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KEY POINTS

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KEY POINTS

  1. ACA. The Patient Protection and Affordable Care Act (ACA), voted into law in 2010 with implementation through 2014, has been upheld by the US Supreme Court, but continues to face challenges on the political front.

  2. HIPAA/HITECH. The Health Insurance Portability and Accountability Act (HIPAA) protects healthcare information while asking for acknowledgment that it may be released for uses related to medical treatment, payment, and/or healthcare operation, such as auditing performance evaluation and training program. The Health Information Technology for Economic and Clinical Health (HITECH) initiative promotes development of the Electronic Health Records (EHR) initiative with ongoing protection afforded by HIPAA.

  3. Exclusive Contracts. Exclusive arrangements are used by hospitals to contract for anesthesiology service, which may be challenged on allegation of violation of federal antikickback prohibitions and Stark Law.

  4. Medical Negligence. To succeed in a medical malpractice action, the plaintiff must prove four elements by preponderance of the evidence: (a) duty—the defendant owed a duty of care to the plaintiff, (b) breach of duty—the defendant failed to act consistently with the standards of care, (c) causation—the injury suffered by the plaintiff is linked to or caused by the defendant’s breach of duty, and (d) damages—there is actual compensable loss resulting from the defendant’s breach of duty.

  5. Guardianship. Parents are the natural guardians of their children and are expected to seek care that is in their children’s best interest when needed. Courts usually appoint a guardian other than the parent and support decisions for medical care deemed to be clearly in the child’s best interest.

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INTRODUCTION

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Anesthesiology and the broader practice of medicine intersect with the legal system in two fundamental ways: (1) the legal system establishes the framework of permissible conduct, through regulation; and (2) the legal system provides patients and other entities recourse when these regulations have been breached, or when there is a possibility that an avoidable injury has occurred that should have been prevented. This chapter focuses on interactions between the practice of anesthesiology and the American legal system as an example; treatment of the myriad medicolegal considerations for anesthesiologists in all of the legal jurisdictions around the world is beyond the scope of this text.

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The American legal system is composed of federal and state systems, both of which impact the practice of anesthesiology. Although day-to-day anesthesia practice is largely regulated at the state level, there are significant overarching federal laws that require some degree of understanding. These are addressed first.

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AFFORDABLE CARE ACT

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The Patient Protection and Affordable Care Act, commonly referred to as “Obamacare” or the Affordable Care Act (ACA) (Public Law 111-148: HR 3590. Patient Protection and Affordable Care Act, March 23, 20100) was voted into law in 2010 with implementation ongoing into 2014. Its intent, to provide paid healthcare coverage for millions of uninsured or underinsured ...

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