Health Law Midterm

Question 1

Are laws always ethical? What are some of the differences between ethics and laws? Provide examples.

Answer 1

No, laws are not always ethical. Laws are rules set by the governments that may or may not always align with ethical principles. While laws are enforceable and have specific consequences, ethics are not legally enforceable and are more flexible in nature.

The case of Christopher Sercye, a 15 year old who was shot twice in the stomach. He collapsed outside of the hospital doors and due to hospital policy, the medical staff could not leave the building to retrieve and care for him. Although legal, not ethical.

Question 2

Compare and contrast civil law and criminal law

Answer 2

Criminal laws are designed to address offenses that are considered harmful to society at large, even if they involve harm to an individual member of society. In contrast, civil laws pertain to the private rights and obligations of specific parties, such as those involved in contracts, torts, or violations of statutes.

Question 3

What are the purposes and benefits of law?

Answer 3

PPDPSP
Promotion of Justice, Promotion of Commerce, Deterrence of Bad behavior, Protection of Rights, Social Order, and Predictability

Question 4

What is the role of Executive, Legislative, and Judicial branches of government?

Answer 4

Executive is responsible for rule-making. Additionally, they are also tasked with enforcing these laws.

Legislative holds the authority to create its own set of laws, known as statutes or acts.

Judicial is responsible for making laws by deciding specific cases brought before the court. This process involves the application of common law, which comprises the body of legal principles and precedents established by courts in a particular jurisdiction.

Question 5

List the hierarchy of law in the U.S. in order of priority. When there is a conflict between a Federal regulation and a State law, which is likely to have priority?

Answer 5

Federal Constitution
Federal Legislation
Federal Regulation
State Constitution
State Legislation
State Regulation

Federal regulation would take priority

Question 6

What is a tort? What are the four elements of the tort of negligence? Define each one of them. Provide an example.

Answer 6

A tort is a civil wrong committed by one person against another for violation of a legal duty other than a contract between the parties.

Duty: The legal obligation to exercise reasonable care under the circumstances.

Breach of duty: The plaintiff must establish that the defendant breached the duty by failing to meet the applicable standard of care.

Causation: A plaintiff must prove that the defendant’s breach of duty was the cause of the plaintiff’s injuries.

Damages: A plaintiff must prove that they suffered damages as a result of the defendant’s breach of duty. Damages can include physical injuries, emotional distress, property damage, or financial loss.

i.e. bedsores

Question 7

What is contributory negligence? Provide an example. What is comparative negligence? Provide an example. In your estimation, would comparative negligence better serve the citizens of North Carolina? Why or why not?

Answer 7

Contributory negligence is a legal doctrine that bars a plaintiff from recovering any damages if they are found to have contributed in any way to their own injury. Even if the plaintiff is only 1% responsible for the injury, they would be barred from recovering any damages under the principle of contributory negligence.

Example of Contributory Negligence: If a pedestrian is crossing a street outside of a crosswalk and is hit by a speeding car, the pedestrian could be found partially responsible for the accident due to their actions. If the court finds the pedestrian to be even 1% responsible, they would be barred from recovering any damages from the driver.

Comparative negligence, on the other hand, is a legal doctrine that allows a plaintiff to recover damages even if they are partially responsible for their own injury. The plaintiff’s recovery is reduced by the percentage of their own fault.

Example of Comparative Negligence: Using the same example as above, if a pedestrian is crossing a street outside of a crosswalk and is hit by a speeding car, the court may find the pedestrian 30% responsible for the accident and the driver 70% responsible. In a comparative negligence jurisdiction, the pedestrian would still be able to recover damages, but their recovery would be reduced by 30% to account for their own fault.

Comparative negligence would likely better serve the citizens of North Carolina because it allows for a fairer and more equitable allocation of damages. Contributory negligence can result in harsh outcomes where a plaintiff is completely barred from recovering damages even if they are only minimally responsible for their own injury. Comparative negligence, on the other hand, allows for a more nuanced and fair assessment of fault, which can lead to more just outcomes for both plaintiffs and defendants.

