HCA 315 Module 1 The Legal System and Sources of Law Example

Five Questions in One Week: How the Legal System Shapes a Health Care Organization

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Health Care Administration Program, Aspen University

HCA 315: Legal Aspects of Health Care Administration

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Month Day, Year

Five Questions in One Week: How the Legal System Shapes a Health Care Organization

Health care administrators meet the law every day, often without noticing it. Rules about who must be treated, what records may be shared, how staff must be paid and what happens after an injury all come from different sources of law, enforced by different bodies. This paper introduces the American legal system through five questions that arose in one week at a composite urgent care center and traces each to its source.

The Week's Questions

On Monday, a man arrived with chest pain and no insurance, and a new receptionist asked whether he could be sent elsewhere. On Tuesday, an attorney requested a patient's records. On Wednesday, a nurse asked whether she was owed overtime for a double shift. On Thursday, a therapist at the center's behavioral health service heard a patient threaten a named coworker. On Friday, a patient's family said they would sue over a missed fracture.

Sources of Law

American law comes from several sources. The table summarizes them.

Monday: A Statute

The chest pain question is answered by federal statute. A 1986 law known as EMTALA, 42 U.S.C. § 1395dd, obliges Medicare-participating hospitals with emergency departments to screen anyone who comes seeking emergency care and to stabilize or appropriately transfer patients with emergency conditions, regardless of ability to pay (Emergency Medical Treatment and Active Labor Act, 1986). Whether the law applies to a freestanding urgent care center depends on its relationship to a hospital, but the center's policy, following the law's spirit, is to evaluate the patient and call 911 for suspected heart attack.

Tuesday: A Regulation

The attorney's request is governed by federal regulation. The HIPAA Privacy Rule, issued by the federal health department under authority from Congress, generally requires a patient's written authorization before records are released to an attorney, unless another exception such as a qualifying court order applies (U.S. Department of Health and Human Services, 2022). State laws may add protections. The center sent the request to its privacy officer.

Wednesday: Federal and State Layers

The overtime question involves both federal and state labor law. Federal law sets a floor, and states may provide more protection. The center's human resources manager checked both, along with the nurse's employment classification, before answering. Many health care legal questions work this way: federal law sets minimums and states build on them.

Thursday: Case Law

The threat raised a question answered not by statute but by courts. The California Supreme Court held that when a therapist determines, or reasonably should determine, that a patient presents a serious danger of violence to another, the therapist has a duty to use reasonable care to protect the intended victim (Tarasoff v. Regents of the University of California, 1976). Many states have since adopted versions of this duty by statute or case law, with different details, so the center's clinicians follow their state's rule.

Friday: The Civil Justice System

The threatened lawsuit would be a civil case, in which a private party seeks compensation, rather than a criminal case, in which the government seeks punishment. Malpractice claims move through negotiation, and sometimes trial, in state courts. A study of closed claims found that 37% did not involve errors and that most such claims were not paid, while 73% of claims involving injury from error received compensation (Studdert et al., 2006). The system is imperfect but more often right than wrong.

The Courts

State and federal courts have trial courts, which decide facts and apply law, and appellate courts, which review legal questions. Decisions of higher courts bind lower courts in the same system, which is how case law like Tarasoff shapes behavior across a state. Federal courts hear cases involving federal law or parties from different states.

Administrative Agencies

Agencies write and enforce regulations. For a health care organization, important agencies include the federal health department and its Office for Civil Rights, which enforces HIPAA; the Centers for Medicare & Medicaid Services; the Occupational Safety and Health Administration; and state health departments and licensing boards. Agency actions can include inspections, fines and loss of licensure.

Contracts

Much health care law is private law made by contract. Payer contracts set rates and rules, employment agreements define duties, and vendor agreements govern data protection. Courts enforce contracts, so administrators must read them carefully and follow them.

Law and Ethics

Law sets minimum standards; ethics often asks more. The center could legally refuse some requests that ethics would encourage it to meet, such as helping an uninsured patient find follow-up care. Good administrators ask both whether an action is legal and whether it is right.

Getting Legal Help

Administrators need to recognize legal questions, not answer them all. The center keeps a list of which questions go to its privacy officer, human resources, risk manager and outside attorney, and staff are trained to escalate rather than guess.

Criminal Law in Health Care

Although most health care legal matters are civil or administrative, criminal law applies too. Billing fraud, diversion of controlled substances, patient abuse and knowing wrongful disclosure of health information can all be prosecuted. Administrators help prevent criminal exposure through compliance programs, controlled substance audits and prompt reporting of suspected misconduct.

Accreditation and Standards

Not every rule an organization follows is law. Accrediting bodies set standards that organizations adopt to earn accreditation, and payers often require accreditation. These private standards frequently influence what courts treat as reasonable practice, so they matter legally even when they are not statutes or regulations.

Conclusion

One week at an urgent care center touched statutes, regulations, case law and contracts, at both federal and state levels, and both civil and administrative enforcement. Knowing where each rule comes from helps administrators find the right answer and the right person to ask. The legal system is complex, but its structure is logical once its sources are clear.

References

Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd (1986).

Studdert, D. M., Mello, M. M., Gawande, A. A., Gandhi, T. K., Kachalia, A., Yoon, C., Puopolo, A. L., & Brennan, T. A. (2006). Claims, errors, and compensation payments in medical malpractice litigation. New England Journal of Medicine, 354(19), 2024-2033. https://doi.org/10.1056/NEJMsa054479

Tarasoff v. Regents of the University of California, 17 Cal. 3d 425 (1976).

U.S. Department of Health and Human Services. (2022). Summary of the HIPAA privacy rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html