Health Care Law and Ethics

by Hall, Mark A.; Bobinski, Mary Anne; Orentlicher, David

• ISBN13: 9780735526402
• ISBN10: 0735526400
• Edition: 6th
• Format: Hardcover
• Copyright: 2003-03-01
• Publisher: Wolters Kluwer

Summary

HEALTH CARE LAW AND ETHICS, was one of the first casebooks to face the formidable task of providing adequate coverage of the multiple areas where law and medicine intersect. the Sixth Edition continues that tradition by being well-suited for use in a survey course in health care law or a more focused study of malpractice or bioethics: material is logically organized into three main parts:The Patient And The Provider, The Patient, The Provider, And The State, Institutions, Providers, And The State the crucial issues of quality, ethics, access, and cost are considered throughout the book strong coverage of bioethics provides important contextual background for discussions of the right to die, reproductive rights, organ transplantion the authors address cutting-edge issues, such as genetics and managed care along with such standard topics as confidentiality, medical malpractice, public health law, and health care financing and regulation clear author notes provide context and background information, and smooth the transitions between cases helpful introduction supplies an overview of the health care system to help students navigate this complicated area Changes For The Sixth Edition heighten classroom effectiveness while keeping pace with rapid developments in the law: new coverage of todays' most urgent issues: oversight of medical research, including genetic research and cloning, HMO liability, Patient Bill of Rights, and new privacy rules and bioterrorism improved and expanded treatment of ERISA preemption reorganized Part Three for greater clarity, In response to user feedback major new cases, including Rush Prudential v. Moran and Pegram v. Herdich (regulation of managed care), Ferguson v. City of Charleston (reporting drug test results to law enforcement) J.B. v. M.B. (disposition of frozen embryos) an authors' website, where a detailed Table of Contents is hyperlinked To The latest updates

Table of Contents

Preface	xxix
Introduction	1	(100)
Overview Cases	1	(6)
In re Baby K	1	(1)
Notes: Rationing, Justice, and the Doctor-Patient Relationship	1	(3)
Wickline v. State	4	(1)
Notes: Liability and Managed Care	4	(1)
In re A.C.	5	(1)
Notes: The Patient vs. the State	5	(2)
FTC v. Tenet Health Care Corp.	7	(1)
Notes: Economics and Market Restructuring	7	(1)
The Nature of Medical Practice	7	(35)
Doctors and Hospitals	8	(1)
Health Care Past and Present	8	(3)
Doctors, Patients, and Health Insurance: The Organization and Financing of Medical Care	11	(2)
Competing Solutions: American Health Care Proposals and International Experience	13	(2)
Doctors, Patients, and Health Insurance: The Organization and Financing of Medical Care	15	(2)
Clinical Decision Making From Theory to Practice	17	(1)
Notes: Doctors and Hospitals	17	(1)
The Culture of Medicine	18	(1)
Magic or Medicine? As Investigation of Healing and Healers	18	(2)
The Tyranny of Health	20	(1)
The Machine at the Bedside	21	(1)
Notes: The Social Construction of Disease	22	(1)
The Phenomenology of Sickeness and Healing	22	(1)
Making Medical Spending Decisions	22	(6)
Notes: The Power of Medicine and the Vulnerability of Patients	28	(1)
The Nature of Medical Judgment	29	(1)
Variations in Physician Practice: The Role of Uncertainty	29	(6)
Notes: Medical Decisionmaking	35	(1)
Law and Medicine	36	(1)
Physicians versus Lawyers: A Conflict of Cultures	37	(1)
Note: Law vs. Medicine: A Culture Clash	37	(1)
