Healthcare services delivery and law courrse for graduate program U.S.A

Name: _____________________________

Case Study #3

H 516

Health Care Service Delivery & the Law

Case Study #2

Instructions:

The case study below is designed to test your ability to issue spot and apply the legal principles discussed in the course to isolated fact patterns. Questions, issues, and, importantly, responses may be pulled from all of the Course Materials (e.g. lectures, readings, etc.). You may use your notes, your book, the slide decks, the internet. But you cannot consult one another or otherwise coordinate with each other in any way. In addition, you cannot use any type of Artificial Intelligence program or software (e.g., ChatGPT).

You are to approach each question as if you are corporate and/or individual counsel engaged by your client to identify the legal issues involved in each fact pattern below. There are no word limits for responses, however in rendering your advice you should endeavor to be accurate and concise (e.g. you will not be awarded extra points for providing additional analysis that is not applicable to the situation at hand). Answers receiving full points will (1) correctly identify all applicable legal issues; (2) summarize the rule(s) applied to each legal issue; and (3) correctly apply the rule to the fact pattern at hand.

Rubric:

Each subpart of the Case Study will be graded on a Point Scale ranging from 5 (Full Points) to 0. The rubric below sets forth how each response will be analyzed and graded. Partial points will not be awarded.

Question 1 (20 points)

Patient is admitted to the hospital with severe headaches. Patient initially seems to have all his mental faculties, but the nurses notice that while he understands the diagnoses of his symptoms as the nurses communicate them, he has trouble remembering certain facts (such as his wife’s name or the last time IU made the NCAA tournament). The longer the day goes on he has trouble speaking in coherent sentences when talking to the nursing staff and physicians.

Will this patient be deemed to have decisional capacity? Discuss what factors will be considered by the physician, and how those appear to cut in this case?

Assume that the patient has become incapacitated and has not executed an advance directive naming a Health Care Representative or Health Care Power of Attorney. Knowing that the patient’s health has been deteriorating throughout the day, the patient’s wife and only sister are at the hospital when the physician recommends that the patient undergo surgery because the benefits of the surgery would outweigh the risks of not having the surgery. The patient’s sister agrees with the physician’s recommendation, but the wife disagrees because she can’t bear the thought of her husband undergoing surgery. The physician calls you to ask whether she can perform the surgery. What do you tell the physician? What steps do you take to reach that conclusion?

Assume the patient has become incapacitated, has not executed an advance directive naming a Health Care Representative or Health Care Power of Attorney, and the sister tells you that the wife just recently filed for a petition for dissolution of marriage in court. Does this change your answer in (b)? Why or why not?

Assume the patient has become incapacitated, but has executed an advance directive naming his sister as his Health Care Representative. Does this change your answer in (b)? Why or why not?

Question 2 (15 points)

Rob Knight, avid Purdue fan living in Indianapolis, hits the bars hard the night after Purdue loses yet another basketball game. The next morning, he has a raging headache and asks one of his roommates to take him to the nearest hospital emergency room (which happens to be an IU Health facility). Other than a massive headache, there does not seem to be anything wrong with Rob.

1. What obligation does the hospital have to Rob Knight under these circumstances?

While IU Health Hospital properly completes its obligations (as you’ve just described), they discover that Rob has what they believe to be Purdue-Basketball-phobia (fear of rooting for a team that never fulfills expectations). However, to their relief it is determined that when Rob Knight was out drowning his sorrows, he fell and hit his head (as he is in severe pain).

What additional obligations does this discovery create for the hospital?

Rob is such a huge Purdue fan and so sick about the mounting losses that he can’t stand to be at the IU Health Hospital and demands that he be transferred to another hospital where he will not have to look at IU logos at every turn.

Can IU Health Hospital transfer Rob as he requests? What criteria must they consider, and how might those criteria cut in this case?

Question 3 (15 points)

A medium sized county hospital (Hospital) enters into an arrangement with a local cardiologist (who regularly practices at the hospital) for the provision of call coverage services at the Hospital. The hospital will pay the cardiologist $500 per day for call coverage, which is fairly standard in the industry for this type of call coverage. The parties draft a contract which has a term of 1 year.

1. Do these payments implicate the Stark Law? Why or why not?

Assume the Stark Law is implicated, what needs to be done to ensure compliance with the Stark Law, and please explain how the current facts help meet compliance, and what additional facts you’d want to be sure of to ensure compliance with the Stark Law?

Do we have a legal problem under the Anti-kickback statute? Why or why not? If you need more information, what do you need to know, and why?

Question 4 (20 Points)

Horizon Health System is embarking on an ambitious plan to expand its services with the establishment of a new hospital. The Board of Directors at Horizon feels that this was allow the entities to vastly expand the patient populations they serve, however, its administrative team does not have any experience with opening a new facility and has come to you with threshold questions about the regulatory and reimbursement environments that .

a. Assume that Horizon Health System operates in a state that requires hospital licensure. How can their new hospital ensure continued compliance with licensure laws?

b. What steps must the hospital take before it can participate in the Medicare program?

c. Do you recommend that the hospital be accredited by an accreditation organization approved by CMS or wait for a State Agency survey?

d. What methods of payment will be used for inpatient services provided at the hospital? What about for outpatient hospital services?