Question 8

What is rule (9)j? of the N.C. Rules of Civil Procedure? What is its significance?

Answer 8

Rule 9(j) of the North Carolina Rules of Civil Procedure is a specific provision that applies to medical malpractice lawsuits. It requires that a plaintiff in a medical malpractice suit must include a certification from a medical expert, along with the initial pleading (the complaint), stating that there exists a reasonable expectation of grounds for a malpractice claim.

The significance of Rule 9(j) is that it sets a procedural requirement to ensure that medical malpractice claims are founded on expert medical opinion. This is important because medical malpractice cases often involve complex medical issues that require expert understanding. By requiring a certification from a medical expert, the rule aims to prevent frivolous malpractice claims and ensures that only valid claims proceed to trial.

Question 9

Define respondeat superior. Provide an example of it. Is this kind of liability fair? Why or why not?

Answer 9

“Respondeat superior” is a legal doctrine that holds an employer responsible for the actions of their employees when those actions occur within the scope of their employment. The doctrine is based on the idea that the employer benefits from the work of the employee and should therefore bear the responsibility for any harm caused by the employee’s actions.

Example of Respondeat Superior: A delivery truck driver who is employed by a shipping company accidentally runs a red light and causes a collision with another vehicle. The driver was making a delivery for the company at the time of the accident. Under the doctrine of respondeat superior, the shipping company would be held liable for the damages caused by the driver’s actions.

Whether this kind of liability is fair depends on the circumstances of the case. In some situations, it may be fair to hold the employer responsible for the actions of their employees, especially if the employee was acting within the scope of their employment. However, there may be cases where the employer should not be held liable, such as when the employee was acting outside the scope of their employment or was engaged in intentional wrongdoing. Ultimately, the fairness of respondeat superior liability depends on the specific facts of each case.

Question 10

What is the difference between an Employee and an Independent Contractor? Provide an example.

Answer 10

Employee: An employee works under the direct control and supervision of the employer. The employer has the right to control the details of how the work is performed, including when, where, and how the work is done. Employees are typically eligible for benefits such as health insurance, retirement plans, and paid time off.

Example: A software engineer works for a technology company. The company determines the engineer’s work hours, provides them with a workspace and equipment, and directs the engineer on which projects to work on.

Independent Contractor: An independent contractor is self-employed and provides services to the employer under a contract. The contractor has more control over how the work is performed and is responsible for their own taxes, insurance, and other business expenses. Independent contractors do not receive employee benefits from the employer.

Example: A freelance graphic designer is hired by a marketing agency to create a logo for a client. The designer sets their own schedule, works from their own location, and is responsible for providing their own equipment.

Question 11

Describe four reasons why someone would choose to form a corporation?

Answer 11

Tax Purposes, Establishing a focus or mission, Limited Liability, Longevity, Raising Capital

Question 12

Define statute of limitations. In North Carolina - How long is it for a case of medical malpractice? How long is it in the case of death? For a retained foreign body? For a child harmed during birth? Is the statute of limitations fair? Why or why not?

Answer 12

The statute of limitations is the time period within which a lawsuit or legal claim must be filed. It is intended to ensure that legal actions are brought in a timely manner, allowing for the prompt resolution of disputes and the preservation of evidence.

In North Carolina, the statute of limitations for medical malpractice is generally as follows:

For cases involving death: 2 years from the date of death.
For cases not involving death: 3 years from the date of the negligent act or omission.
For cases involving a retained foreign body: 10 years from the date of the negligent act or omission.
For cases involving a child harmed during birth: 10 years from the date of the negligent act or omission, unless the child was under 10 years old at the time of the act or omission, in which case the statute of limitations is extended until the child’s 10th birthday.
In addition to the specific time limits, North Carolina law also provides for an additional 120-day extension to the statute of limitations in medical malpractice cases to allow for the identification of an expert witness.

