Contemporary Issues in Healthcare Law and Ethics

by Harris, Dean M.

• ISBN13: 9781567931983
• ISBN10: 1567931987
• Edition: 2nd
• Format: Hardcover
• Copyright: 2003-11-01
• Publisher: Foundation of the Amer College

Table of Contents

List of Figures	xiv
List of Problems	xv
Preface	xvii
Acknowledgments	xix
I THE ROLE OF LAW IN THE U.S. HEALTHCARE SYSTEM
1 Using the Law to Promote Our Policy Goals and Ethical Principles	3	(10)
"There Ought to Be a Law!"	3	(2)
Ethics in the Healthcare Field	5	(2)
The Relationship Between Law and Ethics	7	(3)
The Goals of this Book	10	(3)
2 The American Legal System	13	(16)
Who Makes the Laws, and Who Changes the Laws?	13	(3)
Substantive Areas of Law	16	(2)
State and Federal Court Systems	18	(4)
The Process of a Civil Lawsuit	22	(7)
The Plaintiffs Complaint and Summons	22	(2)
The Defendant's Answer or Motion to Dismiss	24	(1)
Discovery	25	(1)
Pretrial Motions	26	(1)
The Trial	27	(1)
Posttrial Motions	27	(1)
The Appeal	28	(1)
3 How to Conduct Legal Research	29	(14)
Understanding Legal Citation Form	30	(4)
Citations to Case Law	30	(2)
Citations to Statutes and Regulations	32	(2)
How to Find Legal Materials in the Easiest Possible Way	34	(9)
Federal Legislation	36	(1)
Federal Regulations	37	(1)
Federal Cases	38	(1)
State Law Materials	38	(5)
II MANAGING AND REGULATING THE HEALTHCARE SYSTEM
4 The Legal Structure and Governance of Healthcare Organizations	43	(22)
Healthcare Providers As Legal Entities	44	(8)
Public Healthcare Facilities	45	(1)
For-profit Corporations	46	(3)
Private, Nonprofit Corporations	49	(3)
Current Issues and Trends	52	(13)
The Purchase of Public and Nonprofit Facilities	55	(3)
Conversion from Nonprofit to For-profit Status	58	(2)
Joint Ventures	60	(1)
The Development of New Forms of Business Organization	61	(4)
5 Government Regulation of Public Health and Healthcare Services	65	(36)
Government Regulation to Protect the Public Health	67	(2)
Government Regulation for Quality of Care	69	(10)
Licensure of Individual Healthcare Professionals	71	(3)
Licensure of Healthcare Facilities	74	(1)
Accreditation of Healthcare Facilities	75	(1)
Certification for the Medicare and Medicaid Programs	76	(1)
Government Regulation of Diversified Organizations	77	(2)
Government Regulation for Cost Containment and Access	79	(13)
The Purposes and Effects of CON Laws	79	(3)
The System of CON Regulation	82	(2)
The Medical Arms Race	84	(8)
Government Regulation of Insurance for the Protection of the Consumer	92	(9)
State Regulation of Insurance Companies and HMOs	93	(1)
The Problem of Extending Access to Coverage	93	(8)
6 Protecting the Privacy of Medical Information	101	(22)
State Laws on Privacy of Patient Information	104	(4)
Federal Law and the HIPAA Privacy Rule	108	(15)
7 Medical Staff Membership and Clinical Privileges	123	(14)
The Relationship Between Physicians and Hospitals	124	(2)
Employment	125	(1)
Contractual Agreement	125	(1)
Medical Staff Membership and Clinical Privilege Status	126	(1)
The Organized Medical Staff	126	(4)
Denial or Termination of Membership and Privileges	130	(2)
Judicial Review of Credentialing Decisions	132	(5)
8 The Law of Government Payment Programs: Medicare, Medicaid, and Fraud and Abuse	137	(56)
The Medicare Program	137	(8)
Medicare Eligibility and Benefits	138	(2)
Medicare Payment Issues	140	(4)
Medicare Managed Care and Part C	144	(1)
The Medicaid Program	145	(10)
An Exercise in Federalism	145	(3)
Eligibility for Medicaid	148	(1)
Medicaid Benefits	149	(3)
Medicaid Payment Issues	152	(3)
State Efforts to Increase Federal Medicaid Funding	155	(1)
The SCHIP Program	155	(1)
Fraud and Abuse of the Medicare and Medicaid Programs	155	(38)
False Claims	160	(9)
Kickbacks	169	(12)
Self referrals	181	(2)
Compliance Programs for Healthcare Providers	183	(10)
9 Antitrust Law in the Healthcare Field	193	(40)
The Federal Antitrust Laws	194	(7)
The Major Categories of Antitrust Violation	195	(1)
The Major Federal Antitrust Statutes	196	(5)
Specific Areas of Antitrust Concern in the Healthcare Industry	201	(32)
Mergers and Acquisitions	201	(9)
Medical Staff Membership and Clinical Privileges	210	(4)
Provider Networks and Integrated Delivery Systems	214	(19)
III PATIENT CARE ISSUES
10 The Law of Tort Liability	233	(28)
The Tort of Negligence	234	(1)
Imposing Negligence Liability on the Institution or Organization	235	(8)
Malpractice in the System of Managed Care	243	(2)
Informed Consent	245	(7)
Proposals for Medical Malpractice Reform	252	(9)
The Need for Reform in the Current System	252	(2)
Advantages and Disadvantages of Various Proposals for Reform	254	(7)
11 Legal and Ethical Obligations to Provide Care	261	(24)
The Traditional Common Law Rules for Doctors and Hospitals	262	(2)
The COBRA Antidumping Law	264	(4)
Coming to the Emergency Department	268	(2)
The Appropriate Medical Screening Examination	270	(2)
Requirements for a Proper Transfer	272	(4)
Prohibitions Against Discrimination	276	(9)
12 Legal and Ethical Issues in Termination or Refusal of Care and Physician-assisted Suicide	285	(32)
The Right to Refuse Treatment	286	(7)
The Right to a Natural Death	293	(8)
Physician-assisted Suicide	301	(16)
13 Human Reproduction	317	(22)
Sterilization	318	(3)
Contraception and Abortion	321	(10)
Maternal fetal Conflict	331	(8)
IV LEGAL AND ETHICAL ISSUES IN MANAGED CARE
14 Selective Contracting with Providers	339	(20)
Limitations on Patients' Free Choice of Provider	340	(1)
Limitations on Providers' Participation in Health Plans	341	(11)
Contract Law Issues	343	(7)
Antitrust Law Issues	350	(1)
Any Willing Provider Laws	351	(1)
Proposed Federal Legislation to Protect Patients and Providers	352	(7)
15 Financial Incentives to Provide Less Care	359	(16)
Types of Financial Incentives to Provide Less Care	361	(3)
Legal Implications of Financial Incentives to Provide Less Care	364	(11)
16 Controlling Utilization of Healthcare Services	375	(26)
The Process and Consequences of Prospective Utilization Review	375	(2)
Legal Liability for Improper Denial of Claims	377	(2)
The Purpose and Effect of the Federal ERISA Law	379	(4)
The Statutory Language of ERISA	383	(4)
Proposals to Amend ERISA	387	(5)
Placing Managed Care Reform and Patients' Rights in Perspective	392	(9)
Table of Cases	401	(4)
Table of Statutes	405	(3)
Table of Regulations	408	(3)
Index	411	(12)
About the Author	423