Sonography's Legal And Ethical Challenges: A Guide

Sonographers are highly skilled healthcare professionals who play a crucial role in modern medicine. They are responsible for performing ultrasound examinations, capturing images of internal organs, tissues, and blood flow patterns to aid in diagnosis and treatment planning. As such, they have a number of legal and ethical obligations to uphold. Sonographers must adhere to laws and ethical guidelines that govern patient care, confidentiality, consent, and professional conduct. Understanding and fulfilling these dual obligations are essential to their practice, ensuring patient safety, privacy, and well-being.

Patient consent and confidentiality

Sonographers must be aware of the legal and ethical issues associated with patient care. They are responsible for any harm that a patient may suffer as a result of their actions, and can be held personally liable for damages. Therefore, it is essential for sonographers to understand the legal constraints of their profession and the importance of patient consent and confidentiality.

Patient Consent

The concept of informed consent is based on the principle that a patient has the right to prevent unauthorized contact with their person. Healthcare professionals have a duty to disclose information that will allow the patient to make knowledgeable decisions regarding any proposed procedures or treatments. Informed consent can be either express or implied. Express consent is given by the patient verbally or in writing, while implied consent is understood from the circumstances surrounding the procedure. For example, consent is implied for necessary procedures a surgeon may perform during an operation to which the patient has consented.

To obtain valid informed consent, patients should be provided with all the information they require to make a decision. This includes describing the procedure, clearly stating the risks and benefits, discussing possible outcomes and alternative treatments, and ensuring the patient understands that the procedure is voluntary. Consent must be given voluntarily by a mentally competent patient and should be documented with a signed consent form.

Patient Confidentiality

Ensuring the security, privacy, and protection of patients' healthcare data is critical for all healthcare professionals, including sonographers. The Health Insurance Portability and Accountability Act (HIPAA) was enacted to ensure that patient medical data remains private and secure. Under HIPAA, any protected health information (PHI) that can be used to identify a patient must be omitted before being used for research. PHI includes demographic information, prescription records, and discharge and follow-up appointments.

Healthcare professionals must obtain consent before disclosing PHI and should only disclose the minimum necessary information. There are some exceptions to this rule, such as consultation between providers or referring a patient, which are permitted without prior consent. However, disclosing PHI to individuals not involved in the patient's care, such as administrative personnel or third-party contractors, is a violation of HIPAA.

To protect patient confidentiality, healthcare institutions should implement security measures such as unique user identification, strong authentication, and customized access based on an individual's role in patient care. Additionally, all healthcare workers should have secure passwords and regularly update them.

Professional accountability

Sonographers are highly skilled healthcare professionals who play a crucial role in the healthcare industry. They are responsible for performing ultrasound examinations, capturing images of internal organs, tissues, and blood flow patterns to aid in diagnosis and treatment planning. As such, they hold a significant level of professional accountability.

In terms of ethical conduct, sonographers must demonstrate behaviour that aligns with the core values of their profession. This includes maintaining medical ethics, following hospital procedures, and providing compassionate and respectful patient care. They should also strive for excellence in their practice, continuously developing their skills and competencies to ensure they deliver safe and ethical care.

Sonographers are expected to exercise a high level of competence in their field. This involves mastering technical skills, staying up-to-date with advancements in ultrasound technology, and participating in continuing education to maintain their credentials. They must also possess effective communication skills, enabling them to interact appropriately with patients, their families, and other healthcare professionals.

Additionally, sonographers should prioritise patient comfort and safety. This includes explaining procedures, addressing patient concerns, and ensuring proper positioning to optimise imaging results. Adherence to stringent safety protocols is essential to minimise risks associated with ultrasound technology and maintain a safe environment.

Overall, professional accountability for sonographers entails a commitment to legal and ethical standards, technical competence, continuous learning, ethical conduct, and prioritising patient well-being. By upholding these standards, sonographers maintain the integrity of their profession and contribute to positive patient outcomes.

Ethical decision-making

Patient Well-being

Sonographers must always prioritize patient well-being. This includes ensuring patient comfort and safety during procedures, maintaining confidentiality, and providing emotional support when needed. They should respect the dignity and privacy of patients, maintaining a harassment-free environment and obtaining informed consent before any procedure.

Professional Competence and Integrity

Sonographers are responsible for maintaining a high level of professional competence. This involves staying updated with technological advancements, adhering to safety protocols, and continuously developing their skills and knowledge. They must also demonstrate integrity by upholding ethical standards in all areas of their work, including patient care, decision-making, documentation, and interactions with other healthcare professionals.

Accountability and Responsibility

Sonographers have a duty of care to their patients and must be accountable for their actions. They should be aware of the legal implications of their work and understand their responsibilities to avoid malpractice suits. This includes knowledge of the standard of care expected of a reasonably prudent sonographer and the concept of negligence.

Ethical Theories and Socio-cultural Factors

When facing ethical dilemmas, sonographers can refer to ethical theories to guide their decision-making. Additionally, they should consider how socio-cultural factors may influence ethical choices, ensuring that their practices are fair and just, respecting individual rights and adapting to societal advancements.

