bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of Stat5 and induction of a pregnancy‐like mammary gland differentiation by eicosapentaenoic and docosapentaenoic omega‐3 fatty acids
Authors: Liu Yiliang E. , Pu Weiping , Wang Jingdong , Kang Jing X. , Eric Shi Y.
Published: June 2007

The protective effect of early pregnancy against breast cancer can be attributed to the transition from undifferentiated cells in the nulliparous to the differentiated mature cells during pregnancy. Considerable evidence suggests strongly that the n‐3 polyunsaturated fatty acid (PUFA) content of adipose breast tissue is inversely associated with an increased risk of breast cancer. Here, we report that there was a decrease in the n‐6/n‐3 PUFA ratio and a significant increase in concentration of n‐3 PUFA docosapentaenoic acid and eicosapentaenoic acid in the pregnant gland. The functional role of n‐3 PUFAs on differentiation was supported by the studies in the fat‐1 transgenic mouse, which converts endogenous n‐6 to n‐3 PUFAs. Alternation of the n‐6/n‐3 ratio in favor of n‐3 PUFA, and particularly docosapentaenoic acid, in the mammary gland of fat‐1 mouse resulted in development of lobulo‐alveolar‐like structure and milk protein β‐casein expression, mimicking the differentiated state of the pregnant gland. Docosapentaenoic acid and eicosapentaenoic acid activated the Jak2/Stat5 signaling pathway and induced a functional differentiation with production of β‐casein. Expression of brain type fatty acid binding protein brain type fatty acid binding protein in virgin transgenic mice also resulted in a reduced ratio of n‐6/n‐3 PUFA, a robust increase in docosapentaenoic acid accumulation, and mammary differentiation. These data indicate a role of mammary derived growth inhibitor related gene for preferential accumulation of n‐3 docosapentaenoic acid and eicosapentaenoic acid in the differentiated gland during pregnancy. Thus, alternation of n‐6/n‐3 fatty acid compositional ratio in favor of n‐3 PUFA, and particularly docosapentaenoic acid and eicosapentaenoic acid, is one of the underlying mechanisms of pregnancy‐induced mammary differentiation.
Uptake and distribution of root‐applied or foliar‐applied 65Zn after flowering in aerobic rice
Authors: Jiang W. , Struik P.C. , Lingna J. , Van Keulen H. , Ming Z. , Stomph T.J.
Published: June 2007

We investigated the uptake and distribution of zinc (Zn) either applied to the roots or to the leaves in rice during grain development. Plants of two aerobic rice cultivars were grown in a nutrient solution with either sufficient Zn or surplus Zn. Root treatment with 1 week‘s supply of both 65Zn and unlabelled Zn was started at flowering or 15 days after flowering (DAF). Foliar treatment with 65Zn applied to the flag leaf or to senescent leaves was carried out at flowering. When 65Zn was applied to roots, plants continued to take up Zn after flowering, even beyond 15 DAF, irrespective of cultivar and Zn nutritional status of the plants. During the 1 week of supply of both 65Zn and unlabelled Zn, which either started at flowering or 15 DAF, the absorbed 65Zn was mainly distributed to roots, stem and grains. Little 65Zn was allocated to the leaves. Following a week of 65Zn supply directly after flowering, under sufficient Zn or surplus Zn, the proportions of total 65Zn uptake allocated to the grains continued to change during grain filling (9–33%). This Zn mainly came from the roots but under sufficient Zn supply also from the stem. With 65Zn applied to leaves (either the flag leaf or the lowest senescent leaf), both cultivars showed similar Zn distribution within the plants. About 45–50% of the 65Zn absorbed was transported out of the 65Zn‐treated leaf. From that Zn, more than 90% was translocated to other vegetative organs; little was partitioned to the panicle parts and even less to the grains. These results suggest that in rice plants grown under sufficient or surplus Zn supply, most of the Zn accumulated in the grains originates from uptake by roots after flowering and not from Zn remobilisation from leaves.
New Developments in Health Care Delivery
Authors: Norris John A.
Published: June 2007

The letters HMO (short for Health Maintenance Organization) have very quickly become household words. In general, an HMO may be described as the organizational entity of a health care system which contracts with hospital and medical care providers on behalf of its enrolled members. More precisely, it is an organization, (usually a corporation) which accepts the responsibility to provide, directly or through contract, an agreed upon set of comprehensive health maintenance and treatment services for a volun. tariiy enrolled group of persons and is reimbursed through a premgotiated payment made by or on behalf of each person enrolled in the plan. (U. S. Department of H.E.W., Health Maintenance Organization [1971]).

