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Segall SE, Pearl W. Should due process be part of hospital peer review? South Med J. 1993;86:368–369. Setness PA. What do you know about the NPDB? Postgrad Med. 1996;100:15–16, 21– 22. Sfikas PM. Peer review and antitrust. J Am Dent Assoc. 1997;128:496–498. Sheets V. Why disciplinary databanks? Why the National Practitioner Data Bank (NPDB)? Issues. 1996;17:10–11. Smart CM III. The peer review privilege: what documents are protected from discovery in litigation. Mo Med. 1998;95:205–206. Smith MA, Atherly AJ, Kane RL, Pacala JT. Peer review of the quality of care: reliability and sources of variability for outcome and process assessments. JAMA. 1997;278: 1573–1578. Snelson E. Quality assurance implications of federal peer review laws: the Health Care Quality Improvement Act and the National Practitioner Data Bank. Qual Assur Util Rev. 1992;7:2–11. Snelson EA. Peer review, hearing requirements, and antitrust: maximizing federal Health Care Quality Improvement Act compliance and immunity. J Med Assoc Ga. 1992;81:495– 497. Snelson EA. Physicians under surveillance: the National Practitioner Data Bank. Minn Med. 1993;76:31–33. Stern DF. Handling clinical incidents. Nurs Manage. 1997;28:48B–48C, 48G–48H. Todd JS. National Practitioner Data Bank: just numbers or knowledge? Public Health Rep. 1995;110:377–378. Wolfe SM. Congress should open the National Practitioner Data Bank to all. Public Health Rep. 1995;110:378–379. Wolfe SM. Questionable doctors—lots of them! Revolution. 1996;6:20–22, 85. Wyden R. Transparency: a prescription against malpractice. Public Health Rep. 1995;110:380–381. Yessian MR. Putting the controversy aside, how is the Data Bank doing? Public Health Rep. 1995;110:381–382. XV. Public Health and Communicable Disease Control HIGHLIGHTS The Constitution grants the states broad powers to protect the public health. Public health puts the safety of society above the rights of the individual. 459
Introduction All medical care practitioners have duties under the public health laws. Disease reporting is critical for controlling existing and emerging infectious diseases. Medical care practitioners have many statutory reporting duties. From Pasteur’s and Koch’s discoveries in the 1800s through the conquering of polio in the 1950s, public health was one of the most prominent and powerful medical specialties. All physicians received training in basic public health and public health officers were respected members of the community. With the advent of magic bullets, effective vaccines, and widespread sanitation, public health fell into disrepute. When the National Institutes of Health studied the public health system in the United States, it found a system in chaos, with little consistent professional leadership. [Institute of Medicine (U.S.). Committee for the Study of the Future of Public Health. The Future of Public Health. Washington, DC: National Academy Press; 1988.] In retrospect, it is clear that the disorganized public health system hastened the spread of HIV/ AIDS in the United States. The advent of new emerging infectious diseases and the resurgence of old foes such as tuberculosis and foodborne illness has made public health newsworthy again. With the realization that bacterial and viral resistance is bringing the golden age of antimicrobials to an end, public health is again becoming a concern for every medical care practitioner. The internist who diagnoses salmonellosis in a patient, the emergency room physician who suspects that a child may have been abused, and the family practitioner who signs a death certificate, wear the cloak of public health in these endeavors. Many medical care practitioners are unaware of these public health responsibilities. This section introduces the basic legal and medical issues in public health that every medical care practitioner should know. [Maxcy KF, Rosenau MJ, Wallace RB. Public health and preventive medicine. Stamford, CT: Appleton & Lange; 1998.] A. Disease Control The control of communicable disease, the essence of traditional public health, is not the same as the internal medicine subspecialty of infectious disease treatment. This subspecialty is concerned with the treatment of individual patients infected with viral and bacterial organisms, and the training is oriented to individual patients, not the community. In contrast, disease control is concerned with the prevention of the spread of diseases in the community rather than the treatment of individual patients. Disease control was the core of public health until the last polio epidemics in the 1950s. With the development of antibiotics and effective immunizations, the public lost its fear of communicable diseases, undermining public support for disease control in the general populace and in schools of public health. Since the 1960s, public health has become a broad umbrella, encompassing every cause from nuclear war to controlling cholesterol levels. This loss of focus has weakened the disease control 460
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Public Health Law Map - Beta 5.7 I.
