Chapter 12Public Health Preparedness Policy.docx

Chapter 12:
Public Health Preparedness
Policy
Chapter Overview
• Describe what public health preparedness is and the
role of the public health community in preparing for
and responding to emergencies
• Understand the breadth of public health emergencies,
and the types of communities public health must
work with to prepare for and respond to specific
events
• Understand the threats from and history of use of
weapons of mass destruction

Chapter Overview
• Define public health threats from biological
agents and naturally occurring diseases
• Discuss both the federal, state, and local
policies and laws that support public health
preparedness and the infrastructure that has
been built to support preparedness activities at
the federal, state and local levels
Defining Public Health Preparedness
• “[P]ublic health emergency preparedness . . . is the
capability of the public health and health care systems,
communities, and individuals, to prevent, protect
against, quickly respond to, and recover from health
emergencies, particularly those whose scale, timing, or
unpredictability threatens to overwhelm routine
capabilities. Preparedness involves a coordinated and
continuous process of planning and implementation that

relies on measuring performance and taking corrective
action.” – The RAND Corporation
• Public health “emergencies” fit into four basic
categories:
– the intentional or accidental release of a chemical,
biological, radiological, or nuclear (CBRN) agent;
– natural epidemics or pandemics, which may involve
a novel, emerging infectious disease, a re-emerging
agent, or a previously controlled disease;
– natural disasters such as hurricanes, earthquakes,
floods, or fires; and
– manmade environmental disasters such as oil spills.
• A fifth category of public health emergency, as
defined by the World Health Organization’s

International Health Regulations, is “an extraordinary
event which is determined . . . to constitute a public
health risk to other States through the international
spread of disease and to potentially require a
coordinated international response.” Such an
emergency can involve any of the above four types of
public health events, as long as it has the potential to
cross borders.
Public Health Preparedness Policy
• While government officials have long been aware of
public health emergencies and the need for
coordinated action to detect, report, and respond
appropriately, the U.S. preparedness infrastructure
did not truly take shape until after the attacks of
September 11, 2001
• The two initial, significant organizational changes:
the establishment of the federal Office of Homeland

Security and the Homeland Security Council within
the White House, and the creation of the Department
of Homeland Security
Public Health Preparedness Policy
• In addition to the creation of DHS, in the wake of the
9/11 attacks many existing government departments
and agencies established new offices, expanded
existing ones, and redirected resources towards
preparedness and homeland security. The following
agencies and offices are most directly linked to public
health preparedness policy at the federal level:
– Office of the Assistant Secretary for Preparedness
and Response
– Centers for Disease Control and Prevention
Public Health Preparedness Policy (continued)
– Centers for Disease Control and Prevention

– National Institutes of Health
– The Food and Drug Administration
– Department of Agriculture
– Department of Justice, Federal Bureau of
Investigation
– Department of Defense
Public Health Preparedness Policy (continued)
• These agencies and offices are charged with
enforcing many statutes, regulations, and
policy guidance documents that form the
foundation of public health preparedness.
Public Health Preparedness Federalism
• Public health preparedness requires cooperation
among multiple levels of government. Indeed, while
a strong federal policy and infrastructure is essential,
public health professionals recognize that most public

health activities occur at the local and state level.
• Not only is this a reality in practice, it is codified by
the 10th Amendment of the Constitution: “The
powers not delegated to the United States by the
Constitution, nor prohibited by it to the States, are
reserved to the States respectively, or to the people.”
• States have responsibility for developing their own
emergency preparedness plans, and all have some
level of planning and preparedness training in place.
(continued)
• Preparedness efforts at the state level focus on the
unique threats, challenges, assets, and populations
specific to particular jurisdictions. States that are
subject to relatively more frequent hurricanes may have
well developed plans to address that particular hazard,

while landlocked states far from oceans may have
better-developed plans for other disasters. States will
also take into account the particular demographics of
their region when planning how to address vulnerable
populations, nursing homes, and schools in
emergencies.
COUN6331 Case Study Treatment PlanCASE STUDY
TREATMENT PLAN
Reminder: Please review the scoring guides for the Unit 5 and
Unit 9 assignments to ensure your papers include all required
information.Instructions
Please type directly into this template as you develop your
treatment plan. Your submitted assignments in Unit 5 and Unit
9 must be completed within this template in order for you to
receive credit for your paper.
Unit 5 Assignment: Complete the first six sections of the
template, plus your reference list, for the Unit 5 assignment.
After you have completed the final draft of these sections, save
the template as a Word document with your name (for example,
Smith Unit 5 assignment) and submit it to the courseroom
assignment area by the deadline for the Unit 5 assignment.
Unit 9 Assignment: Complete the last five sections of the
template, plus your reference list, for the Unit 9 assignment.
Although your instructor will only be reviewing the last five
sections to score your paper for Unit 9, please retain the

