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give permission, the officer should be politely but firmly shown the door. If the patient is in custody, the officer still has no right to consent to or know about the patient’s medical care beyond the specific requirements of the state’s laws. Being under arrest increases the importance of the patient’s right of privacy. The physician must be careful not to interfere with the officer’s duties, just as the physician should not allow the officer to interfere with the patient’s medical care. If privacy is required for the medical examination, the patient’s dignity should be protected as much as possible consistent with preventing the patient’s escape. The physician should not interfere with actions that are necessary to maintain custody of a conscious and potentially dangerous prisoner. Court-ordered medical care is different from care requested by a peace officer. A police officer does not have the right to overrule a patient’s decisions on medical consent; a court does. A physician who is presented with a valid court order to do something to or for a patient may either honor the order or get a lawyer to fight the order. Physicians who are routinely involved with court- ordered care should be well versed in the procedures. The emergency physician in the county hospital may be routinely ordered to do drug testing on specific prisoners. This physician or the nurses who work there regularly may know the forms and the judges’ names and have no problem with honoring the order. The physician in a private hospital who is presented with an unusual order should contact the hospital attorney or someone in the court system for a clarification of the order. Some medical records are protected even from court orders, but these are usually in the custody of agencies that know the extent of their authority to withhold records. Venereal disease control programs frequently receive subpoenas for medical records that are protected from subpoena by state law. The judge in a divorce proceeding may not know about the law protecting these records or may have authorized that subpoena as one in a large group. The public health program will routinely request that the subpoena be quashed. A physician in public health or drug rehabilitation who deals regularly with protected records must view the possibility of spending some time in jail on a contempt citation as an occupational hazard. The physician who does not deal with these matters frequently should consult an attorney when presented with a court order. E. The Role of Community Physicians in Public Health ources available through the public health system and national organizations such as chemical manufacturers. A private physician should be cautious about making pronouncements on environmental hazards, either to patients or to the news media. An association between exposure and disease may seem obvious to a physician who has seen several cases, and yet be scientifically incorrect. A physician who publicly accuses a business of wrongdoing, rather than making a report to the health department, may be open to a suit for damages by the business. Public health officials are protected from such suits 489
when they are acting as officers of the state. Their job is made more difficult by the publicity that often arises when individual physicians seek to publicize public health risks. It is better to discuss the problem with the health department personnel before attempting to publicize a risk that may not be significant. If, however, the health department is unresponsive, the physician might want to contact a state or national environmental protection group. F. References - Public Health 1. Disease Control Allos BM, Genshelmer KF, Bloch AB, et al. Management of an outbreak of tuberculosis in a small community. Ann Intern Med. 1996;125:114–117. Balogun MA, Wall PG, Noone A. Undernotification of tuberculosis in patients with AIDS. Int J STD AIDS. 1996;7:58– 60. Behr MA, Hopewell PC, Paz EA, Kawamura LM, Schecter GF, Small PM. Predictive value of contact investigation for identifying recent transmission of Mycobacterium tuberculosis. Am J Respir Crit Care Med. 1998;158:465– 469. Braden CR. Infectiousness of a university student with laryngeal and cavitary tuberculosis: investigative team. Clin Infect Dis. 1995;21:565–570. Braveman P, Pearl M, Egerter S, Marchi K, Williams R. Validity of insurance information on California birth certificates. Am J Public Health. 1998;88:813–816. Chen RT, Rastogi SC, Mullen JR, et al. The Vaccine Adverse Event Reporting System (VAERS). Vaccine. 1994;12:542–550. Clarke J. Contact tracing for chlamydia: data on effectiveness. Int J STD AIDS. 1998;9:187–191. Clayton EW, Hickson GB. Compensation under the National Childhood Vaccine Injury Act. J Pediatr. 1990;116:508– 513. Dorsinville MS. Case management of tuberculosis in New York City. Int J Tuberc Lung Dis. 1998;2:S46–S52. Drysdale SF. Knowledge of infectious disease reporting amongst military and civilian medical officers. J R Army Med Corps. 1994;140:125–126. Edwards SK, White C. HIV seroconversion illness after orogenital contact with successful contact tracing. Int J STD AIDS. 1995;6:50–51. Evans G. National Childhood Vaccine Injury Act: revision of the vaccine injury table. Pediatrics. 1996;98:1179–1181. Faxelid E, Ndulo J, Ahlberg BM, Krantz I. Behaviour, knowledge and reactions concerning sexually transmitted diseases: implications for partner notification in 490
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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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the physician is directly supervisi
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a. Penicillin V potassium 250 mg q.
