Health Care Law and Ethics

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

Edition: 6th

ISBN13: 9780735526402

ISBN10: 0735526400

Format: Hardcover

Pub. Date: 2003-03-01

Publisher(s): Wolters Kluwer

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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

Preface

xxix

Introduction

(100)

Overview Cases

(6)

In re Baby K

(1)

Notes: Rationing, Justice, and the Doctor-Patient Relationship

(3)

Wickline v. State

(1)

Notes: Liability and Managed Care

(1)

In re A.C.

(1)

Notes: The Patient vs. the State

(2)

FTC v. Tenet Health Care Corp.

(1)

Notes: Economics and Market Restructuring

(1)

The Nature of Medical Practice

(35)

Doctors and Hospitals

(1)

Health Care Past and Present

(3)

Doctors, Patients, and Health Insurance: The Organization and Financing of Medical Care

(2)

Competing Solutions: American Health Care Proposals and International Experience

(2)

Doctors, Patients, and Health Insurance: The Organization and Financing of Medical Care

(2)

Clinical Decision Making From Theory to Practice

(1)

Notes: Doctors and Hospitals

(1)

The Culture of Medicine

(1)

Magic or Medicine? As Investigation of Healing and Healers

(2)

The Tyranny of Health

(1)

The Machine at the Bedside

(1)

Notes: The Social Construction of Disease

(1)

The Phenomenology of Sickeness and Healing

(1)

Making Medical Spending Decisions

(6)

Notes: The Power of Medicine and the Vulnerability of Patients

(1)

The Nature of Medical Judgment

(1)

Variations in Physician Practice: The Role of Uncertainty

(6)

Notes: Medical Decisionmaking

(1)

Law and Medicine

(1)

Physicians versus Lawyers: A Conflict of Cultures

(1)

Note: Law vs. Medicine: A Culture Clash

(1)

Evidence-Based Medicine

(1)

Oversight of the Quality of Medical Care: Regulation, Management, or the Market?

(4)

Note: Outcomes and Effectiveness Assessment

(1)

The Health Care Financing and Delivery System

(24)

Insurance and Regulation

(1)

U.S. Health Care Coverage and Costs: Historical Development and Choices for the [Future]

(7)

The Sad History of Health Care Cost Containment as Told in One Chart

(2)

The Crisis in Coverage and Spending

(1)

The Future of the American Health Care System

(2)

Why Conservatives Don't Talk About America's Health System

(1)

Dangerous Medicine: A Critical Analysis of Clinton's Health Plan

(1)

Notes: The Crisis in American Medicine

(4)

Changes in Financing and Delivery Systems

(1)

Medicare and the American Health Care System: 1996 Report to Congress

(2)

The Health Care Revolution: Remaking Medicine in California

(2)

Transcript of Interview with Jaime Robinson, Ph.D.

(1)

Notes: Managed Care vs. Consumer-Directed Care

(2)

Moral, Economic, and Political Themes

(35)

Competing Paradigms

(1)

Allocating Health Care Morally

(1)

The Professional Paradigm of Medical Care: Obstacle to Decentralization

(1)

Ethics and Empiricism

(1)

The Practice of Autonomy: Patients, Doctors, and Medical Decisions

(3)

Medical Law and Ethics in the Post-Autonomy Age

(5)

Notes: Medical Ethics and Professionalism

(2)

Postmodern Critical Theory

(1)

Slavery, Segregation and Racism: Trusting the Health Care System Ain't Always Easy! An African American Perspective on Bioethics

(2)

The Colonization of the Womb

(3)

Notes: Feminist and Critical Race Theory

(2)

Economics

(1)

Health Plan

(3)

For-Profit Enterprise in Health Care

(2)

Notes: Markets vs. Regulation

(1)

Distributive Justice

(1)

Uncompensated Hospital Care: Rights and Responsibilities

(3)

Note: Social Justice

(1)

Patient Power: Solving America's Health Care Crisis

(1)

Making Medical Spending Decisions: The Law, Ethics, and Economics of Rationing Mechanisms

(3)

Notes: Health Care Rationing; Institutional Analysis

(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

Health Care Law and Ethics

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