provide data for reimbursement and cost analysis, and legally protect the caregiver.

The medical record of a patient belongs to the hospital or transport service, although the patient has a right to the information contained therein. ^{12 and 320} The medical record is the documentation of the patient’s course of treatment. It serves as a means of communication between various providers of service. It protects the legal interests of the patient, the hospital, and the healthcare practitioner. ^{12 and 320} The patient’s privacy must be protected in these situations. The Health Insurance Portability and Accountability Act (HIPAA) and transport are briefly discussed later in this chapter. The contents of the medical record should be factual and based on objective data. ²⁰

The medical record should be:

Abbreviations are strongly discouraged today. The Joint Commission offers guidelines on the use of abbreviations. Only approved abbreviations should be used. The entries should be readable, concise, and complete. ²⁰ The patient description should be objective and include the patient’s appearance, signs and symptoms, and interventions and responses. Documentation should occur in a timely fashion. If an untoward incident occurs, an event report should be completed and appropriate personnel notified. Today, several computer-based transport records are available; however, these programs must provide the components of patient documentation pertinent to the transport service using the program. The several advantages to computer-based documentation include the ability to read the documentation, time stamping of procedures and medication administration, recordkeeping of transport team interventions, and retrieval of data for research and continuous quality improvement. The transport record should “tell the story” of the transport process. Documentation of any deviations from protocols and orders obtained from medical control is also important. ²⁰