Evidence-Based Medicine	38	(1)
Oversight of the Quality of Medical Care: Regulation, Management, or the Market?	38	(4)
Note: Outcomes and Effectiveness Assessment	42	(1)
The Health Care Financing and Delivery System	42	(24)
Insurance and Regulation	43	(1)
U.S. Health Care Coverage and Costs: Historical Development and Choices for the [Future]	43	(7)
The Sad History of Health Care Cost Containment as Told in One Chart	50	(2)
The Crisis in Coverage and Spending	52	(1)
The Future of the American Health Care System	52	(2)
Why Conservatives Don't Talk About America's Health System	54	(1)
Dangerous Medicine: A Critical Analysis of Clinton's Health Plan	55	(1)
Notes: The Crisis in American Medicine	56	(4)
Changes in Financing and Delivery Systems	60	(1)
Medicare and the American Health Care System: 1996 Report to Congress	60	(2)
The Health Care Revolution: Remaking Medicine in California	62	(2)
Transcript of Interview with Jaime Robinson, Ph.D.	64	(1)
Notes: Managed Care vs. Consumer-Directed Care	64	(2)
Moral, Economic, and Political Themes	66	(35)
Competing Paradigms	67	(1)
Allocating Health Care Morally	67	(1)
The Professional Paradigm of Medical Care: Obstacle to Decentralization	68	(1)
Ethics and Empiricism	69	(1)
The Practice of Autonomy: Patients, Doctors, and Medical Decisions	69	(3)
Medical Law and Ethics in the Post-Autonomy Age	72	(5)
Notes: Medical Ethics and Professionalism	77	(2)
Postmodern Critical Theory	79	(1)
Slavery, Segregation and Racism: Trusting the Health Care System Ain't Always Easy! An African American Perspective on Bioethics	79	(2)
The Colonization of the Womb	81	(3)
Notes: Feminist and Critical Race Theory	84	(2)
Economics	86	(1)
Health Plan	86	(3)
For-Profit Enterprise in Health Care	89	(2)
Notes: Markets vs. Regulation	91	(1)
Distributive Justice	91	(1)
Uncompensated Hospital Care: Rights and Responsibilities	91	(3)
Note: Social Justice	94	(1)
Patient Power: Solving America's Health Care Crisis	95	(1)
Making Medical Spending Decisions: The Law, Ethics, and Economics of Rationing Mechanisms	95	(3)
Notes: Health Care Rationing; Institutional Analysis	98	(3)
Part I The Provider and the Patient	101	(388)
The Treatment Relationship: Formation and Termination	103	(60)
The Duty to Treat	104	(38)
The Duty to Accept Patients	104	(1)
Hurley v. Eddingfield	104	(1)
Wilmington General Hospital v. Manlove	104	(3)
Sophie's Choices: Medical and Legal Responses to Suffering	107	(1)
Wideman v. Shallowford Community Hospital	108	(3)
Notes: The Differing Obligations of Physicians and Hospitals; Hospitals as Quasi-Public Facilities	111	(5)
Notes: Moral and Constitutional Rights to Health Care	116	(2)
Burditt v. U.S. Department of Health and Human Services	118	(5)
Notes: The Federal Patient Dumping Statute	123	(5)
Wrongful Reasons to Reject Patients	128	(1)
United States v. University Hospital	129	(6)
Glanz v. Vernick	135	(2)
Walker v. Pierce	137	(1)
Notes: Discriminatory Denials of Care	138	(4)
The Structure of the Treatment Relationship	142	(21)
Forming a Patient-Physician Relationship	142	(1)
Clanton v. Von Haam	142	(2)
Reynolds v. Decatur Memorial Hospital	144	(2)
Lyons v. Grether	146	(1)
Notes: Creating the Patient-Physician Relationship	147	(4)
Limiting the Scope of the Treatment Relationship	151	(1)
Tunkl v. Regents of the University of California	151	(2)
Notes: Limiting the Standard of Care and Scope of Practice	153	(2)
Terminating the Treatment Relationship	155	(1)
Ricks v. Budge	155	(2)
Payton v. Weaver	157	(4)
Notes: Abandonment Liability	161	(2)
The Treatment Relationship: Confidentiality, Consent, and Conflicts of Interest	163	(92)
The Fiduciary Nature of the Treatment Relationship	163	(2)
