The field of medicine is very sensitive since it involves dealing with human beings. Precautionary measures should be taken so as not to violate the fundamental rights of individuals/clients. Some actions in the course of interaction between the medical professionals and their clients may be so gross as to call for stern reaction in order to redress them.
There are some instances where the clients have been mistreated by physicians and just like any other criminal case, legal actions are pursued (Sharpe, 2005). The essay discusses two common legal concepts; gross negligence, negligence, and malpractice and unintentional versus intentional torts and how they may apply in a health care setting.
Gross negligence as used in legal terms refers to a misconduct exhibited as a result of being obviously reckless or careless that even an ordinary person with no legal background can tell (Westrick & Dempski, 2008). It is an incident that may be termed an act of ignorance. Usually, ignorance is no defense in any court of law.
Simple negligence, on the other hand, is a form of negligence that is exhibited by an individual but some degree of care seems to have been exercised by the defendant (Sharpe, 2005). Malpractice is closely related with negligence and refers to a practice that contravenes what is expected of a given individual, usually a professional or specialist like in the case of the medical field (Sharpe, 2005).
When applied to a health care setting, these concepts help in categorizing the various malpractices by the medical professionals. Gross negligence, for instance, refers to utter disregard of principles and careless conduct that is so reckless even an individual with no medical background or training can tell its gravity (Westrick & Dempski, 2008).
These acts are usually deliberate and with ill intent. Some of the actions may include; willfully leaving a surgical instrument in a patient’s body cavity or a surgeon deliberately amputating a limb which is not affected or infected in any way (Sharpe, 2005). However, sometimes the medical professional may end up committing a serious act even after exercising some degree of care and had no intention of maltreating the client. This amounts to simple negligence although it may prove difficult to differentiate between the two.
In general, medical professionals and specialists like surgeons, dentists, and opticians may be charged with different cases of malpractices. Malpractice refers to the careless misconduct or negligent/improper actions by a professional in the course of his duties.
Medical malpractice generally refers to various forms of omissions and commissions as a result of varying degrees of negligence on the side of a medical professional (Westrick & Dempski, 2008). Some of the medical malpractices include exposing confidential/patient-specific information, surgical or diagnostic errors, below-par healthcare services, and lack of consent in non-emergency incidences.
The other legal term is unintentional versus intentional tort which has been defined by many courts with an aim of distinguishing the various misconducts. Unintentional tort refers to a behavior that results in the injury or harm of another person though not intended to do so
. In the medical field, unintentional tort refers to those acts by a medical professional that unintentionally cause harm to a client (Hill & Howlett, 2005). They can be regarded as ‘accidents’ resulting from negligence or in most cases omission. Intentional tort, on the other hand, refers to torts that are committed intentionally/at will.
For a case to be regarded intentional, the plaintiff must prove beyond any reasonable doubt that the defendant acted willfully with an aim of harming the complainant (Springhouse Corporation, 2004). Examples of these acts include unjustified imprisonment, battery, cross-land trespass, psychological torture, violation of confidentiality laws, fraud, operation without consent of the patient or next of keen, and assault. They also include all the ill acts that a specialist may commit outside the medical profession.
References
Hill, S. S. & Howlett, H. A. (2005). Success in practical nursing (5th ed). Elsevier Health Sciences
Sharpe, C. C. (2005). Medical malpractice: liability and risk management. Greenwood Publishing Group
Tort gives rise to an action for damages to compensate the injured party. It seeks to give the patients what is considered a monetary equivalent of the loss suffered. In this case, the defendant can be the healthcare provider and the plaintiff can be the uninsured patient (Williams, 1951). On the other hand, a punitive damage is one set at a level intended to punish the actor so as to serve as an example to make others refrain from such mistakes. It basically warns them that dire consequences could result from their negligent behavior (Mark and Ken, 2003).
The question whether tort law should demand less of healthcare providers who treat uninsured patients is a bit debatable. Take for instance, legitimate tort claims arising from damages caused by medical malpractices. It would be impractical to harmonize the damage imposed on the defendant on grounds that they served an uninsured patient. Mistakes and negligence should be subject to punishment to prevent them from happening in the future. Therefore leniency would just be a recipe for disaster in medical practices. On the other hand, one would argue that due to high cost of treating uninsured patients, it is quite practical to reduce charges impounded on them by torts especially if such hospitals or medical providers do not get a considerable support from the government. High cost of health services added to tort damages is a financial load big enough to bring down a health facility. This would do more harm than good to the poor majority of the population who depends on its services (van Gerven, 2001).
In most cases, it is apparent that tort litigation is a very important tool for the prevention of injuries on patients. This is because doctors or physicians tend to minimize situations that might risk the life of or harm the patient in order to avoid future damages. For this reason, it is not a good idea to adjust the damages for tort features serving insured or uninsured patients. Despite this, reducing tort damages for medical providers treating uninsured patients can be beneficial in reducing instances of defensive medicine -altering clinical behavior or procedure because of the threat of malpractice liability, for example, eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. When such fears are eliminated by imposing a reasonable tort damages, then the healthcare providers are likely to serve patients more appropriately (Mark and Ken, 2003).
Tort law should demand less of healthcare providers who treat uninsured patients; this can be a major step in reducing the cases of frivolous plaintiffs where the damages sought by the injured plaintiff are perceived to be too high for the injuries sustained. This implies that existence of torts and medical malpractice system is of advantage, and its strength should not be diluted by either putting caps on non-economic damages or by decreasing the statute of limitations (Deakin and Markesinis, 2008).
In conclusion, I would confidently say that tort laws should not demand less of health care providers who treat uninsured patients since tort damages play a significant role in keeping them under check. It would also be unreasonable to discriminate health care providers in terms of the patients they treat whether insured or uninsured.
References
Deakin, Johnston and Markesinis (2008). Markesinis & Deakin’s Tort Law. Oxford: Oxford University Press.
Mark Lunney, Ken Oliphant (2003). Tort Law – Texts, Cases. 2nd Ed. Oxford University Press.
van Gerven, W. et al. (eds) (2001). Cases, Materials and Text on National, Supranational and International Tort Law. Oxford: Hart Publishing.
Williams, G. (1951) “The Aims of the Law of Tort”, Current Legal Problems 137.
The Federal Government Is a Leader in Insurance Programs
Federal programs help to create a significant basis for public health services and services that could be available to all people on the territory of the United States.1 Nowadays, the federal government turns out to be a leader in insurance reform because of its power to make changes, the abilities to control different spheres of living and even the necessity of having a strong body that could improve safety and quality of healthcare services.
Driving healthcare reforms and the improvement of healthcare services’ quality are the initial tasks of the federal government, and it is important to understand the effects of such practices as reimbursement or billing on Medicare and other programs to identify the bodies that could succeed in pharmacy reforming.
