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1
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0027513755
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The Metamorphosis of Medical Ethics: A 30‐Year Retrospective
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See generally, ; Karen Rothenberg, “New Perspectives for Teaching and Scholarship: The Role of Gender in Law and Health Care,”Maryland Law Review, 54 (1995): 473–87; and Susan M. Wolf, “Shifting Paradigms in Bioethics and Health Law: The Rise of a New Pragmatism,”American Journal of Law &Medicine, XX (1994): 395–415
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(1993)
JAMA
, vol.269
, pp. 1158-1162
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Pellegrino1
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2
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84985216028
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Conroy is an exception to the norm, in the sense that the court established procedures specifically for the nursing home setting; however, the substantive principles developed in the case did not depend on the setting of care. See In re Conroy, 98 N.J. 321, 486 A.2d 1209 (N.J. 1985).
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3
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0026130829
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New Directions in Nursing Home Ethics
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S1, 15,. See also Bart Collopy, Nancy Dubler, and Connie Zuckerman, “The Ethics of Home Care: Autonomy and Accommodation,”Hastings Center Report, 20, no. 2 (1990): S1–16
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(1991)
Hastings Center Report
, vol.21
, Issue.2
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Collopy1
Boyle2
Jennings3
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4
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84985265962
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Again, some exceptions exist. For example, Judge Blackmar, dissenting in Cruzan, stated: The absolutist position [to continue treatment that extends life] is also infirm because the state does not stand prepared to finance the preservation of life, without regard to the cost, in very many cases. An absolutist would undoubtedly be offended by an inquiry as to whether the state, by prolonging Nancy's life at its own expense, is disabling itself from extending needed treatment to others who do not have such dire prospects. See Cruzan by Cruzan v. Harmon, 760 S.W2d 408, 429 (Mo. 1988).
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7
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84985252292
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( Gaithersburg:, Aspen): at 124–30. Some administrators have described compliance with government regulations to be “at the core of the administrative function.” See B. Abramovice, Long Term Care Administration (New York: Haworth Press, 1988): at 173.
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(1993)
Long‐Term Care Administration Handbook
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Goldsmith1
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8
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0029245912
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Bridging the Cultural Gaps
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A growing literature is focusing on the tension inherent in the health care administrator's role, especially when that role is assumed by physicians. See, for example, ; and David A. Kindig and Anthony R. Kovner, eds., The Role of the Physician Executive (Ann Arbor: Health Administration Press, 1992)
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(1995)
Physician Executive
, vol.21
, pp. 3-6
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Kissick1
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10
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0027691012
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Changes in the Practice of Medicine
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See inter alia, ; and Virendra Saxena, “Putting Out the Flames that Threaten Medicine,”American Medical News, Mar. 22, 1993, at 31. As to nursing home regulations, see, for example, James F. Childress, “If You Let Them, They'd Stay in Bed All Morning: The Tyranny of Regulation in Nursing Home Life,” in Rosalie Kane and Arthur Caplan, eds., Everyday Ethics: Resolving Dilemmas in Nursing Home Life (New York: Springer, 1990): 79–89
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(1993)
Physician Executive
, vol.19
, pp. 59-63
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Linney1
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11
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84977423473
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Enforcement of Quality Nursing Home Care in the Legal System
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and Institute of Medicine, Committee on Nursing Home Regulation, Improving the Quality of Care in Nursing Homes (Washington, D.C.: National Academy Press, 1986)
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(1985)
Law, Medicine &Health Care
, vol.13
, pp. 160-172
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Jost1
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12
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84985229719
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On the subject of incentives for overtreatment in fee‐for‐service (FFS) medicine, see, Washington, D.C.:, OTA, OTA 22–23, (concluding that it was impossible to separate the overtreatment inducements of the medical malpractice system from those of FFS payments)
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(1994)
Defensive Medicine &Medical Malpractice
, pp. 104-105
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13
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0029024253
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The Reconfiguration of U.S. Medicine
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(using this phrase to describe the Blue Cross/Blue Shield structure prior to the cost‐control drive)
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(1995)
IAMA
, vol.274
, pp. 85-90
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Bodenheimer1
Grumbach2
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17
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84985265958
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David Strand as quoted in Baden, supra note 15, at 1A.
