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University of Maryland University College

HCAD650

1. What is meant by the term standard of care in the context of medical liability? Provider
examples as to the application of this legal term. How is this standard determined and defined in
the health care field? Are you satisfied that it protects both patients and health care providers or
neither and why so?

Standard of care in the health care field describes the diagnostic and treatment process
that physicians follow when treating patients according to their specific illnesses. In context of
medical liability, standard of care is when practicing physicians would treat patients similarly to
other physicians in the community. It determines how alike physicians would have treated the
patients care given the same or related situations. For example; A patient with a medical history
of high blood pressure is usually prescribed high blood pressure medications by their physician.
This standard of care is practiced frequently between similarly qualified physicians, where some
physicians prefer prescribing one brand over another to their patients. A violation or breech of
this standard of care will come as a medical malpractice case. If a patient of one physician was
not prescribed high blood pressure medication even though they clearly suffered from the
disease, this patient can demonstrate that the standard of care has been breached under failure to
administer medications tort law (Pozgar, p.33).
The requisite standard of care is usually determined by evaluating the performance and
abilities of doctor's practicing near the doctor accused of malpractice. Exactly how near can be
different in each state (LaMance, 2012). With a physician practicing in the countryside their
counterparts are less extensive when comparing to physicians that practice in a metropolitan
area. Once the breach of the standard of care can be proven, a negligence lawsuit can be filed
against the faulty physician. Personally I feel this standard of care in context to medical liability
protects both patients and providers. For physicians to follow the acceptable treatment program
for all patients is a way that management of care is practiced uniformly. Of course treatment
plans will not be an exact match because physicians look at the patients personal circumstances,
additional ailments and such that is only unique to that individual patient. Some physicians learn
different treatment techniques because of their different training and experience, but the root of
treatment is all the same.

2. Compare and contrast, if need be, the legal duties of publicly owned and privately owned
hospitals to maintain emergency medical services and treat and/or admit such patients. How do
these legal standards change, if at all, towards so-called non-emergency patients seeking
treatment at these facilities?

Emergency departments (EDs) are a vital component in our health care safety net,
available 24 hours a day, 7 days a week, for all who require care. The duties for both public and
private hospital emergency departments are similar when it comes to treating and admitting
patients. However, private hospital emergency departments tend to have a lower waiting period
compared to public hospitals but it usually is specialized in a treatment of care. To avoid waiting
a long time to find out they dont have the equipment necessary for your illness and being
transferred, its best to go to a public hospital. Public emergency departments are often
overcrowded, but it is due to their wide range of treatment types.
The Emergency Medical Treatment and Active Labor Act (EMTALA) was created
out of concern that patients were being denied emergency medical treatment because of their
inability to pay (Schecter, 2010). The initial intent of EMTALA was to address the allegation
that some hospitals were transferring, discharging, or refusing to treat patients who did not have
insurance. The two basic requirements of EMTALA are: For any person who comes to a hospital
emergency department, "the hospital must provide for an appropriate medical screening
examination . . . to determine whether or not an emergency medical condition exists; If the
screening examination reveals an emergency medical condition, the hospital must "stabilize the
medical condition" before transferring or discharging the patient (Schecter, 2010). EMTALA
regulations apply to all hospitals that participate in the Federal Medicare program and apply to
all patients. Private hospitals, military and Federal hospitals dont receive funds from Medicare
and are exclude from EMTALA. But most hospitals in the U.S abide by these rules to protect
patient safety and the entity itself.
EMTALA applies to all persons who come to a hospital emergency department and
request an examination, whether they report they have or actually have an emergency medical
condition when they arrive at the emergency department. Hospitals which participate in
Medicare must develop and uniformly follow medically-appropriate procedures for screening,
examining and treating all persons who come to the emergency room. The final rule states that
if an individual comes to a hospitals dedicated emergency department and a request is made for
examination or treatment for a medical condition, but the nature of the request makes it clear that
the medical condition is not of an emergency nature, the hospital is only required to perform such
screening as would be appropriate for any individual presenting in that manner and as would be
necessary to determine that the individual does not have an emergency medical condition
(McDermott Will & Emery, 2012).

3. Hospital governing boards, while nominally in charge (but composed as they often are of
unpaid, lay, volunteer members with limited relevant expertise) are free under the law to
delegate policy-making and key decision-making powers to the trained, professional hospital
chief executive officer who, in turn, is legally accountable for the quality of patient care within
the facility. This explains why the administrator is really at the center of hospital operations and
is responsible directly for the medical staffs performance within the facility. Accept or reject
this statement with specific authority.

The role of a health care governing board is to ensure that the hospital and/or system
provide high-quality, affordable care which meets community and area needs (IHA, 2010). The
hospitals administration is ultimately responsible for providing the board members with
resources and education they need to carry out their duties. This statement is true since the
hospital administrator acts as the voice for the medical staff of the hospital. When staff members
want to raise issues that affect quality care, they present it to the administrator so that the
governing board can be aware of this issue and come up with a solution. The administrator is the
center of the hospitals operation and must take responsibility of their staffs performance. They
act as liaisons between governing boards, medical staff, and department heads and integrate the
activities of all departments so they function as a whole.
The most important issue is if the board understands what the medical staff issues is that
occur at their facility. When the administrator expresses this to the board, the medical staff will
gain a sense of trust and cooperation with the institution. A hospital that cannot fulfill its mission
due to distrust between the medical staff and governing board are sure to crash. This ultimately
affects the quality of care that is given to patients that then look bad on the hospitals
administration team.
Reference

McDermott Will & Emery. (2012). EMTALA Final Regulations. Retrieved from
http://www.mwe.com/publications/uniEntity.aspx?xpST=PublicationDetail&pub=5224

Schecter, S. C. (2010). COBRA Laws and EMTALA. Retrieved from


http://emedicine.medscape.com/article/790053-overview

LaMance, K. (2012). Standard of Care for Medical Malpractice. Retrieved from


http://www.legalmatch.com/law-library/article/standard-of-care-for-medical-malpractice.html

IHA. (2010). Board Self Assessment Guide. Retrieved from


http://www.ihaonline.org/publications/Board%20Self-Assessment%20Guide%20-
%20Mar'05.pdf