Insurance Reimbursement
The evaluation of the governmental impact on healthcare reforms shows that Medicare is one of the most sensitive programs in regards to insurance reimbursement. This kind of payment is made to a provider or a patient in exchange for certain healthcare services.2 The peculiar feature of reimbursement concerning Medicare is the necessity to consider all limitations and barriers that include appropriate therapy choices, consider the product development, and understand the effects of payment rates regarding covered therapies and other cost-sharing requirements.3 Other insurance plans do not have such specific characteristics and requirements. Therefore, the impact of insurance reimbursement on other healthcare plan and programs remains to be insignificant.
Billing Practices
Billing services introduce another important type of insurance practice that has to be properly organized and run by professionals, who understand how to design and implement the accounts in healthcare practice.2 Federal government insurance billing practices usually impact Medicare because of the necessity to consider insurance claims, additional payments, patient demographics, charges, and other insurance information. In other words, billing practices of Medicare are predetermined by the government and cannot be changed in accordance with a patient or hospital demand. Other insurance plans do not have such strict restrictions and obligations, and patients are free to choose the types of fees in their insurance programs.
Underlying Factors that Create More Impact on Medicare
Medicare is one of the well-known federally funded programs that aim at providing Americans with health insurance and support for a long period of time.4 In comparison to other insurance plans, Medicare has a number of advantages plans that could help to cover general medical and hospital benefits and additional medical, prescription, vision, and dental services.4 Regarding such opportunities, the federal government has to follow the conditions under which Medicare cooperates with patients and offers its services. Another important factor that could explain the phenomenon and its impact is the absence of a certain out-of-pocket maximum and the possibility to spend as much money as possible on any healthcare services.
Effective Legislative Bodies to Create Reform
The American President could face a number of challenges while presenting various policies and laws to be implemented in the healthcare system. Congress is the legislative branch that controls the decisions. There are two legislative bodies in Congress, including the House of Representatives and the Senate.3 Each body type could represent different parties, and the division of powers has to be properly organized and explained. The House of Representatives usually supports the interests of ordinary people, and the Senate considers the general financial and political position of the country to make weighted decisions.
Most Effective Legislative Body Pertaining to Pharmacy
The quality of pharmaceutical service is a frequently discussed topic in the United States because it deals with drugs, food, and cosmetics control. Legislation and regulation should not be defined as the same thing. Regulations are the rules that help to interpret laws, and legislation is the process of laws’ creation.3 The laws could pass or be rejected. Therefore, one of the main impacts of the body is the necessity to identify the steps that could prove the importance of a bill or reduce such importance. Another effective means includes the possibility to control the drugs that should be imported and offered to people whose lives depend on the quality of the products.
Potential Areas for Improvement with Pharmacy Legislation
Regarding the impact of pharmaceutical legislation, it is possible to say that there are a number of areas that could be improved with the help of special laws and rules. For example, it could be suggested to evaluate the trade sphere of the country and define appropriate trade relations with the countries, which succeed in producing effective drugs and cosmetics (Switzerland, Germany, or China). Another suggestion touches upon the healthcare system of the country and citizens’ possibility to get access to the drugs they are in need of. Medicare helps people to cover their expenses. However, not all people get a chance to understand the true effect and importance of the offered drugs. Therefore, it is necessary to improve the sphere that could help people to exchange information about drugs in their lives.
Conclusion
In general, the role of Medicare is crucial in the majority of American lives. Still, the federal government is the body that controls this program. Therefore, the role of the government should not be neglected as well because it helps to create appropriate reimbursement and billing standards, define legislative bodies, and develop the laws and rules that could facilitate a life.
Works Cited
Burke, J, Friedman, LH. Essentials of Management and Leadership in Public Health. Sudbury, MA: Jones & Bartlett Learning; 2011.
Beik, JI. Health Insurance Today: A Practical Approach. St. Louis, MO: Elsevier Health Sciences; 2014.
Kronenfeld, JJ, Kronenfeld, M. Healthcare Reform in America: A Reference Handbook. Santa Barbara, CA: ABC-CLIO; 2015.
Kronenfeld, JJ. Medicare. Santa Barbara, CA: ABC-CLIO; 2011.
Among the political and legal concepts of the 20th century, a special place is occupied by the doctrine of natural law and rights. It continues the tradition of a philosophical interpretation of the law and relies on various concepts that have developed in modern Western European and American philosophy. Contemporary natural-legal theories recognize the existence along with a positive law of the ideal order of relations among people.
This highest normative order is called natural law. According to such views, the legislation of the state is valid and legitimate only if it corresponds to the ideal law. In such a public sphere as universal healthcare, the described theory plays a significant role since some provisions of modern medicine largely relate to this concept. Therefore, it is required to review the theory of natural law and rights to consider its application in the field of healthcare and draw a specific conclusion as to whether the norms of this theory in this public area are observed.
Theory Summary
Christianity, like many other religions, contributes to the development of ideas about the existence of the law given by God. The doctrine of free will in this context is the consequence of the human responsibility to God, as well as a religious and moral regulator of relations among people. An attempt to establish truly fair canons for all the people is the common feature of the whole world’s religions. According to Boyd and Thorsten, natural-legal views in modern jurisprudence are combined with the historical and sociological study of legal ideas (77). The basic essence of such a concept is to show that the formation of the society does not affect its ability to adapt to modern conditions and does not violate the established order of freedoms and values.
Among natural rights, the right to life occupies a special place. This fundamental concept is at the top of the natural-legal pyramid, which is understandable – when depriving someone of life, all other freedoms lose their meaning. The human right to life is fixed in most official government documents. Human laws took a significant place in the first bourgeois-democratic constitutions of the late 18th century. For example, the world-famous Declaration of 1776 refers to the possibility of the need to allow each person to have his or her destiny and implies respect for personal dignity (Boyd and Thorsten 103). Over time, this concept has significantly developed since the society was interested in finding ways to preserve the right to personal happiness and self-development.
Locke’s Position
Other views were held by another English thinker Locke who puts forward a different theory of the original and natural state of the human (Boyd and Thorsten 92). The philosopher considers the initial absolute freedom of people not to be the source of struggle but the expression of their natural equality and readiness to follow reasonable natural laws (Boyd and Thorsten 92). This people’s readiness leads them to realize that in the interests of the common good, it is necessary, while retaining freedom, to give part of the function to the government, which is called upon to ensure the further development of the society.
It is how a social contract is reached among people. The more rights the person has, the wider the range of his or her duties to the society is. The state does not have absolute arbitrary power. In Locke’s opinion, a social contract presupposes the responsibility of the country to its residents (qt. in Boyd and Thorsten 93). If the state does not fulfill its duty and violates natural freedoms, people have the right to fight against such a social order.
Jefferson’s Position
Similar approaches to the structure of the country and relations among people belonging to the outstanding American figure of Thomas Jefferson whose views regarding interpreting the theory of natural law and rights differed from Christian ones (Boyd and Thorsten 91). Jefferson focuses on human rights and singles out a range of freedoms – the freedom of conscience, speech, procedural rights, security rights, etc.