HMOs can be either for profit or not for profit, although for profit HMOs are rare since establishing a for profit HMO involves the navigation of uncharted waters, containing many obstacles which most HMO organizers would prefer to avoid.
Pulmonary Embolism and Sudden Death
Authors: Barkan Donald B. , Sagall Elliot L.
Published: June 2007

Charcot testified 110 years ago to a fundamental truth in medicine:

“Disease is very old, and nothing about it has changed. it is we who change as we learn what was formerly imperceptible.”

In ancient Grecian yore, when Hermes, son of Zeus and bearer of the Caduceus, was the heavenly messenger to mediate between the gods and man, the “embolon” was recognized as a mortal peril. Such ram, undetected beneath the waterline of the prow of an ancient warship, could be driven with hydraulic force into an unwary enemy vessel often with catastrophic or fatal effect.

Even today, the threat of sudden death from a pulmonary embolus - the clot which migrates from a source of origin on the inner wall of a vein to lodge in and thereby plug an artery within the lung - remains a major medical and surgical risk. Thrombosis and thrombophlebitis of the deep veins of the legs, often unpreventable and frequently undetectable clinically, are the nidus of a potentially fatal pulmonary embolism.
“Authoratative” Medical Texts
Authors: MacKaut Stephen H.
Published: June 2007

Attorneys and physicians dealing with medicolegal issues frequently are confronted by the question of which medical textbooks a physician is likely to recognize as “authoritative” so that the text may be used in direct or cross-examination. Consequently, doctors and lawyers must have more than a passing familiarity with these texts for pretrial research and preparation for courtroom testimony.

The following list has been prepared as a guide for this purpose. This list itemizes by medical subject the standard textbooks in each field. Where more than one book is listed under a given specialty, the books are listed in rough order of the author's preference.

Those books preceded by the letter “A” are contained in “Recommended Textbooks and Journals for a “Core Medical Library” in 280 New England Journal of Medicine 475-8 (Feb. 27, 1969).
Psychiatry and the Law Reviewed at Symposium
Authors: Beyer Henry A.
Published: June 2007

Over 250 psychiatrists, lawyers and health professionals heard seven distinguished speakers present and defend their views concerning the proper role of psychiatrists in the courtroom and of lawyers in the fieid of mental health at the 1974 Isaac Ray Symposium held at Butler Hospital, Providence, Rhode Island earlier this year.

Dr. Jacques Quen of Cornell University Medical College reviewed the remarkable 19th century contributions of Isaac Ray. He concluded that Ray would have supported the Birnbaum and Wyatt v. Stickney expositions of the right to treatment, (although probably not Wyatt's explicit numerical requirements), but would have objected to the great power which judges possess to release involuntarily committed patients in habeas corpus actions.
The Nonprofit Hospital Amendment to the National Labor Relations Act
Authors: Katz Barbara F.
Published: June 2007

Until the passage of a recent amendment by Congress, nonprofit hospitals were excluded from coverage by the National Labor Relations (Wagner) Act (NLRA), which had established as the national policy the right of workers in most industries affecting interstate commerce to organize themselves into unions. Such exclusion from NLRA jurisdiction primarily affected the unskilled nonprofit hospital employees. such as general aides, orderlies, porters. nursing aides, housekeeping and maintenance personnel as opposed to professional and technical hospital employees.

When there were indications that the nonprofit hospital exemption was being reevaluated. numerous arguments in favor of its retention were advanced by its proponents.

First, it has been contended that unions tend to break down discipline and that once unionized, employees may be less willing to give immediate obedience to orders.
Edelin Decision Sparks New Abortion Controversy
Authors: Holzer James F.
Published: June 2007

Two years and 25 days following United States Supreme Court's controversial decision on abortion, a Massachusetts Superior Court jury of nine men and three women handed down an historic decision of their own against a Boston physician accused of manslaughter in connection with an abortion he performed on a 17 year old girl.

And so on February 15, 1975, 36 year old Dr. Kenneth C. Edelin, Coordinator of Ambulatory Care in OB/GYN at Boston City Hospital, was found gullty as charged:

“ … Kenneth Edelin, on the third day of October in the year of our Lord One Thousand Nine Hundred and Seventy Three did assault and beat a certain person, to wit, a male child described to said jurors as Baby Boy, and by such assault and beating, did kill the same person … ”
Occupational Safety and Health Act … And the Hospital
Authors: Atz Barbara
Published: June 2007

The principles of occupational safety and health have long been applied to industry, but it is only in recent times that serious consideration has been given to their application in the hospital. This interest coincided with the passage, in 1970, of the Occupatinal Safety and Health Act (OSHA), the government's first venture into general occupational safety and health.

