- Do you think there was political malpractice? Why? Walk us through the 4 elements – your post should be a minimum of four paragraphs
Legal Aspects of Health Care
HLAD 4103
Instructor: Carol Schneider
Introductions
Please post a brief introduction of yourself on the Discussion Board entitled:
Introduction
Let us know why you are taking this course, a bit about your background, work place, interest in healthcare and anything else we should know about you
Syllabus
Class participation through discussion board participation- posts and replies for full credit -10%
Weekly readings and quizzes – 15%
Two written assignments -35%
Mid-term – 20%
Final exam – 20%
No late assignments- all assignments due by Thursday 11:00pm
Announcements
Check weekly for Announcements relating to:
assignment updates
grading
and other information to stay current on the class
It is your responsibility to stay informed of any changes or updates
Government, Law, and Ethics
The Law
A system of principles and processes by which people in a society deal with disputes and problems, seeking to solve or settle them without resorting to force.
Types and sources of law
Law and Public Policy
Public & Private Law
Public law
Laws that deal with the relationships between individuals and the government & relationships between individuals that are of direct concern to the public
Private Law
Laws that deal with the recognition and enforcement of the rights and duties of and between private individuals.
Public & Private Law Examples
Public law:
Criminal Law
Tax Law
Constitutional Law
Administrative Law
Private law:
Contracts
Torts
Labor law
Corporate law
Sources of Law
Common law
Derived from judicial decisions
Statutory law
Written laws
Administrative law
Public law, rules, and regulations issued by administrative agencies to direct the enacted laws of the federal and state governments
Common Law in the U.S.
Body of principles that has evolved and expanded from judicial decisions
Lower courts must follow decision from a higher state or federal court
Decision in one state is NOT binding in other states
Common Law Principles
Precedent
A judicial decision that may be used as a standard in subsequent similar cases
Res judicata
Means the thing is decided—refers to that which has been previously acted on or decided by the courts
Stare decisis
Common-law principle: let the decision stand
Based on similar cases and fact patterns (comparable rulings)
Principles of law are subject to change!
Federal Court System
U.S. District Court
94 district courts in 50 states, 1 in DC and 1 in Puerto Rico
Civil, criminal, admiralty, and bankruptcy cases
U.S. Court of Appeals
12 regional courts, 1 judicial circuit in DC
Reviews District court decisions and administrative agency decisions
U.S. Supreme Court
Only court created by federal constitution
Statutory Law
Written law emanating from a legislative body
Hierarchical order
U.S. Constitution
Highest in hierarchy of laws
State constitution
Federal laws take precedence over state laws
State laws are generally applicable when they are more rigid than federal laws
When state and federal laws conflict
Resolution sought in appropriate federal court
Article VI of the Constitution
This Constitution and Law of the United States
. . . Shall be the supreme Law of the Land;
and the Judges in every State shall be bound thereby . . .
Administrative Law
Extensive body of public law issued by administrative agencies to carry out the intent of enacted laws of the federal and state governments
Ex: Department of Health and Human Services (HHS) administers much of the federal health law enacted by Congress
Administrative Procedures Act
Describes different procedures under which federal administrative agencies must operate
Prescribes procedural responsibilities and authority of administrative agencies
Administrative Agencies have their own legislative, judicial and executive functions
Administrative Procedures Act
Provides legal remedies for those wronged by agency actions
Rules and regulations established by administrative agency must be administered within scope of authority delegated by Congress
Subject to judicial review by the courts, but usually must seek recourse within the agency first
Example of how it works
Public Policy: A Principle of Law
What government (any public official who influences or determines public policy, including school officials, city council members, county supervisors, etc.) does or does not do about a problem that comes before them for consideration and possible action.
Law that holds that no one can lawfully do that which tends to be injurious to the public or against the public good.
Government Organization
Legislative Branch: Write and Enact Laws
Executive Branch: Administer and Enforce the Laws
President can veto a bill
Congress can override veto with a 2/3 vote
Pocket veto: President prevents a bill from becoming law by avoiding any action when Congress is in session
Judicial Branch: Interpret and Apply Laws
How does a bill become law?
Separation of Powers
Under this model, government is divided into branches.