He insisted on the separation of church and state, which was a bold proposal in conditions of that society. According to Boyd and Thorsten, Jefferson claimed that, despite the divine origin of the human, higher powers could not control what happened to people on the earth, and the society had the right to decide how it was better to develop (91). Jefferson’s ideas are reflected in many of his followers’ works, and his contribution to the development of the natural rights theory is significant.
Rand’s Position
Another approach related to the theory of natural law and rights is the position of the American writer Ayn Rand who first popularized the idea of freedom determined by property rights and based on the Aristotelian interpretation of the natural law (Boyd and Thorsten 99). Instead of an altruistic approach to understanding human relations, the writer proposes to focus on personal happiness, thereby denying the idea of any action for the benefit of others (qt. in Boyd and Thorsten 100). Certainly, Rand’s worldview was influenced by the classical philosophy of liberalism, which was reflected in her fundamental ideas. Ethical egoism is one of the key points of her theory, and this approach is also famous, despite being criticized by many people.
The Issue of Universal Healthcare
The issues of world medicine are relevant for all countries without exception since the well-being of citizens directly depends on the quality of healthcare. The development of technologies and innovations in this field made it possible to use the most modern methods of treatment, and what previously seemed impossible, for example, cancer therapies, is practiced now. From morality, some controversial issues may arise, for instance, ethical selfishness or the lack of professional performance of immediate duties (Hall and Bobinski 129). A human factor still plays an essential role, even despite the automation of many processes, and some mistakes and contradictions in the work are inevitable.
Patients’ Claims
Patients’ claims for medical and nursing care are primarily related to the insufficient qualification of personnel. The absence of narrow specialists, problems with diagnostics, difficulties in obtaining preferential medicines in pharmacies, high prices for paid medical services, etc. also cause dissatisfaction (Hall and Bobinski 114). Certainly, all these issues complicate the process of work and thereby cause tension, which leads to misunderstandings and conflicts.
Many patients require special treatment, claiming that they are entitled to rely on highly professional care. In some cases, their claims are justified because, according to Almgren, some physicians may not observe the ethical principles of their work and undermine not only their dignity but also the reputation of the healthcare system as a whole (8). Therefore, it is difficult to achieve full harmony if a human factor plays a significant role in the work process.
Level of Medical Personnel’s Training
The quality of medical care largely depends on the level of doctors’ training, the qualifications of other healthcare professionals, and their responsible attitude to their duties and patients. The quality of doctor-patient relationships is the key to successful treatment and the indicator of professionalism in the provision of medical care. Understanding the nature of these relationships influences physicians’ ability to correctly diagnose, prescribe treatment, and also provide psychological support.
People working in the healthcare sector often experience stress at work because their environment makes high demands that exceed the abilities of doctors and nurses. The consequences of stress include high employee turnover, reduced productivity, accidents, rudeness, and medical errors (Hall and Bobinski 274).
Because of doctors’ excessive workload, there is little time to communicate with patients, which leads to complaints about a rough and incorrect attitude. To avoid it, it is essential to strive to improve the working schedule using competent time planning, the possibility of providing psychological assistance to medical specialists themselves, as well as strengthening the motivation of the staff (Almgren 93). Otherwise, changes for the better will not be possible, and constant controversial nuances will arise.
Staff Shortage
Too low salaries and high-performance requirements sometimes cause the lack of completeness of clinics by medical or nursing staff. This issue is unlikely to be relevant to the problem of professionalism and rather refers to a social and ethical problem. The lack of specialists hurts the overall level of medical care since many employees are forced to work overtime, which leads to increased fatigue and the loss of motivation (Almgren 183). All these issues are relevant to universal healthcare and are significant problems that need to be addressed.
Application of the Theory of Natural Rights and Law to Universal Healthcare
The theory of natural rights and law can be applied to the healthcare sector since some ethical issues in this area can be related to the provisions of the concept. Medical issues imply compliance with certain ethical issues that are directly relevant to human rights. The implementation of specific provisions is an indicator of the success and quality of medical services, and their non-compliance, on the contrary, negatively affects the state of medicine.
The Right to Health Services as the Right to Life
All people have the right to their religion and the right to receive appropriate medical care (Muñoz 369). The main purpose of medicine is to protect the health of citizens and provide timely assistance at the request of patients. These provisions are prescribed in all state laws of countries with a developed healthcare system. Modern society promotes people’s interests and provides for human life as the highest value (Marske et al. 61).
Accordingly, the provision of medical services is an inalienable and unconditional right of people to use health services and have access to professional medical consultations. Various insurance documents are designed to legitimize this right and to systematize the possibility of protecting public health. Nevertheless, if the person does not have the opportunity to purchase an insurance policy or another document that confirms his or her access to receiving appropriate care, it does not mean that the state has the right to refuse. Free treatment is the feature of a civilized society, and compliance with this law is natural.
Freedom of Choice
The freedom of choice is a component of natural rights that was considered by Thomas Jefferson (Boyd and Thorsten 91). This concept can be fully applied to the sphere of universal healthcare since every person has the right to independently choose whether medical services are necessary to him or her and what type of assistance is needed. Modern services provide for a free choice of assistance, and although Jefferson’s theory denied God’s participation in human rights, the relationship between religion and medicine can be traced (Muñoz 371). Also, no one can force the human to use the services of doctors, which is also quite natural. Personal motivation and desire play a major role, and the violation of this norm is the violation of human rights, which is inadmissible in a modern civilized society.
Observance of Medical Secrecy
One of the aspects of healthcare that should be strictly observed is compliance with medical secrecy, that is, the prohibition on disclosure of patients’ data. If the theory of natural law is applied in this case, it can be noted that everyone has the right to protect his or her interests and preserve information about the state of health. Some controversial points, however, may arise in this case. For example, if the patient can harm other people, refusing hospitalization or appropriate treatment, medical workers are entitled to bring this person to justice.
This behavior contradicts the concept of protecting human health, and measures should be taken against such violators, for example, by bringing them to administrative responsibility. However, if there is no threat of an epidemic or another problem, and a person insists that his or her data should not be disclosed, doctors cannot pass on information about the state of the patient’s health, which also is a natural right given to people by the state.
Mutual Responsibility
When resorting to the concepts of philosophers, Locke’s claim of mutual responsibility can also be considered as one of the approaches to universal healthcare (Boyd and Thorsten 91). The point is that medical specialists are obliged to help all those in need, which corresponds to the conditions of their professional ethics. However, patients also have some responsibilities that need to be followed to maintain a balance. For instance, such a violation of moral and ethical standards as rudeness towards medical personnel is unacceptable since everyone has a natural right to personal dignity. Also, both doctors and patients should be tolerant of one another.
