PREFACE – OVERVIEW
Legal Medicine v. Health Law
Legal Med – Health law 1 – Physician patient relationship
Health Law – Health law 2 – Organization and delivery and regulation of health care (insurance, medicare, medicaid etc…)
Health law 3 (theoretical) – Bioethics (reproductive, stem cell, death & dying etc…) (seminar course)
Human subject experimentation (seminar course)
Defining Illness –
Subset of disease (not all disease is illness).
Katskee: Any abnormal condition of the body that with its probable progression would cause problems is considered illness.
Quality Issues in Health Care
What is quality
1. Process – interaction between Doc and pt
a. Positive social & psychological interaction
2. Structure – equipment, dollars, personnel
a. Application of technology that maximizes benefits without increasing risk.
3. Outcome – a change in pt condition based on preceding tx
ii. IOM = Institute of Medicine
1. Quality is the degree to which health care will result in desired health outcomes.
Indicators of healthcare quality:
i. Hospital Morbidity/Mortality rates
ii. Adverse event rates
iii. Disciplinary actions
iv. Malpractice awards
v. Process evaluation of doctor tx
vi. Doc specialization
vii. Pt self assessment
viii. Available hospital services
CQI – Continuous Quality Improvement
i. Eliminate unnecessary tx to improve quality and decrease cost.
ii. Focus on outcome and process
iii. Don’t blame staff, use staff to help bring out error and improve quality
i. Buffers: design feature that corrects or allows for correction of error. (ex. Redundancy)
ii. Forcing functions: means to simplicity. Prevents action without meeting critical precondition first.
iii. Standardization: reinforces pattern recognition.
Medical Error Prevention:
i. Less reliance on MEMORY
ii. Improved INFORMATION ACCESS
iii. Error proofing. (forcing functions)
vi. Error absorption (buffers)
i. Risk Management:
1. Outcome oriented
2. to protect hospital staff
3. to manage liability of hospital
4. Uses incident reports – discoverable in civil case
ii. Quality assurance
1. Process oriented
2. Focuses on patient care
JAHCO – deemed status with CMS
i. Sentinel Events policy
1. Event = unexpected occurrence involving
b. Severe injury
c. Or risk thereof
e. Wrong site surgery
f. Infant abduction
2. Must report, or Conduct root cause analysis
a. Start at mistake and look backwar
iv. Licensing board has access upon application
v. General public has no access
Alternative and Complementary Medicine
The Practice of Medicine, defined:
i. The standard of care is “the treatment provided by physicians treating similar patients.”
ii. “A physician must use that degree of skill and learning used by members of the profession in similar circumstances.” Even if different doctors would apply the facts and arrive at a different result.
iii. McDonagh: Innovation is not widely accepted, and “widely accepted” is not the standard.
Healing Arts include a system for the ascertainment, cure, relief or correction of human disease.
Delegation Statute: Practice of Healing Arts does not include persons who’s services are performed under the supervision of a licensed professional.
Ruebke: Widwifery is not a practice of the healing arts. Just because a doctor provides the same services does not make it medicine.
Mauceri v. Chassin: The referral of home care nurses was statutorily defined, and thus under the regulation of the board.
Scope of Practice:
Practice scope defined by statute:
Delegation exceptions: Statutory and usually broad.
Licensing: Statutory requirement
i. Mauceri: Statute required license for home health agency referrals. Held: defendant enjoined until licenced.