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attorney review any agreements.) A husband has no veto or right to be informed of his wife's decisions on contraception, sterilization, or abortion. The state may also determine what care can be obtained or refused under its power to protect either the public health and safety or the best interests of an individual. Unless the state or federal government has passed a law governing consent or access to the care in question, the decision rests with the woman and her medical care practitioner. Medical care practitioners should encourage women to discuss reproductive choices with their husbands or significant others, but it is improper to require the husband's consent. No court has allowed a husband to recover from a medical care practitioner on the theory that the husband had a right to be consulted about his wife's medical care. Medical care practitioners who obtain a husband's consent rather than the wife’s (unless the husband is the legal guardian or has been delegated the right to consent in a durable power of attorney) can be liable for battery to the wife. A more subtle risk arises when the husband and wife are estranged or legally separated. In these cases, the wife’s expectation of privacy is great, and a medical care practitioner who consults her husband without her permission can be sued for breaching the confidential relationship. This becomes a serious medical risk if necessary care is denied or delayed because of a husband’s wishes or because of a delay in finding the husband, or because the communication to the husband triggers abuse of the wife. Medical care practitioners should be very careful about interfering in marital relationships and about giving out patient information to spouses. If a patient does not want a spouse or family member to be informed about medical care, this wish must be honored. In one case, a woman who did not want more children was taking oral contraceptives without her husband’s knowledge. When the husband asked the family doctor why the couple had not conceived, the doctor told the husband about the pills. The husband went home and severely beat his wife. In this case, the medical care practitioner could be held liable for the beating because it was a foreseeable consequence of the medical care practitioner’s improper disclosure of private medical information. B. Taking a Sexual History All reproductive care begins with a sexual history. Traditionally, medical care practitioners avoided discussing sexual practices with their patients, due partly to mutual embarrassment and, more recently, a fear of seeming judgmental. This reticence has contributed to the epidemic spread of sexually transmitted diseases, including HIV. It has also encouraged the perpetuation of the stereotyping of patients, especially women, by the medical care practitioner’s assumptions about their sexual behavior. Sexually active females were not provided information because it was assumed they knew everything; those who were not obviously sexually active were assumed not to need the information. Patients were sometimes injured by medical care practitioners who missed diagnosing sexually transmitted diseases because they assumed the patient was not sexually active. Medical care practitioners can ignore patient sexuality no longer. They must ask 517
patients about high-risk behavior and counsel them in the risks of such behavior: Counseling and testing are recommended in any medical setting in which women at risk are encountered, including private practices and clinics offering services for gynecologic and prenatal care, family planning, and diagnosis and treatment of sexually transmitted diseases. Voluntary and confidential HIV antibody testing, with appropriate counseling and consent, should be offered to all women and encouraged for those who are at risk for acquiring the disease. The risk factors for acquiring HIV infection apply to a woman or to her sexual partner and include the following: illicit drug abuse (especially intravenous drug use) current or previous multiple sexual partners or prostitution transfusion of blood or blood products before adequate screening began in the United States (between 1978–1985) bisexual activity origin in countries where the incidence of HIV is high symptoms of HIV-related illnesses history of or current sexually transmitted diseases In addition, testing is recommended in the presence of tuberculosis or any illness for which a positive test result might affect the recommended diagnostic evaluation, treatment, or follow up. [ACOG Technical Bulletin 169. Human Immune Deficiency Virus Infections. June 1992.] This sexual history must be documented as carefully as any other part of the medical history. The medical care practitioner should ask every patient the same basic questions. Even if a woman is self-identified as homosexual, she should be counseled to ensure that she understands the options for contraception and reproductive health. These matters may not be of immediate concern to her, yet many male and female homosexuals do enter into heterosexual relationships to conceive children or as a variant on their usual sexual activity. It is also important to ask self-identifed heterosexuals about homosexual activity. This is especially important for prisoners who may engage in homosexual activities in prison but self- identify as heterosexuals and have only heterosexual relationships outside prison. The medical care practitioner’s duty to ask about a patient’s sexual activity must be balanced against the patient’s right of privacy. If a patient denies sexual activity and there is no objective evidence to the contrary, the medical care practitioner should treat this information like any other patient- reported information. As with other changeable behavior, however, the medical care practitioner has a duty to re-explore the area on future visits. Given the general unreliability of self-reported information about behavior that the patient may wish to conceal, the medical care practitioner should continue to consider pregnancy and venereal diseases when indicated by the patient’s 518
