HAS 4400HAS 4400

Session OneSession One

Dr. BurtonDr. Burton

• Course Title: Legal Aspects of Health Care

• Course Number: HAS 4400

• Quarter Credit Hours: 3

• Meeting Time: Monday 5:00 – 8:00

• Location: DV 320

• Prerequisites: Advanced Standing

• Professor: Dr. Lloyd R. Burton

• Phone: 626-7008

• E-mail: lburton1@weber.edu

Course Description

A review of laws concerning legal responsibilities of physicians, health care institutions and allied health workers. Licensing laws are reviewed and as well as legal liability for professional negligence. Issues concerning health care and professional ethics are addressed and evaluated. Through research and reflection the student will be guided towards development of a coherent philosophy of professional ethics.

Course ObjectivesA.     Be able to identify and discuss the sources of law in

United States.B.     Be able to understand the principles of ethical decision-

making as they apply to health care.C.     Be able to identify and differentiate the three basic

types of tort liabilityD.     Be able to apply principles of tort liability to situations

that have potential for malpractice.E.      Be able to understand and identify the problems and

issues regarding confidentiality of health care information.

F.      The student will develop and articulate a statement of their personal philosophy of ethics as a health care professional.

Methods and Procedures

1. Lecture & discussion of concepts in assigned readings.

2. Student reflection and development of philosophy.

3. Essay Examination.

4. Assign and discuss journal research with oral presentation.

Grading

Final Exam 30%

Case studies, 5 points each 20%

Student Presentation 15%

Philosophy of Ethics Statement 20%

Participation/attendance 15%

Total100%

Texts

• Miller, Robert D. and Rebecca C. Hutton, 1999, Problems in Health Care Law 8e, Gaithersburg, MD, Aspen Publishers.

 

• Flynn, Eileen P., 2000, Issues in Health Care Ethics, Upper Saddle River, NJ, Prentice Hall.

Case Studies:

Students will research four cases related to law and ethics in health care.

The student will read the assigned cases and prepare written answers to the questions at the end of the case.

Student Presentations

The student will research and prepare a presentation on an issue regarding health law and ethics (Topic approved by the instructor). The student will prepare a 7-10 minute audiovisual presentation of their findings and conclusions. At the beginning of the presentation the student will turn-in a copy of the audiovisual materials used for the presentation and a copy of the presentation outline. The presentation will be evaluated on content, style and organization. Organization includes evaluation of time management. Presentations that exceed the time limit will receive a reduction on points for the grade.

Personal Philosophy of Professional Ethics

The Student will develop a written personal statement of their philosophy of ethics as a health care professional. The student will articulate the ethical basis on which they make moral judgments and conduct their behavior as a health care professional. The statement will include guiding principles and values that the student uses to make critical decisions and resolve ethic dilemmas. Although brevity and conciseness are laudable, the statement should be at least one page or more in length providing a clear statement of philosophy yet avoiding repetitious ambiguity.

Four Primary Sources of Law

• Constitutions

• Statutes

• Decisions and Rules of Administrative Agencies

• Court decisions (Case Law)

THE PREAMBLE TO THE BILL OF RIGHTS

Congress of the United States

begun and held at the City of New-York,on Wednesday the fourth of March, one thousand seven hundred and eighty nine.

The Conventions of a number of the States, having at the time of their adopting the

Constitution, expressed a desire, in order to prevent misconstruction or abuse of its powers, that further declaratory and restrictive clauses should be added: And as extending the ground of public confidence in the Government, will best ensure the beneficent ends of its institution.

Resolved by the Senate and House of Representatives of the United States of America, in Congress assembled, two thirds of both Houses concurring, that the following Articles be proposed to the Legislatures of the several

States as amendments to the Constitution of the United States, all, or any of which articles, when ratified by three fourths of the said Legislatures, to be valid to all intents and purposes, as part of the said Constitution; viz.

Articles in addition to, and Amendment of the Constitution of the United States of America, proposed by Congress and ratified by the Legislatures of the several States, pursuant to the fifth Article of the original Constitution.

THE FIRST 10 AMENDMENTS“The Bill of Rights”

Amendment I

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Amendment II

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

Amendment IIINo Soldier shall, in time of peace be quartered in any house, without the

consent of the Owner, nor in time of war, but in a manner to be prescribed by law.

Amendment IVThe right of the people to be secure in their persons, houses, papers, and

effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

Amendment VNo person shall be held to answer for a capital, or otherwise infamous crime,

unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall

private property be taken for public use, without just compensation.

Amendment VI

In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the Assistance of Counsel for his defence.

Amendment VII

In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any Court of the United States, than according to the rules of the common law.

Amendment VIIIExcessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.

Amendment IX

The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

Amendment X

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

AMENDMENT XIV Passed by Congress June 13, 1866. Ratified July 9, 1868.

Note: Article I, section 2, of the Constitution was modified by section 2 of the 14th amendment.

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Section 2. Representatives shall be apportioned among the several States according to their respective numbers, counting the whole number of persons in each State, excluding Indians not taxed. But when the right to vote at any election for the choice of electors for President and Vice-President of the United States, Representatives in Congress, the Executive and Judicial officers of a State, or the members of the Legislature thereof, is denied to any of the male inhabitants of such State, being twenty-one years of age,* and citizens of the United States, or in any way abridged, except for participation in rebellion, or other crime, the basis of representation therein shall be reduced in the proportion which the number of such male citizens shall bear to the whole number of male citizens twenty-one years of age in such State.