Whether the statute of limitations is fair is a matter of debate. On one hand, the statute of limitations serves important purposes, such as ensuring that claims are brought in a timely manner and preserving evidence. On the other hand, the statute of limitations can be seen as limiting access to justice, particularly for plaintiffs who may not discover their injuries until after the statute of limitations has expired. Ultimately, the fairness of the statute of limitations depends on the specific circumstances of each case and the interests of all parties involved.

Question 13

What does the term Res Ipsa Loquitur (also known as Res Ipsa) refer to? Provide an example of a Res Ipsa Loquitur case. Is this fair?

Answer 13

Res Ipsa Loquitur (Latin for “the thing speaks for itself”) is a legal doctrine that allows a plaintiff to establish a prima facie case of negligence based on circumstantial evidence. In other words, it allows a plaintiff to shift the burden of proof to the defendant by showing that the injury or harm that occurred would not have happened in the absence of negligence, and that the defendant had control over the circumstances that caused the injury or harm.

Example of Res Ipsa Loquitur: A patient undergoes surgery to remove their appendix. After the surgery, the patient experiences pain and discomfort. It is later discovered that a surgical sponge was left inside the patient’s abdomen during the surgery, causing the pain and discomfort. In this case, the doctrine of Res Ipsa Loquitur may apply because the presence of the surgical sponge in the patient’s abdomen speaks for itself and suggests that the surgeon was negligent in leaving the sponge inside the patient.

Whether Res Ipsa Loquitur is fair is a matter of debate. On one hand, the doctrine allows plaintiffs to establish a prima facie case of negligence based on circumstantial evidence, which can be useful in cases where direct evidence of negligence is lacking. On the other hand, Res Ipsa Loquitur can be seen as placing an unfair burden on defendants, particularly in cases where the cause of the injury or harm is uncertain or where the defendant did not have control over the circumstances that caused the injury or harm. Ultimately, the fairness of Res Ipsa Loquitur depends on the specific circumstances of each case and the interests of all parties involved.

Question 14

What is EMTALA? What main policy goals does it ensure? What are some of EMTALA’s flaws? Strengths?

Answer 14

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires hospitals with emergency departments to provide a medical screening examination and stabilize any individual who comes to the emergency department seeking treatment for a medical condition, regardless of their ability to pay or insurance status. EMTALA also prohibits hospitals from transferring or discharging patients with emergency medical conditions to another facility or refusing to treat them based on their ability to pay.

The main policy goals of EMTALA are to ensure that individuals have access to emergency medical care regardless of their ability to pay, to prevent hospitals from “dumping” patients who are unable to pay for treatment onto other facilities or the community, and to protect patients from being denied care or transferred to another facility based on their insurance status or ability to pay.

FLAWS:
Lack of Funding: EMTALA does not provide hospitals with funding to cover the costs of providing emergency medical care to uninsured or underinsured patients. This can create financial strain for hospitals, especially those that serve a large number of uninsured or underinsured patients.

Standard of Care: EMTALA creates a standard of care that all hospitals with emergency departments must meet, regardless of their financial resources or ability to provide care. This can be challenging for hospitals that lack the funding or resources to meet the standard of care required by EMTALA

STRENGTH
Access to Care: EMTALA ensures that individuals have access to emergency medical care regardless of their ability to pay or insurance status. This helps to prevent individuals from being denied care or transferred to another facility based on their ability to pay

Protection from “Dumping”: EMTALA prohibits hospitals from transferring or discharging patients with emergency medical conditions to another facility or refusing to treat them based on their ability to pay. This helps to prevent “patient dumping” and ensures that individuals receive the care they need.

Question 15

Under EMTALA what is a MSE? What is an EMC? When does EMTALA allow a patient to be transferred?

Answer 15

Under EMTALA, a Medical Screening Examination (MSE) is a medical assessment that determines whether an individual has an emergency medical condition (EMC).