information you have already written in the first sections within
the template so your instructor can refer back to this when
reading your Unit 9 assignment. When the full template is
completed, save it as a Word document with your name (for
example, Smith Unit 9 assignment) and submit it to the
courseroom assignment area by the deadline for the Unit 9
assignment.
Case Study Treatment Plan
Your Name
Course Number
Date
Mental Health Counseling Clinical Internship 1
Unit 5 assignment sections: The Assessment Process (4–5 pages
plus references)
Section 1: Identifying Information
Describe the client in your own words. Include demographic
data and relevant context (living situation, employment, current
functioning, et cetera). Your description should be concise.
Section 2: Presenting Problem
Describe the key concerns that have brought the client to
counseling at this time. Include a brief description of any
relevant history (for example., previous incidents of concern,
length of time issues have been going on, prior trauma, or other
critical events related to the presenting problems).
Section 3: Previous Treatments

Summarize the client’s previous experience in therapy. Include
hospitalizations as well as any community resources or other
medical/mental health services the client has used. Include the
degree to which previous treatments were successful; has the
client had any experiences with previous treatments that may
have a negative impact on the current counseling process?
Section 4: Strengths, Weaknesses, and Support Systems
· Describe the client’s areas of strength and resilience. How
might these impact treatment success?
· Describe the client’s limitations, challenges, or areas in which
the client lacks knowledge, awareness, or specific skills. How
might these impact treatment success?
· List the support systems the client currently has access to,
such as family, friends, community groups, et cetera, and the
extent to which the client is currently able to utilize these
supports. How will these systems impact the success that the
client may or may not have during the therapy process?
· Describe the impact of a co-occurring substance use disorder
on the client’s medical and psychological disorder.
· Summarize the key factors that may impact this client’s
successful progress in therapy, how and why these factors may
have an impact on treatment success, and how you will take
these factors into account as you develop your treatment plan.
Include a summary of the counselor characteristics that may
impact this client’s treatment success.
Section 5: Assessment
Describe the process you will use to complete a clinical
assessment of this client. If you intend to use specific
instruments (such as self-report instruments, structured
interviews, or psychological tests), state what they are and why
you have selected them. Discuss any concerns you will need to
address regarding the relevance and biases of assessment tools
with multicultural populations. Also discuss the methods you

will use to arrive at an accurate DSM diagnosis for this client,
including the consideration of co-occurring disorders.
Section 6: Diagnosis
Present a DSM-5 diagnosis for the client. Provide a description
of your rationale for making this diagnosis (for example, what
information did you consider?). Discuss other possible
diagnoses that you ruled out (or will need to rule out once you
have additional information). Include your ideas about the
impact of co-occurring substance use disorders on the symptoms
the client is demonstrating and how this was considered in your
diagnosis.
References for Unit 5 Assignment
Support your decisions and ideas for the Unit 5 assignment with
a minimum of two references to articles from current
professional journals (2010 or later) in the field of counseling.
Use correct APA format.
Unit 9 assignment sections: Treatment Goals (4–6 pages plus
references)
Section 1: Treatment Plan Literature Review
Review the current research and best practices presented in the
professional literature that relate to types of clients and
presenting issues that are similar to the case you have selected.
What does the literature have to say about the most effective
types of counseling approaches used with clients who share
similar social-cultural backgrounds, history, current situations,
and/or presenting problems? Be sure to address the impact of
diversity when selecting approaches and interventions.
Summarize your review of the literature so it provides clear
support for your choice of counseling approach, goals, and
interventions that you will be presenting in the sections below.
Keep direct quotes to a minimum; you should paraphrase the
information you have reviewed in your own words. Remember