Confidentiality of Medical Information	165	(20)
The Duty to Maintain Confidentiality	165	(1)
Doe v. Marselle	165	(3)
Notes: Common Law and Statutory Duties to Maintain Confidentiality	168	(6)
The Duty to Breach Confidentiality	174	(1)
Notes: Statutory Disclosure Obligations	175	(1)
Bradshaw v. Daniel	176	(4)
Notes: Common Law Duty to Warn	180	(4)
Discussion Problems	184	(1)
Informed Consent	185	(70)
Goals, Aspirations, Policies	185	(1)
Patient-Centered Medicine: A Professional Evolution	186	(1)
Rethinking Informed Consent	186	(2)
Notes: The Theory and Practice of Informed Consent	188	(4)
The Competing Disclosure Standards	192	(1)
Canterbury v. Spence	192	(5)
Culbertson v. Mernitz	197	(3)
Notes: Competing Disclosure Standards	200	(3)
Notes: The Other Elements of a Nondisclosure Claim	203	(1)
Limiting Liability for Failure to Disclose	204	(1)
Rizzo v. Schiller	204	(3)
Notes: Limiting Liability for Failure to Disclose	207	(4)
Discussion Problem: Informed Refusals?	211	(1)
Fiduciary Obligations, Conflicts of Interest, and Novel Disclosure Obligations	211	(1)
Autonomy and Privacy: Protecting Patients from Their Physicians	211	(2)
Moore v. The Regents of the University of California	213	(5)
Howard v. University of Medicine & Dentistry of New Jersey	218	(5)
Notes: Fiduciary Principles and the Disclosure of Provider-Associated Risks	223	(5)
Problem: Moore Liability?	228	(1)
Human Experimentation and Research	229	(2)
Why Informed Consent? Human Experimentation and the Ethics of Autonomy	231	(2)
Grimes v. Kennedy Krieger Institute, Inc.	233	(16)
Notes: Conflicts of Interest and Human Subjects Research	249	(6)
Medical Malpractice	255	(234)
Medical Mistakes and Quality	257	(23)
The Nature and Extent of Medical Error	257	(1)
Making Medical Errors into ``Medical Treasures''	257	(1)
Error in Medicine	258	(3)
A Complex Sorrow: Reflections on Cancer and an Abbreviated Life	261	(2)
Notes: Medical Mistakes and Malpractice Litigation	263	(8)
Approaches to Improving Quality of Care	271	(1)
The Necessary and Proper Role of Regulation to Assure the Quality of Health Care	271	(6)
Notes: Quality Measurement and Control	277	(3)
Physician Liability	280	(48)
The Custom-Based Standard of Care	280	(1)
McCourt v. Abernathy	280	(3)
Locke v. Pachtman	283	(6)
The Role of the Jury in Modern Malpractice Law	289	(3)
Notes: The Custom-Based Standard of Care	292	(4)
Variations in the Standard of Care	296	(1)
Jones v. Chidester	296	(3)
Chapel v. Allison	299	(3)
Notes: Variations in the Standard of Care: Location, Schools of Thought, Experiments, and Specialization	302	(5)
Problem: What Is the Standard of Care?	307	(1)
Note: The Impact of Economic Constraints	308	(2)
Problem: Economic Malpractice	310	(1)
Qualification and Examination of Medical Experts	311	(1)
Thompson v. Carter	312	(1)
Trower v. Jones	313	(3)
Notes: Qualification and Impeachment of Experts	316	(2)
Trial Tactics and Methods	318	(1)
McCourt v. Abernathy	319	(1)
Stang-Starr v. Byington	320	(2)
Notes: Examination of Experts; Introduction of Treatises and Guidelines	322	(4)
Notes: Discovery and Confidentiality	326	(2)
Alternative Theories of Liability	328	(44)
Res Ipsa and Negligence Per Se	328	(1)
Locke v. Pachtman	328	(1)
Notes: Res Ipsa Loquitur and Negligence Per Se	329	(3)
Ordinary Negligence	332	(1)
Helling v. Carey	332	(3)
Medical Uncertainty, Diagnostic Testing, and Legal Liability	335	(3)
One Hundred Years of Harmful Error: The Historical Jurisprudence of Medical Malpractice	338	(1)
Notes: Ordinary Negligence and the ``Hand Formula''; Defensive Medicine	339	(4)
Problem: To Test or Not to Test	343	(1)
Breach of Contract	343	(1)
