Lesson 1. US Constitution & The Bill of Rights

Why do we review the constitution? Because that is THE fundamental law of all of the United States and its territories. No federal, State or local law, rule or regulation can go against the intent of The Constitution or it will be declared unconstitutional and is automatically null and void. The declaration of independence says

“-We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
-That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed...

• ●  As you can see, the Constitution recognizes “The Creator” as the universal source of all law, the same way gravity and everything else that governs matter and spirit, our Rights are self evident and unalienable this means they are not transferable to another or not capable of being taken away or denied;

• ●  Also The government gets its power from the CONSENT of the Governed, that is you and me. So right from the get go, it is all about consent.

  The U.S. Constitution is composed of the Preamble, seven articles, and 27 amendments. The first 10 amendments are known as the Bill of Rights.
  I highly encourage you to learn all you can about the 27 amendments to the constitution. They spell out Americans' rights in relation to their government.The amendments guarantee civil rights and liberties to the individuals—like freedom of speech, press, and religion. They set rules for how processes should be conducted and reserve all powers not delegated to the Federal Government to the people or the States. Now more than ever, it is crucial that everyone understand all they can about this great document.
  Since we are here to learn about your rights as a patient, I will be focussing on the sections of the Bill of Rights that relate to them.
  Let's Jump right in. The first amendment or the first statement of the bill of rights says....
  (Read the 1st) what do we gather from these statements?

● It recognizes the right of the press to be free of influence or coercion.

• ●  It recognizes and protects your right to express your opinions, get together with others in a peaceful manner and make complaints to the government but also have the government respond and resolve those grievances or complaints.

• ●  It invalidates any law that imposes any one religion for everyone.

• ●  But the key for us here, is that no rule or regulation can interfere with the free exercise of

  religion. What is religion? Religion is very loosely defined. It is basically what you believe in your heart to be true. It has to do with your personal relationship with the divine. The first amendment declares your religious beliefs must be respected and accommodated for, in any setting.

  • ○  One famous example is that certain medical substances are prepared using aborted fetal cells and if you determine that this goes against what you believe God to be or what aligns with God; you are automatically exempted from taking it.

  • ○  Same goes for blood transfusions . We probably heard of Jehova’s witnesses going to the supreme court to uphold their right to refuse transfusions. If you are ok with receiving Blood, You also have the right to be specific about it’s source.

    .
    Next we have the 4th amendment - it says.... Read it

    The relevant part is that you have the right to be safe in your body. That is the basis for your right to refuse anything that you think might harm you. In other words; no one can force you to do something that you believe is not safe or has an unacceptable risk for your body. They can’t coerce you into accepting medications or procedures without your expressed consent.

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An example of this is to leave the hospital against medical advice. And if they tell you that your insurance won't cover the bill if you leave against medical advice, then I will consider staying but refusing anything that is problematic to you. They can’t do anything to your body without your consent, whether you are conscious or unconscious.

Another example is food at the hospitals, they can’t force feed you, they can’t give you any medication you do not agree to.

Notice that every time a nurse comes to administer a medication they tell you what it is and say OK? In question tone. They dont give you much time to decide because they dont want you to think but, Next time you're in that situation, try saying no or “hold on” or “wait a minute”and watch what happens... don't worry, you can always agree after they give you all the explanations you need.

9th amendment - this means that all your rights come from the creator, every right that is not specifically mentioned or recognized in the constitution, belongs to the particular states and to the people who live in them. That is “we the people” or you and me.
As time has gone by Congress has recognized the need (to use their term) “enumerate”’ and define more rights and so the bill of rights has expanded such as amendment 13 that abolishes slavery. Now we will go into more recent national laws that respond to situations that interfere with the you will see how the laws that were put in place

Lesson 2. Civil Rights and State Laws

• ●  In 1964 the Civil Rights Act was approved at the Federal level. It prohibits discrimination on the basis of skin color, race, religion (once again) and now recognizes sex and national origin and it applies more specifically, in the area of employment. Notice it does not cover sexual orientation, that will come later.