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1942.] The English statutory and co
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health or individual health officer
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actions through the district attorn
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3. The Judicial Branch The federal
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consumer protection, such as requir
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With these exceptions, most litigat
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the court in Los Angeles might allo
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subject matter and may also have in
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2. Implementing ADR The major benef
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III. Tort Claims against Private Pa
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cannot be proved, but it is clear t
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uterus, triggering a miscarriage. T
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first were passed immediately after
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years. If the practitioner violates
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defendant’s conduct or (for the d
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proving a case against a physician
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e important for their adult medical
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emoving the plantar wart. This emph
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Blake BL. Sgt. Friday, Dr. Welby, a
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Walter C, Richards EP. Keeping junk
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earning capacity. b) Medical Expens
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simple as installing wheelchair ram
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cases do not give rise to injury-re
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medical costs from the lawsuit. Som
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compilation of legal principles. It
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traditional sense. Fetal heart moni
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oxygen saturation. When saturation
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1993;56:12-14. King JY. Practice gu
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are handled through an administrati
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U.S.C. § 1491. As such, the Court
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waiving immunity provide the only m
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against the United States in federa
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A discretionary function is an act
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deviant sexual conduct by an Air Fo
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The government can be liable under
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decision of the hospital officials
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constitutional rights have been vio
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case basis. The critical element in
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allegedly defective product was a m
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that state law is displaced if it i
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adopted. Therefore, Congress may au
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alleged. The “color of state law
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Importantly, the DeShaney analysis
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In the context of public health, on
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Also, immunity from suit is preserv
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The mere fact a private corporation
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1. Absolute Immunity Absolute immun
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prisoners were infected with HIV an
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against physicians who sold prescri
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The key distinction between crimina
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it almost impossible for practition
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forced to give hair samples, blood
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medical care practitioner does not
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assume that a hospital has an incen
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fined not more than $25,000 or impr
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charitable, religious, or philanthr
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(2) The Everyone-Does-It Defense De
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automatically invoke attorney-clien
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The Federal government, and several
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e of no benefit to the community, t
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activities of the large professiona
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Some of these provisions, such as t
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not support the scheme to reduce ho
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(1) Sentencing Guideline Standards
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did not provide full information ab
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5. If an employee chooses not to re
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documents until the court had made
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Frech HE III, Danger KL. Exclusive
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1998;29:16-18. Stahl DA. Consolidat
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tampering. b) Search Warrants If th
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defense lawyers to fight claims tha
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a) Service of Process One distressi
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provide as little speculation from
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place for the deposition. Each part
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should include a signed release by
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juries will disregard scientific ev
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the jury may be out of the room for
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entered the patient’s description
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the information being presented is
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are situations where what is genera
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test so generously that it also gav
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defendant’s failure to render the
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fees may be construed as attempting
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Fish R, Rosen P. Physicians should
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$150,000 to fight a case that could
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case; rather, it encourages the att
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were below the acceptable standard
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A. Establishing Agencies For its fi
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local level because the employees a
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dispute before the court. The lawye
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c) The Goldberg Rights Persons whos
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the cost of butter. A public intere
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standards and who agree to complian
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a) Agency Interpretation of Law All
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Johnson JA. Court limits board of m
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persons—business law, constitutio
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5. Corporate Employers and Institut
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prohibited the attorney from asking
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supervising the work. A more fundam
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medical problems. Whether it is can
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for buying insurance is that it pay
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Lawyers working on a contingency do
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Review deposition summary: 30 Novem
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of an effective preventive law plan
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ibes were in the form of consulting
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detailed summaries of important doc
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A very important part of the invest
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cases. Houston Bar Assoc. 1996;34:2
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state civil rights laws and health
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must carry out these actions correc
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c) Informal Consultations One of th
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on relinquishing care and follow-up
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The manufacturers of emergency kits
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equire a consultation before certai
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any differences of opinion between
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to refer a patient to such an insti
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help the patient deal with the insu
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diagnostic interest to the physicia
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attendant duties. When they exercis
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physician must be notified at once.
