Midterm Exam Case Studies Flashcards
IRAC Analysis: National Federation of Independent Business v. OSHA (2022)
ISSUE: Whether OSHA had statutory authority to impose a COVID-19 vaccine-or-test mandate on employers with 100+ employees.
RULE: 1) Administrative agencies can only exercise powers granted by Congress; 2) Under the “major questions doctrine,” Congress must speak clearly when authorizing agencies to exercise powers of vast economic and political significance; 3) OSHA’s authority is limited to regulating “occupational” safety and health hazards.
ANALYSIS: The Court found that COVID-19 is not an occupational hazard but a universal risk present in all settings. OSHA’s mandate failed to account for the crucial distinction between occupational risk and general risk. The vaccine-or-test requirement was unprecedented in scope, affecting 84 million workers, and represented a significant expansion of OSHA’s authority without clear congressional authorization. While OSHA could regulate specific workplace risks related to COVID-19 (like researchers working with the virus), a blanket mandate exceeded its statutory authority.
CONCLUSION: The Court stayed OSHA’s vaccine-or-test mandate, finding that the agency exceeded its statutory authority by attempting to regulate a general public health threat rather than an occupational hazard.
IRAC Analysis: Jacobson v. Massachusetts (1905)
ISSUE: Whether a Massachusetts law permitting cities to require smallpox vaccination violated Jacobson’s constitutional rights.
RULE: 1) States possess police power to enact reasonable regulations to protect public health; 2) Individual liberty is not absolute and is subject to reasonable restrictions for the common good; 3) Courts should defer to legislative judgment on public health matters unless the measure has “no real or substantial relation” to public health or is “beyond all question, a plain, palpable invasion of rights.”
ANALYSIS: The Court found that Massachusetts acted within its police power to protect public health. The smallpox vaccination requirement was a reasonable means to combat a dangerous epidemic based on medical and scientific understanding. While acknowledging that liberty is protected by the Constitution, the Court emphasized that liberty does not mean absolute freedom from restraint, as organized society requires certain restrictions for the common welfare. The Court noted it would not substitute its judgment for the legislature’s on a matter of medical expertise and public safety.
CONCLUSION: The Court upheld the Massachusetts vaccination law as a valid exercise of state police power that did not violate constitutional rights, establishing a precedent that states can mandate vaccinations to protect public health.
White v. Harris (Telepsychiatry Case)
Issue: Whether a psychiatrist who conducted a one-time telepsychiatry consultation as part of a research study established a doctor-patient relationship with the patient, creating a duty of care.
Rule: A duty exists when “the relationship of the parties was such that the defendant was under an obligation to use some care to avoid or prevent injury to the plaintiff.” Courts consider factors including whether the doctor was in a unique position to prevent harm, the plaintiff’s reliance on the doctor’s expertise, and the closeness between the defendant’s conduct and the injury.
Analysis: Despite limited duration (90 minutes) and context (research study), the psychiatrist performed a psychiatric evaluation of the patient, offered recommendations for treatment, and had expertise the treatment team sought out. The court found it significant that the doctor’s involvement was through a referral from the patient’s treatment team and that he reported findings and recommendations after evaluation.
Conclusion: The Supreme Court of Vermont held that the telepsychiatry consultation created a doctor-patient relationship that imposed a duty of due care on the psychiatrist, even though it was limited in scope and formally terminated after the evaluation.
Mills v. Pate (Liposuction Case)
Issue: Whether a cosmetic surgeon’s statements that a patient would look “beautiful” after liposuction with “smooth skin and no bulges” constituted an enforceable express warranty.
Rule: A physician may be held liable for breach of express warranty when making specific representations about surgical results that do not require a determination of whether the physician failed to meet the standard of medical care.
Analysis: The patient presented evidence that the surgeon promised she would look beautiful after surgery with smooth skin and no bulges. The court distinguished between express warranties (specific promises about results) and mere opinions/statements about the procedure. While related to their professional relationship, these representations were not inseparable from her negligence claims and didn’t require determination of whether the doctor failed to meet medical standards.
Conclusion: The court found sufficient evidence existed to support the patient’s breach of express warranty claim. When a physician promises particular surgical results and those promises form the basis of the parties’ bargain, the physician may be held liable for breach of express warranty if the results don’t match what was promised.
Hawkins v. McGee (Hand Case)
Issue: What is the proper measure of damages when a surgeon breaches a warranty promising a “100% perfect hand” through a skin grafting operation?