The statute's purpose is “to provide for the general welfare, to assure so far as possible every working man and woman in the nation safe and healthful working conditions and to preserve our human resources.” In general, the Act permits the Secretary of Labor to promulgate occupational safety and health standards. The secretary or his authorized representative may, “with Out delay,” enter the premises of any employer who is covered by the Act, which includes virtually every private sector employer. The legislation applies to 5 million businesses and 57 million employees, who in a year suffer 14,000 deaths and 2 million disabling injuries or diseases related to their occupation.
Childbirth and the Courts: The Wrong Issue in the Wrong Forum
Authors: Annas George J.
Published: June 2007

While most courtroom confrontations involving childbirth concern parents seeking damages for alleged physician and hospital negligence, a number of recent cases have involved parents seeking simply to have their babies with a minimum of medical intervention. Courts, however, have consistently deferred to “expert” medical opinion in this area.

The extreme reluctance of courts to substitute their judgment for that of hospital boards is nowhere better illustrated than in the cases involving fathers in the delivery room. While most hospitals with maternity wards currently permit “husband-coached' (Lamaze or psychoprophylactic being the most common method) childbirth, in which the father is with the mother throughout labor and delivery, supplying physical and emotional support, lawsuits to compel a change in the policies of those institutions that do not, have been universally unsuccessful to date.
The Impact of P.L. 93-641 on the State Certificate of Need Process
Authors: Glantz Leonard
Published: June 2007

One of the most significant aspects of P.L. 93-641, the National Health Planning and Resources Development Act of 1974 is the requirement that States adopt certificate of need laws as a method of health facilities regulation. This demonstrates a certain Congressional dissatisfaction with health planning alone and a desire to be more active in the actual distribution of health care facilities.

Over the years Congress has made a number of attempts to institute federal programs that would insure an adequate supply of health services to all people In 1946 it passed the Hill-Burton Act which was designed to respond to Congress perception that an inadequate supply of hospital beds existed in the United Slates. In addition to providing funds for the actual building of hospital beds, Hill-Burton required states to conduct surveys of bedding patterns and to participate in some rudimentary planning.
Judicial Review of Malpractice Reform Legislation: The Story so Far
Authors: Gold Jay Alexander
Published: June 2007

The malpractice Insurance crisis of 1975 saw many insurance companies which had provided medical malpractice coverage leave the field. Those that stayed increased their premium rates astronomically. One of the results has been a flood of legislation, a torrent unparalleled , , , in the history of medical law In this country. We may expect soon to be deluged again, this time with court decisions reviewing and interpreting the constitutionality of these laws. This brief article reviews the first trickle of such cases.

The bulk of the issues litigated to date have centered around the use of screening panels. A number of states have set up such panels. in all of the cases so far litigated. the panels contained a judge who usually sat with a physician and a lawyer. Before a lawsuit is filed, the plaintiff is required to bring the case before Me panel, which makes a determination of liability and damages. Either party may there after bring the case to trial.
The Right to Refuse Treatment and Natural Death Legislation
Authors: Raible Jane A.
Published: June 2007

A great deal of discussion and debate has centered around the right of a terminally ill patient to refuse life-sustaining treatment. The statement of policy found in Idaho's recent Natural Death Act summarizes many of these issues:

The legislature finds that adult persons have a fundamental right to control decisions relating to the rendering of their medical care, including the decisions to have life sustaining procedures withheld or withdrawn in instances of a terminal condition.

The legislature further finds that modern medical technology has made possible the artificial prolongation of human life beyond natural limits.

The legislature further finds that patients suffering from terminal conditions are sometimes unable to express their desire to withhold or withdraw such artificial life prolongation procedures because of the progress of the disease process which renders the patient comatose or unable to communicate with the physician.
Local Control of Recombinant DNA Research — Only for Accidents?
Authors: Christensen Ken
Published: June 2007

Proposed federal legislation concerning recombinant DNA research attempts to restrict the ability of local governments to regulate the research. In March of 1978, the House Commerce Committee approved a bill that would “bar states and localities from setting their own standards over gene transplant technology.” Two weeks later, the House of Representatives Science, Research, and Technology Subcommittee approved a bill which would permit a state to regulate such researchonly when it is “necessary” to protect local health. The “necessary” standard usually requires strict proof that a regulated substance or activity will cause significant harm to public health. Under this standard a locality might have to wait for significant harm to occur before it could adopt regulations that are stricter than federal requirements.