Each branch:
Has separate and independent powers
Has separate areas of responsibility
Is able to place limited restraints on the power exerted by the other branches
Department of Health & Human Services
Responsible for carrying out national health and human services policy objectives
Administration on Aging
Improve the life of senior citizens
Centers for Medicare and Medicaid Services
Administer Medicare, Medicaid and State Children’s Health Insurance Program (CHIP)
Public Health Service
Promote the protection of the nation’s physical and mental health through various agencies
Public Health Service
National Institutes of Health
Principal federal biomedical research agency
Centers for Disease Control and Prevention
Prevention and control of infectious and chronic diseases and public health emergencies
Food and Drug Administration
Ensure the effectiveness, quality and security of drugs, medical devices and food
Substance Abuse and Mental Health Services Administration
Reduce the impact of substance abuse and mental illness
Public Health Service
Health Resources and Services Administration
Improve access to healthcare services and achieve health equity
Agency for Healthcare Research and Quality (AHRQ)
Provide evidence-based information on healthcare outcomes, cost, use and access
Agency for Toxic Substances and Disease Registry
Prevent or mitigate harmful exposures and related diseases
Indian Health Service
Provision of healthcare to Native Americans
Medicare
Medicare: federal health insurance covers adults 65+, disabled, certain diseases (ex: end stage rental disease)
Part A: Hospital, hospice, home health care and skilled nursing care (in-patient care)
Part B: Physician visits and medical procedures (out-patient care)
Part C: Medicare Advantage Plans (Medigap) (supplemental private insurance plans)
Part D: Prescription drug plans (also private)
Medicare
Premium: what you pay each month
Deductible: what you pay before the insurance company does
Copayments: what you pay for a service regardless of what the deductible is
Coinsurance: the percentage of the service the insurance company doesn’t cover
Out of Pocket Maximum: how much you will pay out of your pocket each year in an absolute worst-case-scenario situation
Medicaid
Medicaid: jointly sponsored/financed by the federal government and states
For those with very low incomes
Patients pay nothing except for a small-copayment on rare occasions
Varies from state to state
Ethics
Law and ethics are intertwined
Well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues.
The continuous effort of studying our own moral beliefs and our moral conduct, and striving to ensure that we, and the institutions we help to shape, live up to standards that are reasonable and solidly-based.
Government Ethics Committees
Executive Branch
Office of Government Ethics
Prevent and resolve conflicts of interest among government employees
Government Ethics Committees
U.S. House of Representatives
Committee on Ethics
U.S. Senate
Senate Select Committee on Ethics
U.S. Judicial Code of Conduct
Office of Congressional Ethics
Independent, nonpartisan office, governed by a board comprised of private citizens
Provides public review & insight into ethical conduct of members of the House of Representatives
OCE reviews allegations of misconduct against members, officers, and staff of the House and, when appropriate, refers matters to the House Committee on Ethics
Exercise 1 –Government Scandal
Research an ethics investigation or government/political scandal
´Can be domestic or international
´Share the facts with the class by posting on Discussion Board:
´Who was being investigated? And by whom?
´How did unethical allegations come to light?
´Outcome of investigation or scandal
´Why is this type of conduct a problem?
Format this assignment in full narrative form and include the questions above in your heading
State Ethics Committees
Hear complaints of ethics violations by legislators
Investigate complaints and impose penalties for ethics-related violations
Ethicists in Public Service
An independent, unbiased, professionally trained decision maker seen as an “outsider” may be more acceptable to councils, mayors, citizens, employees, or the press than one derived from inside the political process.
Political Malpractice
Negligent conduct by an elected or appointed political official
Duty
Breach
Injury
Causation
Exercise 2: Flint Water Crisis
Download from Blackboard and read Michigan Governor Rick Snyder’s remarks on the Flint Water Crisis.
Do you think there was political malpractice? Why? Walk us through the 4 elements – your post should be a minimum of four paragraphs
Reply to one other Discussion Board post with your comments and feedback- your reply post should be a minimum of two paragraph
,
Prepared remarks on the Flint Water Crisis
Gov. Rick Snyder Jan. 19, 2016 – 7 p.m.
Tonight will be a different State of the State. There is so much we could discuss about how we can make
our great state even greater, better, and stronger over the next year. But tonight I will address the crisis
in Flint, first and in-depth.