Sullivan v. O'Connor	343	(3)
Notes: Liability Based on Contract or Fraud	346	(2)
Vicarious Liability	348	(1)
Franklin v. Gupta	348	(6)
Notes: Physicians' Vicarious Liability,; ``Captain of the Ship''	354	(1)
Strict Liability	355	(1)
Helling v. Carey	355	(1)
Notes: Designing a No-Fault Liability System	356	(3)
Products Liability	359	(1)
Brown v. Superior Court	360	(5)
Notes: Products Liability for Defective Drugs and Medical Devices	365	(6)
Review Questions: Products Liability	371	(1)
Causation and Affirmative Defenses	372	(29)
Causation	372	(1)
Herskovits v. Group Health Cooperative of Puget Sound	372	(6)
Notes: Causation and Loss of Chance	378	(3)
Problem: Loss of a Chance	381	(1)
Statutes of Limitations	381	(1)
Cunningham v. Huffman	381	(3)
Notes: Statutes of Limitations	384	(2)
Affirmative Defenses	386	(1)
Schneider v. Revici	387	(3)
Notes: Affirmative Defenses	390	(3)
Arbitration and Waiver of Liability	393	(1)
Madden v. Kaiser Foundation Hospital	393	(4)
Notes: Alternative Dispute Resolution; Contractually Set Standards of Care	397	(2)
Informed Consent Law	399	(2)
Damages and Settlement	401	(17)
Fein v. Permanente Medical Group	401	(4)
Roberts v. Stevens Clinic Hospital	405	(3)
Notes: Damages; Wrongful Life Cases	408	(5)
Exercise: ``A Day in the Life''	413	(1)
Exercise: Damages Settlement	413	(1)
Bleday v. OUM Group	414	(1)
Regulatory System in Shambles; Negligent Doctors Stay on Job	415	(2)
Notes: Settlement; National Practitioner Data Bank; Insurance	417	(1)
Institutional Liability	418	(24)
Hospital Liability	419	(1)
Schloendorff v. Society of New York Hospital	419	(2)
Notes: Hospital Liability; Charitable and Governmental Immunity	421	(2)
Adamski v. Tacoma General Hospital	423	(4)
Notes: Hospital Vicarious Liability	427	(4)
Darling v. Charleston Community Memorial Hospital	431	(2)
Johnson v. Misericordia Community Hospital	433	(3)
Notes: Hospitals' Direct Liability; Risk Management Programs	436	(6)
Managed Care Liability	442	(47)
Boyd v. Albert Einstein Medical Center	442	(4)
Wickline v. State	446	(6)
Notes: Managed Care Liability	452	(7)
Problem: Enterprise Liability	459	(1)
Dukes v. U.S. Healthcare, Inc.	460	(3)
Notes: ERISA Preemption	463	(4)
Medical Malpractice Reform	467	(1)
Fein v. Permanente Medical Group	467	(4)
Crushed by My Own Reform	471	(1)
Legislation on Medical Malpractice: Further Developments and a Preliminary Report Card	472	(11)
Notes: Medical Malpractice Reform Statutes	483	(4)
Problem: Malpractice Reform Legislation	487	(2)
Part II The Patient, the Provider, and the State	489	(396)
The Right and ``Duty'' to Die	491	(116)
Refusal of Life-Sustaining Treatment	491	(74)
The Competent Patient	492	(1)
In the Matter of Karen Quinlan	493	(3)
In re Conroy	496	(3)
Cruzan v. Director, Missouri Department of Health	499	(4)
Notes: The Individual Interest in Refusing Treatment	503	(5)
Notes: The State's Interest in Preserving Life	508	(5)
Notes: The State's Interest in Preventing Suicide	513	(1)
Notes: The Ethical Integrity of the Medical Profession	514	(2)
Notes: The Protection of Innocent Third Parties	516	(2)
The Patient Whose Competence Is Uncertain	518	(1)
Lane v. Candura	518	(1)
Department of Human Services v. Northern	519	(1)
Notes: Assessing Competence	520	(3)
The Incompetent Patient	523	(1)
In re Conroy	524	(5)
In re Jobes	529	(5)
Cruzan v. Director, Missouri Department of Health	534	(5)
Notes: Deciding for the Incompetent Patient	539	(13)
Notes: Advance Planning	552	(5)
Problems: Interpreting and Drafting Advance Directives	557	(1)
Notes: Young Children and Adolescents (Not Competent)	558	(3)
Notes: Severely Disabled Newborns	561	(4)