This anomaly presents the basic question of this article: Who should decide whether recombinant DNA research is a health hazard — the local or the federal government? This article will utilize a legal approach to answer the question, analyzing and weighing the issues presented by pertinent cases.
Section 504 Challenges Hospitals’ Care of the Deaf
Authors: Holzer James F.
Published: June 2007

Much has been written and discussed this past year about the responsibility and obligation of hospitals to actively support and comply with Section 504 of the Rehabilitation Act of 1973. which was designed to ensure that federally assisted programs and activities would be operated without discrimination on the basis of handicap. The Department of Health, Education and Welfare (HEW) last year published comprehensive regulations implementing this controversial section of the law. Since almost all hospitals and health care institutions receive some form of Medicare, Medicaid or Hill-Burton Funds, this regulation is of special significance to the administrators of facilities who must now make both their physical plant and programs accessible to individuals suffering from a broad range of disabilities.

In as much as a significant portion of the regulations relate to the development of plans to identify physical obstacles limiting accessibility and time schedules for making required modifications to buildings, many hospital officials equate Section 504 solely with the needs of individuals confined to wheelchairs or utilizing other such devices to assist in mobility
Who “Pulls the Plug:” The Practical Effect of the Saikewicz Decision
Authors: Dunn Lee J.
Published: June 2007

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.
The Hospital's Obligation to Protect Patients from Carriers of Infectious Diseases
Authors: Cram Sheila
Published: June 2007

Nosocomial infection is a serious problem in hospitals and other inpatient health care facilities. It has been receiving increasing attention in the medical literature since the first outbreaks of penicillin-resistant staphylococcal infections were recognized in the 1950s. The medical profession has been forced to acknowledge, albeit reluctantly, that infectious diseases are not going to be eradicated by the administration of antibiotics and antimicrobials alone. Microogranisms have shown amazing resilience in their ability to protect themselves against the most sophisticated drugs in our armamentarium by the formation of resistant strains. Further, organisms which were never believed to cause disease in the pre-antibiotic era are now linked with devastating infections in seriously ill hospitalized patients. Even the organisms commonly found on the skin of a healthy person can cause disease given the right set of circumstances. A carrier, however, is a person who harbors a specific pathogenic organism, yet fails to exhibit any discernible symptom of the disease. Nonetheless, the carrier is capable of spreading the organism to others.
The Future of Workers' Compensation
Authors: Stander Irvin
Published: June 2007

Dissatisfied with state workers' compensation laws, business interests, labor unions, state compensation bureaus, self insurers, and private insurance carriers, despite their disparate interests, increasingly agree that such laws are in need of significant revision. But the call for reform has been heard before. In 1972, the National Commission on State Workmen's Compensation Laws (hereinafter referred to as the National Commission) reported to the President and Congress that “… the protection furnished by workmen's compensation to American workers presently is, in general, inadequate and inequitable.”

Between 1972 and 1977 hundreds of state laws were enacted in response to the recommendations of the National Commission and the threat of federalization. Yet, in its 1977 report to the President and Congress, the Policy Group of the Interdepartmental Workers' Compensation Task Force concluded:
The Medicolegal History
Authors: Sagall Elliot L.
Published: June 2007

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.
Fourth Circuit Limits §504 Employment Rights of the Handicapped
Authors: Hull Kent
Published: June 2007

The United States Fourth Circuit Court of Appeals decision in Trageser v. Libbie Rehabilitation Center, Inc., has severely limited the use of §504 in combating employment discrimination, and the United States Supreme Court has refused to review the case. Fortunately, the Department of Justice, the Department of Health, Education and Welfare (hereafter DHEW), the Senate Committee on Labor and Public Welfare, and the United States District Court for the Northern District of California disagree with the Fourth Circuit's finding.

This decision is ironic considering the purpose of the Rehabilitation Act of 1973. Traditionally, the overriding objective of federal and state rehabilitation programs has been to put handicapped people to work. And there can be little doubt, from the legislative history of the Rehabilitation Act, that Congressional sponsors of the law viewed the probability of increased employment opportunities as a major justification for the civil rights provisions of the Act.
The Pregnant Minor: Contraception and Abortion under Canadian Law
Authors: Somerville Margaret A.
Published: June 2007

Regulation of access to contraception or abortion by minors has been a major issue in many jurisdictions over the past decade. This article will investigate the current law in Canada and will enable comparisons to be drawn with the situation in other jurisdictions, particularly those in the United States in light of the United States Supreme Court's recent decision upholding the Hyde Amendment which restricts the use of federal funds for abortions.

