17 Jan Research and discuss with

HMGT372 Legal and Ethical Issues in Health Care

Week 1 Discussion

Theme 1:

It is a challenging job to be a student. All students juggle multiple priorities and responsibilities trying to gain the highest grades at the same time. Please offer your strategies on time management and study skills to your peers. Provide minimum three of the most helpful tools and/or strategies that you use to a high degree of success. Tell us how you apply those tools or skills by sharing an example. Discuss the tips offered by your peers and reflect how or if they will work for you. Some of the additional information could be found in Helpful Tips overview.

Theme 2:

Discuss with your colleagues the following questions: What is “Legality”? What are “Ethics”? Compare and contrast legality and ethics in health care. Provide one (1) specific real life legal case example of a violation of legality in a healthcare organization and one (1) specific real life legal case example of a violation of ethics in a healthcare organization that you find on the internet or in the print media. See Discussion Expectations and Grading for rules on discussions. Read background articles. This discussion requires additional research beyond reading the articles.

Assigned reading materials:

Understanding Federal Courts – (Control>>Click>>From Drop down Menu select Open in New Window or Copy/Paste into your URL) http://www.uscourts.gov/about-federal-courts/court-role-and-structure

Introduction to the U.S. Legal System- http://litigation.findlaw.com/legal-system/introduction-to-the-u-s-legal-system.html

Legal issues facing health care professionals-http://www.beckershospitalreview.com/hospital-management-administration/13-legal-issues-for-hospitals-and-health-systems.html

Ethical and legal analysis of health care case-http://ijahsp.nova.edu/articles/Vol2num1/pdf/lazaro.pdf

This educational resource is designed to help health care organization directors ask knowledgeable and appropriate questions related to health care corporate compliance.http://www.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Clinical_Practice_Compliance_Conference/2007/Fri/601Handout.pdf

Example of an Employee Handbook from Johns Hopkins: https://www.hopkinsmedicine.org/human_resources/_docs/employee_handbook_non-union_non-represented.pdf

Health Care Ethics – samples.jbpub.com/9781449665357/Chapter2.pdf (copy/paste into your URL)

A Framework for Thinking Ethically

This document is designed as an introduction to thinking ethically. We all have an image of our better selves-of how we are when we act ethically or are “at our best.” We probably also have an image of what an ethical community, an ethical business, an ethical government, or an ethical society should be. Ethics really has to do with all these levels-acting ethically as individuals, creating ethical organizations and governments, and making our society as a whole ethical in the way it treats everyone.

What is Ethics?

Simply stated, ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves-as friends, parents, children, citizens, business people, teachers, professionals, and so on.

It is helpful to identify what ethics is NOT:

Ethics is not the same as feelings. Feelings provide important information for our ethical choices. Some people have highly developed habits that make them feel bad when they do something wrong, but many people feel good even though they are doing something wrong. And often our feelings will tell us it is uncomfortable to do the right thing if it is hard.

Ethics is not religion. Many people are not religious, but ethics applies to everyone. Most religions do advocate high ethical standards but sometimes do not address all the types of problems we face.

Ethics is not following the law. A good system of law does incorporate many ethical standards, but law can deviate from what is ethical. Law can become ethically corrupt, as some totalitarian regimes have made it. Law can be a function of power alone and designed to serve the interests of narrow groups. Law may have a difficult time designing or enforcing standards in some important areas, and may be slow to address new problems.

Ethics is not following culturally accepted norms. Some cultures are quite ethical, but others become corrupt -or blind to certain ethical concerns (as the United States was to slavery before the Civil War). “When in Rome, do as the Romans do” is not a satisfactory ethical standard.

Ethics is not science. Social and natural science can provide important data to help us make better ethical choices. But science alone does not tell us what we ought to do. Science may provide an explanation for what humans are like. But ethics provides reasons for how humans ought to act. And just because something is scientifically or technologically possible, it may not be ethical to do it.

Why Identifying Ethical Standards is Hard

There are two fundamental problems in identifying the ethical standards we are to follow:

1. On what do we base our ethical standards?

2. How do those standards get applied to specific situations we face?

If our ethics are not based on feelings, religion, law, accepted social practice, or science, what are they based on? Many philosophers and ethicists have helped us answer this critical question. They have suggested at least five different sources of ethical standards we should use.

Five Sources of Ethical Standards

The Utilitarian Approach

Some ethicists emphasize that the ethical action is the one that provides the most good or does the least harm, or, to put it another way, produces the greatest balance of good over harm. The ethical corporate action, then, is the one that produces the greatest good and does the least harm for all who are affected-customers, employees, shareholders, the community, and the environment. Ethical warfare balances the good achieved in ending terrorism with the harm done to all parties through death, injuries, and destruction. The utilitarian approach deals with consequences; it tries both to increase the good done and to reduce the harm done.