Physician-Assisted Suicide	565	(26)
Washington v. Glucksberg	565	(5)
Vacco v. Quill	570	(5)
Notes: Physician-Assisted Suicide	575	(15)
Problem: Is It Assisted Suicide or Is It Withdrawal of Treatment?	590	(1)
Futility	591	(16)
In re Baby K	591	(4)
Causey v. St. Francis Medical Center	595	(2)
Notes: Medical Futility	597	(4)
Note: Brain Death	601	(6)
Organ Transplantation: The Control, Use, and Allocation of Body Parts	607	(56)
Note: The Shortage of Organs for Transplantation	608	(1)
Organ Donation	609	(16)
Competent Organ Donors	609	(2)
Incompetent Organ ``Donors''	611	(1)
Strunk v. Strunk	611	(3)
In re Pescinski	614	(2)
Notes: The Incompetent Organ Donor	616	(1)
Problem: Conceiving a Child to Make Tissue Available for Transplantation	617	(1)
Redefining Death	618	(1)
In re T.A.C.P.	619	(4)
Notes: Redefining Death	623	(2)
Ownership and Control of the Body	625	(21)
Mandates or Incentives for Organ Donation	625	(1)
State v. Powell	625	(4)
Brotherton v. Cleveland	629	(3)
McFall v. Shimp	632	(1)
Notes: Obligations to Give Up Organs and Tissues; Autopsies	633	(5)
Problem: Obligatory Bone Marrow Donation	638	(1)
Notes: Financial Incentives for Organ Donation	638	(3)
Ownership of Human Tissue	641	(1)
Moore v. The Regents of the University of California	641	(5)
Notes: Human Tissue in Research	646	(1)
Allocation of Organs	646	(17)
UNOS Policy for Organ Distribution	648	(4)
Notes: Criteria for Rationing Organs	652	(11)
Reproductive Rights and Genetic Technologies	663	(120)
Note: Many Streams or One River: Reproductive Rights and Substantive Due Process	664	(1)
A Right to Procreate?	665	(10)
Buck v. Bell	665	(1)
Skinner v. Oklahoma	666	(4)
Notes: The Right to Procreate	670	(3)
Problem: Sterilization and Advances in Genetics	673	(1)
Problem: Chemical or Surgical Castration of Male Sex Offenders	674	(1)
A Right to Avoid Procreation?	675	(34)
Contraception	675	(1)
Griswold v. Connecticut	675	(3)
Notes: A Right to Avoid Procreation	678	(3)
Problem: Incompetent Persons and Long-Term Contraception	681	(1)
Abortion	682	(1)
Roe v. Wade	682	(2)
Notes: Roe v. Wade	684	(3)
Planned Parenthood of Southeastern Pennsylvania v. Casey	687	(8)
Stenberg v. Carhart	695	(7)
Notes: The Post-Casey Landscape	702	(1)
Notes: Thirty Years of Abortion Jurisprudence	703	(5)
Problem: Late Trimester Abortions	708	(1)
State or Federal Recognition of Fetal Interests	709	(29)
Introduction	709	(1)
State Law and Fetal Personhood	709	(3)
Federal Recognition of Fetal Interests	712	(2)
Pregnant Women and Forced Medical Treatment	714	(1)
In re A.C.	714	(5)
Notes: Forced Medical Treatment	719	(3)
Problem: Pregnancy and Living Wills	722	(1)
Pregnant Women and Drug Use	723	(1)
Whitner v. South Carolina	723	(4)
Ferguson v. City of Charleston	727	(7)
Notes: Maternal Substance Abuse	734	(4)
Using Reproductive Technologies to Create New Families	738	(45)
Parenting Possibilities	739	(1)
Assisted Reproductive Technology and the Family	739	(2)
What Does It Mean to Be a ``Parent''? The Claims of Biology as the Basis for Parental Rights	741	(1)
Notes: Parenting Possibilities	742	(2)
Notes: Genetics and Reproduction	744	(2)
Gamete Donation	746	(2)
Notes: Gamete Donation	748	(3)
In Vitro Fertilization and Frozen Embryos	751	(1)
Problems: Ethical Aspects of IVF	752	(1)
J.B. v. M.B. & C.C.	753	(6)
Notes: Frozen Embryo Disputes	759	(3)
Womb and Ovum Donors	762	(1)
R.R. v. M.H.	762	(5)
Culliton v. Beth Israel Deaconess Medical Center	767	(4)
Notes: Traditional and Gestational Surrogacy	771	(6)
Cloning	777	(2)
Notes: Human Reproductive Cloning	779	(1)
Problems: Determining Parentage	780	(1)
Note: Concluding Thoughts	781	(2)
Public Health Law	783	(102)
