Corporate Authority define
The typical health care organization is incorporated under state law as a freestanding for-profit or not-for-profit corporation. The governing body, having ultimate responsibility for the operation and management of the organization, generally delegates r
Corporate Authority
Express Corporate Authority
Implied Corporate Authority
Ultra Vires Acts
Express Corporate Authority
Authority specifically delegated by statute. Health care corporations derive authority to act from the laws of the state in which they are incorporated. Delegated by statute
Implied Corporate Authority
Authority to perform any and all acts necessary to exercise a corporation's expressly conferred authority and to accomplish the purposes for which it was created. Arises where there is a need for corporate powers not specifically granted in the articles o
Ultra Vires Acts
beyond the powers"; those acts conducted by a corporation that lies beyond its scope of authority to perform. If any action is in violation of a statute or regulation, it is illegal. E.g., the known employment of an unlicensed person in a position that by
Code of Ethics for Organizations define
organizations provide guidelines for behavior that help carry out an organization's mission, vision, and values to build trust, increase awareness of ethical issues, guide decision-making, and encourage staff to seek advice and report misconduct when appr
Code of Ethics for Organizations
Unprofessional Conduct
Trust and Integrity
False Advertising
Concealing Mistakes
Unprofessional Conduct
Continue to plague the health care system. Complex heath care fraud schemes, for example, resulting in losses of billions of dollars annually impede advances in medicine and deny high quality health care to the people. Enforcing and bringing to justice th
Trust and Integrity
Health care fraud schemes. Organizations must encourage patients to ask questions and seek second opinions both for peace of mind and to aid in determining the best course of treatment.
False Advertising
False or misleading advertising by health care entities continues to confuse and mislead the public in the search for high-quality care. Following numerous complaints by health care orgs and surveyors, numerical scoring was discontinued, arguably due in p
Concealing Mistakes
The Joint Commission in its accreditation process requires that patients be informed when a mistake has been made. Surgical procedure cover-up (e.g., removed wrong kidney). Appearance may not be reality
Corporate Negligence Definition
occurs when a corporation fails to perform whose duties it owes directly to a patient or to anyone else to whom a duty may extend. Maintenance of safe and adequate facilities and equipment; Select & retain only competent physicians; oversee all who practi
Darling v. Charleston Community Memorial Hospital
- The court in this case enunciated a "corporate negligence doctrine" under which hospitals have a duty, for example, to provide adequately trained medical and nursing staff. A hospital is responsible, in conjunction with its medical staff, for establishi
Darling v. Charleston Community Memorial Hospital (2)
The patient complained about continuous pain and two weeks later a specialist saw him and found a lot of dead tissue and during 2 months the doctor removed his leg. The first doctor should have referred the patient to a specialist because he hadn't applie
Doctrine of Respondeat Superior
Let the master respond" - legal doctrine holding employers liable, in certain cases, for the wrongful acts of their agents (employees). Doctrine also referred to as vicarious liability, whereby an employer is answerable for the torts committed by employe
Doctrine of Respondeat Superior (2)
The question of liability frequently rests on whether persons treating a patient are independent agents (responsible for their own acts) or employees of the organization. This depends on whether the organization can exercise control over the particular ac
Independent Contractor
Responsible for their own negligent acts; the principal has no right of control over the manner in which the agents' work is to be performed. E.g., Mehlman v. Powell, the court held that a hospital could be found vicariously liable for the negligence of a
Corporate Duties and Responsibilities
These responsibilities are considered duties because they are imposed by law and can be enforced in legal proceedings. Governing body members are considered by law to have the highest measure of accountability. They have a fiduciary duty that requires act
Trustees and managers
duty to act as a reasonably prudent person would act under similar circumstances in administering the affairs of the organization and exercise its powers in good faith.
Appointment of a CEO define
A Chief Executive Officer (CEO) to act as its agent in the management of the organization. The CEO is responsible for the day-to-day operations. The individual selected as CEO must possess the competence and the character necessary to maintain satisfactor
Appointment of a CEO
CEO Challenges and Responsibilities.
Screen Job Applicants
CEO Challenges and Responsibilities
o Uphold the organizations and ones professional code of ethics
o Show support and respect to all physicians and staff, knowing that as a team they are the things they think they cannot.
o Develop friendships and supporters who can help the organization t
Screen Job Applicants
False Statements. All job applicants must be closely screened prior to employment, regardless of the responsibilities for which they are seeking employment.
Credentialing, Appointment, and Privileging categories
1. Delineation of clinical privileges.
2. Ensure Competency.
3. False Statements - Hoxie v. Ohio State Medical Board.
4. Masquerading as a Physician - Insinga v. LaBella.
5. Discipline of Physicians - Taylor v. Kennestone Hospital.
Credentialing, Appointment, and Privileging
The governing body is ultimately responsible for the credentialing, appointment, and privileging process of the organization's professional staff to maintain high standards of practice and fairness.
Credentialing - process for validating the background of
Delineation of clinical privileges
privileges is the process by which the medical staff determines precisely what procedures a physician is authorized to perform; based on the credentials necessary to competently perform the privileges requested.