The Rights Approach

Other philosophers and ethicists suggest that the ethical action is the one that best protects and respects the moral rights of those affected. This approach starts from the belief that humans have a dignity based on their human nature per se or on their ability to choose freely what they do with their lives. On the basis of such dignity, they have a right to be treated as ends and not merely as means to other ends. The list of moral rights -including the rights to make one’s own choices about what kind of life to lead, to be told the truth, not to be injured, to a degree of privacy, and so on-is widely debated; some now argue that non-humans have rights, too. Also, it is often said that rights imply duties-in particular, the duty to respect others’ rights.

The Fairness or Justice Approach

Aristotle and other Greek philosophers have contributed the idea that all equals should be treated equally. Today we use this idea to say that ethical actions treat all human beings equally-or if unequally, then fairly based on some standard that is defensible. We pay people more based on their harder work or the greater amount that they contribute to an organization, and say that is fair. But there is a debate over CEO salaries that are hundreds of times larger than the pay of others; many ask whether the huge disparity is based on a defensible standard or whether it is the result of an imbalance of power and hence is unfair.

The Common Good Approach

The Greek philosophers have also contributed the notion that life in community is a good in itself and our actions should contribute to that life. This approach suggests that the interlocking relationships of society are the basis of ethical reasoning and that respect and compassion for all others-especially the vulnerable-are requirements of such reasoning. This approach also calls attention to the common conditions that are important to the welfare of everyone. This may be a system of laws, effective police and fire departments, health care, a public educational system, or even public recreational areas.

The Virtue Approach

A very ancient approach to ethics is that ethical actions ought to be consistent with certain ideal virtues that provide for the full development of our humanity. These virtues are dispositions and habits that enable us to act according to the highest potential of our character and on behalf of values like truth and beauty. Honesty, courage, compassion, generosity, tolerance, love, fidelity, integrity, fairness, self-control, and prudence are all examples of virtues. Virtue ethics asks of any action, “What kind of person will I become if I do this?” or “Is this action consistent with my acting at my best?”

Putting the Approaches Together

Each of the approaches helps us determine what standards of behavior can be considered ethical. There are still problems to be solved, however.

The first problem is that we may not agree on the content of some of these specific approaches. We may not all agree to the same set of human and civil rights.

We may not agree on what constitutes the common good. We may not even agree on what is a good and what is a harm.

The second problem is that the different approaches may not all answer the question “What is ethical?” in the same way. Nonetheless, each approach gives us important information with which to determine what is ethical in a particular circumstance. And much more often than not, the different approaches do lead to similar answers.

Making Decisions

Making good ethical decisions requires a trained sensitivity to ethical issues and a practiced method for exploring the ethical aspects of a decision and weighing the considerations that should impact our choice of a course of action. Having a method for ethical decision making is absolutely essential. When practiced regularly, the method becomes so familiar that we work through it automatically without consulting the specific steps.

The more novel and difficult the ethical choice we face, the more we need to rely on discussion and dialogue with others about the dilemma. Only by careful exploration of the problem, aided by the insights and different perspectives of others, can we make good ethical choices in such situations.

We have found the following framework for ethical decision making a useful method for exploring ethical dilemmas and identifying ethical courses of action.

A Framework for Ethical Decision Making

Recognize an Ethical Issue

Could this decision or situation be damaging to someone or to some group? Does this decision involve a choice between a good and bad alternative, or perhaps between two “goods” or between two “bads”?

Is this issue about more than what is legal or what is most efficient? If so, how?

Get the Facts

What are the relevant facts of the case? What facts are not known? Can I learn more about the situation? Do I know enough to make a decision?

What individuals and groups have an important stake in the outcome? Are some concerns more important? Why?

What are the options for acting? Have all the relevant persons and groups been consulted? Have I identified creative options?

Evaluate Alternative Actions

Evaluate the options by asking the following questions:

Which option will produce the most good and do the least harm? (The Utilitarian Approach)

Which option best respects the rights of all who have a stake? (The Rights Approach)

Which option treats people equally or proportionately? (The Justice Approach)

Which option best serves the community

as a whole, not just some members?

(The Common Good Approach)

Which option leads me to act as the sort of person I want to be? (The Virtue Approach)

Make a Decision and Test It

Considering all these approaches, which option best addresses the situation?

If I told someone I respect-or told a television audience-which option I have chosen, what would they say?