Public Health Strategies	784	(14)
Medical and Legal Views of Public Health	784	(1)
History of CDC	785	(1)
Summary of Notifiable Diseases---United States, 2000	786	(2)
The Law and the Public's Health: A Study of Infectious Disease Law in the United States	788	(4)
Notes: Traditional Public Health Strategies	792	(2)
Risk Assessment and Regulatory Competence	794	(1)
American Dental Association v. Martin	794	(3)
Notes: Risk Assessment by Legislatures, Agencies, and Courts	797	(1)
The Source and Limit of Authority to Protect Public Health	798	(11)
Constitutional Principles	798	(1)
Jacobson v. Commonwealth of Massachusetts	798	(3)
Notes: The State Police Power and Federalism	801	(3)
Problem: Smallpox Vaccination and Bioterrorism	804	(1)
Disability Discrimination	805	(1)
School Board of Nassau County v. Arline	805	(2)
Notes: Balancing Risk Reduction with Other Values	807	(2)
Regulating the Treatment Relationship	809	(74)
Professional Licensure	810	(1)
The Abuse of Occupational Licensing	810	(1)
Notes: Professional Licensure	811	(2)
State v. Miller	813	(2)
Notes: Unlicensed Practice of Medicine	815	(6)
Modi v. West Virginia Board of Medicine	821	(5)
Notes: Professional Disciplinary Actions	826	(6)
Problem: Professional Licensure	832	(1)
Regulating Access to Drugs	833	(1)
United States v. Rutherford	833	(3)
Notes: Pharmaceutical Regulation	836	(5)
Notes: Federal Regulation of Alcohol and Tobacco	841	(2)
Testing, Reporting, and Contact Tracing	843	(1)
People v. Adams	843	(6)
Notes: Testing Programs	849	(4)
Problem: HIV Screening for Pregnant Woman and Newborns	853	(1)
Problem: State Law and Bioterrorism Preparedness	853	(2)
Note: Confidentiality, Reporting, and Contact Tracing	855	(1)
Whalen v. Roe	855	(4)
Notes: Informational Privacy	859	(1)
Middlebrooks v. State Board of Health	860	(2)
Notes: Reporting and Contact Tracing	862	(2)
Problem: Bioterrorism, Reporting, and Contact Tracing	864	(2)
Quarantine, Civil Commitment, and Mandatory Treatment	866	(1)
Wong Wai v. Williamson	866	(3)
Notes: Isolation and Quarantine	869	(2)
Note: Civil Commitment and Mandatory Treatment	871	(1)
Addington v. Texas	871	(2)
In the Interest of J.A.D.	873	(2)
Notes: Mandatory Mental Health Treatment	875	(2)
Notes: Mandatory Treatment for Contagious Diseases	877	(3)
Problem: Sexually Violent Predators---Treatment or Punishment?	880	(1)
Problem: Bioterrorism, Mandatory Treatment, and Quarantine	880	(3)
Conclusion	883	(2)
Part III Institutions, Providers, and the State	885	(366)
Health Care Financing and Reform	887	(178)
Sources of Health Insurance	887	(37)
The Right to Health Care	887	(1)
Uncompensated Hospital Care: Rights and Responsibilities	887	(1)
The Right to a Decent Minimum of Health Care	888	(2)
Notes: The Right to Health Care	890	(1)
The United States: Breakthroughs and Waste	891	(1)
United States v. Milligan	892	(1)
Private Health Insurance	893	(1)
U.S. Health Care Coverage and Costs: Historical Development and Choices for the [Future]	893	(1)
Paying for Health Care	894	(5)
Notes: Uninsured Patients; Insurance Fraud; Patient Cost-Sharing	899	(4)
Notes: Access to Private Health Insurance	903	(6)
Notes: Patient Cost-Sharing	909	(3)
Public Insurance Programs	912	(1)
Medicaid: Past Successes and Future Challenges	912	(5)
The American Health Care System: Medicare	917	(3)
Notes: Medicare and Medicaid; Long-Term Care Insurance	920	(4)
Insurance and HMO Regulation	924	(20)
Jordan v. Group Health Ass'n	925	(3)
The Health Care Revolution: Remaking Medicine in California	928	(1)
Transcript of Interview with Jaime Robinson, Ph.D.	928	(1)
Rush Prudential HMO v. Moran	928	(3)
Health Maintenance Organizations	931	(5)
