Health Care Law and Policy

by Havighurst, Clark C.; Blumstein, James F.; Brennan, Troyen A.

• ISBN13: 9781566626170
• ISBN10: 156662617X
• Edition: 2nd
• Format: Hardcover
• Copyright: 1998-07-01
• Publisher: Foundation Pr

Summary

This extensive revision of a widely-praised book examines health care law in light of a changing industry. The authors take you beyond legal doctrine and statutory rules to the recent fundamental changes in the organization and financing of health services. Ultimately, the book helps foster a clear understanding of how the health care industry can maintain a solid legal footing while responding to consumer demands and the need for more efficient resource allocation.

Table of Contents

EDITORS' NOTE	iii	(2)
ACKNOWLEDGMENTS	v	(6)
FOREWORD	xi	(22)
TABLE OF CASES	xxxiii	(16)
GLOSSARY OF ACRONYMS	xlix
PART I INTRODUCTION TO THE DILEMMAS OF AMERICAN HEALTH POLICY	1	(286)
CHAPTER 1 Access to Health Care: Of Obligations and Entitlements	2	(128)
A: A Case Study in Tragic Choices	2	(18)
Muse v. Charter Hospital of Winston-Salem, Inc.	2	(4)
Notes and Questions on the Roles of the Various Actors in the Muse Tragedy	6	(13)
Problem	19	(1)
B: Uncompensated Care	20	(66)
Notes on Providers' Common-Law Duty to Render Care	20	(2)
Hospitals' Duties Toward Nonpaying Patients	22	(1)
Stanturf v. Sipes	22	(5)
Questions	27	(1)
Notes and Questions on Hospital Obligations Under the Hill-Burton Act	27	(4)
Notes on State Statutes Mandating Indigent Care	31	(3)
Federal Legislation Mandating Emergency Care	34	(1)
Emergency Medical Treatment and Active Labor Act of 1986, as Amended	34	(3)
Notes and Questions on the Scope of Hospitals' Obligations	37	(1)
Baber v. Hospital Corporation of America	38	(4)
Notes and Questions on Emtala	42	(6)
Problem	48	(1)
Does Federal Legislation Override Professional Standards?	48	(1)
In the Matter of Baby "K"	48	(7)
Further Notes and Questions on EMTALA	55	(2)
In the Matter of Baby K	57	(2)
Notes and Questions on the Rehabilitation Act, the Ada, and the Child Abuse Amendments	59	(3)
Financing Uncompensated Care	62	(1)
Notes and Questions on Uncompensated Care and Internal Cross-Subsidization	62	(4)
Introductory Note on ERISA	66	(2)
New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Insurances Co.	68	(8)
Notes and Questions	76	(1)
Notes and Questions on State Regulation of Hospital Rates	76	(6)
Notes and Questions on the Uninsured	82	(4)
C: Introduction to Public Programs for Financing Health Care	86	(44)
Note on the Suppositional Constitutional "Right to Health Care"	86	(3)
Should Health Care Be Distributed Equally?	89	(1)
Paul Starr, Ph.D.
The New Critics of Medical Care: The Politics of Therapeutic Nihilism	89	(8)
Notes	97	(3)
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Securing Access to Health Care: The Ethical Implications of Differences in the Availability of Health Services	100	(4)
Notes and Questions	104	(5)
Public Programs and Policies	109	(1)
Notes on Federal Health Care Programs for the Elderly and the Poor	109	(9)
Notes and Questions on Movements for Fundamental Health Care Reform	118	(12)
CHAPTER 2 Purchasing Health Care	130	(157)
A: The Nature of the Product	130	(30)
Medical Care as a "Good"	130	(1)
Paul Starr, Ph.D.
A National Health Program: Organizing Diversity	130	(5)
Questions	135	(1)
Alain Enthoven, Ph.D.
