LEGAL AND ETHICAL ISSUES IN HEALTH SERVICES MANAGEMENT Syllabus
Course Learning Objectives
Upon successfully completing this course, students will be able to:
- Develop a basic understanding of business law as it affects health services delivery, including choice of corporate form, imposition of liability for clinical decision making and regulated financial practices (e.g., health care fraud) on the various elements of the delivery system and the legal and ethical implications of health service delivery through tax-exempt and for profit corporate structures.
- Identify and define legal and ethical conflicts arising in the current health care delivery system, including the manner in which particular financial arrangements and management theories create conflict between different legal and ethical principles and individual and institutional stakeholders.
- Examine legislative and judicial responses to conflicts in health care as an expression of public policy and societal concerns.
- Explore the inherent limitations of the legal system to address and resolve conflict and the role of ethical analysis.
- Identify the differences between legal and ethical issues.
- Analyze ethical issues within the context of individuals and collective value systems and the organizational structure, mission and culture of health care delivery systems.
- Utilize different methods of ethical analysis, problem solving, and conflict resolution for ethical disputes.
This course provides students with an overview of the legal environment as it affects medicine and business. Cutting-edge cases are utilized as students explore medical mal-practice, negligence, liability (physician, product, and corporate), the changing physician-patient relationship, the care of vulnerable and high-risk populations, intellectual property, criminal aspects of health care, patient consent and rights, and health care refore.
This course has been structured in the form of lectures, discussions, and case analysis sessions. There are a number of modes of instructions, which shall include: legal case analysis, class discussions, role-play, research, and illustrative videos.
The purpose of this course is to introduce health care professionals to the legal issues they are likely to face in managing a health care organization. With the increasing intersection between health care delivery and law, health care professionals will encounter a wide range of legal and regulatory issues. It is thus important for students to be familiar with basic legal principles affecting how healthcare institutions are operated, how legal rules and doctrines are formulated, and how to interact effectively with attorneys. The course is also design to for students to develop skills in the ethical analysis of policies and conflicts that arise in the delivery of health care services. The course explores the ethical implications of the fundamental structural changes taking place in the U.S. health care market, with attention to the perspectives of the health care professional, the organization "managing care," and the consumer.
Summary of Topics
Topic areas covered:
- Background: being a patient; quality health care; medical error;
- Beyond the individual patient: scarce resources; public health law;
- State regulation aimed at patient protection: licensing of health care professionals; regulation of health care facilities;
- Aspects of the physician-patient relationship: contractual elements, informed consent, treatment refusal, decision making when the patient is incompetent, and confidentiality/privacy;
- Patient protection and compensation through tort litigation: medical malpractice; institutional liability;
- Access to care, especially in a medical emergency;
- Paying for care: state regulation of private insurance and managed care; partial federal preemption; public insurance (Medicare and Medicaid);
- Structuring the delivery of care: relationship of health care professionals to hospitals, hospital, and
- Economic wrongdoing: fraud and abuse, self-referral.
Assignment Descriptions and Guidelines
Industry Portfolio and Final Paper
Different industries experience “the legal environment” differently. Issues that are of utmost importance in the medical insurance industry are much different than issues of utmost importance in the herbal supplements or aroma therapy industry. The pharmaceutical, medical devise, vaccines, and biotechnology industries are all examples of industries that help shape, and respond to, legislation and administrative rules.
This semester, you will submerse yourself in a particular industry. Your team will select one from the list, if however, you would like a research an industry not on the list, please let me know – I am always open to expanding the list of choice to study. There is also the possibility to do the complete industry assignment individually. If you are interested in this option, please see me.
Next, you will find and gather information about legal issues that are important in the industry you chose. Then, you will prioritize the issues, organize your research, and engage in preliminary writing. This writing will provide an overview of the legal and regulatory environment in your industry. Additionally, it will outline two to three significant legal issues from the perspectives of at least two different stakeholders (e.g., shareholders, employees, customers, managers, communities, and future generations). This part of the assignment is the “portfolio” component, and it is worth 15% of your course grade.
Twenty five (25%) percent of your course grade will be a final paper you turn in toward the end of the semester. The portfolio you will have worked on over the course of the semester will set the stage for you to write the final paper. The final paper will be a minimum of twelve, double-spaced pages in length. The paper will give you an opportunity to summarize what you have learned about legal issues that affect the industry you selected.