If the MSE determines that the individual has an EMC, the hospital must provide stabilizing treatment within its capabilities, admit the individual for treatment, or transfer the individual to another facility that can provide the necessary care.

Has to be transferred to a better facility

Question 16

In North Carolina - upon what is the standard of care based? Is it the same / similar everywhere? Why or why not? Is it fair that the standard of care is higher in some places but lower in other places?

Answer 16

In North Carolina, the standard of care for medical professionals is based on the “same or similar community” test. This means that medical professionals are held to the standard of care that is generally recognized and accepted in the same or similar community where the care is being provided. The purpose of this test is to allow doctors to practice in rural areas without the threat of being sued for malpractice. It also ensures that doctors are held to standards that they can realistically meet, taking into account factors such as money and resources available in the community.

The standard of care can vary from place to place, depending on factors such as the availability of medical resources, the level of training and expertise of medical professionals, and the prevailing medical practices in the community. This means that the standard of care may be higher in some places and lower in others, depending on the circumstances.

Whether it is fair for the standard of care to be higher in some places and lower in others is a matter of debate. On one hand, it may be argued that the standard of care should be consistent across all communities to ensure that patients receive the same level of care regardless of where they live. On the other hand, it may be argued that the standard of care should take into account the unique circumstances of each community, including factors such as the availability of medical resources and the level of training and expertise of medical professionals. Ultimately, the fairness of the standard of care depends on the specific circumstances of each case and the interests of all parties involved.

Question 17

What ethical as well as legal principles support the doctrine of informed consent?

Answer 17

Patient Self-Determination: The principle of patient self-determination holds that individuals have the right to make decisions about their own medical care. Informed consent allows patients to exercise this right by providing them with information about their treatment options, including the risks and benefits, so that they can make informed decisions about their care.

Autonomy: Autonomy is the principle that individuals have the right to make their own choices and decisions. Informed consent respects the autonomy of patients by allowing them to make informed decisions about their medical care based on their own values and preferences.

Beneficence: The principle of beneficence holds that medical professionals have a duty to act in the best interests of their patients. Informed consent ensures that patients are fully informed about the risks and benefits of their treatment options so that they can make decisions that are in their best interests.

Question 18

Who has the capacity to give consent? What conditions may cause loss of the capacity for consent?

Answer 18

The capacity to give consent is generally limited to adults of sound mind who are able to understand the nature and consequences of their decisions.

Conditions that may cause loss of capacity for consent include:

Unconsciousness: Individuals who are unconscious or in a coma do not have the capacity to give consent because they are not able to understand or appreciate the nature and consequences of their decisions.

Mental incapacity: Individuals who have a mental illness or cognitive impairment that affects their ability to understand or appreciate the nature and consequences of their decisions may lack the capacity to give consent.

Altered mental status: Individuals who are under the influence of drugs or alcohol, or who have a temporary or permanent impairment of their mental faculties, may lack the capacity to give consent.

Age: Children and minors generally lack the legal capacity to give consent, although there are some exceptions for mature minors who are able to understand and appreciate the nature and consequences of their decisions.

Question 19

What values are considered when a health insurance program determines whom should have coverage? In your opinion should older patients receive the same amount of health insurance coverage as younger patients? Should those who have some responsibility for their own bad health receive the same health insurance coverage as
those who have “random” bad health? Defend your answers.

Answer 19

Equity: The principle of equity holds that individuals should be treated fairly and receive the same level of access to healthcare regardless of their age, income, or health status.

Efficiency: The principle of efficiency holds that healthcare resources should be allocated in a way that maximizes the overall health and well-being of the population.

Solidarity: The principle of solidarity holds that individuals should support each other and contribute to the common good by sharing the costs and risks of healthcare.

In my opinion, older patients should receive the same amount of health insurance coverage as younger patients. This is because older patients are more likely to have chronic health conditions and require more medical care, and providing them with comprehensive health insurance coverage can help ensure that they receive the care they need to stay healthy and manage their conditions.