What Medical Care Is and Isn't	135	(1)
Questions	135	(6)
What Can Health Services Research Tell Us?	141	(1)
Notes on Variations in Medical Practice	141	(7)
Notes and Questions on Clinical Decision Making	148	(8)
Notes and Questions on Technology Assessment and the Regulation of Medical Technology	156	(4)
B: Introduction to Health Economics	160	(23)
Should Money Matter?	160	(1)
Alain Enthoven, Ph.D.
Why Financial Incentives Make a Difference	160	(3)
Notes on Economic Theory	163	(4)
Trade-Offs Between Costs and Benefits	167	(1)
Clark C. Havighurst
The Rising Cost of Health Care: Growing Pains or Something Worse?	167	(14)
Questions on the Problem of Health Care Costs	181	(2)
C: Health Plans Today	183	(43)
Notes on the History of Health Insurers' Cost-Containment Efforts	183	(2)
Coping With the Trade-Offs	185	(1)
Notes and Questions on Writing Health Care Contracts to Counteract Moral Hazard	185	(14)
Bradley v. Empire Blue Cross and Blue Shield	199	(4)
Notes and Questions on Coverage of Emerging Medical Technologies	203	(2)
Organizational Responses to the Cost Problem	205	(1)
Notes and Questions on Limiting Patient Choice of Provider and Selective Contracting	205	(5)
Shea v. Esensten	210	(2)
Notes and Questions	212	(1)
Notes and Questions on HMOs	213	(4)
Notes and Questions on the Emerging Health Care Marketplace	217	(7)
Note and Questions on "Provider-Sponsored Organizations" (PSOs)	224	(2)
D: Prudent Purchasing in Public Programs	226	(61)
Medicare as a Third-Party Payer	226	(1)
Notes on Medicare Cost Reimbursement	226	(2)
Notes and Questions on Medicare's Prospective Payment System for Hospitals	228	(13)
Physician Payment Review Commission, [Reforming the Payment of physicians Under Medicare]	241	(5)
Notes and Question on Physician Payment Under Medicare	246	(3)
Notes and Questions on Medicare as a Purchaser of Other Services	249	(3)
Reinventing Medicare	252	(1)
Lynn Etherdge
Reengineering Medicare: From Bill-Paying Insurer to Accountable Purchaser	252	(7)
Notes and Questions on Bringing Managed Care to Medicare	259	(5)
Notes on Adverse Selection (Risk Selection)	264	(3)
Robert P. Charrow
David C. Main
Joseph N. Onek, Esqs.
Retooling Medicine Through PSOs and Medicare + Choice Plans: Can Providers Catch the Brass Ring?	267	(8)
Notes and Questions on the Medicare + Choice Program	275	(2)
Reforming Medicaid	277	(1)
Notes and Questions on Purchasing Strategies in State Medicaid Programs	277	(5)
Notes and Questions on Medicaid Managed Care	282	(5)
PART II SHIFTING PARADIGMS IN AMERICAN HEALTH CARE	287	(504)
CHAPTER 3 Commercialism Versus Professionalism	288	(211)
A: Tensions and Conflict	288	(23)
William J. Goode, Ph.D.