• ●  Also at the Federal level is the Americans with Disabilities Act of 1990

  This one is important to us because it outlaws the practice of making assumptions. Let me explain. If you assume that a person that once spent time at a mental institution is automatically “crazy” you are discriminating and you get punished.
  By the same token, you can not assume that a person has any disease. No one other than a qualified physician can “diagnose” someone. That would be practicing medicine without a license. Even physicians can not presume you have any disease without proper diagnosis procedures. And of course, you can refuse any procedures you don't feel safe with. Do you see where I'm going?

  2.3. To be more clear, let's go into the California Unruh Civil Code of 1959 . This name of this law is specific to California but the content is the same as every other State Civil Code because they all have to align with the Constitution and the civil rights Act of 1964

  The Unruh Civil Rights Act AKA California Civil Code Section 51.

• ●  expands protection from discrimination in employment to the treatment that all business

  establishments in California, as well as housing and public accommodations give people.

• ●  And hospitals, and medical offices are public accommodations.

• ●  This law forbids discrimination based on ancestry, color, disability, national origin, race, religion, gender, and the new ones are age and sexual orientation.

• ●  It also establishes specific penalties for violations such as (a) Whoever denies, aids or incites a denial, or makes any discrimination or distinction contrary to Section 51, 51.5, or 51.6, is liable for each and every offense for the actual damages, and any amount that may be determined by a jury, or a court sitting without a jury, up to a maximum of three times the amount of actual damage but in no case less than four thousand dollars ($4,000), and any attorney's fees that may be determined by the court in addition thereto, suffered by any person denied the rights provided in Section 51, 51.5, or 51.6.

  (b) Whoever denies the right provided by Section 51.7 or 51.9, or aids, incites, or conspires in that denial, is liable for each and every offense for the actual damages suffered by any person denied that right and, in addition, the following:
  (1) An amount to be determined by a jury, or a court sitting without a jury, for exemplary damages. (2) A civil penalty of twenty-five thousand dollars ($25,000) to be awarded to the person denied the right provided by Section 51.7 in any action brought by the person denied the right, or by the Attorney General, a district attorney, or a city attorney. An action for that penalty brought pursuant to Section 51.7 shall be commenced within three years of the alleged practice.

  Lesson 3. Patient Rights

  In this lesson we talked about your patient rights and responsibilities. Your patient rights are a natural extension of your constitutional Bill of Rights. Every hospital, whether state or private, has a document that is called “Patient Rights and Responsibilities”. They are all very similar and talk about the same set of rights and responsibilities. We encourage you to search for this document on the website of the hospital that you most likely to go to. You can do it in advance, but if you are in an emergency and admitted to the hospital, you or your agent have to request the print-out of the patient rights upon admittance.

  Wewent over our local hospital document, that from the get go states, that “When you are well informed, participate in treatment decisions, and communicate openly with your doctor and other health professionals, you help make your care as effective as possible.” You need to understand that knowing and practicing your rights are actually your responsibilities. But let’s start by looking at the most important part of patient rights document. You can find it on this website. https://www.sutterhealth.org/absmc/for-patients/patient-rights-responsibilities

While you are a patient at Sutter Health, you have the right to:

1. Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual, and personal values, beliefs and preferences.

2. Receive information about your health status, diagnosis, prognosis, course of treatment, prospects for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to effective communication and to participate in the development and implementation of your plan of care. You have the right to participate in ethical questions that arise in the course of your care, including issues of conflict resolution, withholding resuscitative services, and forgoing or withdrawing life-sustaining treatment.

3. Make decisions regarding medical care, and receive as much information about any

proposed treatment or procedure as you may need in order to give informed consent or to refuse a course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, alternate courses of treatment or nontreatment and the risks involved in each, and the name of the person who will carry out the procedure or treatment.

In this right, you can see that they describe the emergency as an exception, in order to understand what kind of behavior from medical personnel to expect during emergencies, please, take a look at the PREP act FAQs page. Here is a summary of what PREP act is:

“The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. Under the PREP Act, a Declaration may be amended as circumstances warrant.”

https://www.phe.gov/Preparedness/legal/prepact/Pages/prepqa.aspx

4. Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment or services. You have the right to leave the hospital even against the advice of members of the medical staff, to the extent permitted by law.