Each week a team is assigned to present a case in the form of a bench trial. Members of each team will take on the roles of defendant, plaintiff, and judge. Each side, defendant, and plaintiff will present their arguments to the class. The judge will provide the ruling along with the legal reasoning behind it. Teams need not dress in business attire. No power point slides are required. The aim of this exercise is to encourage students to engage in in-depth critical thinking and analysis from a particular point of view. When a team member is called on to answer questions, s/he will answer from the view point of his or her assigned role.
* All materials followed by an asterisk are posted on CoursePlus.
Individual in-class contributions......................................................................... 5%
Team Member Evaluation ................................................................................. 5%
Cumulative Final Exam.................................................................................................. 45%
Case Presentation and Problem Presentation............................................. 5%
Industry Portfolio............................................................................................................ 15%
Industry Paper............................................................................................................... 25%
 This includes preparation for each class session and the quality of participation
 This includes team member evaluation of contributions on all team assignments
 Each will be worth 2.5%
Important notes about grading policy:
The grade for good performance in a course will be a B+/B. The grade of A- will only be awarded for excellent performance. The grade of A will be reserved for the select few who demonstrate extraordinarily excellent performance. *The grades of D+, D, and D- are not awarded at the graduate level. Grade appeals will ONLY be considered in the case of a documented clerical error.
Methods of Assessment
Contributions to Class Discussion/Level of Preparation:
Obviously, class attendance is a pre-requisite for class participation, therefore, students will score a 0 on the day they do not attend class. I do not distinguish excused from unexcused absences. In other words, every absence counts as an absence no matter why you are not in attendance/prepared. I assume that every time a student misses class and/or is not prepared the student has a good reason, such as a family emergency, job-related commitment, or unexpected plans.
Students are expected to have read the material before attending class in order to participate. Students are expected to take a proactive stance with respect to class contributions. While I will sometimes use cold calling, students should not expect this to be sufficient for opportunities to make substantive contributions. Also please note that a minimal grade will be assigned for attendance without active participation – seating warming is discouraged. Finally, I reserve the right to give “pop” quizzes on the assigned reading if participation or preparation appears to be waning.
I will evaluate students immediately after each class on their contribution to class discussions.
Contributions are defined as: observations that advance the discussion or change the direction of the class discussion, insightful commentaries that raise learning points, probing questions that challenge the extant discussion and yield new directions, and analyses that clarify and amplify case facts. Class contribution will be graded 0-5 according to the following criteria:
5 = able to answer or ask questions with good examples from the readings and makes several excellent points that reveals deep thought about the issue(s), and understanding of the readings and cases. Comes to class with additional examples and in effect raises the level of class understanding.
4 = raises a number of good points from the cases and readings, less inspired than a 5, but reveals a clear understanding of the material.
3 = makes one or two good points, and shows a rudimentary grasp of the readings and cases. Essentially, attempts to draw some linkage with the concepts used in the class.
2 = makes one or two points in discussion but does not attempt to apply any concepts learned from the readings or lectures, i.e., superficial common sense-type answers to questions that could have been approached with more insight.
1 = shows up for class but does not participate
0 = does not show up for class
Students are expected to read the assigned readings and arrive prepared to participate in class. While there is a lead team assigned to start the discussion, all students are expected to participate in case discussions. In addition, the PowerPoint slides will be available after class. As a general policy, laptops should NOT be open during class. Notes can be taken by hand and notes taken in preparation for class can be printed out in advance of class. In addition, texting and cellphone use during class is strictly prohibited.
Showalter, S.J. (2011). The Law of Healthcare Administration, 6th ed. Chicago: Health Administration Press. ISBN978-1-56793-57-6.
Other articles will be made available through Course Plus.
Please see the course Session for a full list of dates and items for this course.
Academic Ethics Code
Students enrolled in the Bloomberg School of Public Health of The Johns Hopkins University assume an obligation to conduct themselves in a manner appropriate to the University's mission as an institution of higher education. A student is obligated to refrain from acts which he or she knows, or under the circumstances has reason to know, impair the academic integrity of the University. Violations of academic integrity include, but are not limited to: cheating; plagiarism; knowingly furnishing false information to any agent of the University for inclusion in the academic record; violation of the rights and welfare of animal or human subjects in research; and misconduct as a member of either School or University committees or recognized groups or organizations.
Intended AudienceMHA and DrPH student in Healthcare Leadership and Management
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