Ipso facto is a Latin phrase, directly translated as "by the fact itself," which

means that a certain effect is a direct consequence of the action in question,

instead of being brought about by a subsequent action such as the verdict of
a tribunal. It is a term of art used in philosophy, law, and science. An
example in law is money laundering: the act is ipso facto illegal because it is
done as a cover for something else, so the act puts the actions of an
individual in question.

Long title

AN ACT TO PROMOTE DONATIONS IN GOOD FAITH OF MEDICINES, FOOD

PRODUCTS OR SUPPLIES BY ESTABLISHMENTS AND OTHER ENTITIES,
INCLUDING INDIVIDUALS BY EXEMPTING THEM FROM ANY FORM OF LIABILITY
ARISING THEREFROM
Senator many villar

A holographic will is a will and testament that has been entirely

handwritten and signed by the testator. Normally, a will must be signed by
witnesses attesting to the validity of the testator's signature and intent, but
in many jurisdictions, holographic wills that have not been witnessed are
treated equally to witnessed wills and need only to meet minimal
requirements in order to be probated:

• There must be evidence that the testator actually created the will,
which can be proved through the use of witnesses, handwriting
experts, or other methods.
• The testator must have had the intellectual capacity to write the will,
although there is a presumption that a testator had such capacity
unless there is evidence to the contrary.
• The testator must be expressing a wish to direct the distribution of his
estate to beneficiaries.

Holographic wills are common and are often created in emergency

situations, such as when the testator is alone, trapped and near death.
Jurisdictions that do not generally recognize unwitnessed holographic wills
will accordingly grant exceptions to members of the armed services who are
involved in armed conflicts and sailors at sea, though in both cases the
validity of the holographic will expires at a certain time after it is drafted.

Nuncupative
will
Definition
: a will allowed in some states that is dictated orally before witnesses and set
down in writing within a statutorily specified time period (as 30 days) and
that is allowed only for one in imminent peril of death from a terminal illness
or from military or maritime service.

Professional Practice:
Nursing Law
Nurse Practice Acts (NPAs) are laws in each state that are
instrumental in defining the scope of nursing practice. State boards
of nursing oversee this statutory law. They have the responsibility
and authority to protect the public by determining who is competent
to practice nursing. Common Law is derived from principles or
social mores rather than from rules and regulations. It consists of
broad, interpretive principles based on reason, traditional justice
and common sense. Together, the NPAs and Common Law define
nursing practice.

It is a nurse's responsibility to be informed on both the NPA and

Common Law for the state(s) in which they are licensed to practice.
It is critical for students and nurses need to be aware of the legal
issues pertaining to the profession. Familiarity with the law and
relevant court rulings helps in understanding the scope of practice
and responsibilities that come with being a licensed caregiver, as
well as providing insight on how to prevent legal problems before
they happen.

Read up on the NPA for your state - know your responsibilities and
limitations. You may also want to subscribe to professional nursing
journals to stay abreast of the latest court rulings. Here are a
couple of case studies provided by Legal Eagle Eye Newsletter for
the Nursing Profession, a monthly journal covering court cases,
rulings and legislation pertaining to the nursing profession:
 Healthcare Facility Liable for Student Nurse Error

QUICK SUMMARY: A nursing student's negligence resulted in the fall and injury of patient during
transfer. A nursing student at this student’s level had the training and should have been able to care for
this patient. The student nurse testified she had received training to assist patients with ambulation and
transfer. The nursing student’s preceptor testified the patient needed someone close with her at a safe
distance at all times to ambulate. The healthcare facility was held to the same legal standard of care for a
student nurse’s error or omission as for the same error or omission by a licensed professional nurse.

COURT OF APPEALS OF OHIO, 1996.

The patient’s chart indicated that she had serious difficulty with her balance which made it necessary for
her to have assistance when standing or walking with a walker and when transferring. She had fallen
backward six days earlier, but was caught and lowered to the floor without being injured. She was afraid
of falling and needed not only physical assistance, but also encouragement to take steps forward with her
walker.