Some of the legal issues present are common to both contraception and abortion. However, because abortion is expressly regulated by the Criminal Code of Canada, there are also significant differences. The two major issues are the legality of the procedures themselves and consent. These questions are both separate and related: they are separate because the legality of a medical intervention must be looked at apart from consent, and related because consent is one of the factors upon which legality depends.
Reproductive Freedom and the Prevention of Birth Defects: A New and Developing Standard of Medical Care
Authors: Grumet Barbara R.
Published: June 2007

The past fifteen years have witnessed parallel advances in law and medicine which enable physicians and future parents to prevent the birth of many handicapped children. The right of reproductive freedom has been included as one facet of the constitutionally based right to privacy. Medical science has developed and refined techniques for detecting parental carriers of many handicapping conditions, as well as means to determine whether a particular fetus is afflicted. As these advances have progressed, a sort of mutual dependency has evolved: The parents' right to decide whether and when to have children cannot be fully exercised unless parents have the benefit of available medical knowledge. Nor can advances in detecting birth defects be fully implemented without legally sanctioned means of preventing or terminating pregnancy.

Along with these advances has come increased litigation over the issue of the standard of care a physician owes his or her pregnant patients. Several parents who have given birth to severely handicapped children have attempted to impose an additional duty on physicians: that is, to warn parents of the risks of having a handicapped child, and/or to diagnose the handicap in time for the parents to terminate the pregnancy.
Hospital Corporate Liability: The Trend Continues
Authors: Dunn Lee J.
Published: June 2007

Traditionally, hospitals have been liable for the acts of their employees or agents under the doctrine of respondeat superior, but have not been considered liable for the actions of those whom they did not employ or over whom they had no control. Accordingly, hospitals and their insurers were able to avoid legal responsibility for the acts of medical malpractice committed by physicians on their medical staffs. Although elements of a new and distinct theory of hospital corporate responsibility unrelated to respondeat superior had emerged before, the widely discussed opinion of the Illinois Supreme Court in Darling v. Charleston Community Hospital is generally considered the hallmark of a change in judicial thinking in respect to a hospital's duty to monitor the quality of care rendered within its walls. However, Darling was not a forerunner of a spate of similar holdings, and, in fact, has never been specifically relied upon even in Illinois. Only in the last several years have significant additional strides been taken in developing this theory. Two recent intermediate appellate decisions in Wisconsin and North Carolina seem to reflect the trend of the law and the affirmative duty of a hospital to monitor the quality of care rendered by its medical staff.
Legal Criteria for Orders Not to Resuscitate: A Response to Justice Liacos
Authors: Robertson John
Published: June 2007

Justice Liacos's comments on the Saikewicz decision should end much of the debate that has swirled around the scope of this landmark case, and I commend MEDICOLEGAL NEWS or publishing his remarks. However, two aspects of the article deserve further comment.

First, it seems unfair to criticize lawyers for not immediately reading the case the way Justice Liacos now says it should have been read. While the opinion in Saikewicz is reasonably clear about the substantive rights of incompetent patients, it is imprecise about the procedures to be followed in implementing those rights. For example, in discussing the role of the probate court in such cases, the broad language used in the decision could be read as requiring a judge to review all treatment decisions involving incompetent patients.
How to Make the Massachusetts Patients’ Bill of Rights Work
Authors: Annas George J.
Published: June 2007

At one point in Edgar Allan Poe'sNarrative of Arthur Gordon Pym of Nantucket,Pym, who has stowed away in the hold of a whaling vessel, believes he has been abandoned and that the hold will be his tomb. He expresses sensations of “extreme horror and dismay,” and “the most gloomy imaginings, in which the dreadful deaths of thirst, famine, suffocation, and premature interment, crowded in as the prominent disasters to be encountered.”

It is probably uncommon for hospitalized patients to feel as gloomy as Pym. Nevertheless, installed in a strange institution, separated from friends and family, forced to wear a degrading costume, confined to bed, and attended to by a variety of strangers who may or may not keep the patient informed of what they are doing, the average patient is intimidated and disoriented. Such an atmosphere encourages dependence and discourages the assertion of individual rights.
Limiting Davis: Educating Handicapped People for Health Care Professions
Authors: Hull Kent
Published: June 2007

The Davis decision, which allowed a federally-assisted college to exclude a severely hearing impaired woman from its registered nurse training program, provoked great concern among handicapped people and their advocates. Institutions of higher education also have reason for dissatisfaction with the decision since it fails to provide sufficient guidance for those federal recipients to measure their compliance with section 504. In a letter to college presidents dated October 5, 1979, Secretary of Health, Education and Welfare Patricia Roberts Harris sent forth the department's official statement concerning the decision.