Act and Reflect on the Outcome

How can my decision be implemented with the greatest care and attention to the concerns of all stakeholders?

How did my decision turn out and what have I learned from this specific situation?

This framework for thinking ethically is the product of dialogue and debate at the Markkula Center for Applied Ethics at Santa Clara University. Primary contributors include Manuel Velasquez, Dennis Moberg, Michael J. Meyer, Thomas Shanks, Margaret R. McLean, David DeCosse, Claire André, and Kirk O. Hanson. It was last revised in May 2009.

HMGT372 Legal and Ethical Issues in Health Care

Week 2 Discussion

Patients have a bill of rights. Patients also consent to care and have a right to self-determine their care. Those who care for patients are to keep information protected.

Select one of the patient rights (ethical or legal issues) from readings this week. Discuss with your colleagues the right, the legal and/or ethical basis for this right and how this translates into responsibility for a specific health service organization setting. Provide two specific real life legal case examples that you find on the internet or in the print media. Examples: assisted living facilities for disabled, long term care facility, a home care nursing association, a small physician practice, a hospital, a rehabilitation center, or a first responder/ambulance. Remember:

1. The patient right (with proper legal citation);

2. The setting; and

3. The health care organization’s responsibility.

Peer comments should compare and contrast the impact of the patient rights on each setting. Read the background articles. This discussion requires research beyond the above articles. See Discussion Expectations and Grading for rules on discussions.

Assigned reading materials:

Federal Law on Advance Directives-http://www.nrc-pad.org/images/stories/PDFs/fedaddirectives2a.pdf

Patients’ rights, protections and the law- http://www.healthsourceglobal.com/docs/patient%20bill%20of%20rights_merged.pdf

Partnership for patients- http://partnershipforpatients.cms.gov/

Shared decision making- http://www.nejm.org/doi/full/10.1056/NEJMp1209500

HMGT372 Legal and Ethical Issues in Health Care

Week 3 Discussion

Health care fraud is a form of white collar crime. It involves filing illegitimate health care claims to turn an illicit profit. The 3 major laws that protect against healthcare fraud are the Anti-kickback statute, Stark, and the False Claims Act. From the readings and independent research, find one (1) specific real life legal case example of how kickback arrangements would violate the Stark Law. In addition, discuss with your colleagues how the kickback arrangements could violate trust between provider organizations and patients. From the readings and independent research, find one (1) specific real life legal case example of a breach of the False Claims Act by a health-related organization. In addition, discuss whether health care organizations are properly equipped to ensure compliance and minimize exposure risks. If not why not?

Read the background articles. This discussion requires research beyond the articles. See Discussion Expectations and Grading for rules on discussions.

Assigned reading materials:

Medicare Fraud and Abuse: Prevention, Detention, & Reporting – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fraud_and_abuse.pdf

Stark and AKS Chart-http://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf

Breakdown of False Claims Act-(Control>>Click>>From Drop down Menu select Open in New Window or Copy/Paste into your URL) https://www.justice.gov/sites/default/files/civil/legacy/2011/04/22/C-FRAUDS_FCA_Primer.pdf

The Stark Truth about the Stark law Part I http://www.aafp.org/fpm/2003/1100/p27.html

Deficit Reduction Act-http://www.crowell.com/documents/docassocfktype_articles_919.pdf

Brown, J. (2008). Develop a policy for amended records. Journal of Health Care compliance, January-February, 37- 38. [must use UMUC library]

Mekel, M. (2012). The Health Care Quality Improvement Act of 1986 Meets the Era of Health Care Reform: Continuing Themes and Common Threads. Journal of Legal Medicine, (33), 106. [must use UMUC library]

HMGT372 Legal and Ethical Issues in Health Care

Week 4 Discussion

Discuss with your colleagues how a health care organizations can promote a culture of compliance and responsibility? Through your research, identify a specific organizational structure or program that could serve as a “best practice” for other health organizations. What specific health care organization currently uses the program or structure you picked? Describe the program in a paragraph. Is it a training program? A handbook? An immunization program? A patient care involvement program? A financial management practice? Penalties for fraud detection and reporting in the organization? Policy development? Procedure (SOP) creation? Benchmarks? External QA/QC consultants? Is this “best practice” specific to just this setting? Peer comments should compare and contrast their findings with others presented. See Discussion Expectations and Grading for rules on discussions.