The Nature of a Conflict	288	(1)
Community Within A Community: The Professions	288	(5)
Notes	293	(1)
Professional Values in a Changing Market	294	(1)
Notes and Questions on Professionalism as a Response to Market Failure	294	(17)
B: The Emergence of the Corporation	311	(86)
Introduction to the For-Profit/Nonprofit Debate	311	(1)
Note on For-Profit Enterprise in the Health Care Sector	311	(2)
Note: Trustees of Dartmouth College v. Woodward, 17 U.S. (4 Wheat) 518 (1819)	313	(2)
Henry B. Hansmann
Reforming Nonprofit Corporation Law	315	(6)
Notes	321	(1)
State and Federal Tax Exemptions	322	(1)
Utah County v. Intermountain Health Care, Inc.	322	(8)
Notes and Questions on the Federal Tax Treatment of Nonprofit Enterprises	330	(8)
Note and Questions on State and Local Tax Exemptions	338	(3)
General Counsel Memorandum 39,862	341	(6)
Notes and Questions on the Tax Implications of Hospital/Physician Joint Ventures	347	(2)
Problem on Physician Recruitment	349	(2)
Tax Status of New and Complex Health Care Enterprises	351	(1)
Geisinger Health Plan v. Commissioner	351	(6)
Notes and Questions on Tax Exemptions for HMOs and Health Insurers	357	(2)
Geisinger Health Plan v. Commissioner	359	(5)
Notes and Questions on Complex Corporate Structures Involving Nonprofit Firms	364	(2)
Notes on the Tax Treatment of Integrated Delivery Systems	366	(3)
Conversion to For-Profit Status	369	(1)
Memorandum of the Attorney General, Burson v. Nashville Memorial Hospital, Inc., Et Al.	369	(5)
Notes and Questions on the Sale or Conversion of Nonprofit Entities	374	(15)
Notes and Questions on Special Legal Treatment of Nonprofit Firms	389	(3)
Notes and Questions on the Choice Between the Nonprofit and Forprofit Forms	392	(5)
C: Prohibitions on Corporate Practice and Commercialism	397	(47)
Legislation Mandating Professional Control; Judicial Review of Economic Regulation	397	(1)
North Dakota State Board of Pharmacy v. Snyder's Drug Stores, Inc.	397	(2)
Notes and Questions on State Legislation Regulating Professional Services	399	(13)
Regulating Commercial Speech--Use of Trade Names	412	(1)
Friedman v. Rogers	412	(5)
Notes and Questions on Commercial Speech	417	(3)
Notes and Questions on Advertising and Information Problems in Health Care Markets	420	(3)
Implied Prohibitions Against Corporate Practice, Referral Agencies, etc.	423	(1)
Berlin v. Sarah Bush Lincoln Health Center	423	(7)
California Attorney General, Opinion No. 81-1004	430	(2)
Notes and Questions on the Corporate Practice of Medicine	432	(6)
Notes on Professional Ethics Concerning Contract Practice	438	(2)
State v. Abortion Information Agency, Inc.	440	(4)
Notes and Questions on the Aia Case	444	(1)
D: Health Care "Fraud and Abuse"	444	(55)
Notes and Questions on Physician Self-Referral, Fee Splitting, etc.	444	(6)
Paying or Receiving "Remuneration" for Medicare/Medicaid Referrals	450	(1)
United States v. Greber	450	(3)
Medical Development Network, Inc. v. Professional Respiratory Care/Home Medical Equipment Services, Inc.	453	(1)
Notes and Questions on the Medicare/Medicaid Anti-Kickback Legislation	454	(4)
Notes and Questions on Identifying Fraud in Health Care Transactions and Relationships	458	(4)
Notes and Questions on the Administration and Enforcement of the Federal Anti-fraud Legislation	462	(2)
Self-Referral Under the Anti-Kickback Law	464	(1)
Hanlester Network v. Shalala	464	(7)
Notes and Questions on Self-Referral and the Question of Intent	471	(5)
The False Claims Act	476	(1)
United States ex rel. Thompson v. Columbia/HCA Healthcare Corporation	476	(5)
Notes and Questions on the False Claims Act	481	(4)
Overview of Federal Prohibitions and Safe Harbors Relating to Fraud and Abuse	485	(1)
Notes on the Stark Anti-Self-Referral Legislation	485	(2)
Notes and Questions on Specific Relationships and Transactions under the Anti-Self-Referral and Anti-Kickback Laws	487	(7)
Notes and Questions on Fraud and Abuse and Managed Care	494	(5)
CHAPTER 4 The Antitrust Challenge to Professional Dominance	499	(92)
