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Health Law
South Texas College of Law Houston
Carnahan, Sandra J.

Health Law
Professor Carnahan
Spring 2010
Essay Qs modeled after cases and the PROBLEMS in the text
General themes of Health law:
1.    Cost
a.    Why does it cost so much? Dr incentives to provide more or less care? Healthcare fraud and abuse
b.    3 most important statutes
                                         i.    Anti-kickback law
                                        ii.    False Claims Act
                                       iii.    Stark Law –prohibits referrals to entities that Dr. has an ownership interest
2.    Quality
a.    What makes quality healthcare? what makes it good or bad? hospital programs to ensure quality, state and fed acts, medical error, medical mistake
b.    Med malpractice
3.    Access
a.    Who is uninsured and why? Do drs have a duty to provide some kind of care? Do ppl have a right to care when needed? What type of healthcare should or should not be covered? Who decides? Who does have healthcare and how do they get it (employers etc)? Statute limitations and federal programs, Medicare, Medicaid (for the “deserving poor”), federal safety net programs. What is manage care (relationship btwn insurance co, drs, employers etc)? Healthcare reform  
4.    Ethics
a.    Bioethical area- questions about life/death, abortion, when life begins, end of life care, organ distribution, genetics, biotechnology
Defining Sickness: (Ch. 1)
A.   The process of utilization and review- Process for insurance companies to determine what is covered
B.    For Ct to determine if it is an illness
a.    Look at K- is it plain on its face in what it covers?
                                         i.    If ambiguous, look at intent of parties. Construed in favor of P.
b.    From medical dictionary: anything not within normal functioning of body and natural progression is expected to be problematic
A.   More care v. better care
B.    Geographic inconsistency- (EX: tonsils out of a lot of kids in one county vs. another county) 
C.   Most care needed is actually for chronic diseases and doesn’t require high technology
D.   Role of financial incentives
a.    Fee for service
b.    Managed care
Problem with medical error:
A.   Iatrogenic injury
a.    injury caused by the medical system itself
b.    EX) nosocomial- refers to infections contracted in the hospital that are potentially preventable
c.    EX of preventative measures:
                                         i.    Computerized fail safe systems (like pain killers through iv to keep from overdose)
                                        ii.    Standardization of every floor (keeping everything the same on each floor)
B.    Institute of Medicine Reports:
a.    To advise government on matters of health
b.    Medical error is 8th leading cause of death in U.S.
c.    Root Cause Analysis:
                                         i.    Take the problem and step by step work backwards to determine where the problem originated
C.   Responses medical error:
a.    Quality assurance programs
                                         i.    Training, edu, standardization, checklists, forcing function
b.    Clinical guidelines
                                         i.    Results of clinical trials
                                        ii.    Guide for what Drs are to do under certain circumstances
c.    Best Practices
                                         i.    Come from professional groups
d.    Government Regulation
                                         i.    Federal Patient Safety Act of 2003
                                        ii.    Joint Commission for Accreditation of Healthcare Organizations (not really govt) (JCAHO)
1.    Nations predominate body for setting standards for healthcare institutions (not just hospitals)
2.    Accreditation is voluntary, but most all hospitals are anyway because that deems the hospital worthy of all certification requirements for Medicare
3.    Sentinel events policy- must report a list of errors if they occur to the certification body (list similar to the TX list) 
                                       iii.    CMS Never-Events (Center for Medicare and Medicaid Services)
1.    If you do certain things that are preventable then the govt will not pay for them
a.    Such as: object left in body after surgery, given wrong blood type, UTI from catheter, bed sores (if not present when patient comes to hospital) 
                                       iv.    Pay for performance
1.    CMS Never-Events is an example of pay for performance
2.    Other programs are experimenting with paying Drs for good outcomes
                                        v.    Consumer information
1.    Comparing hospitals, Drs etc. online
                                       vi.    TX
1.    Texas Medical Board
a.    Gives a list of violations that endanger your license
b.    Also list of various sanctions that a Dr can be subject to for violations
c.    RESULT: States regulate the practice of medicine through their licensing power
2.    State Patient Safety Program
a.    Hospitals have to have a written safety program
b.    Internal reporting only (if happens in that hospital, stays in that hospital)
c.    HAVE to be disclosed:      
                                                                                         i.    Surgery on wrong body part, wrong blood products given, sexual assault, patient suicide, stolen newborn, etc.

                            iii.    Administrative costs
                                       iv.    Malpractice
1.    Premiums and practicing defensive medicine because worried about lawsuits
                                        v.    Treating “hopeless cases”
1.    Heroic interventions
                                       vi.    Labor costs
1.    Drs make more in this country than other countries
                                     vii.    Technology
                                    viii.    Pork barrel politics
1.    Rapid growth in expenditures on public programs
C.   Approaches to expanding Access/Control Costs
a.    Social Ins
b.    Public programs
                                         i.    Germany- good example- everyone has to purchase insurance within a certain income level (75% of population) and is paid by an employment tax – state subsidizes remaining population that is below the income level
                                        ii.    Rationale- Members of society have an obligation to help each other
c.    National Insurance
                                         i.    UK- financing is through a general tax entirely
D.   Getting people to purchase insurance
a.    Tax credits
b.    Mandates
E.    Control costs
a.    Budget
b.    Managed competition
                                         i.    Similar to social insurance plan
                                        ii.    Competition btwn insurance companies would make prices decline
c.    Managed case
d.    MSA/HAS
                                         i.    Medical Savings Account
1.    Takes part of your paycheck automatically and the money is dedicated to healthcare expenses not covered by insurance or to pay deductibles (not taxed)
2.    Problem is it is a “use it or lose it” so if you don’t use it by the end of the year the $ is gone
                                        ii.    Health Savings Account
1.    Consumer directed healthcare (2 parts)
a.    HAS- is actually a savings account- both employees and employer put $ in it- can pay for everything that your insurance doesn’t cover- also pre-taxed $
b.    High deductable health policy- accompanies the HAS