Assigned reading materials:

It is important that managers understand the responsibilities of operating within the tax-exempt structure-http://www.irs.gov/pub/irs-tege/eotopice00.pdf

Corporate Responsibility and Corporate Compliance: A Resource for Health Care Boards of Directors (n.d)]-http://oig.hhs.gov/fraud/docs/complianceguidance/040203CorpRespRsceGuide.pdf

Facts about The Joint Commission’s Hospital Accreditation – https://www.jointcommission.org/accreditation/accreditation_main.aspx

Benefits of The Joint Commission Accreditations – https://www.jointcommission.org/benefits_of_joint_commission_accreditation/

Joint Commission: Conflict of Interest – https://www.jointcommission.org/conflict_of_interest_policy/

HMGT372 Legal and Ethical Issues in Health Care

Week 5 Discussion

Health executives have a code of ethics and policy statements which guide their behavior. Examine one of the policy statements provided by ACHE.org and comment on how this code may differ in nature than the health care provider codes. Be specific. Do you see any ethical issues emerging out of health care reform yet are not consider in the ACHE documents? Peers are expected to demonstrate critical thinking in their questions related to the classmates’ descriptions. See Discussion Expectations and Grading for rules on discussions.

Assigned reading materials:

Patient Privacy and Genetic Testing-http://www.eeoc.gov/laws/types/genetic.cfm

Standards for Ethical Behavior Among Health Care Executives- http://www.ache.org/ABT_ACHE/code.cfm

Teaching Clinical Ethics Using a Case Study Family Presence During Cardiopulmonary- http://ccn.aacnjournals.org/content/25/1/38.full.pdf&embedded=true

HMGT372 Legal and Ethical Issues in Health Care

Week 6 Discussion

Find a newspaper or scholarly article where a health care organization or a provider was found guilty of malpractice, criminal negligence, false credentials, failure to treat or patient abandonment. Provide specific details of the case. Discuss with your colleagues: 1. Which critical health care error does the article address? 2. Explain the setting and details using your own words. 3. Drawing from your readings and experience to date, what do you assess are factors leading up to the error? Touch on duties and standard of care. Peers are expected to demonstrate critical thinking in their questions related to the classmates’ descriptions. See Discussion Expectations and Grading for rules on discussions.

Assigned reading materials:

Credentialing and Privileges-http://ctel.org/expertise/credentialing-and-privileging/

Summary of Credentialing and Privileges- http://www.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Compliance_Institute/2013/Tuesday/600/607print1.pdf

A Short Overview of Medical Malpractice http://malpractice.laws.com/medical-malpractice-law/medical-malpractice-overview

Medical negligence: Criminal prosecution of medical professionals, importance of medical evidence: Some guidelines for medical practitioners- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779964/

HMGT372 Legal and Ethical Issues in Health Care

Week 7 Discussion

Bow-Tie Analysis is one of many effective tools for communicating risk assessment. Discuss the bow-tie method and then provide another specific example of an effective tool that hospitals use for risk assessment. Which one would you implement in your area and why? Must provide specific examples of each being used and results. Discuss in what areas you feel a risk management analysis could be effective and why? Peers are expected to demonstrate critical thinking in their questions related to the classmates’ descriptions. See Discussion Expectations and Grading for rules on discussions.

Assigned reading materials:

Bow tie -http://www.r4risk.com.au/Bow-tie-Analysis.php

Bow tie – (Control>>Click>>From Drop down Menu select Open in New Window or Copy/Paste into your URL) http://www.ncbi.nlm.nih.gov/pubmed/19591531

Risk Management, Quality Improvement, and Patient Safety-(Control>>Click>>From Drop down Menu select Open in New Window or Copy/Paste into your URL) https://www.ecri.org/components/HRC/Pages/RiskQual4.aspx

The Purpose of Risk Management in Healthcare-http://elearning.scranton.edu/resource/health-human-services/purpose-of-risk-management-in-healthcare

HMGT372 Legal and Ethical Issues in Health Care

Week 8 Discussion

Research and discuss with your colleagues two health care challenges in the future for public or private health care organizations. You must select two challenges and discuss: How will these challenges affect patients and the health care organization? Be specific as to which type of health care organization you are dealing with [i.e. HMOs. PPOs, POS, urgent care centers, physician outpatient care surgical centers, etc.]. Peers are expected to demonstrate critical thinking in their questions related to the classmates’ descriptions. See Discussion Expectations and Grading for rules on discussions.

Assigned reading materials:

Improving Ethical Decision Making in Healthcare Leadership https://www.omicsonline.org/open-access/improving-ethical-decision-making-in-health-care-leadership-2151-6219-4-e101.pdf

Ruger, J.P. (2011). Shared Health Governance. The American Journal of Bioethics, 11 (7), 32-45. See http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1752295 [you can download entire paper for free]