U.S. health care

1. What is the role of the National Practitioner Data Bank (NPDB) in U.S. health care, and what are the requirements for healthcare organizations to report to the data bank? Provide some examples of events which you would find necessary to report to the NPDB

2. What are the legal requirements for healthcare professionals to report child abuse and elder abuse in the process of delivering healthcare? Are there any unique aspects of these laws for your own state? If so, please explain them. Also, using illustrative case examples, discuss the penalties that a person who failed to report child abuse and elder abuse would face.

3. Are there possible criminal aspects of HIV/AIDS? Consider the case law (attached) and elsewhere, and explain. Please provide specific examples.

4. Ethics and morality are related concepts in healthcare, but they are not the same thing. Explain the difference between ethics and morality in medicine. Provide at least one example for each concept

5. Summarize the key ethical theories which impact healthcare today. Provide several specific examples of healthcare applications for three of these theories.

6. Explain the concept of "wrongful birth" and present the key legal/ethical issues which accompany it.

7. Discuss the various types of discrimination in the healthcare workplace. How does the HR director in a healthcare facility avoid discriminatory practices?

8. What provisions (distinct parts) should always be included in a professional liability insurance agreement? List and briefly discuss each provision.

9. Review the case of Mathias v. St. Catherine's Hospital, Inc. Briefly discuss the facts, issue, holding, and rationale in this case. Explain the case's significance for healthcare law and healthcare facilities and professionals. What can we, as healthcare administrators, learn from this case?

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PHYSICIAN'S DUTY TO ADVISE: DELICATE MEDICAL JUDGMENT
Citation: Mathias v. St Catherine's Hosp., Inc., 569 N.W.2d 330 (Wis. App. 1997)

Facts

Mathias, a patient of Dr. Witt's at St. Catherine's Hospital, delivered a full-term son by cesarean section on February 2, 1993, while she was under general anesthesia. In the operating room, witt indicated that he needed a particular instrument that would be used in a tubal ligation. The nurses, Ms. Snyder and Ms. Perri, employees of St. Catherine have looked at Mathias's chart. Snyder informed Witt that she did not see a signed consent form for that procedure. In deposition testimony, Snyder stated that Witt replied, "Oh, Okay."

Witt performed a tubal ligation. Three days after the procedure had been done; a nurse brought Mathias a consent form for the procedure. This nurse told Mathias that the form was "just to close up our records" The nurse testified in her deposition that she signed Perry's name on the same consent form and backdated it to February 2 the day of surgery was performed . As the trial court noted in its oral decision granting summary judgment, these actions after surgery are immaterial to the issue of the hospital's duty to Mathias. The trial court granted summary judgment dismissing St. Catherine's from the malpractice action. Mr and Ms Mathias appealed the summary judgement contending that the hospital owed a duty to Mathias to prevent her physician from performing a tubal ligation for which there was no signed consent.

Issue

Did the hospital owe a duty to Mathias to prevent her physician from performing a tubal ligation for which there was no consent? Did the trial court err in granting summary judgment to St. Catherine's?

Holding

St. Catherine's fulfilled its duty of ordinary care to Mathias and therefore is not liable. The trial court's grant of summary judgment was affirmed.

Reason

The duty to advise a patient of the risks of treatment lies with the physician and not the hospital. The duty is codified in Wisconsin Statutes 448.30, which requires the following:

Any physician who treats a patient shall inform the patient about the availability of all alternate, viable medical modes of treatment and about the benefits and risks of these treatments. The physician's duty to inform the patient under this section does not require disclosure of:

1) Information beyond what a reasonably well qualified physician in a similar medical classification would know.
2) Detailed technical information that in all probability a patient would not understand
3) Risks apparent or known to the patient
4) Extremely remote possibilities that might falsely or detrimentally alarm the patient.
5) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment
6) Information in cases where the patient in incapable of consenting

This statute is the cornerstone of the hospital's duty in this case. The court noted that the legislature limited the application of the duty to obtain informed consent to the treating physician. Although the record is littered with semantic arguments about whether this is a case of non-consent or lack of informed consent, what the Mathiases sought was to extend the duty of ensuring informed consent to the hospital.

The duty to inform rests with the physician and requires the exercises of delicate medical judgment. It is the physician- not the hospital- who has the duty of obtaining informed consent. The surgeon, not the hospital, has the education, training and experience necessary to advise each patient of risks associated with proposed procedure. The physician is in the best position to know the patient's medical history and to evaluate and explain the risks of a particular operation in light of the particular medical history.

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DISCLOSURE OF PHYSICIAN'S HIV STATUS

Citation: Application of Milton S. Hershey Med. Ctr., 639 A.2d 159 (pa.1993)

Facts

The physician, John Doe, was a resident in obstetrics and gynecology (OB/GYN) at the medical center. In 1991, he cuts his hand with a scalpel while he was assisting another physician. Because of the uncertainty that blood had been transferred from Doe's hand wound to the patient through an open surgical incision, he agreed to have a blood test for HIV. His blood tested positive for HIV, and he withdrew himself from participation in further surgical procedures. The medical center and Harrisburg Hospital, where Doe also participated in surgery, identified those patients who could be at risk. The medical center identified 279 patients, and Harrisburg identified 168 patients who fell into this category. Because hospital records did not identify those surgeries in which physicians may have accidently cut themselves, the hospitals field petitions in the court of common Pleas, alleging that there was, under the confidentiality of HIV-Related information act [35 P.S § 7608(a)(2)], a "compelling need" to disclose the information regarding Doe's condition to those patients who conceivably could have been exposed to HIV. Doe argued that there was no compelling need to disclose the information and that he was entitled to confidentiality under the act.

The court issued the an order for the selective release of information by: (1) providing the name of Doe to physicians and residents with whom he had participated in a surgical procedure or obstetrical care;(2) providing a letter to the patients at risk describing Doe as a resident in OB/GYN ;(3) setting forth the relevant period of such service. The physicians were prohibited under HIV act from disclosing Doe's name. The superior court affirmed the decision of the trial court, and Doe appealed.

Issue

Was there a need to release selective information regarding Doe's HIV-positive status as determined by the trial court?

Holding

The Pennsylvania Supreme Court held that a compelling need existed for at least a partial disclosure of the physician's HIV status.

Reason

There was no question that Doe's HIV-positive status fell within the HIV act's definition of confidential information. There were however, exceptions within the HIV act that allowed for disclosure of the information. In this case there was a compelling reason to allow for disclosure of the information. All the medical experts who testified agreed that there was some risk of exposure and that some form of notice should be given to those patients at risk. Even the expert witness presented by Doe agreed that there was at least some conceivable risk of exposure and that giving a limited form of notice would not be unreasonable. Failure to notify patients at risk could result in the spread of the disease to other noninfected individuals through sexual contact and through exposure to body fluids. Doe's name was not revealed to the patients. Only the fact that a resident physician who participated in their care had tested HIV positive. "No principle is more deeply embedded in the law than that expressed in the maxim salus populi suprema lex,..... (the welfare of the people is the supreme law), and a more compelling and consistent application of that principle than the one presented would be quite difficult to conceive" (ld. At 163).