Any forms of intolerant behavior contradict the moral foundations of modern society. Therefore, to create the most favorable working conditions, it is significant to adhere to ethical norms of behavior and to not only demand observance of natural rights but also to personally observe them. Otherwise, disagreements will not allow achieving mutual understanding, and insufficiently quality assistance will be provided because it will be impossible to find a compromise on a specific issue.
Conclusion
Thus, the theory of natural rights and law can be observed in the field of universal healthcare, and some of the provisions of this concept are reflected in medicine. Various philosophers’ approaches confirm the relevance of this topic and some possible contradictions that may arise. The field of modern healthcare has several controversial issues, and following specific theoretical provisions can help to solve these problems.
Works Cited
Almgren, Gunnar. Health Care Politics, Policy, and Services: A Social Justice Analysis. 3rd ed., Springer, 2017.
Boyd, Craig A., and Don Thorsten. Christian Ethics and Moral Philosophy : An Introduction to Issues and Approaches. Baker Academic, 2018.
Hall, Mark A., and Mary Anne Bobinski. Health Care Law and Ethics. 8th ed., Wolters Kluwer Law & Business, 2014.
Marske, Charles E., et al. “The Significance of Natural Law in Contemporary Legal Thought.” The Catholic Lawyer, vol. 24, no. 1, 2017, pp. 60-76.
Muñoz, Vincent P. “Two Concepts of Religious Liberty: The Natural Rights and Moral Autonomy Approaches to the Free Exercise of Religion.” American Political Science Review, vol. 110, no. 2, 2016, pp. 369-381.
For many years the United States government has taken keen interest on the welfare of the healthcare consumers, especially in regard to healthcare fraud. Notably there have been numerous fraudulent transactions within the American healthcare system, which have had severe medical and financial implications. Specifically, the United States government has lost billion of dollars due to healthcare fraud.
This is coupled with many patients who have been conned off their benefits as a result of transfer of policy to a different. As a result the United States government came up with laws to regulate the healthcare sector and minimize, as well as prosecute cases of fraud. These laws are famously referred to as The Anti-Kickback Statutes.
The case of Sundown Community Hospital and Central Park Medical Group joint venture, which offered financial benefits to facilitate the agreement on the transfer to patients, a majority of whom are under Medicare plan, violates the requirement of the Anti-Kickback law. However, this plan can still be safeguarded if it is modeled along a different approach which fulfills the requirement of ‘safe harbor’ exemptions.
There have been a number of healthcare landmark cases, such as Feldstein v. Nash Community Health Services, Inc., which have brought forth a number of urgent concerns.
Suffice to state that healthcare issues are intricate and complicated to the extent that the United States government developed a set of detailed statues referred to as the Anti-Kickback Statutes to address emergent issues in healthcare provision (Office of Inspector General, 1999; Altshuler, Creekpaum and Fang 2008).
The main purpose for this law is to protect the welfare of healthcare consumers from exploitation by fraudulent healthcare providers. One of the major concerns that arise is the determination of whether any (healthcare) transaction is either a minor misdemeanor or fraud. In this regard, it is the primary objective of the prosecutor to determine whether there was intent and objective of obtaining kickbacks.
Furthermore, debate still ranges on, on the definition of the terms kickback and bribe. Out of Subsequent cases, there have emerged several interpretations of the terms kickback. The United States V Hancock case assumed the broader interpretation of the term kickback as the intentional receiving of payments fraudulently.
This definition does not however, address other issues of concern such as nonfinancial benefits. As a result, the congressional amendments of 1977 stipulated that Medicare fraud did not have to result in a kickback. Currently, the Social Security Act stipulates that any party in a Medicare agreement cannot offer or receive payments or any other benefits to engineer a business deal (Schwartz, 2003).
Just like the Feldstein v. Nash Community Health Services, Inc., the Sundown Community Hospital and Central Park Medical Group joint venture involves financial and social security privileges to employees. Sundown Community Hospital is intending to make the deal a success and as such has to put together an attractive offer to Central Park Medical Group in terms of permanent staff privileges to Central Park owners.
This also includes monthly bonuses. Since the deal is proposed by Sundown Community Hospital, the privileges to Central Park Medical Group staff are intended to make an appeal and as such avoid any objection to the deal. Furthermore, 60% of the healthcare consumers at Central Park Medical Group are under Medicare plan.
This implies that Sundown Community Hospital stands to benefit directly from the joint ownership of these consumers who are on Medicare. Such implications made Sundown Community Hospital to offer kickbacks in terms of indirect payments to permanent staff, to successfully engineer the deal. It can thus be concluded that such kickbacks were made willfully and knowingly to induce business.
The anti-kickback statute prohibits and criminalizes any willful payments made knowingly to engineer the referral or transfer of any individual who is a beneficiary of any medicare scheme. As such the statute proposes criminal penalties for any payments made, such as in the United States v Jain to induce the said referrals and transfers, which includes prison terms and fines.
Furthermore, any party found to have willfully offer or received such payments attracts criminal liability for such offenses (Romano and Fox, 2009). This case is therefore in contravention of the Anti-kickback Statutes as well as the 1996 regulation on the movement of healthcare consumers between providers, referred to as The Health Insurance Portability and Accountability Act (Price and Norris, 2009).
Therefore, the joint venture between Sundown Community Hospital and Central Park Medical Group cannot proceed since the two parties faces criminal charges for giving and receiving indirect payment to induce referrals of Medicare consumers.
This deal can however go ahead, but under the 1972 congressional amendments which provided for certain safe harbors regulations. Within these regulations, there are certain business transactions which are can be exempted from the Anti-Kickback Statutes (Schwartz, 2003). While there are numerous safe harbor regulations, two specific one can protect this deal from criminal liability.
Specialty Referral Arrangements between Providers is a regulation within the Anti-kickback Statutes that safeguards the referrals and transfer of Medicare beneficiaries between providers. Under this provision, it is possible to refer a patient from the primary physician to a secondary physician on grounds of specialized treatment.
The regulation also stipulates that the party to whom the patient is being referred to has the obligation of referring the patient back to the primary healthcare provider at some point during the course of the treatment (Office of Inspector General, 1999).
Suffice to say that this kind of an arrangement is closely monitored to ensure that such transfers are motivated by the need for further medical treatment from specialized physician and not timed to benefit the second party financially.
As such, Sundown Community Hospital and Central Park Medical Group patient transfers are only applicable on the grounds of specialized medical treatment. Furthermore, Anti-Kickback Statutes do not exempt such kind of a transaction to the extent of financial benefits if the patient is on a Federal Healthcare plan.
In this case, the parties involved in this plan have to ensure that the 60% of patients are under a state controlled medical plan before filing for exemption from the Anti-Kickback Statutes.
Transfer of patients who are on any form of Medicare plan is not necessarily a fraud. As such, the parties involved may not be criminally liable for engineering patient transfer and co ownership deals on certain grounds.