Ensure Competency
Hospitals have a responsibility to take reasonable steps to ensure that physicians are qualified for the privileges granted. Failure to screen a medical staff applicant's credentials properly can lead to liability for injuries suffered by patients as a re
False Statements - Hoxie v. Ohio State Medical Board
In Hoxie v. Ohio State Med. Bd., it was determined that a physician had made false statements concerning his criminal history when he stated in a deposition that he had never been arrested. There was sufficient evidence presented to support permanent revo
Masquerading as a Physician - Insinga v. LaBella
Insinga v. LaBella. An action was brought against Canton (who was masquerading as a physician, Dr. LaBella), the hospital, and others in Insinga v. LaBella for the wrongful death of a 68-year-old woman whom Canton had admitted and died while she was in th
Discipline of Physicians - Taylor v. Kennestone Hospital
. Any disruptive behavior, incompetence, psychological problems, substance abuse, etc.) governing body has responsibility for disciplinary actions, which are generally delegated to the administrator and various department directors and managers. Disciplin
Corporate Duties & Responsibility:
Provide Adequate Staff
Provide Adequate Supplies & Equipment
Allocate Scarce Resources
Governing body & local community (courts not involved)
Comply with Rules & Regulations
Comply with Accreditation Standards
Provide Timely Treatment
Provide Adequate Staff - know federal law for nursing facilities
know federal law for nursing facilities. Under federal law, nursing facilities must have sufficient nursing staff to provide nursing and related services adequate to attain and maintain the highest practicable physical, mental, and psychosocial well-being
Provide Adequate Supplies and Equipment - know alternatives
know alternatives. If the board is unable to provide the necessary supplies and equipment, it must consider finding the funds necessary to fulfill its mission or scaling back operations and, if necessary, consider other options, such as filing for bankrup
Allocate Scarce Resources.
Courts have no mandate to arbitrate allocation disputes
Recognizing that the medical community is best equipped to conduct the balancing that medical resource allocations inevitably require, Congress has declined to give courts a manage to arbitrate allocation disputes
� Governing body & local community. Court
Comply with Rules & Regulations
The governing body in general and its agents are responsible for compliance with federal, state, and local rules and regulations regarding the operation of the organization. Depending on the scope of the wrong committed and the intent of the governing bod
Comply with Accreditation Standards. Accreditation and Conflict of Interest
Accredited hospitals are responsible for compliance with the accrediting body's standards (e.g., the Joint Commission). Failure to follow the safe practices identified in accreditation standards can result in patient injuries (e.g., patient equipment was
Comply with Accreditation Standards. Accreditation and Conflict of Interest (2)
Accrediting bodies depend upon the hospitals they survey to reimburse them for the costs of those surveys. This obligates the accrediting body to maintain satisfied clients, and in so doing, a conflict of interest arises. How credible can a survey be when
Provide Timely Treatment - Heddinger v. Ashford Memorial Community Hospital
Heddinger v. Ashford Memorial Community Hospital- - Health care orgs are expected to provide timely treatment to patients. Hospitals can be liable for delays in treatment that result in injuries to their patients. For example, the patient in Heddinger v.
Avoid Conflicts of Interest - know the how's of avoiding such conflicts
know the how's of avoiding such conflicts - involves situations where a person has the opportunity to promote self-interests that could have a detrimental effect on an organization with which he or she has a special relationship (e.g., employee, board mem
Provide a Safe Environment
Hospitals are required to provide a safe environment for patients, visitors, and staff. Safety concerns in hospitals flow from general mechanical safety to direct patient care in the operating room. A health care org is liable for injuries resulting from
Provide a Safe Environment: Prevention of Falls - Thomas v. Sisters of Charity of the Incarnate Word
o Prevention of fall - Thomas v. Sisters of Charity of the Incarnate Word fell three stories to his death after he became locked out on the hospital roof and sat on a ledge in an apparent attempt to attract someone to get assistance. The trial court found
Protect Patients and Staff from Sexual Assault
Hospitals are expected to protect patients and staff from sexual assault. A claim that a hospital was negligent in preventing such an assault will succeed only if such an assault is foreseeable.
What is the role of foreseeability?
the reasonable anticipation that harm or injury is likely to result from an act or an omission of an act. As an aspect of causation in a negligence case, the test for foreseeability is whether a person of ordinary prudence and intelligence should have ant
Decisions that Collide with Professional Ethics - Shea v. Esensten
Shea v. Esensten - The principles of autonomy, beneficence, and justice and the ability to practice what is right according to such principles often collide when organizations have to, for example, ration scarce resources. Such rationing may require manag
Decisions that Collide with Professional Ethics: Financial incentive schemes
The managed care industry has historically failed to acknowledge the practice of denying medical claims at the expense of the patient's health, while at the same time benefitting managed care organizations. Dr. Peeno, a Medical Reviewer for Humana, stated
Decisions that Collide with Professional Ethics: Financial incentive schemes (2)
� Recently, the medical community has turned its attention to the authority of state medical boards to police improper physician expert testimony in medical malpractice actions. The discussion has been broadened to consider whether the presentation of tes