As for individuals who have some responsibility for their own bad health, I believe that they should still receive the same health insurance coverage as those who have “random” bad health. This is because health insurance is meant to provide access to healthcare for all individuals, regardless of their health status or lifestyle choices. Denying coverage to individuals who have some responsibility for their own bad health would be discriminatory and would not align with the principles of equity, efficiency, cost-effectiveness, responsibility, and solidarity that underlie health insurance programs. It is important to remember that health insurance is not a reward for good health or healthy lifestyle choices, but rather a means of providing access to healthcare for all individuals.

Question 20

Are the HIPAA Privacy Regulations good for patients in general? Why or why not?

Answer 20

Health Insurance Portability and Accountability Act

Overall, the HIPAA Privacy Regulations are good for patients because they provide important rights and protections related to their health information. These regulations help to ensure that patients’ health information is kept confidential, secure, and used only for legitimate purposes. They also give patients greater control over their health information and provide them with mechanisms for holding healthcare providers accountable for violations of their privacy rights.

Question 21

What government office enforces HIPAA? According to the Frequently Asked Questions on the website for that government office, what are 3 examples of how a healthcare provider (known as a “covered entity”) care share Protected Health Information with Law Enforcement Officers, without a patient’s authorization?

Answer 21

The government office that enforces HIPAA is the Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services (HHS).

As required by law: A covered entity may disclose PHI as required by law, such as in response to a court order, subpoena, warrant, or other legal process.

For law enforcement purposes: A covered entity may disclose PHI for law enforcement purposes, such as in response to a request for information related to a criminal investigation or to identify or locate a suspect, fugitive, material witness, or missing person.

To prevent or lessen a serious and imminent threat to health or safety: A covered entity may disclose PHI to law enforcement if the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public.

Question 22

Which persons(s) can give consent in North Carolina if the patient cannot give consent? In what order? Be specific. What problems, if any, are there about the order of priority for consent in your estimation? Provide an example

Answer 22

Guardian
Attorney of fact appointed of HCPOA
General POA
Spouse
Majority of parents and children
Siblings
Individual that can convey the patient wishes, established relationship

If none, 2 physicians will make the decision

One potential problem with the order of priority for consent in North Carolina is that it may not always reflect the patient’s preferences or wishes. For example, a patient may have a close friend who is familiar with the patient’s medical history and wishes, but if the patient’s close friend is not authorized to make healthcare decisions on behalf of the patient under the order of priority for consent, the patient’s wishes may not be followed. Additionally, the order of priority for consent may not always reflect the patient’s current relationships or support network, as it is based on the patient’s family relationships at the time of the patient’s incapacity. For example, a patient may have a close friend who has been providing support and assistance to the patient, but if the patient’s close friend is not authorized to make healthcare decisions on behalf of the patient under the order of priority for consent, the patient’s close friend may not be able to make healthcare decisions on behalf of the patient.

Question 23

In North Carolina do minors generally have the capacity to give informed consent? Are there exceptions to the general rule? In other words, when may minors make their own medical decisions? Do you think minors should get to make their own medical decisions? Why or why not?

Answer 23

No, they generally do not have the capacity but there are exceptions. Minors can give consent if they are emancipated, married, or in the military. They are able to consent for diagnosis , prevention, treatment
Pregnancy, not sterilization. Exc. abortion
Stds
Drug and Alc abuse
Emotional Disturbance; Mental Illness.

In my opinion, minors should be allowed to make their own medical decisions. Allowing minors to make their own medical decisions can help ensure that they receive timely and appropriate medical care and can help protect their health and well-being.

Question 24

What is the mature minor doctrine? How do mature minors differ from emancipated minors?

Answer 24

if it walks like a duck, then it is a duck. The mature minor doctrine is a legal principle that recognizes that some minors have the capacity to make their own medical decisions based on their level of maturity, intelligence, experience, and understanding. The doctrine allows minors who are deemed to be mature enough to make informed decisions about their medical care to give informed consent for medical treatment without the consent of their parents or legal guardians.

