In 1959, California became the first state to enact legislation protecting good Samaritans from tort liability under certain circumstances. While previously a good samaritan giving aid in an emergency could be held liable only if he acted unreasonably, there was no legislative mandate to affirmatively discourage an injured party from bringing suit against the good samaritan. Although few such cases can be documented, the absence of legislative protection was thought to work a serious detriment to the prompt rendition of aid in emergency conditions, since some medical practitioners might refrain from giving emergency aid for fear of being subjected to legal action. In response to this perceived situation, California enacted its legislation to encourage the giving of emergency aid and to “sufficiently allay [the good samaritan's] fears of legal action:”

Currently, good samaritan statutes exist in all fifty states, the District of Columbia, and the Virgin Islands. These statutes range from the very broad to the very specific, and each is supposedly designed to protect the good samaritan emergency care provider from frivolous litigation. However, developments in recent years have caused commentators to question whether the central purpose behind these statutes—to discourage legal action—has actually been achieved.

Injury control has gained gradual acceptance as both a public policy concern and the focus of scholarly research during the last decade. Observers have noted the costs to American society of both intentional and unintentional injuries and have sought to identify preventive intervention strategies that can reduce their incidence and impact. Although many of these intervention efforts have just begun, researchers have been far more successful at identifying potential strategies for the prevention of unintentional than for intentional injury. Indeed, many observers have asked whether the majority of intentional injuries can be prevented at all. In this paper I examine the various problems associated with the prevention of intentional injuries such as homicide, assaultive violence, and suicide. Homicide among blacks is used to illustrate the variety of theoretical, ideological and practical concerns that must be confronted in efforts to successfully prevent intentionally induced injury.

Proponents of efforts to designate injury, both intentional and unintentional, as a health concern have suggested that one result of such a designation will be the development of more effective strategies for the prevention of injuries.

The recent high-profile financial difficulties of Harvard Pilgrim Health Care, the largest HMO in Massachusetts and consistently rated as one of the top ten HMOs in the nation, shed light on many problems common to health insurers throughout the country. This article explores those difficulties in the context of the short but complicated history of Harvard Pilgrim, and its regulatory and competitive environments. The state legislation which made a receivership proceeding possible for Harvard Pilgrim offered some protection for subscribers, but failed to provide the means for achieving a long term solution. The statute merely presented a method for staving off immediate collapse by temporarily protecting the plan from dissolution, and forcing the plan's contracting providers to continue delivering care even if owed money by the plan. The article concludes by drawing lessons for understanding and ideally avoiding similar managed care nearfatalities in the future.

Today's practicing physicians and attorneys can be assured of increasing contact with the legal and insurance issues stemming from the adverse consequences of a patient's injuries or illnesses. Mounting litigation involving alleged medical negligence as a cause of personal injury, and expanding social legislation and insurance programs which provide benefits to injured or disabled persons, their dependents, or their beneficiaries has required an increase in the medical problem issues encountered in processing and resolving contested claims. Evaluations of such claimants by physicians are essential to the proper handling of their legal and insurance claims.

Medical evaluations performed specifically to provide information to the legal system and the expression of medical opinions formed after such evaluations constitute an area of medicine best termed Forensic Medicine. The traditional concept of “forensic medicine” was limited almost entirely to the medical investigation of the causes of death and the results of trauma, injury, and violent crimes. Forensic medicine practitioners were generally restricted to pathologists who performed medicolegal autopsies.

We argue that voluntary mental health registries integrated into the 9-1-1 system, where patients and caregivers can establish a repository of this information, will help fill this information gap by enabling first responders to quickly understand the context of a call for service with a mental health component, and to make better informed decisions. Despite valid concerns about privacy, stigma, and the potential misuse of protected health information, such registries, if carefully designed and administered, can improve the health outcomes of 9-1-1 calls for service involving mental health-related crises.

As general counsel to one of the largest hospitals in the United States, I want to discuss a topic which affects 15 to 20 patients in our hospital every day, those on whom physicians have written what we call “DNR” orders (Do Not Resuscitate). Any large tertiary care hospital has to deal regularly with this problem with respect to patients who are terminally ill and how to treat such patients in a wide variety of circumstances. What are the physician's and the hospital's obligations to provide Care?

On November 28,1977, the Massachusetts Supreme Judicial Court handed down its opinion in a case that has caused tremendous repercussions in hospitals throughout the country regarding the withholding or withdrawal of life-support to terminally ill patients. At the time this opinion was handed down, the decisions of physicians and hospitals on what to do with respect to withdrawing such care were based primarily on one of four models.

During the past few years, health care professions haw received strong criticism for seemingly ethically wrong or inhumane practices. The Tuskegee syphilis study, experimentation on mentally retarded persons at Willow-brook, forced sterilizations of retarded individuals, and alleged malpractice and Medicaid abuses are a few examples of those instances that have received publicity. Incidents such as these, coupled with the development of an aggressive consumerism and with escalating scientific technological advances, haw created an urgent and widespread concern about medical ethics or bioethics. The Hastings Institute, two presidentially appointed commissions on issues in medical ethics, and the introduction of ethics courses in the curricula of medical and nursing schools are responses to ethical concerns in health care.

Although numerous texts and articles on specific bioethical issues haw been published in recent years, troubling questions remain about the normative ethics that form the foundation of responses to these issues.

This manuscript summarizes the most common barriers to effective administrative preparedness and how to surmount them through the use of promising practices, strategies, and NACCHO developed resources focused on addressing unique jurisdictional requirements and needs.

Promoting and protecting the public's health in the United States and abroad are intricately tied to laws and policies. Laws provide support for public health measures, authorize specific actions among public and private actors, and empower public health officials. Laws can also inhibit or restrict efforts designed to improve communal health through protections for individual rights or structural principles of government. Advancing the health of populations through law is complex and subject to constant tradeoffs. This column seeks to explore the role of law in the interests of public health through scholarly and applied assessments across a spectrum of key issues. The first of these assessments focuses on a critical topic in emergency legal preparedness.

Nurses have traditionally encouraged people to live, regardless of the meaning or consequences of continued life for the client. Despair profound enough to lead to a suicide attempt is viewed as an illness that must be cured. Nurses, as well as physicians, subscribe to the maxim primum non nocere (first, do no harm), although it may not be as clearly articulated in the canons of the nursing profession as it is in those of medicine. Nurses, for the most part, operate under the belief that suicide is always both mentally unhealthy and morally wrong; thus all efforts are made to prevent suicide. The idea that life is good and worthwhile and must be preserved at all costs applies to a wide variety of clients, including those who engage in behaviors that will probably lead to serious illness or death (e.g., overeating, smaoking, and suicide).

This article examines the past, present, and future of individual market policies in the Affordable Care Act (ACA). It does so, first, by reviewing the law's goals, scope, and set of individual market policies, collectively called the Health Insurance Marketplace. The Marketplace, along with the ACA's Medicaid expansion, was designed to fill in gaps to provide all Americans with accessible, affordable coverage. Second, it reviews evidence on the law's impact to date, including changes under a new administration. Third, it discusses the three main policy options for the Marketplace: do nothing, build on it, or replace it. Lastly, it discusses the factors which could determine which pathway policy makers follow.