Health Law deals with regulatory law applicable to healthcare providers, third party payors, and those that provide or pay for health care. Health Law Attorneys assist clients who need legal representation on matters concerning health care. Examples include the representation of physicians, hospitals, physicians groups, nursing homes and health care providers on matters relating to medical malpractice, risk management, peer review boards, Medicare fraud and abuse, health care employment issues and provider regulation. The experienced health lawyer has in-depth knowledge of the healthcare industry and the laws and regulations that affect it.
During the course of this semester, we outlined and discussed the major problems and aspects surfacing healthcare through law. This brief review will explain and summarize the in-depth chapters of the book in which we presented in this course. These chapters discussed are chapter 1, Introduction to the American Legal System, chapter 2, Legal Structure of Health Care Organization, chapter 3, Licensing, Regulation, and Accreditation, chapter 6, Criminal Law and Civil Penalties, chapter 8, Medical Staff, chapter 10, Tort Liability and Malpractice, chapter 11, Relationship with the Patient, chapter 12, Treatment Authorization and refusal, chapter 13, Health Care Information, and finally chapter 15, Death and Dead Bodies.
The first chapter is a basic introduction to the American legal system. It simply introduces the nature of law, explains the governmental organizations and their functions, lists the different sources of law, and briefly breaks down the organization of the court system. This chapter includes general information about law, including the workings of the legal system and the roles of the branches of government in creating, administering, and enforcing the law.
Chapter two introduces the legal structure of health care organizations. The chapter focuses predominantly on hospitals. It explains how a hospital or other health care entity can be one of five types of organizations and also explains the duties, authority, liability, selection, and rights of the board, chief executive officer, and medical staff. Further into the chapter, it discusses some of the legal issues related to conversions between organizational structures; mergers, consolidations, and sales of assets; dissolution of legal entities; relocation and closure of facilities; and bankruptcy.
Chapter three explains the licensing, regulation, and accreditation of an institution. States regulate many health care institutions through licensure.
Chapter eight involves the Medical Staff. The chapter is divided into three parts, in which the first part discusses the present status of the medical staff, appointment to the medical staff, explanation of clinical privileges, periodic reviews, adjustment and execution of clinical privileges, the hearing rights of physicians, the possible liability of those involved in the process of making medical staff appointment and clinical privilege decisions, and contracts between hospitals and physicians. The send part provides a historical background on the growth of the medical staff. The last part of this chapter discusses probable future directions for the relationship of hospitals and physicians.
Chapter ten discusses, in the first part, the general principles of tort liability more in-depth. Tort liability is the liability that is imposed by the common law and some statutes for injuries caused by breaches of duties not based on contractual agreement. The review of tort law includes the three basic types of tort liability and the basis for personal and institutional liability. In this chapter, the author reminds us that everyone involved in health care delivery is acutely aware of the potential for patients or their family to make legal claims for money because of injuries they believe were caused by malpractice or other wrongful conducts and gives a basic understanding of liability principles to help minimize claims and facilitate proper handling of claims. The second part of this chapter reviews the application of those principles to specific situations that have resulted in suits against hospitals and health care professionals, illustrating the scope of the duty of hospitals and their staff members to patients and others.
Chapter eleven discusses the physician-patient relationship and the hospital-patient relationship. It explains some of the ways these relationships begin and end, and lays out some of the aspects of those relationships. A physician-patient relationship may be established in three ways: by contracting to care for a certain population and to have one of that population seek care, by entering an express contract with a patient or the patient’s representative by mutual agreement, or by engaging in conduct from which a contract can be implied. This relationship can be ended if medical care is no longer needed, the patient withdraws from the relationship, the care of the patient is transferred to another physician, ample notice of withdrawal is given by the physician to the patient, or the physician is unable to provide care. In addition, the section about hospital-patient relationships addresses nondiscrimination laws and restrictions on patient recruiting, followed by the hospital’s responsibilities to persons who are not in need of emergency care, the hospital’s responsibilities to persons who need emergency care, issues concerning discharge, and allocation of scarce resources.
The requirements of consent and informed consent, the decision-making roles of patients and their representatives, the exceptions to the consent requirement, and the refusal of treatment are discussed in chapter twelve. This chapter explains the elements of informed consent which is required disclosure, reasonable physician, reasonable patient, elements of disclosure, causation; the exceptions to the disclosure requirement include emergencies, therapeutic privileges, patient waiver, prior patient knowledge, and statutory exceptions.
There are three types of consent forms which are blanket consent forms, battery consent forms, and detailed consent forms. After this, the chapter goes into explaining the three legal bases for the right to refuse treatment which include common law, statutory rights, and constitutional rights and concludes the chapter explaining the provider’s liability in refusal cases.
In chapter thirteen, we focus on health care information that is maintained by health care providers. In this chapter we see the underlying problems and uses of information, such as balancing patient concerns for confidentiality with the need for access to health care information and the cost of implementing confidentiality protections, balancing accountability for health care services with the cost to satisfy documentation requirements, and addressing government and business desires to access information for a wide variety of purposes ranging from la enforcement to budgeting to marketing. The confidentiality of patient information includes physician-patient privileges, psychotherapist-patient privilege, waiver, substance abuse confidentiality, mental health, HIV/ AIDS, professional and hospital licensing laws, and other state confidentiality laws. There are numerous circumstances where providers are authorized or required to release copies of records or otherwise disclose health care information. These circumstances include access by authorization of the patient, patient access, access by others, access by authorization of patient’s representative, and access by law. Computers and other technologies such as audio and visual recordings have been developed for handling some health care information.
The concluding chapter, which is chapter 15, death and dead bodies, is very important and very informative because many deaths occur in hospitals and health care providers must determine death and handle dead bodies. The hospital becomes the custodian of a dead body with many different responsibilities. The first part of the chapter starts off by giving the definition of death, including the medical definition, legal definition, and the declaration and certification of death. The next part discusses the duties of hospitals and health care professionals in handling dead bodies and communicating with families and legal authorities and the following section discusses autopsies, anatomical donations and cadaver transplantation.
Department of Health and Human Services: The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially those who are least able to help themselves. The department includes more than 300 programs, covering medical research, food and drug safety, Medicare, Medicaid, Medical and social science research, and substance abuse, among others.
Health Maintenance Organization (HMO): An HMO provides prepaid medical services. For a set monthly fee, HMOs offer members a range of health benefits including preventive care. Patients or employers pay the set fee that covers all medical expenses from routine medical care to hospitalization. Patients enrolling in an HMO must select a participating primary care provider to monitor their health care needs. If the condition requires more specialized care, a provider must refer the patient to another specialist.