Emancipated minors, on the other hand, are minors who have been legally declared to be independent from their parents or legal guardians. Emancipated minors have the capacity to make their own medical decisions and give informed consent for medical treatment without the consent of their parents or legal guardians. Emancipated minors are considered to be legally independent from their parents or legal guardians and are responsible for their own medical care.

Question 25

What are the principal concepts that a healthcare professional must consider to disclose to patients in the process of obtaining informed consent? Provide an example.

Answer 25

Nature and Purpose of the Procedure: The healthcare professional must explain the nature and purpose of the procedure or treatment to the patient, including the benefits, risks, and alternatives.
Example: Before performing surgery, a surgeon must explain to the patient the nature and purpose of the procedure, including the reason for the surgery, the expected outcome, and any potential risks or complications.

Risks and Benefits: The healthcare professional must disclose the risks and benefits of the procedure or treatment to the patient, including any potential complications or adverse effects.
Example: Before administering a medication, a pharmacist must explain to the patient the potential risks and benefits of the medication, including any potential side effects or adverse reactions.

Alternatives: The healthcare professional must discuss any alternative treatments or procedures with the patient, including the risks and benefits of each alternative.
Example: Before recommending surgery, a physician must discuss alternative treatment options with the patient, such as medication, physical therapy, or lifestyle changes.

Question 26

What are CON laws? What are their purposes and effects? Provide an example

Answer 26

Certificate of Need (CON) laws are regulations in the United States that require certain healthcare providers to obtain approval from a designated state agency or board before opening, expanding, or offering new healthcare services or facilities. These laws were enacted in the 1970s as a response to concerns about the rising costs of healthcare and the overbuilding of healthcare facilities, particularly hospitals.

The purposes of CON laws are to:

Control Healthcare Costs: By limiting the number of healthcare facilities and services, CON laws aim to prevent unnecessary duplication of services and reduce healthcare costs.

Improve Access to Care: By ensuring that healthcare facilities and services are distributed based on need, CON laws aim to improve access to care, particularly in rural and underserved areas.

Promote Quality and Efficiency: By requiring healthcare providers to demonstrate the need for new facilities and services, CON laws aim to promote quality and efficiency in healthcare delivery.

The effects of CON laws can vary depending on the state and the specific regulations in place, but some potential effects include:

Reduced Competition: CON laws can limit competition among healthcare providers, which may lead to higher prices for healthcare services.

An example of a CON law in action is in the state of North Carolina. In North Carolina, healthcare providers must obtain a Certificate of Need from the North Carolina Department of Health and Human Services before opening, expanding, or offering new healthcare services or facilities. The state agency evaluates the need for the proposed healthcare services or facilities based on factors such as the population served, the availability of existing services, and the financial feasibility of the project. If the state agency determines that there is a need for the proposed healthcare services or facilities, the healthcare provider is granted a Certificate of Need and is allowed to proceed with the project. If the state agency determines that there is not a need for the proposed healthcare services or facilities, the healthcare provider is denied a Certificate of Need and is not allowed to proceed with the project.

Question 27

Are you in favor of CON laws? Why or why not?

Answer 27

In my view, CON laws are beneficial for controlling healthcare costs by preventing the overbuilding of healthcare facilities and services, which can otherwise lead to higher prices for healthcare services. They also enhance access to care, particularly in rural and underserved areas, by ensuring that healthcare facilities and services are distributed based on need. Additionally, CON laws promote quality and efficiency in healthcare delivery by requiring healthcare providers to demonstrate the necessity for new facilities and services.

Question 28

Approximately how many states have CON laws? Are CON laws good for patients? For hospitals? For taxpayers?

