Quiz 3 Textbook Discussion Questions Flashcards
Why is the history of healthcare institutions important to understanding their legal liability today?
Evolution from charitable immunity to corporate liability; shift from physician-centered to institutional care; growing public expectations of institutional quality; development of regulatory frameworks; precedents that shaped current liability doctrines.
Why has the importance of independent contractor status declined in recent years?
Rise of apparent agency doctrine; increasing institutional control over physicians; public perception of unified care delivery; courts’ focus on patient expectations rather than contracts; hospitals advertising comprehensive services.
How is corporate liability different from liability under respondeat superior?
Direct vs. vicarious liability; based on institution’s own negligence not employee actions; focuses on institutional duties to patients; requires proving institution’s breach of duty; can exist alongside respondeat superior claims.
What is the liability of an MCO when it makes decisions about insurance coverage for hospital stays?
Potential liability for coverage denials; utilization review decisions; tension between cost management and patient care; distinction between medical necessity and coverage determinations; possible ERISA protection from state tort claims.
Why is ERISA preemption an important consideration for MCOs?
Shields from state-law damages; limits recovery to benefit cost plus fees; preempts state causes of action; creates federal uniformity in employer benefits; significantly reduces MCO liability exposure.
What is the “tangled ERISA regime,” and what are the chances Congress will unsnarl it?
Complex federal-state regulatory overlap; inconsistent court interpretations; technical distinctions between medical and administrative decisions; limited remedies for patients; unlikely congressional action due to insurance industry influence and political gridlock.
Who has ultimate responsibility for decisions about medical staff membership, and why?
Hospital governing board/trustees; legal accountability for institutional quality; fiduciary duty to patients; compliance with regulatory requirements; oversight of credentialing process while respecting medical staff recommendations.
What differences exist between due process standards for public vs. private hospitals?
Public hospitals bound by constitutional requirements; private hospitals follow bylaws and common law; different hearing requirements; varying judicial review standards; state-specific statutory protections may equalize standards.
What categories of professionals are permitted membership on the medical staff?
Physicians (MDs/DOs); dentists; podiatrists; clinical psychologists; advanced practice providers (varying by state); certain allied health professionals under supervision; expanding to include more non-physician practitioners.
What issues of confidentiality and liability does the hospital’s peer review function present?
Tension between transparency and frank evaluation; statutory peer review protections; reporting requirements to national databases; potential liability for inadequate review; balancing physician privacy with patient safety.
How does HCQIA establish “objective reasonableness” rather than “good faith” for peer review?
Focuses on process quality not reviewer motives; establishes specific procedural requirements; creates presumption of proper action if procedures followed; shifts burden to challenger; evaluates actions against reasonable belief standard.
What are the medical staff privileges of contract physicians and CAM/integrative providers?
Contract physicians often have limited privileges tied to service agreements; CAM providers have variable status depending on state licensing; typically more restricted scope; often require physician supervision; limited admitting privileges.
What is the ACO concept and its role in 2010 health reform?
Accountable Care Organizations; provider networks coordinating care; shared savings payment models; emphasis on quality metrics and cost control; alternative to fee-for-service; mechanism for Medicare delivery system reform.
What is common law’s traditional viewpoint on bystander duty, and how has it changed?
No traditional duty to rescue strangers; special relationships create duties; healthcare professionals have higher standards; EMTALA created statutory duty for hospitals; state Good Samaritan laws encouraged voluntary assistance.
What is a hospital’s duty to someone requesting ED treatment? Does indigency matter?
EMTALA requires medical screening regardless of payment ability; stabilization before transfer; no discrimination based on financial status; civil penalties for violations; extends beyond designated ED to hospital property.
What effects have Good Samaritan statutes had on duty to render aid?
Encourage voluntary assistance by limiting liability; protect healthcare providers outside work settings; typically require good faith actions; vary by state in scope and protection; generally don’t create affirmative duty to assist.
What are the two types of consent for medical treatment? When does each apply?
Express consent (explicit authorization) for planned procedures; implied consent (inferred from actions) in emergencies or routine care; express preferred for invasive treatments; implied appropriate when consent reasonably assumed.
What is the standard for consent in an emergency?
Implied consent presumed when patient cannot consent; treatment limited to emergency needs; reasonable person standard applies; ceases when patient can consent; overridden by known prior refusal.
What is the hospital’s role in obtaining informed consent?
Supporting documentation process; policy development; ensuring compliance with regulations; physician bears primary responsibility; hospital liable if inadequate systems or if apparent agency applies.
What is required for informed consent to be valid?
Patient capacity/competence; voluntariness (no coercion); adequate information disclosure; understanding of information; authorization for specific procedure/treatment; properly documented.
How does informed consent apply to competent patients refusing lifesaving treatment?
Right to refuse must be respected; capacity verification required; thorough documentation needed; ethics consultation advisable; court involvement rarely necessary unless third-party interests involved.
What are advantages/disadvantages of living wills vs. DPOA for healthcare?
Living wills: specific but inflexible, often unavailable, limited to end-of-life. DPOA: flexible decision-maker, interpretation possible, potential surrogate disagreement, surrogate may not know wishes. Both better than no directive.
Explain why aid-in-dying laws are or are not “euthanasia”
Not euthanasia: patient self-administers; requires capacity; patient controls timing; physician passive role. Similar: intentional ending of life; involves prescription; physician participation; designed to cause death. Legal distinction maintained in statutes.
Can Buck and Skinner decisions be reconciled?
Represent evolving views on reproductive rights; Buck allowed forced sterilization while Skinner protected reproductive freedom; different eras’ scientific/ethical standards; Skinner effectively overruled Buck’s eugenic principles without explicit reversal; demonstrates constitutional interpretation evolving with societal values.
What is the difference between wrongful life and wrongful birth cases?
Wrongful birth: parents’ claim child would not have been born but for negligence; damages for unexpected costs. Wrongful life: child’s claim they shouldn’t exist; philosophical difficulties valuing non-existence; different damages calculations; wrongful birth more widely recognized.
How should hospitals handle providers refusing services for religious reasons?
Balance provider conscience rights with patient access; develop clear policies; ensure patient notification; maintain emergency coverage; provide reasonable accommodations without undue burden; consider institutional mission and community needs.
