Program Development Committees Established

The response was overwhelming to the recent announcement concerning the creation of the Society's new Program Development Committees. Over one hundred members have volunteered and those who expressed their thoughts agreed this was a significant step for the Society.

Committees are being formed to focus on the areas of: hospital law, medical malpractice, risk management and utilization review, health care for children, health care for the elderly, mental health, nursing, and workers compensation/occupational medicine.

Each committee is multidisciplinary and geographically diverse, and is charged with developing and organizing periodic educational meetings in its respective field. The focus of each meeting, its content, and faculty selection are the primary responsibilities. Complete rosters for each committee will be circulated in the near future.

In addition to their work in planning the Society's educational programs, it is hoped that these program development committees will identify problems and issues to which the Society could make significant contributions. Research and surveys on current problems could be organized by the committees, resulting in educational position papers issued in the name of the Society.

In addition to their work in planning the Society's educational programs, it is hoped that these program development committees will identify problems and issues to which the Society could make significant contributions. Research and surveys on current problems could be organized by the committees, resulting in educational position papers issued in the name of the Society.

The focus of the abortion debate in the United States tends to be on whether and at what stage a fetus is a person. I believe this tendency has been unfortunate and counterproductive. Instead of advancing dialogue between opposing sides, such a focus seems to have stunted it, leaving advocates in the sort of I did not—You did too impasse we remember from childhood. Also reminiscent of that childhood scene has been the vain attempt to break the impasse by appeal to a higher authority. Thus, the pro-choice forces hoped they had proved the pro-life forces wrong by having had the Supreme Court of the United States decide in Roe v. Wade that a fetus is not a person for purposes of the fourteenth amendment. Now the pro-life forces are trying to prove the pro-choice forces wrong by passing legislation or a constitutional amendment that declares a fetus to be a person after all

Expenditures for health care have reached a point where they represent almost 10 percent of the gross national product; health care has become one of the country's largest industries. Moreover, the cost of health care continues to increase more rapidly than inflation. Many policy makers and critics of the health care system believe that the promotion of competition among health care providers can be instrumental in keeping the price of health services down.

The health care boom and ever accelerating health care expenditures have stimulated the availability of new providers, and many hope that these alternative providers will enhance competition in the health care system. Non-physician practitioners, such as podiatrists, optometrists, chiropractors, and nurse-midwives, and such non-traditional delivery mechanisms as health maintenance organizations (HMOs), preferred provider organizations (PPOs), ambulatory surgical centers, and birthing centers, have been gaining increasing support at both the federal and state levels of government. Proponents believe that these alternative providers and mechanisms not only produce more options for consumers but also help contain the cost of health care in the United States.

The attractions of psychiatric mishaps are similar for the journalist and the lawyer - the perverse magnetism of sex and violence. A therapist engages in sex with his female patient; he fails to prevent a patient's suicide; or he releases a patient who then kills a third person. These are the themes of popular journalism, and of current highly publicized litigation involving psychotherapists. In this issue of Law, Medicine& Health Care, two articles look at the liability of the therapist. Michael D. Roth and Laurie J. Levin in Dilemma of Tarasoff: Must Physiciains Protect the Public or Their Patients? offer a careful look at the potential liability of the therapist, concerning the duty to warn others of a patient's threats, in light of the leading cases. The authors outline the parameters of the law, fuzzy as its current boundaries may be, in a useful attempt to offer the psychotherapist guidance through the minefield of tort liability. Sheila Taub, in a broader look at the subject, searches for threads which might link and rationalize the case-law in these hot areas, particularly with regard to abuse of the therapeutic relationship.

For a number of years, some non-physician health service providers have moved to secure status as independent, autonomous providers of health services. In addition, non-physician providers have sought, often through the state legislatures, eligibility to receive payment directly, on a fee-for-service basis, from private and governmental third party payers; alternatively, they have sought for their charges to be reimbursed to their patients by insurers on such a basis. The struggle for autonomy is related to, and is preliminary to, the struggle for access to, or eligibility for, payment through third party payment mechanisms.

The purpose of this article is to explore the implications of access to such payment in the current economic climate concerning the delivery of health services. The primary focus is on the nursing profession, in light of its continuing struggle to secure greater autonomy and to improve the economic rewards for nurses. The nursing profession is waging this struggle because it recognizes that gaining direct access to third party payment would increase the potential for economic success in developing private, independent nursing practices.