The Sundown Community Hospital / Central Park Medical Group joint venture is however suspect. Borrowing from rulings such as Feldstein v. Nash Community Health Services, United States V Hancock and others, the two parties involved are criminally liable since they knowingly exchanged payments as part of the business agreement.
As such the deal is not motivated by medical reasons and as such need to be redesigned to avoid prosecution.
Reference List
Altshuler, M., Creekpaum, J., & Fang, J.. (2008). Health care fraud. The American Criminal Law Review, 45(2), 607-664.
The so-called ‘steer, not row’ approach to defining the conceptual essence of governmental policies, with respect to healthcare, in general, and to the cared-for children and vulnerable adults, in particular, is concerned with the ideology of Neoliberalism, the adherents of which have been put in charge of policy-making in most Western countries ever since the late eighties. This ideology refuses to recognize the role of the clearly societal factors on people’s continual ability to enjoy the ‘fruits of civilization’ while proposing that the task of ensuring the continuation of socio-economic progress is the prerogative of what Neoliberals refer to as the ‘invisible hand of the market’. Hence, the foremost discursive implication of the mentioned approach – the government should refrain from assuming too many responsibilities, within the context of enacting a particular social care policy and ensuring that the associated services are properly delivered to the targeted population (McQueen par. 2). Instead, it should delegate the delivering function to the privately-owned companies and limit its involvement in the process – this is what ‘steering’ is all about (Lister par. 5).
The passing of the Health and Social Care Act by the Parliament in 2012, which resulted in the reorganization of the very operational paradigm of this country’s healthcare system, can be thought of as the most recent epitome of the ‘steer, not row’ principle being applied on an all-national level (Abrahams par. 4). According to the Act, it is no longer the responsibility of the Secretary of State for Health to manage the qualitative dynamics in the domain of British healthcare – the concerned task has been entrusted to the so-called ‘clinical commissioning groups’, consisting of general practitioners (GPs) and representing the interests of the pharmacological industry (Miller par. 1). While in charge of implementing healthcare policies, approved by the government, the ‘clinical commissioning groups’ are expected to make sure that, throughout the course of being implemented, these policies never cease to remain economically feasible (Egerton par. 3). As Richards noted, “The government… made it compulsory for the new local commissioning bodies – clinical commissioning groups – to use market mechanisms to commission health services” (par. 1). In theory, the adoption of the ‘steer, not row’ principle for policy-making was supposed to increase the cost-effectiveness of many of the currently available welfare services in this country. The rationale behind the theoretical assumption at stake is that, as Bloom pointed out, “Society has changed in many ways, but the government has not kept up. In the fast-changing communications era, one-size-fits-all and top-down government increasingly fails… A modern society needs a modern government that embraces technology and the private sector to achieve aims that benefit everyone” (par. 9). However, there is plenty of evidence, as to the fact that the continued privatization of the public sphere is strongly detrimental to the interests of society, as a whole.
To illustrate the validity of this suggestion even further, we can refer to how the adoption of the concerned principle has been affecting the well-being of physically and mentally disabled people in this country since the eighties – the time when the ideology of Neoliberalism began to define the ways of the country’s governmental officials. After all, it was back then that the rationale behind policy-making, with respect to disabled adults, has undergone a qualitative transformation. Whereas prior to the development in question, such individuals used to be encouraged to adopt a socially integrated lifestyle, in order to be considered the society’s productive members, by the late eighties/early nineties this effectively ceased to be the case. The reason for this had to do with the fact that, while remaining committed to the ‘steer, not row’ principle, the liberally-minded governmental officials (both, Conservatives and Labourites) proceeded to promote the idea that one’s disability accounts for the concerned person’s ‘uniqueness’ and, therefore, deserves to be ‘celebrated’ – even if he or she leads a socially withdrawn (non-contributive) existence. Hence, the three principal characteristics of the government’s approach to designing social-service policies throughout the course of the last two decades:
Direct cash payments to disabled citizens. The year 1988 saw the establishment of the so-called Independent Living Fund, the main task of which was to distribute money among the disabled (Hawkins par. 3). The concerned development correlated perfectly well with the Neoliberal assumption that consumption is the solemn purpose of one’s existence and that to make handicapped citizens happier, they must be helped financially. The passing of the Direct Payments Act in1996, which expanded even further the number of the would-be qualified recipients of ‘disability payments’, was also meant to promote the continual commercialization of the healthcare sector in the UK. According to Mercer and Barnes: “By the mid-1990s, the Conservative Government was finally persuaded that cash payments fitted with its agenda to promote market competition and individual choice” (7). The actual intention behind the initiative was well-meaning – to allow disabled individuals to take a better care of their health-related needs and to deinstitutionalize the country’s welfare-policies to an extent, as the foremost precondition of increasing the measure of their cost-efficiency (Humber par. 15). However, the actual outcome of the initiative’s implementation turned out to be much different from what it was expected to be. After all, it did not only result in the dramatic rise in the number of disability-claimants across the nation, but also in making it much harder for the disabled to achieve recovery/betterment (Heslop 5). The reason for this is apparent – after having realized themselves in the position to claim cash on the account of their ‘uniqueness’, the qualified citizens ended up being naturally prompted to yield to their consumerist instincts, which made it even harder for the concerned individuals to be able to stay on the course of betterment. Therefore, there is nothing surprising about the fact that that, ever since the time of both mentioned developments, there appears to have been an exponential momentum to the rise of disability claims across the UK – something that undermines the overall effectiveness of the country’s healthcare system (Banks, Blundell and Emmerson par. 4).
Decentralization. As it was mentioned earlier, the Neoliberal paradigm of healthcare presupposes that, the less there is top-controlled orderliness to the delivery of social services to the disabled, the better. This explains the actual logic behind the ongoing process of these services becoming ever more ‘localized’, in the sense that the task of providing disabled adults with social services is increasingly entrusted to the communal authorities (Edmiston par. 3). The process’s initial phase can be traced back to the adoption of the Chronically Sick and Disabled Persons Act (CSDA) in 1970, which put the municipal authorities in charge of ensuring the adequate quality of housing conditions for the disabled (Griffin par. 12; Broach par. 7). Nevertheless, as time goes on, the initiative’s counter-productiveness becomes apparent to more and more people. There are two reasons for this: 1. As practice shows, the manner in which local authorities address their CSDA-related obligations is mostly concerned with hiring more and more social workers, who are supposed to alleviate the suffering of people with disabilities – something that local authorities tend to perceive as such that has the value of a ‘thing in itself’. Ironically enough, this fosters the bureaucratization/formalization of health-services for the disabled, which is hardly beneficial for the latter. 2. The very notion of ‘incapacitating disability’ suggests that there are long-term effects on the affected person. Consequently, this implies that it is specifically the highly trained professionals who should be in charge of prescribing him or her with the rehabilitative therapy. However, the communal approach to dealing with disabled people often implies the reduced quality of the would-be delivered social services, by definition.