Answer 28

Approx. 35 states. The impact of CON laws on patients, hospitals, and taxpayers is a topic of debate. Some argue that CON laws can improve the quality and accessibility of healthcare by preventing the proliferation of unnecessary and duplicative services, ensuring that healthcare resources are allocated efficiently, and promoting the delivery of high-quality care. Others argue that CON laws can limit competition among providers, potentially leading to higher prices for services and reduced access to care, particularly in rural and underserved areas. Additionally, opponents of CON laws argue that they can increase the regulatory burden on providers, potentially leading to delays in the delivery of care and increased administrative costs.

Question 29

What is the HCQIA? Why was it created? Is this good for hospitals? For physicians? For patients? Defend your answer.

Answer 29

The Health Care Quality Improvement Act (HCQIA) is a federal law enacted in 1986 with the primary goal of encouraging peer review and quality assurance activities among healthcare providers. The law was created in response to concerns about the potential for medical malpractice lawsuits to discourage healthcare providers from participating in peer review and quality assurance activities, which are essential for maintaining and improving the quality of healthcare.

the HCQIA is generally considered to be beneficial for hospitals, physicians, and patients, as it can encourage peer review and quality assurance activities and help ensure the delivery of high-quality care.

Question 30

What does HCQIA stand for? What are the principal purposes of this law? What is the National Practitioner Data Bank? Can anyone access the Data Bank? Is this fair? Why or why not?

Answer 30

HCQIA stands for the Health Care Quality Improvement Act. This federal law was created with several principal purposes:

Encouraging healthcare professionals to engage in peer review and quality assurance activities aimed at improving the quality of healthcare provided.

Protecting healthcare professionals from civil liability when they participate in good faith in peer review and quality assurance activities.

Discouraging the practice of “doctor-hopping” or moving from one healthcare facility to another without disclosing a history of adverse actions or malpractice.

The National Practitioner Data Bank (NPDB) is a federal database that collects and maintains information about healthcare professionals’ professional credentials and conduct. It is designed to facilitate the sharing of information among healthcare entities, state licensing boards, and other authorized users. The NPDB contains information about adverse actions taken against healthcare professionals, such as loss of clinical privileges, licensure actions, and malpractice payments.

Access to the NPDB is restricted to authorized users, including healthcare entities, state licensing boards, and other entities authorized by law. The NPDB is not accessible to the general public. Access to the NPDB is restricted to protect the privacy and confidentiality of healthcare professionals’ information and to ensure the accuracy and integrity of the information contained in the database.

In my view, limiting access to the National Practitioner Data Bank (NPDB) can hinder patients’ ability to obtain crucial information about healthcare professionals’ professional credentials and conduct. This restricted access can potentially impact patients’ capacity to make well-informed decisions about their healthcare.

Question 31

What is HIPAA? What is its significance? What are the positive features of HIPAA and what are its negative features?

Answer 31

HIPAA stands for the Health Insurance Portability and Accountability Act, which is a federal law enacted in 1996. HIPAA has several key provisions aimed at protecting individuals’ health information, ensuring the portability of health insurance coverage, and providing for the security and privacy of health information.

The significance of HIPAA lies in its comprehensive approach to safeguarding sensitive health information and promoting the portability of health insurance coverage. It establishes rules and standards for the secure electronic exchange of health information, and it requires healthcare providers, health plans, and other entities that handle health information to implement safeguards to protect the confidentiality, integrity, and availability of that information.

positive
Protection of Health Information
Enhanced Patient Rights

negative
Limited Enforcement and Penalties
Costs

Question 32

Define the four key principles of bioethics (Autonomy, Beneficence, Nonmaleficence and Justice)

Answer 32

Autonomy: The right of individuals to make their own decisions about their own lives and bodies, including their medical care.

Beneficence: The duty of healthcare providers to act in the best interests of their patients and to do good for them.

Nonmaleficence: The duty of healthcare providers to do no harm to their patients and to minimize the risk of harm.

Justice: The fair distribution of healthcare resources and the fair treatment of patients, without discrimination.