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to find a specialist willing to see
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physicians, a recent U.S. Supreme C
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The law requires a physician to pro
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proper diagnosis. The physician los
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possible, the letter should be sent
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states than in others.) The best ra
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Medical licensing agencies and medi
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If there is a physician-patient rel
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(1) In general If any individual (w
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subject to a civil money penalty of
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condition described in paragraph (1
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(A) Placing the health of the indiv
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may not transfer the individual unl
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sent by certified mail, return rece
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Berlin L. Communication of the sign
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evaluation of distance medicine tec
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consent: reducing conflicts with pa
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) Children in the Emergency Room A
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such as cancer should be withheld f
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eing challenged over their good- fa
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would not require that the risk be
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usual in the community, and in othe
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consent to risks of the treatment b
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) Reasonable-Patient Standard This
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candidates for treatment if their u
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prospective reimbursement systems r
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The child’s legal status should b
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litigation. Most states allow a phy
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should be reported to the child pro
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mental suffering and injury. 5. No
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ensure that all other participants
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(1) The research involves no more t
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different dialects but with differe
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to consent to medical care. Convers
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person. The power of attorney may b
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eligious reasons. Parents may refus
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life-support technologies, patients
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use every possible avenue to prolon
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decision? The court found that Miss
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Cruzan really dead? Justice Rehnqui
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discussed in terms of the patient
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) Following the Patient’s Wishes
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Few termination of life-support cas
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than any element of human behaviora
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Law Policy. 1997;361. Brody, H. Com
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Furthermore, a physician who withdr
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Cunningham N. Fear and informed con
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Invest Radiol. 1996;31:109-113. Nic
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interests test. J Leg Med. 1991;12:
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esearch subjects: proposed guidelin
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1994;8:19-27. Silverman HJ. Ethical
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Insurance Portability and Accountab
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physician, just as the records of c
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and if the patient is the victim of
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Disabilities Act (ADA) limits an em
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that is part of routine medical car
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A description of each purpose of th
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services to the medical care provid
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Access to the records is subject to
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Use appropriate safeguards to preve
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when they were designing research s
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such as an antitrust or false claim
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contain, the potential for harm in
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identification of abnormal findings
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Anything that indicates special tre
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put in the chart to document that t
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keep personal notes, and often the
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night unless she has a serious conc
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difficult to authenticate, unless t
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225. Smith J. Good medical records
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The legal consequences of the corpo
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to set up their own practices or wo
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California. Independent Contractor:
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physician fail to obtain a proper i
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When a physician recommends unneces
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Because employers attempt to limit
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utilization review organization den
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to influence a treating doctor’s
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important if the employee injures a
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these rules vary greatly from state
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If, as frequently happens, the pati
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eviewed completely by the supervisi
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protocols become generic documentat
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Page 411 and 412: a. Penicillin V potassium 250 mg q.
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Page 423 and 424: is injured by a fellow workers’ n
Page 425 and 426: limited due process restrictions on
Page 427 and 428: agreeing to reimburse the MCO for a
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Page 431 and 432: Med Soc. 1996;148:341-343. Maurer W
Page 433 and 434: Fiesta J. Delegation, downsizing an
Page 435 and 436: XIV. Peer Review and Deselection HI
Page 437 and 438: the development of new legal theori
Page 439 and 440: juror’s perspective, peer review
Page 441 and 442: to deal fairly with citizens, these
Page 443 and 444: 5. There is an overriding national
Page 445 and 446: a) Notice of a Right to a Hearing T
Page 447 and 448: equest, to the physician or practit
Page 449 and 450: subchapter. Information about malpr
Page 451 and 452: the standards set forth in the Act,
Page 453 and 454: 2. The Problem of Bias Until recent
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Page 457 and 458: do cost-cutting that the physicians
Page 459: Med. 1997;18:521-538. Maguire D. Te
Page 463 and 464: we are due for another worldwide ep
Page 465 and 466: include nurses, dentists, veterinar
Page 467 and 468: marital disharmony. In the classic
Page 469 and 470: criticisms of the cost of contact t
Page 471 and 472: diseases such as the Marburg or Ebo
Page 473 and 474: organized, powerful political lobby
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Page 477 and 478: eligion or conscience. Thus, he can
Page 479 and 480: high, amounting to several dollars
Page 481 and 482: 1. Birth Certificates Normally the
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Page 485 and 486: D. Law Enforcement Reporting Every
Page 487 and 488: campus police. The campus police de
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Page 491 and 492: when they are acting as officers of
Page 493 and 494: eporting practices. J Emerg Med. 19
Page 495 and 496: Starr P, Starr S. Reinventing vital
Page 497 and 498: October;51:132]. J Am Med Womens As
Page 499 and 500: laws governing air and water pollut
Page 501 and 502: the widespread occurrence of tooth
Page 503 and 504: within the power of the judiciary t
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Page 507 and 508: Still other arguments center on all
Page 509 and 510: (Wash. 1955); Rogowski v. City of D
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adverse effects would occur was arb
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Kaul v. City of Chehalis, 277 P.2d
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Introduction There are special cons
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Under no circumstances should medic
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patients about high-risk behavior a
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arrier method that is only 70% effe
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injectable contraceptive that lasts
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that HIV is less of a threat than a
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for procedures affecting reproducti
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funded services to coerce a person
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The person who obtains the consent;
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The recognition of personal privacy
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medically necessary: On their face,
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Although abortion is still a surgic
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The presumption of legitimacy was a
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Unfitness is also narrowly defined
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consistent with public health and s
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constitutional protections or feder
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information in violation of confide
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Mary Sue’s ova were successfully
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But the rule does not contemplate t
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as not to violate this prohibition.