According to the Court of Appeals of Ohio, the student nurse had read the patient’s chart and knew the
patient had weakness and an unsteady gait. Nonetheless, the student nurse helped her up from the
commode, then walked away and left the patient standing with her walker in the bathroom, while the
student nurse propped the door hinge open and adjusted her wheelchair, expecting the patient to walk to
the wheelchair on her own to transfer with assistance. The patient took a step forward, fell backward and
was injured.

The court ruled a healthcare facility will be held to the same legal standard of care for a student nurse’s
error or omission as for the same error or omission by a licensed professional nurse. There was also
testimony from a nursing instructor, that a nursing student at this student’s level should have known, the
same as a graduate nurse, to stay close by this patient when standing or walking with a walker. Failing to
give proper close attention to a patient’s need for assistance while ambulating is negligence, for which a
healthcare facility can be held liable.

Dimora vs. Cleveland Clinic Foundation,

683 N.E. 2d 1175 (Ohio App., 1996).

Nurses Negligent for Giving Nursing Functions to Aides

QUICK SUMMARY: The physician wanted his patient to receive skilled nursing care. He wrote an order for the home health nurses to re-
pack her hip decubitus wound with antiseptic gauze. Instead, the nurses showed home health aides how to re-pack the wound and left them
on their own to do wound care. Wound healing was delayed more than a year, and the nurses were ruled negligent.

A home health client sued her home health agency because a hip decubitus wound site she sustained in
the hospital took a year longer to heal than it should have. Healing apparently was delayed by old gauze
embedded in the wound, found there by a surgeon who operated on the wound when it failed to heal and
instead worsened. The judge believed the home health aides had been changing the outer dressing, but
they did not understand the rationale for sterile packing and re-packing of a deep wound and had left the
original gauze in the wound the entire time.

The nursing agency tried to defend the lawsuit by claiming its nurses had shown the aides how to re-pack
the wound with sterile gauze and replace the outer bandages, and had taught the patient how to do it
herself. The jury sided with the home health nursing agency and found no nursing negligence. The
patient, however, insisted her physician had a reason for ordering skilled nursing care and insisted she
was entitled to skilled nursing care. The judge agreed with her and threw out the jury's verdict, awarding
the patient more than $100,000 from the nursing agency. The Court of Appeals of Louisiana upheld the
judge's decision to disregard the jury and award the patient damages against the nursing agency
notwithstanding the jury's verdict.

A nurse testified as an expert witness for the patient that nurses do not have the option to change the
physician's orders on their own. The court accepted the nurse as an expert on the nursing standard of
care. The court ruled if the physician orders specific skilled nursing care, it means those specific nursing
functions are to be performed by skilled nurses with their own hands, or by non-licensed persons with
direct supervision by licensed professional nurses.

There was no documentation that licensed nurses ever performed the re-packing procedure or witnessed
non-licensed persons doing it. The aides signed off that they had performed wound care, but there was
no documentation of what exactly they did. The judge interpreted it to mean they only changed the outer
dressing, which would be wholly inappropriate care.
Singleton vs. AAA Home Health, Inc.,
772 So. 2d 346 (La. App., 2000).

Emergency Room Assessment: Hospital Liable for

Nurse's False Assurances that Infant Would Be Okay
QUICK SUMMARY: A nurse cannot reassure parents their infant will be all right without fully assessing
the child’s condition and obtaining a physician’s examination. Based on the nurse’s reassurances, the
parents did not wait to see the physician, and the child died. The hospital was ordered to pay nearly two
million dollars for negligence.

COURT OF APPEALS OF GEORGIA, 1996

The child had been discharged from the hospital’s neonatal intensive care unit the day before his parents
brought him back to the emergency room. The parents told the emergency room triage nurse the baby
had turned blue at home, had not had a bowel movement all day, appeared limp and that his eyes had
rolled back in his head. The parents had been told to bring the child back to the hospital at once if the
baby had even a slight fever, if there was a change in his eating habits or if there was a change in his
color.

From the court record in the Court of Appeals of Georgia, it appeared that a struggle developed in the
emergency room between the parents, who were highly agitated and insistent that their child be seen by a
physician immediately, and the triage nurse on duty, who was intent on insisting that the parents fill out
certain forms.