A: The Sherman Act and Professional Services	499	(28)
Note on the Significance of Antitrust Law in the Health Care Sector	499	(2)
Are the "Learned Professions" Exempt?	501	(1)
Goldfarb v. Virginia State Bar	501	(3)
Notes and Questions on the Applicability of Antitrust Statutes to Professionals	504	(4)
Notes and Questions on Trade Unionism for Physicians	508	(2)
Applying the Sherman Act to Professionals	510	(1)
National Society of Professional Engineers v. United States	510	(7)
Notes and Questions on Goldfarb, Professional Engineers, and "Per Se" Rules	517	(2)
Note on the Antitrust Rule of Reason	519	(7)
Problem	526	(1)
B: Professional Self-Regulation?	527	(49)
The Antitrust Laws and the Ethics of a Profession	527	(1)
AMA v. FTC	527	(6)
American Medical Association, Principles of Medical Ethics	533	(1)
Notes and Questions on AMA v. FTC and Private Restraints on Professional Advertising	534	(4)
Notes and Questions on Codes of Professional Ethics	538	(3)
Professional Boycotts	541	(1)
Note: Klor's Inc. v. Broadway-Hale Stores, Inc., 359 U.S. 207 (1959)	541	(2)
Notes on Cases Involving Professional Boycotts	543	(9)
Questions on Boycotts for Noncommercial Purposes	552	(4)
The Quality of Care as an Antitrust Defense	556	(1)
FTC v. Indiana Federation of Dentists	556	(9)
Questions on the IFD Case	565	(1)
Competitor Collaboration in the Production of Information	565	(1)
Schachar v. American Academy of Ophthalmology, Inc.	565	(3)
Notes and Questions on the Schachar Case	568	(2)
Notes and Questions on Profession-Sponsored Peer Review Programs	570	(6)
C: Antitrust Law and Anticompetitive Governmental Action	576	(15)
The State-Action Antitrust Defense	576	(1)
In re Massachusetts Board of Registration in Optometry	576	(4)
Notes on the Makeup of State Regulatory Boards	580	(2)
Notes and Questions on the Potential Antitrust Liability of Licensing and Regulatory Boards	582	(6)
Collective Action to Obtain Legislative Relief From Competition	588	(1)
Note on the Noerr-Pennington Doctrine	588	(3)
CHAPTER 5 Changing Institutional Providers	591	(200)
A: Power Relationships in Hospitals	591	(25)
Accrediting Requirements and the Organization of Hospitals	591	(1)
Joint Commission on Accreditation of Healthcare Organizations, Comprehensive Accreditation Manual and the Organization of Hospitals (1997)	591	(4)
Notes and Questions on the JCAHO	595	(1)
Notes and Questions on Hospital Organization	596	(5)
How Hospitals Operate	601	(1)
Jeffrey E. Harris, M.D., Ph.D.
Regulation and Internal Control in Hospitals	601	(3)
Notes and Questions on the Harris Article	604	(1)
The Legal Status of Hospital Medical Staffs	605	(1)
St. John's Hospital Medical Staff v. St. John Regional Medical Center, Inc.	605	(4)
Notes and Questions on Medical Staff Bylaws	609	(1)
Notes and Questions on the Nature and Legal Status of the Medical Staff	610	(4)
Notes on the Organization of Other Hospital Personnel; Collective Bargaining	614	(2)
B: Hospital Liability	616	(43)
Corporate Responsibility for Professional Work	616	(1)
Bernardi v. Community Hospital Association	616	(5)
Notes and Questions on Charitable and Governmental Immunities	621	(2)
Note on Access to Hospital Records by Plaintiffs in Malpractice Actions	623	(3)
Notes and Questions on the "Captain-of-the-Ship" and "Borrowed-Servant" Doctrines	626	(4)
Vicarious Liability for Physician Torts?	630	(1)
Sword v. NKC Hospitals, Inc.	630	(3)
Grewe v. Mount Clemens General Hospital	633	(4)
Notes and Questions on the Liability of Hospitals for the Negligence of Hospital-Based Physicians	637	(5)
Corporate Negligence	642	(1)
Darling v. Charleston Community Memorial Hospital	642	(3)
Questions on the Darling Case	645	(1)
Elam v. College Park Hospital	646	(4)
Notes and Questions on Corporate Negligence	650	(4)
Notes and Questions on Hospital Liability for the Torts of Staff Physicians	654	(1)
Allocating Responsibilities Between Physicians and Hospitals	655	(1)
Alexander v. Gonser	655	(3)
Notes and Questions on Hospitals' Duties to Patients Under a Physician's Care	658	(1)