Notes: Regulation of Health Insurance, HMOs, and PPOs	936	(8)
HMO Regulation Quiz	944	(1)
ERISA Preemption	944	(11)
American Medical Security, Inc. v. Bartlett	945	(3)
McGann v. H & H Music Co.	948	(2)
Notes: ERISA Preemption; Mandated Benefits	950	(5)
ERISA Preemption Quiz	955	(1)
Health Insurance Coverage	955	(42)
Rationing and Discrimination	955	(1)
Alexander v. Choate	955	(3)
Will Clinton's Plan Be Fair?	958	(2)
Health Care Rationing and Disability Rights	960	(6)
Notes: Rationing Insurance Benefits; Disability Discrimination; Cost-Effectiveness Studies	966	(8)
Problem: Allocation Choices in a Public Program	974	(1)
Determining What Is Medically Appropriate	975	(1)
Mount Sinai Hospital v. Zorek	975	(3)
Bechtold v. Physicians Health Plan of Northern Indiana	978	(5)
Broken Back: A Patient's Reflections on the Process of Medical Necessity Determinations	983	(1)
Notes: Insurance Coverage Disputes	984	(9)
Notes: Peer Review Organizations and Utilization Review	993	(3)
Research Exercise: Medicare Covered Services	996	(1)
Problem: Choosing Health Insurance	997	(1)
Provider Reimbursement	997	(39)
Reimbursing Physicians and Hospitals	997	(1)
Cost-Based Reimbursement	998	(1)
Health Plan	998	(2)
Memorial Hospital/Adair County Health Center v. Bowen	1000	(2)
``Reasonable Cost'' Reimbursement for Inpatient Hospital Services under Medicare and Medicaid	1002	(2)
Notes: Cost-Based and UCR Reimbursement	1004	(3)
Prospective Payment	1007	(1)
The Complexity of Medicare's Hospital Reimbursement System: Paradoxes of Averaging	1007	(4)
The Medicare DRGs: Efficiency and Organizational Rationality	1011	(4)
Notes: DRGs; Relative Value Scales; Rate Regulation	1015	(5)
Problem: Technology Innovation	1020	(1)
Capitation Payment	1021	(1)
Reimbursing Physicians and Hospitals	1021	(3)
Pegram v. Herdrich	1024	(6)
Payments to Induce Reduction or Limitation of Medicare and Medicaid Services	1030	(1)
Notes: Capitation; Financial Conflicts of Interest; and Risk Adjustment	1030	(6)
Health Insurance Reform	1036	(29)
Reform Proposals and Foreign Models	1036	(1)
Who Shall Pay? Politics, Money, and Health Care Reform	1036	(3)
Health Care Financing in Selected Industrialized Nations: Comparative Analysis and Comment	1039	(3)
Managed Competition and Its Potential to Reduce Health Spending	1042	(2)
Notes: Comprehensive Financing Reform	1044	(6)
Problem: Universal Access to Health Care	1050	(1)
Exercise: Negotiating Health Care Reform	1051	(1)
Economic and Regulatory Theory	1051	(1)
Health Plan	1052	(1)
Health Care into the Next Century	1052	(1)
California Dental Ass'n v. Federal Trade Commission	1053	(1)
Where You Stand Depends on Where You Sit: Musings on the Regulation/Competition Dialogue	1054	(4)
The Inevitable Failure of Current Cost-Containment Strategies: Why They Can Provide Only Temporary Relief	1058	(2)
Health Care Choices: Private Contracts as Instruments of Health Reform	1060	(2)
Health Care, Markets, and Democratic Values	1062	(3)
Regulation of Health Care Facilities and Transactions	1065	(186)
The Structure of Integrated Delivery Systems	1066	(3)
The Scope of This Chapter	1069	(1)
Problem: The History of Marcus Welby Hospital and How It Grew	1070	(1)
Facility Regulation	1071	(16)
Licensure and Accreditation	1071	(1)
Patient Power: Solving America's Health Care Crisis	1071	(2)
Note: Facility Licensing, Accreditation, and Certification	1073	(1)
Estate of Smith v. Heckler	1074	(2)
Cospito v. Heckler	1076	(2)
Notes: Facility Regulation and Accreditation	1078	(4)
Research Exercise: Medicare/Medicaid Certification	1082	(1)
Certificate of Need Regulation	1082	(1)