There is a common misinformation tactic that exists at hospitals, when social workers, nurses or doctors can tell you, that if you leave against medical advice insurance won’t cover your stay, or you won’t be able to get admitted to the hospital again with the same problem, it is simply not true.

When they say “by law”, in this case what they refer to, usually hospitalization of minors, when there are laws that prohibit parents from taking kids out of the hospital and CPS can be called. And situations when resuscitative measure are needed, and you don't have a Do-not resuscitate order in place, they will proceed to resuscitate you, as they are protected under the “good samaritan law”, you can get familiar with it here: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=1799.102.&law Code=HSC

5. Be advised if the hospital/licensed healthcare practitioner acting within the scope of his or her professional licensure proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.

This right is also protected in the Nuremberg Code.

“The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him

to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment. The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs, or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.”

6. Formulate advance directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. Hospital staff and practitioners who provide care in the hospital shall comply with these directives. All patients’ rights apply to the person who has legal responsibility to make decisions regarding medical care on your behalf.

7. Receive care in a safe setting, free from mental, physical, sexual or verbal abuse and neglect, exploitation or harassment. You have the right to access protective and advocacy services, including notifying government agencies of neglect or abuse.

8. Be free from restraints and seclusion of any form used as a means of coercion, discipline, convenience or retaliation by staff.

9. Designate a support person as well as visitors of your choosing, if you have decision-making capacity, whether or not the visitor is related by blood, marriage, or registered domestic partner status, unless:

1. No visitors are allowed.

2. The facility reasonably determines that the presence of a particular visitor would

endanger the health or safety of a patient, a member of the health facility staff, or other visitor to the health facility, or would significantly disrupt the operations of the facility.

c. You have told the health facility staff that you no longer want a particular person to visit.

d. However, a health facility may establish reasonable restrictions upon visitation, including restrictions upon the hours of visitation and number of visitors. The health facility must inform you (or your support person, where appropriate) of your visitation rights, including any clinical restrictions or limitations. The health facility is not permitted to restrict, limit or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation or disability.

10. Have your wishes considered, if you lack decision-making capacity, for the purposes of determining who may visit. The method of that consideration will comply with federal law and be disclosed in the hospital policy on visitation. At a minimum, the hospital shall include any persons living in your household and any support person pursuant to federal law.

“Generally, a patient's capacity is readily apparent, and physicians intuitively assess capacity at every medical visit. Because the four elements of capacity (understanding, appreciation, reasoning, and communication) are built into everyday dialogue and interactions, it can be assumed that patients have the capacity to make medical decisions if their conversation demonstrates basic logic.”

Please get familiar with the approach that most hospitals use to determine your capacity to make decisions here :

https://www.aafp.org/pubs/afp/issues/2018/0701/p40.html#:~:text=Because%20the%20four%20 elements%20of,their%20conversation%20demonstrates%20basic%20logic.

Lesson 4. Patient Responsibilities

The patient has the responsibility to:

1. Provide, to the best of his/her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to his/her health. He/she has the responsibility to report unexpected changes in his/her condition to the responsible practitioner.

2. If able, make it known whether he/she clearly comprehends a contemplated course of action and what is expected of him/her.

3. Keep appointments and, when he/she is unable to do so for any reason, for notifying the responsible practitioner or the hospital.

4. Accept responsibility for his/her actions if he/she refuses treatment or does not follow the practitioner’s instructions.

5. Assume that the financial obligations of his/her healthcare are fulfilled as promptly as possible.

6. Follow hospital rules and regulations affecting patient care and conduct.

7. Be considerate of the rights of patients and hospital personnel, and for assisting in

the number of visitors. No loud, offensive or threatening language is allowed at any time.

8. Be respectful of the property of other persons and the hospitals

To summarize: you have to request to print out the rights and responsibilities document upon your admission and exercise your rights. Your main right is for respectful care, informed consent and you have the power to say “no” to any treatments and procedures, as well as fire your doctor, get a second opinion and leave the hospital against medical advice. Be brave and assertive, DON'T be pushed around or manipulated by doctors or nurses. Know your rights take authority over your or your loved one's health decisions.