To begin, I’d like to address the people of Flint. Your families face a crisis – a crisis you did not create
and could not have prevented.
I want to speak directly, honestly, and sincerely to let you know we are praying for you, we are working
hard for you, and we are absolutely committed to taking the right steps to effectively solve this crisis.
To you, the people of Flint, I want to say tonight—as I have before—I am sorry and I will fix it.
No citizen of this great state should endure this kind of catastrophe.
Government failed you – federal, state, and local leaders – by breaking the trust you placed in us.
I’m sorry most of all that I let you down.
You deserve better. You deserve accountability. You deserve to know that the buck stops here, with me.
Most of all, you deserve to know the truth and I have a responsibility to tell you the truth. The truth
about what we’ve done and what we’ll do to overcome this challenge.
Tomorrow I will release my 2014 and 2015 emails regarding Flint to you, the citizens, so that you have
answers to your questions about what we’ve done and what we’re doing to make this right for the
families of Flint. Anyone will be able to read this information for themselves at Michigan.gov/Snyder.
Because the most important thing we can do right now is to work hard and work together for the people
of Flint.
I know apologies won’t make up for the mistakes that were made—nothing will. But, I take full
responsibility to fix the problem so that it never happens again. Let me tell you what we’ve done so far,
and what we will be doing in the coming days, weeks, months, and years to keep our commitment to
you. To make Flint an even cleaner, safer, stronger city than it was before. Because that’s what you and
your families deserve.
We are working to do whatever we must until this crisis is resolved. The people of Flint have chosen a
new mayor. And I personally commit to work hand in hand with Mayor Weaver so we can rebuild the
trust that’s been broken.
I have already taken steps to bring new leadership to the DEQ – these are individuals who understand
the severity of the problem and who will effectively communicate to the people of our state.
For those whose mistakes contributed to this disaster, we are fully cooperating with investigations and
will hold those individuals accountable. And let me be perfectly clear to all of state government. In the
future, a situation like this must come to my desk immediately. No delays. No excuses. Period.
We will provide resources to help anyone and everyone that is affected. Just as we’ve provided since
we first knew of this crisis.
In addition to emails, tonight I’m releasing a comprehensive timeline of the steps we’ve taken and the
actions underway to solve this crisis.
Here are the facts.
1. First, this crisis began in spring 2013, when the Flint City Council voted 7-1 to buy water from
Karegnondi Water Authority (KWA). Former Flint Mayor Walling supported the move, and the
Emergency Manager approved the plan. DWSD provided notice of termination to be effective
one-year later and, on April 25, 2014, Flint began using water from the Flint River as its interim
source.
2. Second, soon after the switch from Detroit water to Flint River water, residents complained
about the water – the color, the smell, rashes, and concerns with bacteria. Ultimately, localized
boil water advisories were issued by the City of Flint in August and September of 2014, each
lasting several days.
3. Third, the Department of Environmental Quality (DEQ) and the federal Environmental Protection
Agency began communicating about lead concerns in February 2015. Sadly, both were
ineffective in fully addressing and solving the problem. DEQ misinterpreted the water safety
regulations and the EPA did not act with sufficient urgency to address the concerns of one of its
experts about DEQ’s approach and the risk of lead contamination. In May 2015, lead service
lines to one residence were removed and replaced due to high lead levels. But still, they both
failed to systemically identify and solve the problem.
4. Fourth, in July 2015, my office proactively asked about the quality of Flint water, test results and
blood testing. The DEQ told us that Flint was in compliance with the lead and copper rule. They
told us there was one concern with one house that was later corrected and that there was
nothing widespread to address. The DHHS also told us that the elevated blood lead levels were
to be expected because they followed a normal seasonal trend. This conclusion was later shown
to be incorrect when DHHS conducted a deeper analysis of the relevant data.
5. Fifth, In August, Prof. Marc Edwards from Virginia Tech and Dr. Mona Hanna Attisha sounded an
alarm about lead in Flint’s water. But tragically, based on what DEQ and DHHS had seen on the
ground, they initially failed to reach the same conclusion. I want to thank the Professor, the
Doctor and the Concerned Pastors of Flint for bringing light to this issue. We are actively
investigating why these agencies got this so wrong.