Statewide Health Coordinating Council v. General Hospitals of Humana, Inc.	1083	(2)
Notes: Certificate of Need Regulation	1085	(2)
Corporate Form	1087	(48)
Nonprofit and Public Entities	1087	(1)
Queen of Angels Hospital v. Younger	1087	(4)
Columbia/HCA and the Resurgence of the For-Profit Hospital Business	1091	(1)
Notes: Charitable Trust Law; Public and Religious Hospitals; For-Profit Conversions	1092	(5)
Problem: For-Profit Joint Venture	1097	(1)
Charitable Tax Exemption	1098	(1)
Eastern Kentucky Welfare Rights Organization v. Simon	1098	(2)
Utah County v. Intermountain Health Care, Inc.	1100	(4)
Notes: The Basis for Health Care Tax Exemption	1104	(6)
Harding Hospital, Inc. v. United States	1110	(2)
Hospital-Physician Joint Ventures	1112	(5)
Notes: Private Inurement and Joint Ventures	1117	(2)
Notes: Hospital Reorganization and Integrated Delivery Systems	1119	(3)
Problem: Choosing a Corporate Form	1122	(1)
The Corporate Practice of Medicine	1122	(1)
Bartron v. Codington County	1122	(3)
Right of Corporation to Practice Medicine	1125	(2)
Berlin v. Sarah Bush Lincoln Health Center	1127	(3)
Notes: Corporate Practice of Medicine and Choice of Entity	1130	(4)
Problem: Hospital and Physician Contracting	1134	(1)
Medical Staff Structure	1135	(34)
Doctors, Patients, and Health Insurance: The Organization and Financing of Medical Care	1135	(1)
Medical Staff Bylaws	1135	(1)
St. John's Hospital Medical Staff v. St. John Regional Medical Center	1135	(1)
Mahan v. Avera St. Lukes	1136	(3)
Notes: Hospital and Medical Staff Bylaws; Exclusive Contracts; Economic Credentialing	1139	(4)
Notes: Physician Employment; Labor Law	1143	(4)
Problem: Economic Credentialing	1147	(1)
Medical Staff Disputes	1147	(1)
Greisman v. Newcomb Hospital	1148	(3)
Nanavati v. Burdette Tomlin Memorial Hospital	1151	(3)
Notes: Judicial Review of Medical Staff Disputes	1154	(5)
Membership in Managed Care Networks	1159	(1)
Potvin v. Metropolitan Life Insurance Co.	1159	(4)
Notes: Managed Care Contracting; Employment at Will; Interference with Doctor/Patient Relationship	1163	(4)
Exercise: Negotiating a Managed Care Contract	1167	(2)
Antitrust Law	1169	(61)
Note: Introduction to Antitrust Law	1169	(5)
Medical Staff Boycotts	1174	(1)
Weiss v. York Hospital	1174	(8)
Hassan v. Independent Practice Associates	1182	(3)
Notes: Medical Staff Boycotts; Exclusive Dealing	1185	(6)
The Role of Quality of Health Care Considerations in Antitrust Analysis	1191	(7)
California Dental Ass'n v. FTC	1198	(1)
Notes: Quality of Care as a Defense; Allied Health Professionals; Professional Society Rules	1198	(1)
Problem: Medical Staff Boycotts of Allied Health Professionals	1199	(1)
Note: Peer Review Immunity	1200	(1)
Price-Fixing Law	1201	(1)
Arizona v. Maricopa County Medical Society	1201	(6)
Notes: Price-Fixing Antitrust Liability; PPOs; Joint Ventures	1207	(6)
Ocean State Physicians Health Plan, Inc. v. Blue Cross & Blue Shield of Rhode Island	1213	(4)
Notes: Vertical Restraints by Insurers	1217	(3)
Merger Law	1220	(1)
Federal Trade Commission v. Tenet Health Care Corp.	1220	(5)
Notes: Hospital and Physician Mergers; Managed Care Market Definition	1225	(4)
Problem: Rural Hospital Merger	1229	(1)
Referral Fee Laws	1230	(21)
United States v. Greber	1230	(2)
The Hanlester Network v. Shalala	1232	(3)
Limitation on Certain Physician Referrals	1235	(2)
Making Sense of Referral Fee Statutes	1237	(5)
Notes: Referral Fees	1242	(7)
Problem: Medicare/Medicaid Fraud and Abuse	1249	(1)
Problem: Reverse Referral Fees	1249	(1)
Comprehensive Review Problem: Forming an Integrated Delivery System	1250	(1)
Glossary of Organizational Terms and Acronyms	1251	(4)
Table of Cases	1255	(10)
Index	1265