Collaboration and Teamwork

Sonographers work collaboratively with physicians, radiologists, and other specialists as part of a comprehensive patient care strategy. Effective communication and teamwork are essential to ensure accurate diagnoses and timely treatment plans. Clear and precise communication of findings to the medical team is crucial for optimal patient care.

Professional Codes of Conduct and Ethics

Sonographers should adhere to professional codes of conduct and ethics, such as the Society of Diagnostic Medical Sonography's (SDMS) Code of Ethics, which provides guidance on ethical relationships, responsibilities, behaviours, and decision-making. These codes promote excellence in patient care and ensure the integrity of professionals in the field.

In conclusion, ethical decision-making for sonographers involves a commitment to patient well-being, professional competence and integrity, accountability, and collaboration with other healthcare professionals. By adhering to ethical guidelines and legal obligations, sonographers can provide safe, compassionate, and competent care to their patients.

Professional conduct

Sonographers must adhere to a strict code of professional conduct to ensure patient safety and confidentiality, uphold ethical standards, and maintain legal compliance. This involves a commitment to professionalism, encompassing competence, practice, and conduct.

Professionalism is a cornerstone of sonography, influencing how well healthcare professionals work together and serve patients. It involves skill levels, quality practice methods, and appropriate conduct. Sonographers must demonstrate behaviour that aligns with the core values of their organisation, acting professionally and appropriately while providing the best care for patients. This includes maintaining medical ethics, following hospital procedures, and mastering a range of physical and technical skills.

Sonographers should never abuse or use illegal substances, always dress appropriately, and consistently report to work on time. They must work cooperatively with other healthcare professionals to promote high-quality patient care and maintain ethical standards in all areas, including patient care, decision-making, documentation, and legal and medical associations. Ethical decision-making is a critical aspect of a sonographer's role, and they should be able to identify and report ethical issues to facility administration.

Sonographers must also respect patient confidentiality and ensure that all personal health information is protected according to privacy laws. They should only discuss cases with authorised individuals and remove patients' names from monitors after examinations. Additionally, they should obtain informed consent from patients before performing any procedures, ensuring that patients understand the nature of the procedure, its consequences, and their right to withdraw consent at any time.

Furthermore, sonographers should strive for excellence in patient care and maintain a high level of patient care practice. This includes successfully performing scanning procedures, utilising knowledge and skills to benefit patients, adhering to quality standards, and respecting patients' dignity and privacy during procedures and conversations. Sonographers should also maintain professional communication standards with patients and their family members, providing emotional support when necessary.

Malpractice suits

Sonographers must be aware of the legal and ethical issues associated with patient care. Although they often work under the direction of a physician, they are still responsible for any harm that a patient may suffer as a result of their actions.

The threat of legal consequences highlights the need for professional accountability. Accountability is the responsibility for events for which one may have to give a judicial explanation.

When sonographers fail to meet their professional responsibilities, patients may file a malpractice suit. Most cases brought against sonographers are called tort actions. A tort is a wrongful act, other than a breach of contract, for which the law provides a remedy. Torts can be intentional or unintentional.

Intentional torts

Intentional torts include assault, battery, invasion of privacy, and false imprisonment. Any sonographer who causes a patient to be fearful of injury could be held personally liable for any damages caused by that fear. For example, threatening to restrain a patient if they don't cooperate during an exam could be considered assault. Continuing a vaginal examination after the patient has revoked their consent could result in the sonographer being found liable for battery.

Unintentional torts

The most common type of unintentional tort is negligence. Negligence is the failure to use reasonable care. It is doing something that a reasonably prudent person would not do or failing to do something that they would do, under similar circumstances. Generally, medical malpractice occurs when a negligent act or omission by a medical professional results in harm to the patient. In a malpractice action against a sonographer, the most likely scenario is misdiagnosis.

To prevail in a medical malpractice action, an injured patient (the plaintiff) must prove duty, breach, harm, and causation. Duty refers to the standard of care that the medical professional (defendant) is required to follow. Breach refers to the defendant's failure to meet that standard. Harm refers to the injury suffered by the plaintiff. Causation requires that the defendant's failure to meet the standard of care was the actual cause of the plaintiff's injury.

Protecting against malpractice suits

Sonographers should follow their professional scope of practice and understand the concepts and mechanisms of the law, as well as the legal restrictions placed on healthcare professionals. A basic knowledge of the law can help sonographers avoid litigation and allow them to practice with confidence.

Sonographers should also be aware of established standards and guidelines for performing ultrasound studies, as proper and compliant accreditation can aid in defending negligence claims.

A report by Harry Holdorf, PhD/MPA, found that the average paid malpractice claim associated with sonographic problems cost $300,000. Some common concerns include inaccurate sonographic reporting, poor image quality, and failures to adhere to guidelines.

In one instance, a family reached a $13 million settlement with a hospital, a radiology group, and an ultrasound device manufacturer after an ultrasound technician incorrectly calculated a baby's weight, resulting in the baby suffering profound brain damage.

Frequently asked questions