6. Sixth, on September 28, 2015, I was first briefed on the potential scope and magnitude of the
crisis on a phone call with DEQ and DHHS. On October 1, 2015, DHHS epidemiologists validated
Dr. Hanna-Attisha’s findings, confirming the lead problem in Flint’s water supply. At this point, I
immediately ordered them to develop and implement a 10-point plan that included the
immediate distribution of water filters, immediate water testing in schools, and expanded water
and blood testing for anyone who might be exposed. About 12,000 filters were distributed, 700
water tests and 2,000 blood tests were conducted within the first three months.
7. Seventh, on October 8, I announced that the Flint system would be reconnected to the Detroit
water system to end any further damage, and later that month I announced the independent
Flint Water Task Force to review the actions taken so far and to make further recommendations
to address this crisis.
8. Eighth, the Task Force issued its initial actionable recommendations and identified critical
problems in mid-December. Specifically, they pointed to a primary failure of leadership at the
DEQ and a culture there that led to this crisis. The task force was right, and I immediately took
action, appointing new leadership at the department.
9. Ninth, I declared an emergency in Flint on January 5 so that we could access additional
resources and mobilize additional support, including the Michigan State Police and the National
Guard. These critical resources were needed to help families get clean water and end any risk or
exposure for every resident in Flint. I also requested a presidential declaration of federal
emergency, which was granted. And to the members of our Congressional delegation who are
here tonight, this is a challenge we must work together to solve, and we look forward to
working with you to bring additional support from the federal government for the people of
Flint.
10. Tenth, to date, more than 37,300 cases of water, more than 53,700 water filters, and more than
7,300 water testing kits have been distributed. More than 21,300 homes have been visited. I am
increasing the support from the National Guard starting tomorrow to ensure that every house
we need to visit in Flint gets visited as soon as possible. And I am appealing the president’s
decision not to grant a major disaster declaration. We’ll continue to deliver water and filters.
We will not stop working for the people of Flint until every single person has clean water every
single day. No matter what.
That’s why today, I made an official request to the Legislature to fund a series of immediate actions to
provide everyone in Flint clean water, and care for Flint’s children. In addition to the $9 million
supplemental appropriation for Flint made in October 2015, the request today is for $28 million, with
$22.6 million from the general fund. It includes:
1. Additional bottled water, filters, and replacement filters for anyone who needs these resources.
2. Assistance for the City of Flint to help with its utility related issues.
3. Testing and replacing fixtures in schools, day care facilities, and other higher risk locations.
4. Treatment of children with high lead levels, including diagnostic testing, nurse visits, nutrition
counseling and environmental assessments.
5. Services will be available for the treatment of potential behavioral health issues such as ADHD
for those who have or could have had an elevated blood lead level.
6. We will also work with local primary care providers and hospitals to educate the community
about toxic stress and how to identify early developmental delays.
7. Support for child and adolescent health centers and additional support for children’s health care
access
8. An infrastructure integrity study for pipes and connections, using outside, independent experts
An important note: this will not be the last budget request for Flint. Additional resources will be needed
for water related needs, health care needs, educational needs, economic development needs, and
more.
If you would also like to aid Flint, please to to HelpforFlint.com to volunteer or donate. If you are a Flint
resident who needs help getting the water you need – go to HelpforFlint.com
Those are the facts of what we’ve done and what we’re doing. But just as important to solving short-
term needs are providing real long-term solutions so that nothing like this ever happens again in ANY
Michigan city.
We began that process by creating the independent Flint Water Task Force and asking them to report on
exactly what happened, what accountability measures must be in place, and what investments need to
be implemented.
This month, I issued an Executive Order to ensure state and local leaders have everything they need to
clean up the mess, and ensure anyone with lingering health concerns is quickly, compassionately, and
effectively treated. I know that there will be long-term consequences – but I want you to know that we
will be there with long-term solutions for as long as it takes to make this right.
There can be no excuse. When Michiganders turn on the tap, they expect and they deserve clean, safe
water. It is that simple. It is that straight-forward. So that is what we will deliver.
To the families in Flint. It is my responsibility, my commitment to deliver. I give you my commitment
that Michigan will not let you down again.
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