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committed before she knows the stre
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1. Adoption 2. Family Planning and
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Soderberg H, Andersson C, Janzon L,
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Hum Reprod. 1992;7:1029-1033. Snowd
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condition. This conflict can take t
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eaching a level of 1 per 11 births
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who has finally conceived after thr
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should be sure that she understands
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The treatment of infertility poses
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disorder should not be helped to co
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Choosing a sperm donor can be legal
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prevent the spread of disease, and
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problems before they cause accident
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Beyond a structured prenatal care s
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patient’s decisions. The patient
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covered in signs that ask women if
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decisions not to use medical interv
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lifesaving care. Many physicians ig
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profound differences in the underly
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midwife’s skills and judgment, as
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who might sue on her behalf or on t
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contraception, but contraception ha
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One example has been the developmen
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Marshall BM. Ethical issues in assi
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1995;115:39-43. Greely HT. Genetic
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3. General Obstetrics Abrams FR. Co
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King NM. Informed consent and the p
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XIX. Occupational Medicine and Disa
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and balances inherent in having gen
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putative illness, requesting an exc
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compensation system. The company ma
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In some circumstances, the union ma
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ethical obligations concerning the
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Records concerning voluntary employ
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employee’s health status.” In t
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films shall be preserved in their o
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Employees may also have a financial
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available information on the proper
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lood tests that are medically neces
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hospital. Both the medical care pro
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Section 504 was a remedial statute
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or recurrent, that the key word was
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government officials investigating
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incorrect, so this area of the law
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is to ensure that patients have eno
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problems. The Court also reiterated
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the medical problems have affected
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normal eyes and kidneys and no peri
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not constitute a disability. The pa
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workplace, their legal status is no
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hepatitis A, the onset of the disea
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(2) The nature and severity of the
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Many diseases are spread by insects
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eporting duties that apply to the c
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9. Bloodborne Pathogens All workpla
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this includes all types of medical
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clinics or home health visits. An i
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Purtilo RB. Ethical issues in the h
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Disabilities Act: a decision analys
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occupational accidents and diseases
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1998;13:241-272. Pollack R. Update
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legislation, set minimum standards
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hearing seems to be rooted in the l
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ates among drug addicts. Beyond the
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Team physicians’ duties are to th
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first aid and training programs are
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equired by the school is not accept
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interfere with getting the child pr
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4. Handicapped Children Handicapped
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1996;35:237-242. Cheng TL, Savageau
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Med Sci Law. 1995;35:45-47. Mitten
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handling prisoners in a burns unit.
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legislation. The FDA, DHHS, HCFA, a
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of a lower court to a higher, appel
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assaulted will bring a legal action
Page 705 and 706:
anesthesiologists and nurses with i
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Negligence to consider the plaintif
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declaratory judgments about the con
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Durable Power of Attorney ensurance
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fiduciary relationship, as is the r
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Hearsay Rule Testimony of what anot
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In Loco Parentis Literally, in the
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to dangerous products such as drugs
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filing of all official documents. I
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Perjury The willful act of giving f
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had that reasonable person been in
Page 727 and 728:
RICO The common abbreviation for st
Page 729 and 730:
person seeks damages or other legal
Page 731 and 732:
appropriateness. Vacate When a cour
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