Table of Contents
List of Exhibits xiii
List of Activities xv
Preface to the Fourth Edition xvii
Acknowledgments xxi
Part I The Role of Law in the US Healthcare System
1 Using the Law to Promote Our Policy Goals and Ethical Principles 3
"There Ought to Be a Law!" 3
Ethics in the Healthcare Field 5
The Relationship Between Law and Ethics 6
The Goals of This Book 9
2 The American Legal System 13
Who Makes the Laws, and Who Changes the Laws? 13
Substantive Areas of Law 17
State and Federal Court Systems 19
The Process of a Civil Lawsuit 22
3 How to Conduct Legal Research 31
Understanding Legal Citation Form 32
How to Find Legal Materials in the Most Efficient Way 36
Conclusion 40
Part II Managing and Regulating The Healthcare System
4 The Legal Structure and Governance of Healthcare Organizations 45
Healthcare Providers as Legal Entities 46
Trends in Change of Ownership 60
5 Government Regulation of Public Health and Healthcare Services 67
Government Regulation to Protect the Public Health 69
Government Regulation for Quality of Care 71
Government Regulation for Cost Containment and Access 80
6 Protecting the Privacy of Medical Information 97
State Laws on Privacy of Patient Information 99
Federal Law and the HIPAA Privacy Rule 102
7 Medical Staff Membership and Clinical Privileges 127
The Relationship Between Physicians and Hospitals 128
The Organized Medical Staff 131
Denial or Termination of Membership and Privileges 134
Judicial Review of Credentialing Decisions 146
8 The Law Of Government Payment Programs: Medicare, Medicaid, and Fraud and Abuse 151
Medicare 151
Medicaid 159
The State Children's Health Insurance Program 165
Fraud and Abuse of Medicare and Medicaid 166
Compliance Programs for Healthcare Providers 182
9 Antitrust Law in Healthcare 197
The Federal Antitrust Laws 199
Specific Areas of Antitrust Concern in Healthcare 207
Conclusion 221
Part III Patient Care Issues
10 The Law of Tort Liability 229
The Tort of Negligence 230
Imposing Negligence Liability on the Institution or Organization 231
Malpractice in the Context of Cost Containment and Managed Care 240
Informed Consent 241
Proposals for Medical Malpractice Reform 247
11 Legal and Ethical Obligations to Provide Care 261
Traditional Common-Law Rules for Doctors and Hospitals 262
The COBRA Antidumping Law (EMTALA) 264
Prohibitions Against Discrimination 275
12 Legal and Ethical Issues in Termination or Refusal of Care and Physician-Assisted Suicide 283
The Right to Refuse Treatment 284
The Right to a Natural Death 291
Physician-Assisted Suicide 298
13 Reproductive Health 317
Sterilization 318
Contraception and Abortion 321
Emergency Contraception 331
Maternal-Fetal Conflict 333
Part IV Legal and Ethical Issues in Cost Containment, Health Insurance, and Health Reform
14 Legal Issues in Healthcare Cost Containment 343
Selective Contracting with Providers 344
Financial Incentives to Provide Less Care 348
Controlling Utilization of Healthcare Services 353
Legal Liability for Improper Denial of Claims 355
The Statutory Language of ERISA 360
The Alternative Approach of External Review 364
15 Legal Issues in Health Insurance and Health Reform 375
State Regulation and Reforms 376
Federal Regulation and Reforms Before 2010 378
The 2010 Federal Affordable Care Act 380
Glossary 403
Index 409
About the Author 439