C: Hospital Staff Privileges	659	(50)
Judicial Review of Hospital Actions and Policies on Admitting Privileges	659	(1)
Silver v. Castle Memorial Hospital	659	(5)
Notes and Questions on the Reviewability of Privileges Decisions in Hospitals	664	(8)
King v. Bartholomew County Hospital	672	(3)
Notes and Questions	675	(2)
Notes and Questions on Procedural and Substantive Issues in Administering Staff Privileges	677	(3)
Admitting Privileges as a Matter of Contract	680	(1)
Notes and Questions on the Legal Effect of Hospital and Staff Bylaws	680	(2)
Bartley v. Eastern Maine Medical Center	682	(3)
Notes and Questions on Exclusive Contracts With Hospital-Based Physicians	685	(2)
Competition and Antitrust Issues in the Allocation of Admitting Privileges	687	(1)
Notes and Questions on the Rights of Nonphysician Practitioners	687	(3)
Hackett v. Metropolitan General Hospital	690	(4)
Notes and Questions on Antitrust Analysis in Staff Privileges Cases	694	(4)
Notes and Questions on Antitrust Defenses in Staff Privileges Cases	698	(5)
Federal Statutory Immunity for Peer-Review Actions, etc.	703	(1)
Smith v. Ricks	703	(3)
Notes and Questions on the Health Care Quality Improvement Act	706	(3)
D: Controlling Institutional Growth Through Central Planning and Regulation	709	(43)
Introduction to Certificate-of-Need Regulation	709	(1)
St. Joseph Hospital and Health Care Center v. Department of Health	709	(5)
Notes on the History of Health Planning and Certificate-of-Need Regulation	714	(6)
Notes and Questions on the Policy and Politics of Certificate-of-Need Regulation	720	(5)
Notes and Questions on the Role of Incumbent Competitors in Certificate-of-Need Proceedings	725	(3)
Determining "Need" for New Facilities or Services	728	(1)
Sinai Hospital of Baltimore, Inc. v. Maryland Health Resources Planning Commission	728	(5)
Notes and Questions on Determinations of "Need"	733	(2)
Access as a Consideration in CON Regulation	735	(1)
Chambery v. Axelrod	735	(1)
Notes and Questions	736	(5)
Reconciling CON Regulation With Policies Favoring Competition	741	(1)
Oregon Eye Associates v. State Health Planning and Development Agency	741	(5)
Notes and Questions on Competition and Certificate-of-Need Regulation	746	(6)
E: Horizontal and Vertical Integration	752	(39)
Analyzing Hospital Mergers Under the Antitrust Laws	752	(1)
Hospital Corporation of America	752	(16)
Notes and Questions on the Antitrust Treatment of Hospital Mergers	768	(11)
The Effect of Statutes Fostering Provider Cooperation	779	(1)
Notes and Questions on Immunities for Provider Cooperation and Mergers	779	(6)
Other Business Strategies of Hospitals Today	785	(1)
Notes on Hospital Diversification and Vertical Integration	785	(6)
PART III QUALITY-ASSURANCE MECHANISMS IN A POLICY PERSPECTIVE	791	(388)
CHAPTER 6 Public and Industry-Sponsored Quality Controls	792	(131)
A: Regulating Health Care Personnel	792	(46)
Introductory Notes and Questions on Quality and Quality Assurance in Medical Care	792	(10)
Occupational Licensure and Nonphysician Health Workers	802	(1)
Notes and Questions on the Economics, Politics, and Effects of Occupational Licensure	802	(10)
Physician Extenders; Scope of Practice	812	(1)
Sermchief v. Gonzales	812	(6)
Notes and Questions on Physician Assistants and Nurse Practitioners	818	(10)
Notes and Questions on Scope-of-Practice, Supervision, and Payment Issues	828	(4)
Notes and Questions on Unorthodox Practitioners and Practices	832	(6)
B: Public Oversight of Physicians	838	(30)
Notes and Questions on the Licensing and Discipline of Physicians	838	(8)
Participation in Medicare; PROs	846	(1)
Greene v. Bowen	846	(5)
Notes and Questions on Federal Oversight of Physicians	851	(1)
The Supply of Physicians	852	(1)
Notes and Questions on Controlling the Number and Distribution of Physicians	852	(4)
Selman v. Harvard Medical School	856	(4)
Notes and Questions on Foreign Medical Graduates	860	(1)
Training Tomorrow's Physicians; Educational Accreditation	861	(1)
Clark C. Havighurst, J.D.