The letter indicates a middle-of-the-road approach to Davis and HEW's future enforcement of section 504: it views the Supreme Court's decision as consistent with regulations adopted by the Department to implement section 504. While recognizing that colleges can establish legitimate academic requirements, it states that they must demonstrate the necessity and legitimacy of policies which result in the exclusion of handicapped people.
Disclosure of Injury and Illness: Responsibilities in the Physician-Patient Relationship
Authors: LeBlang Theodore R.
Published: June 2007

In one of his few decisions addressing the interface of law and medicine, Oliver Wendell Holmes observed that, The patient has no more right to all the truth than he has to all the medicine in the physician’s saddlebag. He should only get so much as is good for him.

During the last 60 or so years, the question of how much medical information is indeed good for the patient has been the subject of innumerable lawsuits. From this plethora of litigation, a clear common law trend which favors maximum disclosure of information has become evident. Relying upon the fiduciary nature of the physician-patient relationship, the courts have imposed upon the physician a duty to inform a patient fully regarding the condition of his or her body. It is appropriate, therefore, to examine various exemplary case decisions in an effort to portray effectively the nature and scope of the physician’s rights and responsibilities in this context.
The Physician's Right to Due Process in Public and Private Hospitals: Is There a Difference?
Authors: Southwick Arthur F.
Published: June 2007

This article will discuss the rights of a licensed physician to acquire and retain a hospital medical staff appointment. The focus of the discussion will be the relationship between the independent fee-for-service private practitioner and the community general hospital. The relationship of the organized medical staff to both the hospital and the individual doctor will also be clarified. The hospital involved this discussion may be owned by a governmental unit and hence identified as a “public hospital,” but more likely it will be aprivate, non-profit charitable corporation and will be referred to as a “private” hospital. Specifically, this article will explore the differences, if any, between a physician's rights vis-a-vis the public hospital and his or her rights when a private hospital is involved.

Excluded from this analysis are situations where the doctor is an employee of a hospital or health care institution. Also excluded are cases involving hospitals which limit their service to particular patients (e.g., the mentally ill or children), and university-owned teaching hospitals that impose a faculty appointment in the medical school as a pre-requisite to staff privileges.
Vox Clamantis in Deserto:Do YouReallyMean What You Say inSpring?
Authors: Dunn Lee J. , Ator Nancy E.
Published: June 2007

Probably the most vexing result of the Massachusetts Supreme Judicial Court's [SJC] opinion in theSpringcase is that judges, lawyers, and others faced with similar problems in other jurisdictions are likely to read the opinion and commend the Supreme Judicial Court for its efforts. Yet, once the background of this case is known, or once one reads the opinions of the Court of Appeals or of the Probate Court, or the briefs submitted by the parties and theamici curiae,the inadequacies of the opinion become apparent. In our view, theSpringdecision works a disservice on all those both within and without Massachusetts who seek guidance from the courts as they attempt to resolve similar cases.

The Illinois Association of Hospital Attorneys [IAHA], among others, filed a briefamicus curiaein theSpringcase for three reasons: First, to ask that the SJC reconsider the position it had taken inSaikewicz,and thereby to alleviate some of the misunderstanding caused by that decision. Second, to ask the court to reconsider whether the tests it enunciated inSaikewiczwere truly workable in the contemporary health care delivery system.
The Continuing Clinicolegal Conundrum of the Boston State Hospital Case
Authors: Mills Mark J.
Published: June 2007

Whatever powers the Constitution has granted our government, involuntary mind control is not one of them….

[S]ubjecting a patient to the humiliation of being disrobed and then injected with drugs powerful enough to immobilize both body and mind is totally unreasonable by any standard.
Hospital Corporate Liability: The Walls Continue to Tumble
Authors: Zaremski Miles J.
Published: June 2007

Today's hospitals and health care facilities are being increasingly subjected to pressures to monitor the quality of the health care provided in their institution. One vehicle is the courts which, utilizing the doctrine of hospital corporate liability, have imposed a duty upon the hospital to use reasonable care in the selection and maintenance of physicians on its medical staff. This article will discuss three different approaches from three different states.

The first case is Johnson v. Misericordia Community Hospital, decided by the Wisconsin Supreme Court in January 1981. In its decision, the court sought to answer two questions: “Does a hospital owe a duty to its patients to use due care in the selection of its medical staffand the granting of specialized surgical (orthopedic) privileges?;” and second, “What is the standard of care that a hospital must exercise in the discharge of this duty to its patients…?”
The Application of Reasonable Prudence to Medical Malpractice Litigation: The Precursor to Strict Liability?
Authors: Peters Brian M.
Published: June 2007

Recently, the California Supreme Court found an established medical standard of care to be inadequate and replaced it with a judicially constructed medical standard of practice premised on the rule of reasonable prudence. California thus joined the State of Washington and became the second state to sanction the invocation of reasonable prudence in the fashioning of judicially formulated medical standards of care.