XIV (con’t)

Section 3.

No person shall be a Senator or Representative in Congress, or elector of President and Vice-President, or hold any office, civil or military, under the United States, or under any State, who, having previously taken an oath, as a member of Congress, or as an officer of the United States, or as a member of any State legislature, or as an executive or judicial officer of any State, to support the Constitution of the United States, shall have engaged in insurrection or rebellion against the same, or given aid or comfort to the enemies thereof. But Congress may by a vote of two-thirds of each House, remove such disability.

Section 4. The validity of the public debt of the United States, authorized by law, including

debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned. But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void.

Section 5. The Congress shall have the power to enforce, by appropriate legislation, the provisions of this article.

*Changed by section 1 of the 26th amendment. (Age changed from 21 to 18)

Statutes• Law Enacted by legislature

• State legislatures have all powers not denied by the U. S. Constitution, by valid federal laws and by state constitutions.

• Local legislative bodies have only those powers granted by the state. (Home Rule)

• When state law or local law conflicts with federal law, valid federal law supersedes.

Administrative Agencies• Legislatures have delegated to

administrative agencies the responsibility and power to implement various laws.

• Federal Agencies– Health Care Financing Administration

(HCFA)– Food and Drug Administration (FDA)– National Labor Relations Board (NLRB)– Internal Revenue Service (IRS)

Court Decisions• The Role of Courts is to resolve disputes.• Courts interpret statutes and regulations.• Doctrine of primary jurisdiction:

– Courts generally refuse to accept a suit until administrative remedies have been pursued. (exhaustion of remedies)

• Courts determine whether statutes or regulations violate the Constitution.

• Common Law– Progenitor of legal principles and rules applied by

courts.– Principles that evolve from court decisions.– Differs from state to state.

International Law“A Fifth Source”

Expressed in Treaties between the United States and other Nations.

Organization of the Court System

Trial CourtsTrial Courts

Intermediate CourtsOf Appeal

SupremeCourtCourt

Trial Court• Both state and federal• Applicable law is determined assessed to decide

what the “facts” are.• Applicable law is applied to the facts.• Judge determines what the law is.• Jury/Judge determines the facts and applies the

law.

Burden of Proof• When analyzing any statute or legal principle, identify

the default outcome:– What happens if no one can prove that something else should

happen?

• If default outcome is not desirable, then identify what what must be proven by admissible facts to meet the burden of proof.

• Usually the plaintiff has the initial burden of proof.

• When the burden of proof has been met the burden shifts to the defendant to prove an exception applies.

Federal Court System• Diversity Jurisdiction:

– Federal Trial court decides a controversy between citizens of different states

• Abstention– Federal trial court may decline to decide state

law questions until they have been decided by a state court.

• Writ of certiorari– a petition requesting review of a lower court

decision by the Supreme Court.

Stare Decisis

• “Following precedent”

• By applying principles developed in previous similar cases, the court arrives at the same ruling in the current case as it did in the preceding one.

Res Judicata

• “a thing or matter settled by judgment”

• Avoids duplicative litigation and conflicting decisions.

• Once a cases has been decided no more appeals are available, those involved in the suit may not take the same matters to court again.

Standing

• Person bringing suit before a court must have standing.

• Person bringing the suit must have an actual stake in the controversy.

Chapter Two

Legal Structure of Health Care

Organizations

Legal basis

• Establishes powers and governance structure

• Sets limitations on powers

Five Types of organizations

• Governmental entity

• Nonprofit corporation

• For-Profit corporation

• Partnership (limited or general)

• Sole proprietorship

ULTRA VIRES Acts

“Acts by a corporation outside of its authority.”

Three key components of a hospital

Governing Body(Board)

Management(CEO et. al.)

Medical Staff

Governing Board (Duties)• Duty to act with due care• Preservation of Assets• Basic Management duties:

– selection of corporate officers and other agents

– general control of compensation of such agents

– delegation of authority to the chief executive officer and subordinates

– establishment of policies

– exercise of businesslike control of expenditures

– provision for planning

– supervision of and vigilance over the welfare of the whole corporation

• Duty to provide satisfactory patient care• Duty of loyalty (corporate opportunities, self-dealing,

conflict of interest)

Governing Board (liabilities)

• Criminal liability (e.g. kickbacks)• Civil liability (e.g. gross negligence)• Liability limits and insurance (D&O liability

insurance)

• Selection and Dismissal• Board members must be selected in accordance with

applicable laws, articles of incorporation, and by laws.

CEO

• Functions as the agent and employee of the governing board.

• General supervision of all operations

• Responsible for implementing board approved policies.

CEO

• Authority

• Selection, Evaluation and Discharge

• Liability– Criminal (e.g. fraud)– Civil

• Management Contracts

Changes

• Conversion– Between private nonprofit and for profit

– Between public and private

– Eminent Domain

– Between type of public organizations

– Between secular and religious

• Merger, consolidation, and sale• Dissolution• Relocation and closure• Bankruptcy

Discussion Problems1. How do governmental and private health

care institutions differ in their powers and liabilities?

2. The board member of a health care facility owns and operates a paving company. The issue before the next board meeting is a decision to get estimates and selection a company to pave the parking lots. What should the board member do?

Discussion Question OneEthics

Based on what you have read and studied thus far, what ethical approach do you believe represents the prevailing world view in American culture today? What challenges and opportunities does that present us as health care professionals?