An introduction of new/additional charges for social services. This particular effect of the utilization of ‘steer, not row’ approach has been brought about by the fact that, as of today, private sector providers are in the position to have an active voice within the NHS, as the Organization’s stake-holding subsidizers. As a result, they demand from the NHS to take into the consideration their own corporate interests, within the context of how the Organization goes about setting up its policies for the disabled. This simply could not be otherwise, as it is in the very nature of private sector providers to prioritize making money above everything else, It is understood, of course, that this may hardly have any positive effect on the concerned category of people, as those who have been traditionally considered the most socially unprivileged of all (Dykes par. 1).
In light of what has been said earlier, the ‘steer, not row’ approach cannot be deemed thoroughly appropriate, when it comes to designing policies, meant to be taken advantage of by the disabled. Apparently, the promoters of such an approach do not understand the systemic nature of the interrelationship between the society’s integral elements – hence, their insistence that the domain of social services should be commercialized. This idea is based on the assumption that while seeking to receive high-quality social services, disabled people never cease to remain socially alienated in one way or another – hence, these people’s supposed preoccupation with trying to qualify for as many welfare-payments, as possible (Browne par. 1; Wood, par. 8). This point of view, however, ignores the fact that it is in the very nature of people to aspire for the socially sound ways of self-actualization – regardless of what happened to the nature of their disability. It is not such physical or mental disability that the affected individuals want to celebrate, but their ability to overcome it – something that can only be achieved if the government actively ‘rows’ to address these people’s needs.
Therefore, it will only be logical to conclude this paper by reinstating once again that the ‘steer, not row’ approach to dealing with disabled citizens is certainly not the best. While claiming that it is the other way around, the approach’s advocates strive to conceal their actual agenda – to treat such citizens as a ‘social burden’ (giving them some money and forgetting about them) which in turn is supposed to revitalize the functioning the country’s free-market economy (Daley par. 11). However, despite the presumed soundness of the approach, the idea of ‘steering and not rowing’ in the social domain is synonymous with the idea of the state refusing to address its statehood-functions – something that may never prove justified in the long term.
The importance of ensuring confidentiality in health and social care cannot be underestimated, as it represents the foremost functioning principle of the Health and Social Care Information Centre (HSCIC). In its turn, this can be explained by the highly sensitive nature of the data, processed at HSCIC on a daily basis. After all, in order to qualify for a particular social service, an individual is commonly asked to disclose much personal information, such as the history of past illnesses, on his or her part. As of today, social workers are expected to observe the following five major rules while on the line of addressing their professional responsibilities: 1. Confidential information must be handled in the highly responsible manner. 2. If this type of information is to be used in social research, it must be anonymized prior to being made available to researchers 3. In cases when the release of confidential information is deemed to be in the client’s best interests, he or she (or the person’s legal guardians) must be approached with the request for consent. 4. Social workers are there to safeguard sensitive information from any attempts to be assessed by a third party – unless ordered to act otherwise by the court. 5. Social workers are in the position to share confidential information with each other if this will benefit the concerned clients.
Thus, the mentioned rules are best seen as such that provide social workers with the methodological framework for handling confidential information. Moreover, this framework is flexible enough to allow such workers a certain degree of autonomy while striving to ensure that their decisions, on managing one’s personal data as a recipient of social services, are circumstantially sound. This, in turn, is supposed to contribute to the functional integrity of the HSCIC.
For effective delivery of quality and standard healthcare services, legislations are imperative. The legislations ensure that medical professionals adhere to their expected professional ethics and principles when conducting medical business and offering healthcare services. Without proper legislations in the healthcare system, there would be unethical or poor healthcare practices that are not only detrimental to the lives of patients, but also to the entire members of the society. Since sustainability of the healthcare system depends on lucrative businesses that various healthcare institutions conduct, there is a tendency that these institutions can, at times, go beyond their prime mandate of offering quality and standard healthcare services, and focus on making profits. The tendency of health institutions to neglect their responsibilities and focus on fraudulent businesses that fleece patients and government could increase if proper legislations are not in place. Roath asserts that, “healthcare delivery has been increasingly recognized as a business avenue and hence regulatory norms are constantly becoming stringent” (2010, p.6). Government has realized that inefficient regulation and legislation of healthcare system would result into tragic consequences that cost lives of people due to unprofessionalism and negligence of ethics. In view of legal aspect of healthcare, this essay examines medical fraud by Robert Ray Courtney as a case study and explores criminal and contractual aspects of the case.
Case Background
Robert Ray Courtney was a pharmacist and a proud owner of a pharmacy called Research Medical Tower at Missouri, Kansas City since 1990. He began his pharmaceutical business in 1990 and embarked on illegal activities of buying fake drugs and diluting genuine ones to increase profit margins. The medical representatives who worked for him in the pharmaceutical company wondered that there was significant difference between amount of drugs they bought and the amount they sold. One of the suspicious medical representatives leaked the matter to an oncologist, Dr. Verda Hunter, one of the customers who usually bought cancer drugs. Dr. Verda Hunter too became suspicious and ordered nurses to carry out qualitative and quantitative tests on the cancer drugs bought from the Research Medical Tower Pharmacy, which proved that indeed there were dilutions of the drugs. Upon the discovery that Robert Ray Courtney had been adulterating cancer drugs, Dr. Verda Hunter notified healthcare authorities leading to Courtney’s arrest in 2001 pending more investigations.
According to investigations, Robert Ray Courtney has been diluting drugs since 1990 when he started his pharmaceutical company until 2001 when police arrested him for alleged drug adulteration. The preliminary report accused him of diluting over 90,000 prescriptions and over 70 different types of drugs, which had affected the lives of thousands of patients who used his medications. When the healthcare authorities arraigned him in court, Robert Ray Courtney “pleaded guilty to eight counts of product tampering causing serious bodily injury and twelve counts of adulterating or misbranding drugs…the district court sentenced him to thirty years in prison” (Hansen, 2005, p.). Due to the nature of his crime, the district court ruled that his imprisonment period would be 30 years, which was abnormally high because he did conduct medical fraud knowingly to satisfy his selfish interests for money. His case became a landmark that indicates how medical professionals can sacrifice human health for material gain.
Biographical Description
Robert Ray Courtney was born in 1952 in Kansas with a twin sister who is currently a preacher at the church of Assembly of God. He attended Wichita South high school in Kansas and went to University of Missouri where he earned a degree in pharmacy, which he achieved in 1975. After graduation in 1975, “Courtney went to work for pharmacist James Frederich, and soon was managing Research Medical Tower Pharmacy in Kansas City” (Roath, 2010, p.3). Working with James Frederich, Robert Ray Courtney gained enough experience on pharmaceutical practices and by 1990; he opened his own pharmaceutical company in Kansas City called, Research Medical Tower Pharmacy. In 2001, a suspicious medical representative reported him to one of the customers, Dr. Verda Hunter, who tested cancer drugs and found them diluted. Dr. Verda Hunter contacted the Federal Bureau of Investigation (FBI), and Food and Drug Administration (FDA) to conduct further investigation into the issue that eventually led to Courtney’s arrest.