Gaylord Cummins, Ph.D.
Letter to Ernest L. Boyer, U.S. Commissioner of Education (Designate)	861	(4)
Notes and Questions on Medical Education and the Accrediting of Educational Programs	865	(3)
C: Private Credentialing of Health Care Personnel	868	(24)
Certifying Health Workers	868	(1)
Clark C. Havighurst
Nancy M.P. King
Private Credentialing in the Health Care Field	868	(6)
Notes and Questions on Private Credentialing	874	(2)
Notes and Questions on Judicial Review of Membership and Credentialing Decisions	876	(2)
Antitrust Issues in Competitor-Sponsored Credentialing, etc.	878	(1)
Notes and Questions on Antitrust Issues in Private Credentialing	878	(1)
Kreuzer v. American Academy of Periodontology	879	(7)
Further Notes and Questions on Antitrust Issues	886	(5)
Problem	891	(1)
D: Public and Private Oversight of Institutional Providers	892	(31)
Private Accreditation	892	(1)
Notes and Questions on Institutional Accrediting and the JCAHO	892	(10)
Problem	902	(2)
Regulating Nursing Homes	904	(1)
Estate of Smith v. Heckler	904	(7)
Michigan Association of Homes and Services for the Aging, Inc. v. Shalala	911	(5)
Notes and Questions on Controlling the Quality of Care Rendered by Institutional Providers	916	(7)
CHAPTER 7 Liability for Medical Accidents	923	(256)
A: Of Crisis and Reform	923	(69)
Policy and Historical Perspectives on Medical Injuries, Liability, and Liability Insurance	923	(1)
Introductory Notes and Questions on the Reparations System for Medical Malpractice	923	(18)
Malpractice Reform Legislation: Constitutional and Other Issues	941	(1)
Carson v. Maurer	941	(10)
Fein v. Permanente Medical Group	951	(2)
Notes and Questions on Movements for Malpractice Reform	953	(2)
Notes and Questions on Constitutional Issues in Malpractice Reform	955	(9)
Notes and Questions on Reforms Relating to Damages	964	(9)
Notes and Questions on Reforms Limiting Access to Courts	973	(4)
Roa v. Lodi Medical Group, Inc.	977	(10)
Notes and Questions on Reforms Targeting Attorneys	987	(2)
Empirical Evidence on the Effects of Malpractice Reforms	989	(1)
Paul C. Weiler, J.D.