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18
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0026784516
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Physician's Utilization and Charges for Outpatient Diagnostic Imaging in a Medicare Population
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and Jean M. Mitchell and Elton Scott, “Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits and Service Characteristics,”JAMA, 268 (1992): 2055–59. Each report on increased utilization where there is self‐referral
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(1992)
JAMA
, vol.268
, pp. 2050-2054
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Hillman1
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19
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0028948523
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Conflicts in Managed Care
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(describing such clauses)
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(1995)
N. Engl. J. Med
, vol.332
, pp. 604-607
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Rodwin1
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20
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0027572689
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Racist Health Care: Reforming an Unjust Health Care System to Meet the Needs of African‐Americans
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For an analysis of the impact of race in managed care, see,. There may also be an adverse discriminatory impact on physicians serving poor and minority populations. See Note, “The Impact of Managed Care on Doctors Who Serve Poor and Minority Patients,”Harvard Law Review, 108 (1995): 1625–42
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(1993)
Health Matrix
, vol.3
, pp. 127-194
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Randall1
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21
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84985230209
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Ethical Issues in Managed Care
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Many significant efforts have been made to guide physicians on that difficult question. See, for example, ; Susan M. Wolf, “Health Care Reform and the Future of Physician Ethics,”Hastings Center Report, 24, no. 2 (1994): 28–41; and Ezekiel J. Emanuel and Nancy N. Dubler, “Preserving the Physician‐Patient Relationship in the Era of Managed Care,”JAMA, 273 (1995): 323–29
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(1995)
JAMA
, vol.273
, pp. 1937-1942
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22
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33750022165
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Of course, the physician and the MCO have a legal duty to provide the patient with treatment required under the applicable standard of care. For a complete discussion of the relative legal liability of doctors and managed care, see, ( Minneapolis:, West Treatise Series): ch. 8.
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(1995)
Health Law
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Furrow1
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23
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84985227908
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California has enacted a statute to protect physicians from termination in retaliation for acting as an “advocate for appropriate health care for their patients.” See Cal. Bus. &Prof. Code § 2056. This statute was based on legislation developed by the American Medical Association. Similar legislation was passed by the Texas legislature, but was vetoed by the governor. See PR Newswire, “Statement of the Group Health Association of America on Veto of Texas Physician Protection Legislation,” June 18, 1995.
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24
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0026560827
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Nursing Home Restraints and Legal Liability: Merging the Standard of Care and Industry Practice
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For background on the regulatory and other legal issues regarding physical restraints, see, ; and Sandra H. Johnson, “The Fear of Liability and the Use of Restraints in Nursing Homes,”Law, Medicine &Health Care, 18 (1990): 263–73
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(1992)
Journal of Legal Medicine
, vol.13
, pp. 1-32
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Kapp1
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25
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84985212242
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For a review of such a situation in another context, see Duggan v. Bowen, 691 F. Supp. 1487 (D.D.C. 1988). In this case, the court reviewed an agency action in which the definition of “part‐time or intermittent” home health care was altered, through a transmittal letter to intermediaries, to exclude part‐time care if given over more than five days per week. The Department of Health and Human Services routinely denied coverage for more extensive home care services, but routinely granted coverage on appeal to its highest level of appeal.
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27
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84985211543
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See, for example, Letter from Vivienne Wisdom, Executive Director of the New Hampshire Health Care Association to John Sununu, Mar. 11, 1991 (describing that the members of the New Hampshire Health Care Association a nursing home trade association) experienced “profound improvement in the quality of life,” increased staff morale, and more frequent visitors to residents on reduction of restraints.
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28
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84985267014
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See, for example, Council on Ethical and Judicial Affairs, supra note 21 (describing a choice between contrast media based on cost and pain); and Edmund Faltermayer, “Will the Cost of Cutting in Health Care Kill You?,” Fortune, 130 (1994): 221–27 (describing how less invasive techniques preferred in managed care can avoid painful outcomes for patients).
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30
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84985267021
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Doctors, HMOs Give Peace a Chance: Colorado Providers Negotiate Pact on Physician Contract Protections
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at 3.
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(1995)
American Medical News
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Somerville1
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