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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
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juror’s perspective, peer review
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to deal fairly with citizens, these
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5. There is an overriding national
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a) Notice of a Right to a Hearing T
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equest, to the physician or practit
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subchapter. Information about malpr
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the standards set forth in the Act,
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2. The Problem of Bias Until recent
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from general disclosure, but it sho
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do cost-cutting that the physicians
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Med. 1997;18:521-538. Maguire D. Te
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Introduction All medical care pract
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we are due for another worldwide ep
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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 and 490: the law enforcement authorities are
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
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: Under no circumstances should medic
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
Page 543 and 544: consistent with public health and s
Page 545 and 546: constitutional protections or feder
Page 547 and 548: information in violation of confide
Page 549 and 550: Mary Sue’s ova were successfully
Page 551 and 552: But the rule does not contemplate t
Page 553 and 554: as not to violate this prohibition.
Page 555 and 556: committed before she knows the stre
Page 557 and 558: 1. Adoption 2. Family Planning and
Page 559 and 560: Soderberg H, Andersson C, Janzon L,
Page 561 and 562: Hum Reprod. 1992;7:1029-1033. Snowd
Page 563 and 564: condition. This conflict can take t
Page 565 and 566: eaching a level of 1 per 11 births
Page 567 and 568: who has finally conceived after thr
Page 569 and 570:
should be sure that she understands
Page 571 and 572:
The treatment of infertility poses
Page 573 and 574:
disorder should not be helped to co
Page 575 and 576:
Choosing a sperm donor can be legal
Page 577 and 578:
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
Page 583 and 584:
patient’s decisions. The patient
Page 585 and 586:
covered in signs that ask women if
Page 587 and 588:
decisions not to use medical interv
Page 589 and 590:
lifesaving care. Many physicians ig
Page 591 and 592:
profound differences in the underly
Page 593 and 594:
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
Page 601 and 602:
Marshall BM. Ethical issues in assi
Page 603 and 604:
1995;115:39-43. Greely HT. Genetic
Page 605 and 606:
3. General Obstetrics Abrams FR. Co
Page 607 and 608:
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
Page 625 and 626:
films shall be preserved in their o
Page 627 and 628:
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
Page 633 and 634:
hospital. Both the medical care pro
Page 635 and 636:
Section 504 was a remedial statute
Page 637 and 638:
or recurrent, that the key word was
Page 639 and 640:
government officials investigating
Page 641 and 642:
incorrect, so this area of the law
Page 643 and 644:
is to ensure that patients have eno
Page 645 and 646:
problems. The Court also reiterated
Page 647 and 648:
the medical problems have affected
Page 649 and 650:
normal eyes and kidneys and no peri
Page 651 and 652:
not constitute a disability. The pa
Page 653 and 654:
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
Page 659 and 660:
Many diseases are spread by insects
Page 661 and 662:
eporting duties that apply to the c
Page 663 and 664:
9. Bloodborne Pathogens All workpla
Page 665 and 666:
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
Page 685 and 686:
first aid and training programs are
Page 687 and 688:
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
Page 697 and 698:
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
Page 711 and 712:
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
Page 717 and 718:
In Loco Parentis Literally, in the
Page 719 and 720:
to dangerous products such as drugs
Page 721 and 722:
filing of all official documents. I
Page 723 and 724:
Perjury The willful act of giving f
Page 725 and 726:
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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