According to the court, the triage nurse made a cursory examination of the baby. She then repeatedly
reassured the parents the baby
was fine, apparently to calm the parents and

stop their demanding behaviors. The nurse then classified the baby as semi-urgent under the hospital’s
classification scheme, which meant the baby would require medical intervention within eight hours, but did
not have an immediately life-threatening problem. The nurse told the parents to wait, and the physician
would be with them shortly.

The parents, however, based on the nurse’s reassurances concerning their child’s condition, within a few
minutes elected to get up and leave, without waiting for the child to be seen by the emergency room
physician. The baby died several hours later.

The court faulted the triage nurse in several respects. She did not take a complete history and did not
correctly assess the gravity and immediacy of the baby’s condition. The nurse did not bring the baby to
the physician’s immediate attention, as she should have. Most importantly, the nurse, in an apparent
effort to control and defuse the parent’s demanding behaviors, had falsely reassured the parents the baby
was all right and was not in need of immediate medical attention. The court blamed the parents’ leaving
the hospital on the nurse’s false reassurances and held the hospital liable for payment of substantial legal
damages for the nurse’s actions. The parents were not to blame for leaving against medical advice.
South Fulton Medical Center, Inc. vs. Poe, 480 S.E. 2d 40 (Ga. App, 1996.)

Legal Eagle Eye Newsletter for the Nursing Profession

http://www.nursinglaw.com
Nursing Legal Issues: How to Protect
Yourself
With any professional license comes ethical and legal responsibility. Doctors take the
Hippocratic Oath pledging to do no harm to patients; lawyers are held responsible for their
clients in court; and architects are responsible for the safety of the structures they build. Nurses
are no different. Whether it's administering a medication incorrectly or failing to obtain an
informed consent from a pre-op patient, nurses may be held legally responsible if they fail to
meet certain standards.

Five Legal Issues in Nursing: What Every Nurse Should Know

All nurses should be familiar with nursing law and ethics and understand how nursing legal
issues can affect them. Know your basic nursing laws and avoid lawsuits and liability:

1. Signatures Are Golden

When a physician or other health care provider orders a procedure be done to a patient, it is the
nurse's responsibility to obtain an informed consent signature. This means that the patient:

• Understands the procedure and the alternative options

• Has had a chance to ask the provider any questions about the procedure
• Understands the risks and benefits of the procedure
• Chooses to sign or not sign to have the procedure performed.

If the nurse does not obtain signatures, both the nurse and the operating provider can be held
liable for damages incurred.

2. Document, Document, Document

It is the nurse's responsibility to make sure everything that is done in regards to a patient's care
(vital signs, specimen collections, noting what the patient is seen doing in the room, medication
administration, etc.), is documented in the chart. If it is not documented with the proper time and
what was done, the nurse can be held liable for negative outcomes. A note of caution: if there
was an error made on the chart, cross it out with one line (so it is still legible) and note the
correction and the cause of the error.

3. Report It or Tort It

Allegations of abuse are serious matters. It is the duty of the nurse to report to the proper
authority when any allegations are made in regards to abuse (emotional, sexual, physical, and
mental) towards a vulnerable population (children, elderly, or domestic). If no report is made, the
nurse is liable for negligence or wrongdoing towards the victimized patient.

4. Rights to Privacy

The nurse is responsible for keeping all patient records and personal information private and only
accessible to the immediate care providers, according to the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). If records get out or a patient's privacy is breached, the
liability usually lies on the nurse because the nurse has immediate access to the chart.

5. You're Dosing WHAT?!

Medication errors account for 7,000 deaths and 770,000 patients injured each year in the US. It is
the nurse's responsibility to follow the five "rights" of medication administration: right dose,
right drug, right route, right time, and right patient. If a nurse pays attention to those details, the
likelihood of a medication error is greatly reduced, thereby saving the nurse and health care
institution from liability for damages.

While these are some of the main issues nurses might face legally, you should visit your state
nursing board's Website for more information. Another good source for nursing legal issues is
the American Nurses Association Website. It has a Code of Ethics guide that may be purchased
online.