Contemporary Issues in Healthcare Law and Ethics

, by Harris, Dean M.

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ISBN: 9781567931983 | 1567931987
Cover: Hardcover
Copyright: 11/1/2003

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Supplemental Materials

List of Figures

xiv

List of Problems

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

(10)

"There Ought to Be a Law!"

(2)

Ethics in the Healthcare Field

(2)

The Relationship Between Law and Ethics

(3)

The Goals of this Book

(3)

2 The American Legal System

(16)

Who Makes the Laws, and Who Changes the Laws?

(3)

Substantive Areas of Law

(2)

State and Federal Court Systems

(4)

The Process of a Civil Lawsuit

(7)

The Plaintiffs Complaint and Summons

(2)

The Defendant's Answer or Motion to Dismiss

(1)

Discovery

(1)

Pretrial Motions

(1)

The Trial

(1)

Posttrial Motions

(1)

The Appeal

(1)

3 How to Conduct Legal Research

(14)

Understanding Legal Citation Form

(4)

Citations to Case Law

(2)

Citations to Statutes and Regulations

(2)

How to Find Legal Materials in the Easiest Possible Way

(9)

Federal Legislation

(1)

Federal Regulations

(1)

Federal Cases

(1)

State Law Materials

(5)

II MANAGING AND REGULATING THE HEALTHCARE SYSTEM

4 The Legal Structure and Governance of Healthcare Organizations

(22)

Healthcare Providers As Legal Entities

(8)

Public Healthcare Facilities

(1)

For-profit Corporations

(3)

Private, Nonprofit Corporations

(3)

Current Issues and Trends

(13)

The Purchase of Public and Nonprofit Facilities

(3)

Conversion from Nonprofit to For-profit Status

(2)

Joint Ventures

(1)

The Development of New Forms of Business Organization

(4)

5 Government Regulation of Public Health and Healthcare Services

(36)

Government Regulation to Protect the Public Health

(2)

Government Regulation for Quality of Care

(10)

Licensure of Individual Healthcare Professionals

(3)

Licensure of Healthcare Facilities

(1)

Accreditation of Healthcare Facilities

(1)

Certification for the Medicare and Medicaid Programs

(1)

Government Regulation of Diversified Organizations

(2)

Government Regulation for Cost Containment and Access

(13)

The Purposes and Effects of CON Laws

(3)

The System of CON Regulation

(2)

The Medical Arms Race

(8)

Government Regulation of Insurance for the Protection of the Consumer

(9)

State Regulation of Insurance Companies and HMOs

(1)

The Problem of Extending Access to Coverage

(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

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