The Impact of Malpractice Legislation	989	(2)
Notes and Questions	991	(1)
B: The Legal Standard of Care	992	(95)
Notes and Questions on the Legal Duties of Physicians	992	(7)
Holding Doctors to Standards	999	(1)
Allan H. McCoid
The Care Required of Medical Practitioners	999	(4)
Jones v. Porretta	1003	(6)
Notes and Questions on Basic Issues in Assigning Liability for Medical Injuries	1009	(6)
Proving Physician Negligence: Experts, Standards, and Practice Guidelines	1015	(1)
Notes and Questions on Expert Testimony in Malpractice Cases	1015	(7)
Kramer v. Milner	1022	(4)
Notes and Questions on Practice Guidelines as Legal Standards	1026	(5)
Legal Tests for Negligence	1031	(1)
Hood v. Phillips	1031	(5)
Notes and Questions on Standards for Judging Physicians' Performance	1036	(4)
What If the Customary Standard Is Too Low?	1040	(1)
Gates v. Jensen	1040	(6)
Notes and Questions on Raising Inadequate Standards to Deter Poor Practice	1046	(7)
The Locality Rule	1053	(1)
Shilkret v. Annapolis Emergency Hospital Association	1053	(8)
Notes and Questions on the Locality Rule	1061	(4)
Notes and Questions on the Tort Liabilities of Hospitals	1065	(1)
Confronting Trade-offs Between Cost and Quality	1066	(1)
Notes and Questions on Cases Involving a Failure to Diagnose	1066	(4)
Problem: Customary Practice and Fetal Monitoring in a Managedcare Plan	1070	(1)
Liability for Defective Products	1071	(1)
Porter v. Rosenberg	1071	(3)
Kozup v. Georgetown University	1074	(3)
Notes and Questions on Liability for Poor-Quality Blood and Other Health Care Products	1077	(8)
Notes on the Standards Applicable to Nonphysician Health Care Personnel	1085	(2)
C: The Physician's Obligation to Obtain the Patient's Informed Consent	1087	(40)
Cobbs v. Grant	1087	(6)
Notes and Questions on the Legal Duty to Disclose the Risks of Treatment	1093	(15)
Johnson v. Kokemoor	1108	(6)
Notes and Questions on Duties With Respect to Provider-Specific Risks	1114	(2)
Note on Legislation Concerning Informed Consent	1116	(2)
Truman v. Thomas	1118	(5)
Questions on Truman v. Thomas	1123	(1)
Notes and Questions on Disclosure Requirements and Consent in the Managed Care Era	1124	(3)
D: Other Reforms	1127	(52)
Alternative Mechanisms for Resolving Claims	1127	(1)
Notes and Questions on Pretrial Screening Panels	1127	(2)
Thomas B. Metzloff, J.D.
Arbitrating Malpractice Disputes: Insights From the Real World	1129	(7)
Arbitration Legislation	1136	(1)
Colorado Permanente Medical Group, P.C. v. Evans	1136	(4)
Notes and Questions on State Malpractice Arbitration Acts	1140	(3)
Notes and Questions on Alternative Dispute Resolution in Malpractice Cases	1143	(3)
Reforming Tort Law by Private Contract: Arbitration Clauses	1146	(1)
Madden v. Kaiser Foundation Hospitals	1146	(7)
Notes and Questions on the Enforceability of Arbitration Agreements	1153	(2)
Reforming Tort Law by Private Contract: Substantive Reform	1155	(1)
Emory University v. Porubiansky	1155	(3)
Notes and Questions on Contractual Modification of Tort Rights	1158	(7)
No-Fault and Strict-Liability Alternatives	1165	(1)
Notes and Questions on No-Fault Compensation	1165	(2)
Notes and Questions on No-Fault (Strict) Liability	1167	(12)
PART IV HEALTH CARE LAW IN A PERIOD OF RAPID CHANGE	1179	(204)
CHAPTER 8 Managed Care and the Law	1180	(119)
A: MCO Accountability for the Quality of Care	1180	(28)
Note on Modern Health Care Contracts	1180	(3)
Vicarious Liability for Physician Torts?	1183	(1)
Boyd v. Albert Einstein Medical Center	1183	(2)