Antitrust challenges to agreements between hospitals and physicians who provide patient services have become one of the most common types of antitrust litigation in the past few years. Two recent decisions by different circuit courts of appeal highlight the legal and medical principles on which such disputes will be decided.

In August 1982, the United States Court of Appeals for the Seventh Circuit vacated a preliminary injunction entered in favor of an individual anes-thesiologist who had complained that after an anesthesia group terminated her employment, the hospital wrongfully refused to allow her to continue to serve patients. The Seventh Circuit, in Dos Santos v. Columbus-Cuneo- Cabrini Medical Center, expressed serious doubt whether under antitrust analysis, a single hospital could ever be treated as a distinct market for the purchase and sale of health care services. The court remanded the case to the federal district court, where it is still pending.

Skyrocketing health care costs are endemic during inflationary periods, affecting not only health care consumers, but also health care providers. Virtually all governmental policymakers recognize spiraling health care costs, but hospital costs continue to escalate faster than the general rate of inflation. In response, alternatives to the traditional physician-patient and hospital-patient relationships have experienced a dramatic resurgence in the last decade, competing for the health care dollar. Two health care alternatives, the health maintenance organizstion (HMO) and the ambulatory surgical center (surgicenter) at which minor surgical procedures can be performed on an out-patient basis. have emerged to provide health care services in a more cost-efficient manner, thereby increasing price competition in the health care sector. The most recent alternative health care system on the health care horizon is the free standing emergency center or “emergicenter.” The growth of these emergicenters within the last few years has heen dramatic—500 in existence as of March 1982.

The “medical malpractice crisis” in the 1970s involved not only a greater number of suits, but also the emergence of new sorts of claims against medical practitioners. One such claim was the wrongful birth suit, where parents sued their physician on their own behalf for negligence that resulted in the birth of an unwanted child. A related claim, wrongful life, involved a suit brought on behalf of a defective infant against a physician or laboratory that failed to give correct information about a potential defect to the parents. These claims have been the subject of much controversy for judges and commentators.

The debate over wrongful life suits involving “impaired” children continues. Courts in Michigan have recently rejected the wrongful life cause of action, while, in Washing ton, the action has been allowed. Some academic critics have also continued to oppose the wrongful life action. In a recent commentary in the pages of this journal, one critic wrote: “Wrongful life actions, by whatever name they may be called, accord with neither logic nor experience, and should not be allowed.”

Lawsuits alleging malpractice in psychiatric diagnosis or treatment, once rather rare, appear to be growing in number. The low incidence of such claims in the past has been attributed to the difficulty of proving the applicable standard of care and a causal relationship between the breach of the standard of care and the alleged injury, the patient's reluctance to publicize his psychiatric history, the patient's inability either to formulate cleat expectations for the results of treatment or to assess the results, and the belief that the success of psychotherapy depends to a great extent on the cooperation of the patient.

Nonetheless, the number of claims against psychiatrists is rising, in part because of a more open attitude about psychiatric treatment coupled with increased expectations of its efficacy. Other factors which may be contributing to this trend are the emphasis on mental patients rights in recent court decisions and the popular literature, the emergence of legal doctrines finding new legal duties arising out of the therapist-patient relationship, and the publication of several sizable verdicts in suits based on psychiatric malpractice.

The “medical malpractice crisis” in the 1970s involved not only a greater number of suits, but also the emergence of new sorts of claims against medical practitioners. One such claim was the wrongful birth suit, where parents sued their physician on their own behalf for negligence that resulted in the birth of an unwanted child. A related claim, wrongful life, involved a suit brought on behalf of a defective infant against a physician or laboratory that failed to give correct information about a potential defect to the parents. These claims have been the subject of much controversy for judges and commentators.

The debate over wrongful life suits involving “impaired” children continues. Courts in Michigan have recently rejected the wrongful life cause of action, while, in Washing ton, the action has been allowed. Some academic critics have also continued to oppose the wrongful life action. In a recent commentary in the pages of this journal, one critic wrote: “Wrongful life actions, by whatever name they may be called, accord with neither logic nor experience, and should not be allowed.”