Research Medical Tower Pharmacy had a humble start but it did exponentially rise leaving many people wondering about lucrative nature of pharmacy and entrepreneurship skills of Robert Ray Courtney. Robert Ray Courtney made great deal of money that increased his fame in Kansas City for he gave ‘good’ money for charity organizations, to his former school, and his church. His parents and friends praised him for being generous and encouraged him to continue for he was a role model since many envied and admired his character. In early 1990s, Research Medical Tower Pharmacy had began adulterating drugs to increase its profit margins because Courtney was able to divorce his wife and paid $200 000 as half of his property and in 1993, he remarried and acquired property worth $700 000. “In 1999, Courtney pledged $1 million to the building fund of the Northland Cathedral, where he worshipped. He made 2 payments of $333,000 in 1999 and 2000” (Roath, 2010, p.7). By the year 2001, Research Medical Tower Pharmacy had accumulated great wealth that resulted from its fraudulent activities.
Criminal and Contractual Aspects of the Case
The case of Robert Ray Courtney is a criminal activity that does not only violate medical professional ethics, but also encompasses fraud. He violated medical professional ethics of being an advocate of patient’s health concerns and helping them acquire appropriate and quality health care services. Instead, he defrauded them by attaching more importance to his selfish interests while neglecting his responsibility. According to Hansen, “the FBI estimates that the dilutions reverberated through 400 doctors, 4,200 patients, and up to 98,000 prescriptions … diluted and adulterated prescriptions surely led to incalculable suffering and consequences that reverberated through the lives of Courtney’s patients and their loved ones” (2005, p.8). Since the court found out that Robert Ray Courtney has been committing this crime for a period of ten years, it found it reasonable to imprison him for 30 years.
Due to the escalating cases of medical fraud in Kansas, the Congress has formulated legislations that allow for stiffer penalties including life imprisonment. The case of Robert Ray Courtney represented a worst-case scenario of medical fraud because it depicted the extent to which medical professionals can apply unethical professionalism if limiting legislations and penalties are not in place. The Congress has passed statute to ensure that, medical professionals who commit fraud face sentence of not more than ten years or pay fine or both. The statute provides stiffer sentences for medical fraud that results into injury or death, and as Bennett argues, “in the case of bodily injury, imprisonment of up to 20 years is allowed, while in the case of death, imprisonment for any term of years, or for life, is authorized” (2007, p.12). The district court of Missouri made a landmark ruling by exceeding the required sentence period that led Robert Ray Courtney to appeal for reduction after admitting his crime. The court of appeal reviewed the case of Robert Ray Courtney and ruled that they were reaffirming position of the district court, thus his appeal did not change the sentence.
In terms of contractual aspect, the case depicts the importance of proper federal legislations that will regulate activities of the healthcare system in case of any eventualities regarding fraudulence. In support of federal laws that check healthcare systems, the Congress has established the “Kansas Medicaid Control Act that prohibits knowingly making of a false claim, statement, or representation to the Medicaid program or its fiscal agent with the intent to defraud” (Bennett, 2007, p.14). This implies that concerted legislative efforts by the FDA, FBI, healthcare systems and the Congress is going to enhance contractual relationship in fight against medical fraudulence.
Conclusion
The case of Robert Ray Courtney presents a shocking revelation of what might be taking place behind the scenes of healthcare system. For more than ten years, Courtney managed to defraud unsuspecting patients and doctors alike by adulterating genuine drugs to get more profits. Although he was a competent pharmacist, he neglected professional ethics and concentrated on fraudulent business activity at the expense of many lives that suffered due to ineffectiveness of his drugs. Due to criminal nature of his fraud, the court found it reasonable to imprison him for 30 years and Congress continues passing stiffer amendments to curb increasing cases of medical fraud.
References
Bennett, M. (2007). Criminal Prosecutions for Medicare and Medicaid Fraud. Health Care Legislations, 1- 23.
Hansen, M. (2005). United States of America v. Robert Ray Courtney. The United States Court of Appeal, 1-17.
Roath, B. (2010). Robert Courtney. Journal of Medical Fraud, 6(4), 1-47.
Healthcare frauds that individual clinics and medical institutions resort to are a nationally regulated aspect. The relevant legislation is designed to track the cases of the misuse of funds allocated by the government under state insurance programs. As an example, the case of Benevis Dental and its many affiliated clinics under the Kool Smiles brand will be reviewed. The charges against the corporation are significant, and this precedent is a landmark in the American justice system.
Case Description
The corresponding indictment was issued in January 2018 as a direct charge. As the key stakeholders, Benevis Dental corporation and its more than 130 subsidiary clinics under the Kool Smiles brand were involved, as well as the Department of Justice. Clinic patients from several states were additional interested parties. According to the United States Department of Justice (2018), all charges were made by the False Claims Act and its healthcare fraud policy. As a basis, the financial transactions of the group of companies were presented with the results of their activities in 17 states from early 2009 to late 2011 (the United States Department of Justice, 2018). The case caused a significant resonance since a large number of patients, including children, were involved in the fraud of Benevis and its affiliated clinics. As a result, in addition to a negative impact on its reputation, the group of companies suffered colossal financial losses as payments to all affected parties.
Actual Charges
The actual charges against Benevis and its affiliated clinics were for financial claims fraud. The United States Department of Justice (2018) notes that the group of companies provided dental services to the public, which, however, were of no practical medical relevance. Moreover, additional charges were brought against Benevis due to the use of children as patients for their fraudulent scheme. According to Berke (2016), statutory health billing systems were developed for this purpose to track down improper or unfounded financial claims from medical providers. Since Benevis and its affiliated clinics conducted their illegal activities for almost three years, a sufficient basis was gathered to assess the damage caused and impose appropriate punishment. Based on the findings, as the United States Department of Justice (2018) highlights, several categories of employees were indicted. They included both the management of the network of clinics and ordinary dentists who received cash bonuses for successful fraud and the number of cheated patients. Thus, a wide range of charges is commensurate with the general punishment imposed on the group of companies.
Official Punishment
The official punishment of Benevis and Kool Smiles clinics was announced by the United States Department of Justice (2018). In compensation to the government paying off fraudulent financial claims, the authorities ordered the group of companies to pay $23.9 million, including interest (the United States Department of Justice, 2018). At the same time, most of the funds were to be transferred to the federal authorities. Less than half of the fine (approximately $9.7 million) was to be received by the state representatives that made direct payments under official insurance programs (the United States Department of Justice, 2018). However, as Perez and Wing (2019) argue, the Benevis case is not unique, although the total sum is extremely large. According to the authors, the amount of payments depends on both the size of a healthcare institution and its profile since charity organizations tend to receive less severe punishments (Perez & Wing, 2019). Thus, due to the large size of the dental network, Benevis and Kool Smiles clinics were forced to pay off a significant share of the losses incurred by the government.
