Why we need the independent sector: the behavior, law, and ethics of not-for-profit hospitals

Among the major forms of corporate ownership, the not-for-profit ownership form is distinct in its behavior, legal constraints, and moral obligations. A new empirical analysis of the American Hospital industry, using eleven years of data for all urban general hospitals in the country, shows that corporate form accounts for large differences in the provision of specific medical services. Not-for-profit hospitals systematically provide both private and public goods that are in the public interest, and that other forms fail to provide. Two hypotheses are proposed to account for the findings, one legal and one moral. While no causal claims are made, not-for-profit hospital behavior is consistent with the behavior required by law and morality. The moral argument, developed as a preliminary theory of not-for-profit ethics, also provides a potential reason to prefer not-for-profit hospitals. The findings provide a new justification for the not-for-profit tax exemption for hospitals, and also suggest new uses for ownership categories as regulatory tools.     

The business judgment rule and other protections for the conduct of not-for-profit directors

The authors review the Business Judgment Rule as applied to a not-for-profit director's duty of care, with particular emphasis on the different forms of state statutory liability shields that serve to enhance the protections of the Rule. They also examine current trends in enforcement of breach of fiduciary duty of care standards, and provide a series of specific recommendations for not-for-profit boards to consider implementing as a means of increasing the likelihood of affording such protections to individuals serving as directors.     

Markets,profits, labor and smack

Conclusion I began this paper by noting that the theoretical paradigms we usually invoke in an attempt to understand crime are often misleading and unfruitful. By seeking to understand crime through the vision implied by the normative paradigm we focus upon too narrow a set of phenomenon: namely the ideological structure of social systems or individual personalities. We would do well to shift our vision to include at the very least the political and economic history of that collection of activities which are generally defined by law as criminal. The historical development and political economy of opium and heroin from its introduction by European capitalists into China and Southeast Asia down to its current place in the political economy of the United States has been explored in an effort to demonstrate the utility of refocusing our energies towards a macro-sociological perspective.Copyright 1976 by William J. Chambliss     

The legal risks of quality assurance in Australian public hospitals

Quality assurance techniques aim to measure and uphold the quality of patient care. Tools have been developed that investigate bad outcomes, and identify system errors that may lead to bad outcomes. Hospital administrators are motivated to use these tools, but worry that quality assurance may itself cause legal risks to a hospital. For example, if a hospital finds and documents substandard care, a patient who has suffered a bad outcome might discover this and try to use it in litigation against the hospital. This article examines the legal doctrine behind document discovery, freedom of information, legal professional privilege, medical professional privilege, qualified privilege and defamation, to explore how patients and their relatives may, first, come across and obtain quality assurance findings, and second, use them in legal action. With this knowledge, public hospital administrators might then be able to engage in quality assurance without unduly causing legal risk for their hospital.     

The conundrum of charitability: reassessing tax exemption for hospitals

Tax exemption is an ancient, honorable and expensive tradition. Tax exemption for hospitals is all of these three, but it also places in sharp focus a fundamental problem with tax exemption in general. Organizations can retain their tax exemption while changing circumstances or expectations undermine the rationale that led to the exemption in the first place. Hospitals are perhaps the best example of this problem. The dramatic changes in the health care environment have eliminated most of the characteristics of a hospital that originally persuaded the citizenry to grant it an exemption. Hospitals have entered into competition with tax-paying businesses, and have increasingly behaved like competitive actors. Such conduct may well be beneficial, but it does not follow that tax exemption is appropriate. Rather than an undifferentiated subsidy, a shift to focused goals will provide charitable hospitals with the opportunity and incentive to "do the right thing."     

Medicaid reimbursement of teaching hospitals

This paper examines current Medicaid policies on the reimbursement of hospitals' medical education expenses. These policies are of interest because of the pressure on Medicaid programs to reduce expenditures. Data for the paper come mainly from two sources: a survey of Medicaid programs and a survey of teaching hospitals. Teaching hospitals receive a disproportionate share, nearly 70 percent in 1978, of Medicaid short-term hospital payments. Nevertheless, most Medicaid programs either have no explicit policies in this area or have not acted aggressively to limit reimbursement of hospitals' teaching expenses. Revenues from Medicaid are most important to public teaching hospitals. Thus, across-the-board reductions in Medicaid's reimbursement of teaching expenses would most severely affect public institutions, many of which already face cuts in their local government appropriations. Savings to Medicaid would also be short-lived, since teaching hospitals would have the incentive to reduce teaching program size and substitute reimbursable personnel (nurses and staff physicians) for residents.     

“上访者被强送精神病医院”的法律分析

上访者等于精神病,这是个别地方政府的逻辑.不想群众上交矛盾,就要解决问题化解矛盾. 捂和堵只会使上访问题愈来愈严重.上访本身并不可怕,关键的是如何依法对待上访,如何对待上访中反映出的问题.本文以上访者被强送精神病医院为例,分析其中反映出的法律问题.     

Treating drug-dependent patients in hospitals

Are hospital staff legally permitted to test drug-dependent patients for drugs or infectious disease without the patient's consent in order to treat the patient or to protect themselves or other patients? What should staff do with "suspicious" items in the patient's possession (drugs, credit cards in different names, firearms)? Can drug-dependent patients lawfully use illicit drugs in hospital? Who should supply and administer them?     

The impact of public policy and publicity on admissions to state mental health hospitals

This paper examines the impact of broadened Washington state civil commitment standards on utilization of the state's mental hospitals. Included in the analysis is an assessment of the impact of a public event (a well-publicized murder case) which was in all likelihood a precursor to the law's revision. We also examine the different ways Washington's two state hospitals managed the dramatic increase in civilly committed patients that occurred after the revision took effect. The findings indicate that the murder case, in which the defendant had been denied voluntary admission to a state hospital prior to the killing, resulted in an increase in involuntary admissions in the county where it occurred a full year before the standards were revised. The law itself had the effect of increasing commitments throughout the state, reducing the levels of voluntary admissions, and increasing the likelihood of involuntary admission for individuals previously admitted voluntarily, thus transforming a principally voluntary system into one which was primarily involuntary. Finally, it was found that the increased demand for services mandated by the broadened commitment standards was managed differently in the two state hospitals: one imposed a cap on admissions; the other phased out voluntary admissions at a rate roughly equal to the increase in commitments. These findings illustrate both the substantive impact of broadened civil commitment law and the importance, when assessing the impact of laws, of examining public events and administrative interventions which may have significant causal links with legal interventions.