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they hospitalize or refer a patient
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patient’s right of privacy should
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Medical students are often enthusia
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unauthorized practice of medicine.
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staff knows that the orders are onl
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is injured by a fellow workers’ n
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limited due process restrictions on
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agreeing to reimburse the MCO for a
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collective action, a close reading
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Med Soc. 1996;148:341-343. Maurer W
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Fiesta J. Delegation, downsizing an
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XIV. Peer Review and Deselection HI
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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
Page 455 and 456: from general disclosure, but it sho
Page 457 and 458: do cost-cutting that the physicians
Page 459 and 460: Med. 1997;18:521-538. Maguire D. Te
Page 461 and 462: Introduction All medical care pract
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
Page 475 and 476: homosexual activists and the religi
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
Page 483 and 484: caused or contributed to by infecti
Page 485 and 486: D. Law Enforcement Reporting Every
Page 487 and 488: campus police. The campus police de
Page 489: the law enforcement authorities are
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
Page 505 and 506: [specify fluoridation measure at is
Page 507 and 508: Still other arguments center on all
Page 509 and 510: (Wash. 1955); Rogowski v. City of D
Page 511 and 512: adverse effects would occur was arb
Page 513 and 514: Kaul v. City of Chehalis, 277 P.2d
Page 515 and 516: Introduction There are special cons
Page 517 and 518: Under no circumstances should medic
Page 519 and 520: patients about high-risk behavior a
Page 521 and 522: arrier method that is only 70% effe
Page 523 and 524: injectable contraceptive that lasts
Page 525 and 526: that HIV is less of a threat than a
Page 527 and 528: for procedures affecting reproducti
Page 529 and 530: funded services to coerce a person
Page 531 and 532: The person who obtains the consent;
Page 533 and 534: The recognition of personal privacy
Page 535 and 536: medically necessary: On their face,
Page 537 and 538: Although abortion is still a surgic
Page 539 and 540: The presumption of legitimacy was a
Page 541 and 542:
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
Page 579 and 580:
problems before they cause accident
Page 581 and 582:
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
Page 595 and 596:
who might sue on her behalf or on t
Page 597 and 598:
contraception, but contraception ha
Page 599 and 600:
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
Page 609 and 610:
XIX. Occupational Medicine and Disa
Page 611 and 612:
and balances inherent in having gen
Page 613 and 614:
putative illness, requesting an exc
Page 615 and 616:
compensation system. The company ma
Page 617 and 618:
In some circumstances, the union ma
Page 619 and 620:
ethical obligations concerning the
Page 621 and 622:
Records concerning voluntary employ
Page 623 and 624:
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
Page 629 and 630:
available information on the proper
Page 631 and 632:
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
Page 655 and 656:
hepatitis A, the onset of the disea
Page 657 and 658:
(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
Page 667 and 668:
clinics or home health visits. An i
Page 669 and 670:
Purtilo RB. Ethical issues in the h
Page 671 and 672:
Disabilities Act: a decision analys
Page 673 and 674:
occupational accidents and diseases
Page 675 and 676:
1998;13:241-272. Pollack R. Update
Page 677 and 678:
legislation, set minimum standards
Page 679 and 680:
hearing seems to be rooted in the l
Page 681 and 682:
ates among drug addicts. Beyond the
Page 683 and 684:
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
Page 689 and 690:
interfere with getting the child pr
Page 691 and 692:
4. Handicapped Children Handicapped
Page 693 and 694:
1996;35:237-242. Cheng TL, Savageau
Page 695 and 696:
Med Sci Law. 1995;35:45-47. Mitten
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handling prisoners in a burns unit.
Page 699 and 700:
legislation. The FDA, DHHS, HCFA, a
Page 701 and 702:
of a lower court to a higher, appel
Page 703 and 704:
assaulted will bring a legal action
Page 705 and 706:
anesthesiologists and nurses with i
Page 707 and 708:
Negligence to consider the plaintif
Page 709 and 710:
declaratory judgments about the con
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Durable Power of Attorney ensurance
Page 713 and 714:
fiduciary relationship, as is the r
Page 715 and 716:
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
Page 723 and 724:
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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