Question 33

What is Utilitarianism? What are strengths and weaknesses of Utilitarianism? Provide an example. Do you think Utilitarianism is fair? Why or why not? (in the context of health law and ethics)

Answer 33

considered morally right if it produces the greatest overall happiness or pleasure for the greatest number of people. Utilitarianism is often associated with the principle of “the greatest good for the greatest number.”

strength
Promotes the Common Good

weaknesses
Difficulty in Measuring Happiness
Potential for Injustice
Lack of Respect for Individual Rights

Suppose a hospital has a limited number of ventilators during a pandemic and must decide which patients to prioritize. Utilitarianism might suggest that the hospital should prioritize patients who are most likely to benefit from the ventilator and recover, as this would produce the greatest overall happiness for the greatest number of people.

As someone who opposes Utilitarianism in the context of health law and ethics, I believe that this approach can be inherently unfair and unjust. While Utilitarianism focuses on the overall happiness or pleasure of the greatest number of people, it often overlooks the rights and interests of individuals, particularly those who are most vulnerable or marginalized.

Question 34

If you were asked to develop a better healthcare system, what are the top three changes you would make? Why have those changes not been adopted already?

Answer 34

Universal Access to Healthcare
Preventive Care Focus
Transparency and Accountability

not adopted:
Political Opposition
Financial Concerns

Question 35

What is a Qui Tam Relator? Under what conditions would you be a Qui Tam Relator? Is it fair to reward a Qui Tam Relator? Why or why not?

Answer 35

A Qui Tam Relator is an individual who brings a lawsuit on behalf of the government against a person or entity that has defrauded the government. Whistleblower.

conditions:
knowledge of fraud
first to file- gets 30%

argue that rewarding whistleblowers encourages individuals to come forward with information about fraud and helps the government recover funds that have been wrongfully obtained. This can lead to improved accountability and transparency in government contracting and healthcare.

Question 36

What is the name of the government office that maintains the exclusions list? What does it mean if an individual gets on the list. Generally, how do you get on the list? Is that fair?

Answer 36

The government office that maintains the exclusions list is the Office of Inspector General (OIG)

it means that they are excluded from participating in federal healthcare programs, such as Medicare and Medicaid. This exclusion can have serious consequences, including the loss of the ability to bill federal healthcare programs for services rendered and the potential for civil monetary penalties and other legal actions

how u get on list:
Criminal Convictions
Program-Related Actions

agree that it is fair for individuals or entities to be excluded from federal healthcare programs if they have been convicted of certain criminal offenses, such as healthcare fraud, patient abuse, or controlled substance violations. This helps protect the integrity of federal healthcare programs and the beneficiaries they serve.

Question 37

Explain the elements of Mail Fraud or Wire Fraud.

Answer 37

Mail fraud and wire fraud are federal crimes that involve the use of the mail or electronic communications to defraud individuals or entities.

Intent to Defraud
Use of the Mail or Electronic Communications

Punishment is up to five years in prison or up to a million dollar fine for each charge.

Question 38

What does the term ERISA mean? Generally, why was ERISA put in place?

Answer 38

ERISA stands for the Employee Retirement Income Security Act. It is a federal law that was enacted in 1974 to protect the interests of employees who participate in employee benefit plans, such as pension plans, health insurance plans, and other welfare benefit plans.

reasons:
Protection of Employee Benefits
Funding and Tax Incentives

Question 39

What is the Anti-Kickback Statute? Generally, what does it prohibit? What are the possible punishments for violation of the Anti-Kickback Statute?

Answer 39

The Anti-Kickback Statute (AKS) is a federal law that prohibits the exchange or offer of anything of value in an attempt to induce or reward the referral of federal healthcare program business.

The AKS prohibits any person or entity from knowingly and willfully offering, paying, soliciting, or receiving remuneration in exchange for referrals of patients covered by federal healthcare programs, such as Medicare and Medicaid.

3x damages and fines up to $25,000 or up to 5 years in prison per violation