Notes and Questions on Vicarious and Other Liability of MCOs	1185	(11)
ERISA and Malpractice Claims Against MCOs	1196	(1)
Dukes v. U.S. Healthcare, Inc.	1196	(7)
Notes and Questions on ERISA Preemption of State Malpractice Law	1203	(5)
B: Legal Issues in the Administration of Health Benefits	1208	(59)
"Bad-faith" Actions; Interpretation of Health Care Contracts	1208	(1)
Sarchett v. Blue Shield of California	1208	(1)
Hughes v. Blue Cross of Northern California	1208	(12)
Notes and Questions on the Duty of Good Faith and Fair Dealing	1220	(3)
Notes and Questions on the Interpretation and Enforcement of Contractual Limits on Coverage	1223	(7)
Liability for Errors in Utilization Management	1230	(1)
Wickline v. State	1230	(6)
Notes and Questions on Payer Liability for Denial of Prior Authorization	1236	(2)
Notes and Questions on the Role of Physicians in the Administration of Benefits	1238	(4)
ERISA's Effects on Legal Actions Alleging Mistakes in Benefit Administration	1242	(1)
Corcoran v. United HealthCare, Inc.	1242	(8)
Notes and Questions on ERISA and Utilization Management	1250	(2)
Phillips v. Lincoln National Life Insurance Co.	1252	(5)
Further Notes and Questions on Coverage Disputes and the Interpretation of Health Care Contracts	1257	(6)
Problem on the Administration of Coverage	1263	(4)
C: Regulation of Managed-Care Organizations	1267	(32)
Notes and Questions on the History and Nature of HMO Regulation	1267	(10)
Protecting Consumers in the Age of Managed Care	1277	(1)
Advisory Commission on Consumer Protection and Quality in the Health Care Industry, Consumer Bill of Rights and Responsibilities	1277	(6)
Notes and Questions on New Trends in Regulating Managed Care	1283	(7)
Provider Protection or Consumer Protection?	1290	(1)
CIGNA Healthplan of Louisiana, Inc. v. Louisiana ex rel. Ieyoub	1290	(4)
Notes and Questions on Plan/provider Relations	1294	(5)
CHAPTER 9 Maintaining Competition in Health Care Financing and Delivery	1299	(84)
A: Physician-Sponsored Arrangements	1299	(46)
Antitrust Challenges to Physician Control	1299	(1)
United States v. Oregon State Medical Society	1299	(4)
Notes and Questions on the OSMS Case	1303	(3)
Arizona v. Maricopa County Medical Society	1306	(9)
Notes and Questions on the Maricopa County Medical Society Case	1315	(4)
Physician Collaboration in Today's Markets	1319	(1)
Statement of Department of Justice and Federal Trade Commission Enforcement Policy on Physician Network Joint Ventures	1319	(10)
Notes and Questions on Antitrust Enforcement and Physician Networks	1329	(9)
Providers of Care or Insurers Against Financial Risk?	1338	(1)
Notes and Questions on Insurance Regulation of Risk-Bearing Provider Networks	1338	(7)
B: Dominant Health Plans	1345	(38)
The "Blues," Then and Now	1345	(1)
Travelers Insurance Company v. Blue Cross of Western Pennsylvania	1345	(4)
Notes and Questions on the History of Blue Cross and Blue Shield	1349	(3)
Ball Memorial Hospital, Inc. v. Mutual Hospital Insurance, Inc.	1352	(4)
Notes and Questions on the Power of Purchasers in Markets for Providers' Services	1356	(4)
Exclusionary Practices?	1360	(1)
Ocean State Physicians Health Plan, Inc. v. Blue Cross & Blue Shield of Rhode Island	1360	(6)
Brief of American Managed Care and Review Association as Amicus Curiae Supporting Petitioners	1366	(4)
Notes and Questions	1370	(2)
Successful Group Practice or Vicious Medical Monopoly?	1372	(1)
Blue Cross & Blue Shield United of Wisconsin v. Marshfield Clinic	1372	(7)
Notes and Questions on the Marshfield Clinic Case	1379	(4)
INDEX	1383