Rule: The measure of damages for breach of warranty is “the difference between the value of the machine [or body part] if it had corresponded with the warranty and its actual value” plus incidental losses that were reasonably foreseeable.
Analysis: The court rejected including pain and suffering as an element of damages because it was part of the consideration the patient gave for the promised result. The proper measure was the difference between the value of a perfect hand (as promised) and the value of the hand in its post-operation condition. Presenting “change for worse” as a separate element of damage was erroneous and misleading.
Conclusion: The Supreme Court of New Hampshire held that damages should be based on the difference between the value of a perfect hand as warranted and the actual value of the hand after surgery, not on pain and suffering or worsened condition as separate elements.
Ostrowski v. Azzara
ISSUE:
Does a patient’s poor pre-treatment health habits (smoking, failure to maintain proper weight/diet/blood sugar) constitute comparative fault that can bar recovery in a medical malpractice case?
RULE:
Pre-treatment health habits of a patient cannot be considered as evidence of fault that would bar recovery for injury due to professional misconduct.
Post-treatment conduct may be considered for mitigation of damages but will not bar recovery except to the extent the patient’s fault caused specific damages.
The defendant bears the burden of proving that their mistreatment did not aggravate a preexisting condition and that damages were avoidable by the plaintiff.
ANALYSIS:
The diabetic plaintiff with circulatory problems suffered complications requiring multiple bypass surgeries after the podiatrist performed toenail removal surgery without adequate vascular testing. The jury found the doctor negligent but denied recovery because they determined plaintiff’s fault (51%) exceeded the doctor’s (49%). The court held the trial instructions failed to properly distinguish between:
Pre-treatment habits (which cannot be considered as comparative fault)
Post-treatment conduct (which can only mitigate damages, not completely bar recovery)
Actions that truly cause specific damages
CONCLUSION:
The Supreme Court reversed, holding that a patient’s pre-treatment health habits cannot be considered as comparative fault, and post-treatment conduct can only reduce damages to the extent it actually caused those damages. The case was remanded for proper instructions.
Wickline v. State of California
ISSUE:
What legal responsibility does a third-party payer (Medi-Cal) have when its cost containment program allegedly affects a physician’s treatment decisions, resulting in harm to a patient?
RULE:
A third-party payer can be held legally accountable when medically inappropriate decisions result from defects in cost containment mechanisms.
However, a physician who complies with limitations imposed by a third-party payer when medical judgment dictates otherwise cannot avoid ultimate responsibility for patient care.
The determination of medical necessity and discharge decisions remain the treating physician’s responsibility.
ANALYSIS:
Medi-Cal denied the physician’s request for an 8-day hospital extension for the plaintiff following vascular surgery, authorizing only 4 days. The patient was discharged and later suffered complications requiring leg amputation. Although Dr. Polonsky felt intimidated by Medi-Cal, he admitted he could have appealed, kept the patient hospitalized despite denial, or made further efforts if he believed her condition was critical. All medical witnesses agreed the discharge met the standard of care. Medi-Cal was not given the opportunity to override the medical judgment since no further appeal was made.
CONCLUSION:
The court reversed plaintiff’s judgment, holding that while third-party payers can be liable when cost containment mechanisms lead to harm, in this case Medi-Cal was not liable because the physicians made the discharge decision within standard of care and did not attempt to challenge the payment denial.
Helling v. Carey
ISSUE:
Should ophthalmologists be held liable for failing to administer a pressure test for glaucoma on patients under 40, despite this not being the standard practice in the profession?
RULE:
The standard practice of a profession is not conclusive of what constitutes reasonable care when a simple, harmless test could detect a serious condition.
Courts can establish that certain precautions are so imperative that even their universal disregard will not excuse their omission.
Sometimes reasonable prudence requires more than common practice.
ANALYSIS:
The plaintiff, under 40, developed glaucoma that was not detected until significant vision loss had occurred. Medical experts for both sides confirmed that standard practice did not require routine pressure tests for glaucoma on patients under 40 because of the disease’s rarity in this age group (1 in 25,000). However, the test was:
Simple and inexpensive
Harmless
Definitive in detecting glaucoma
Capable of preventing irreversible damage through early detection
CONCLUSION:
The court held that, as a matter of law, the standard of reasonable care required administering the pressure test regardless of the patient’s age, even though this exceeded the standard practice of the ophthalmology profession. This established judicial authority to determine when professional standards are inadequate to protect patients.