As this article will illustrate, the Supreme Courts of California and Washington are, in a narrow class of cases, imposing a greater duty of care on physicians than previously mandated by the medical profession. These courts are impliedly stating that although the physicians complied with the particular standard of care within their profession, they could have better protected their patients had they pursued a more prudent course of conduct. Moreover, in choosing between the innocent and damaged plaintiff and the equally innocent and compliant physician, the courts have reasoned that the plaintiff should not have to bear the risk of loss and, consequently, have imposed liability on the physician.
Iatrogenesis and Medical Error: The Case for Medical Malpractice Litigation
Authors: Furrow Barry R.
Published: June 2007

Discussions of medical malpractice seem to end up at either of two extremes: the trial lawyer's view that injured patients deserve compensation, with the treating physician the best source; and the doctor's view that such suits unfairly penalize judgmental errors while raising the costs of practicing medicine. The parties to this debate make different assumptions about the nature, purpose, and likely impact of malpractice suits; as a result, the issues are muddied rather than clarified. This article suggests that, viewed in light of recent studies of iatrogenic illness in hospital settings, malpractice litigation may help rather than hinder the quality of medical care delivered.

latrogenesis, defined as the undesirable side-effects of medical interventions, is not a new phenomenon. The major study undertaken by the Department of Health, Education and Welfare in 1973 noted that a substantial percentage of adverse medical outcomes occur as the result of treatment. Others have concluded that many surgical deaths are avoidable.
Nursing Ethics, Physician Ethics, and Medical Ethics
Authors: Veatch Robert M.
Published: June 2007

The term “nursing ethics” is controversial. Some insist that nursing ethics is a unique field posing issues that cannot be understood fully by adapting the professional ethics of physicians. They insist that the term “nursing ethics” connotes the uniqueness of the moral problems that nurses face in the health care setting.

On the other hand, others argue against the term. Some suggest that it is demeaning and has somewhat the connotation of watered-down ethics —the flavor of such textbook titles as anatomy for nurses or pharmacology for nurses Others critical of the term “nursing ethics” argue that there is really very little that is morally unique to nursing. The same ethical principles and the same moral issues emerge in the health care setting whether one is a physician, nurse or patient. This article puts forth the view that nursing ethics is a legitimate, if very limited, term referring to a field that is a sub-category of medical ethics.
Prescribing Approved Drugs for Nonapproved Uses: The Pharmacist’s Potential for Liability
Authors: Mazzucca Gerald A.
Published: June 2007

Drugs are frequently used for purposes not included in the manufacturers’ package inserts which are approved by the Federal Food and Drug Administration (FDA). A current example involves the industrial solvent dimethyl sulfoxide (DMSO), which is approved for human use only for the treatment of chronic interstitial cystitis, but is reportedly widely sold for the nonapproved purpose of arthritis treatment. The placing of this product in the pharmacy for sale to consumers could constitute the basis for an action by FDA against the pharmacy. This article will discuss the potential legal ramifications when a pharmacist dispenses an approved drug for a nonapproved use.

The question of a pharmacist’s liability for dispensing approved drugs for nonapproved uses has not yet been litigated. Courts have, however, held physicians liable for improperly prescribing drugs for nonapproved uses, as discussed by Professor Kapp in the preceding article. The premise of this article is that the pharmacist is potentially liable, and that the basis of this liability may be analogized to that of the physician’s liability.
Failure to Use Siderails: When is it Negligence?
Authors: Greenlaw Jane
Published: June 2007

Nurses frequently wonder about the legal aspects of using siderails to prevent patient falls from bed. Questions arise as to when siderails are clinically indicated; whether a patient may refuse the use of siderails; whether, when a patient does fall from bed, the fall resulted from negligent failure to use siderails; and whether a decision to use siderails is a medical or nursing judgment. This article examines the legal issues involved in the use of siderails and provides some recommendations for the use of siderails and other restraints.

Liability for a patient's fall from bed is imposed according to the general principles of the law of negligence—when the patient-plaintiff can demonstrate that a particular act or omission on the part of the defendant (usually the hospital, through its nursing staff) did not conform to the accepted standard of care, and that this deviation resulted in harm to the patient.
Medicolegal History: A Review of Significant Publications and Educational Developments
Authors: Frey Emil F.
Published: June 2007

The development of the medicolegal field in the United States has followed an uneven course, marked by successions of rich and fallow periods. By the beginning of the nineteenth century a number of universities had qualified professors of medical jurisprudence on their faculties, and the field appeared to be in full flower. Yet, in 1876. a well-known American medical professor and dean, Stanford Emerson Chaille, wrote with some bitterness of the deplorable state of medical jurisprudence in this country. Today, there is considerable interest in the field, but the comparative dearth of medicolegal instruction at medical schools remains an issue.