Case Outcomes
Since the decision to pay to the government was made by the state official agency, the verdict could not be appealed, and Benevis and Kool Smiles clinics had to accept the terms of the charge. At the same time, according to the United States Department of Justice (2018), the group of companies did not agree with the charges brought against them and did not accept the fact of gross financial violations. However, the official review proved numerous unfounded claims made by the guilty party between 2009 and 2011. Park (2019) cites individual situations and considers various cases of false claims and their consequences, and, as the author notes, as a rule, such organizations cannot provide evidence in support of their innocence. In the case of Benevis and Kool Smiles clinics, the representatives of the group of companies argued that the number of payments from the state to them was less compared to many other dental medical institutions. Nevertheless, there is no unambiguous data that could confirm this statement. Consequently, the decision to recover the funds due to the financial fraud committed is justified.
Conclusion
The financial fraud charges against Benevis and Kool Smiles dental clinics are commensurate with the fraud the group committed, and the severity of the punishment is reasonable. The defendant’s lack of a substantive basis reduced the likelihood of a favorable resolution of the case that became a landmark in the American system of medical insurance and government subsidies. The outcomes are logical, and the recovery rate is determined based on the calculation of funds issued to Benevis as a result of false claims.
References
Berke, D. M. (2016). Drive-by-doctoring: Contractual issues and regulatory solutions to increase patient protection from surprise medical bills. American Journal of Law & Medicine, 42(1), 170-189.
Park, E. (2019). Can your medical opinion subject you to criminal or civil liability? Recent federal cases involving medical opinions and false claims. Missouri Medicine, 116(6), 442-444.
Perez, V., & Wing, C. (2019). Should we do more to police Medicaid fraud? Evidence on the intended and unintended consequences of expanded enforcement. American Journal of Health Economics, 5(4), 481-508.
The United States Department of Justice. (2018). Dental management company Benevis and its affiliated Kool Smiles dental clinics to pay $23.9 million to settle False Claims Act allegations relating to medically unnecessary pediatric dental services. Web.
To begin with, this is objectively one of the most important bills among recent ones that is taken into the legislation process. This is due to the fact that from the very beginning of the increasing tendency of the human immunodeficiency virus (HIV) widespread, people who became infected by this illness are not only physically but also mentally destroyed. Moreover, when turning to the young generation, if a person became ill at a heavy stage, then the medical expenditures for this individual will only rise, while the cash flow to the government, imposed through taxes and insurances, immediately stops. As a result, this issue influences many spheres of society’s life, such as macroeconomics and medicine.
A brief description of the bill using bullet format:
Type of the bill: Federal.
Bill Number: H.Res. 461.
Title: Commemorating the 40th anniversary of the HIV/AIDS epidemic.
Purpose: While in the USA, over 770,000 individuals with AIDS have died from the onset of the HIV pandemic, around 16,000 fatalities of those diagnosed with HIV in 2018 (H. Res. 461, 2021)
Intended group/population: The whole population of the United States, especially those who died or who are ill owing to the HIV/AIDS epidemic, their close friends, and family circle.
The possible outcome is determined: One of the most significant theoretical impacts of implementing this bill into the governmental healthcare system is that it encourages significant and sustainable investment for HIV-impacted regions, and HIV-diagnosed individuals, in the U.S. and abroad to prevent the widespread of the illness and provide more qualitative health and treatment services, research programs (H.Res. 461, 2021).
The main legislative sponsors are Barbara Lee, who is the primary sponsor, and 7 other original sponsors: Nanette Barragán, Bobby Rush, Janice “Jan” Schakowsky, Paul Tonko, Karen Bass, Ami Bera, and David Cicilline. In addition, all of them are Democrats, and overall, there were 34 votes in total, while 33 of the voters were Democrats, and only one was the Republican party representative.
When discussing the main reason for selection, it is important to note that this problem concerns all of the world’s population, and the risk exposure of to being HIV positive did not disappear even after 40 years after the first “wave” of this illness. To me, more specifically, the main way of being HIV positive is providing two people’s blood mixture, one of whom is infected (Pietrangelo, 2021). This process usually occurs during the unprotected sexual act or by neglecting the specific sterilization measures when some drugs should be directly sent to the blood. At the early stage of the illness, the person is usually HIV positive, which does not lead to mortal results in the nearest future. However, when the illness develops to a heavier stage, the person might become AIDS (acquired immunodeficiency syndrome) positive, which leads to the mortal result in most cases. The biggest danger of HIV and AIDS is that it forces all facets of an individual’s life due to the limitations of personal activity and a great number of psychological diseases caused by the significant life direction changes.
While most of the U.S. population almost forgot about the presence of such illness, HIV and AIDS do not have a decreasing tendency, mainly owing to the impossibility of the vaccination process. Consequently, the new generation should be aware of the issues that HIV-positive people faced during the first boom of this illness in the United States society.
HIPPA is committed to maintaining the privacy of any patient’s personal information. In this case, healthcare professionals need to ensure that any medical information that can be used to identify a patient is not disclosed to third parties without consent (What is considered protected, n.d). Medical professionals have access to any information that can be used to provide medical services to a patient. Therefore, it is legitimate to use the data to continue treatment and to ensure patient safety. I can use the patient’s medical data to communicate and transmit the necessary prescriptions and instructions since the quality of the services provided by the hospital depends on this. I can correct this error and send copies of the documents to the patient by email or other technically reliable communication channels, having previously obtained his consent. The patient can also visit the hospital to receive written prescriptions and instructions for recovery.
Hospitals can use a variety of methods to enhance and maintain the privacy of reception or waiting room information. First, it is necessary to strictly monitor all documents so that they do not appear in the hands of visitors or other patients. Second, it is necessary to plan the space so that patients and visitors do not have direct visual contact with any personal data. Third, it is important to separate the area for communication between medical workers from the reception itself so that information cannot be accidentally overheard. The breach in confidentiality leads to the legal responsibility of the medical professional to the patient since the disclosure of personal data can cause significant harm. Additionally, the healthcare professional can face fines, disciplinary penalties, including dismissal, as such episodes damage the reputation of the healthcare facility.
There are exceptions to the confidentiality rules that exist to prevent any dangerous or unfavorable situation. For example, a court may require the disclosure of personal medical information in case of proceedings or in the investigation of crimes as evidence. HIPPA also emphasizes that data that cannot be used to identify a patient is not private, which also makes it possible to use them for statistics or research (What is considered protected, n.d). However, in this case, it is necessary to observe all precautions to conceal the specific individuals who own the data.