This article briefly traces the development in the United States of the medicolegal field, which for our purposes encompasses the legal questions concerning medicine and allied sciences Selected advances in education and publishing are highlighted; lastly, the article reviews those problems which appear to have prevented the full development of this field.
Communication Failure: Some Case Examples
Authors: Greenlaw Jane
Published: June 2007

Communication is an essential component of effective health care. Ideally, information to ensure continuous safe treatment and to prevent decisions or actions that can be harmful is transmitted among all who are involved in a patient's care, including the patient.

In the course of a normal day, a nurse processes a great volume of information about a patient. The nurse must decide which information calls for further action, which should be recorded in the patient's record, which should be reported to others involved in the patient's care, and which should be told to the patient or his family. Making such decisions about communication can present serious problems. A recent California case, Sanchez v. Bay General Hospital, illustrates what can happen when nurses fail to recognize the significance of certain patient information and therefore fail to communicate it or react to it properly.
The Impact of Recent Antitrust Case Law on Health Care Professionals
Authors: Fried Jules M.
Published: June 2007

The application of the antitrust laws to the health care field has generated intense debate over the last few years. Responsible for this debate in no small measure are the numerous health care antitrust cases that have reached and been decided by the United States Supreme Court. In the final weeks of the October 1981 term, the Court decided three such cases which should be of great interest to health care professionals. Although each involves a different point of law, collectively the decisions underscore the increasing amount of litigation that challenges joint conduct by health care providers, and the increasingly rigorous scrutiny that courts are giving such conduct under the antitrust laws.

The case that has received the most recent attention is Arizona v. Maricopa County Medical Society,’ which involved an alleged price-fixing agreement among physicians. Defendants were the county medical societies in Maricopa and Pima Counties in Arizona, and the foundations for medical care which each society had created.
Pharmacists Challenge Third Party Prescription Programs: A Legal Analysis
Authors: Abood Richard R.
Published: June 2007

Rare is the pharmacist today who does not participate as a service provider in one or several third party prescription insurance programs. Latest figures indicate that 372.7 million prescriptions or 25.4 percent of all prescriptions dispensed in this country were paid for at least in part by some form of prescription drug insurance.’ The economic impact which these third party programs are having on the retail pharmacist has caused their prominence as one of the most serious and important issues in pharmacy today.

Most third party prescription programs (TPPPs) are similar in structure and include a program administrator or insurance company, a sponsor (often an employer or labor union), subscribers or beneficiaries. and the participating pharmacies. Typically, the insurer or program administrator (hereinafter. the administrator) offers a contract or a “pharmacy agreement” to each pharmacy in a particular area. Each pharmacy must then decide whether or not to accept the agreement and become a participating pharmacy.
Designated Compensable Events: A No-Fault Approach to Medical Malpractice
Authors: Tancredi Laurence R.
Published: June 2007

It has been seven years since the last major medical malpractice crisis, when the cost of liability insurance rose so astronomically that several important insurers withdrew from providing insurance coverage to physicians and health care institutions. Government and private policy groups at that time established committees to evaluate the medical malpractice crisis and to recommend changes that would bring about an amelioration of the adverse financial and health care features surrounding medical malpractice. The United States Department of Health, Education and Welfare published its Report of the Secretary's Commission on Medical Malpractice in 1973, documenting the extent of the crisis and recommending that alterations be made in the existing tort law to alleviate some of the financial burdens brought on by the increasing number of cases. In 1977, the Institute of Medicine of the National Academy of Sciences formed a Steering Committee on Medical injury Compensation that reviewed some of the special problems of the medical malpractice system and published its report.
In-House Hospital Law Offices: How Healthy are They?
Authors: Brown Max Douglas
Published: June 2007

Medical centers. with increasing frequency, are employing their own in-house attorneys. The express purpose for this is to avoid the cost of large corporate law firms, as well as to secure greater control over costs connected with medical malpractice litigation, such as loss control, risk management, and self-insurance programs. But are these offices appropriately and competently providing the full spectrum of legal services to the medical centers they serve?

This past spring, a conference in Chicago explored the role of in-house counsel in controlling corporate legal costs. The general consensus was that corporate clients, who consume from 65 to 85 percent of the legal services in the country, have allowed themselves to be “cowed by the demands of prestigious outside counsel.” According to press reports, ineffectual in-house counsel were criticized for their inability to curb excessive corporate legal fees and expenditures. The legal fees of outside firms were characterized as “just plain unnecessary.”