to use correct APA format for all citations.
Section 2: Goals and Interventions
List four goals that you will work on with this client during the
first three months of counseling. Present these goals in concrete
and specific terms. For each goal, list two specific interventions
that you will use during counseling sessions to assist the client
in making progress towards the goal. What will let you know if
these interventions are effective (for example, what changes
would you expect to see in the client during sessions; what
changes between sessions might the client report; will you
utilize any self-report measures or other assessment instruments
to help measure change)? Be sure your interventions reflect the
effective practices that you described in your treatment plan
literature review; address how your approaches will also take
the client’s sociocultural background into account and their
appropriateness for addressing addiction and co-occurring
disorders.
Section 3: Communication With Other Professionals
Who will you consult with as you develop your client’s
treatment plan and begin to work with him or her in therapy (for
this segment, assume that you have a written consent from the
client to do so)? This might include other medical/mental health
professionals currently working with the client, as well as
previous therapists; it could also include experts in the field
with whom you may want to consult about the client’s
presenting issues. How will this information inform your work
with the client?
Section 4: Medications
Discuss in the section any medications your client is currently
taking. What impact do these medications have on the client
(for example, side-effects, improvement in symptoms,
interactions with other drugs, et cetera)? What information do
you want to provide to the client about these medications and

how might you need to continue addressing the issue of
medication in your work with this client over time? Do you
think psychopharmacological medications are advisable for this
client? Would you consider referring this client to appropriate
medical professionals for evaluation for psychopharmacological
medications?
Section 5: Legal, Ethical, and Other Considerations
How will the ACA Ethical Standards apply to your work with
this client? Describe any potential legal or ethical issues that
may arise and how you will address them. Refer to the specific
state laws or regulations or ethical standards in your discussion.
Also list any other red flag issues that you have identified and
the ways in which you address these issues with the client.
References for Unit 9 Assignment
Support your decisions and ideas for the Unit 9 assignment with
a minimum of four references from current professional journals
in the field of counseling. Use correct APA format.
1
COUN633
1 Case Study Treatment Plan
1
CASE STUDY TREATMENT PLAN
Reminder: Please review the scoring g
uides for the Unit 5 and Unit 9 assignments to

ensure your papers include all required information.
Instructions
Please type directly into thi
s template as you develop your treatment plan.
Your
submitted assignments in Unit 5 and Unit 9 must be completed
within
this
template in
order for you to receive credit for your paper.
U
nit
5
Assignment
:
C
omplete the first
six
sections
of the template
, plus your reference
list,
for the Unit 5 assignme
n
t.
After

you have completed the final draft of these sections,
save the template as a Word document with your name (
for example,
Smith
Unit 5
assignment) and submit it to the courseroom assignment area
by the deadline for
the Unit
5 assignment
.
Unit 9 A
ssignment
:
C
omplete the last
five
sections
of the template
, plus your reference
list,
for the Unit 9 assig
nment.
Although your instructor will only be reviewing the last
five
sections to score your paper for Unit 9, p

lease
retain
the information you ha
ve
already written
in
the first sections within the template so your instructor can refer
back
to this when reading your Unit 9 assignment.
When the full template is completed, save it
as a Word document with your name (
for example,
Smith
Unit 9
assignment
) and submit
it to the courseroom assignment area
by the deadline for
the Unit 9 assignment
.
Your Name
Course Number

Date
Mental Health
Counseling Clinical Internship 1
COUN6331 Case Study Treatment Plan
1
CASE STUDY TREATMENT PLAN
Reminder: Please review the scoring guides for the Unit 5 and
Unit 9 assignments to
ensure your papers include all required information.
Instructions
Please type directly into this template as you develop your
treatment plan. Your
submitted assignments in Unit 5 and Unit 9 must be completed
within this template in
order for you to receive credit for your paper.
Unit 5 Assignment: Complete the first six sections of the
template, plus your reference
list, for the Unit 5 assignment. After you have completed the
final draft of these sections,
save the template as a Word document with your name (for
example, Smith Unit 5
assignment) and submit it to the courseroom assignment area by
the deadline for the Unit
5 assignment.
Unit 9 Assignment: Complete the last five sections of the
template, plus your reference
list, for the Unit 9 assignment. Although your instructor will
only be reviewing the last

five sections to score your paper for Unit 9, please retain the
information you have
already written in the first sections within the template so your
instructor can refer back
to this when reading your Unit 9 assignment. When the full
template is completed, save it
as a Word document with your name (for example, Smith Unit 9
assignment) and submit
it to the courseroom assignment area by the deadline for the
Unit 9 assignment.
Your Name
Course Number
Date
Mental Health Counseling Clinical Internship 1
Introduction
For your course project, you will develop a treatment plan for
one case study subject that you select from two possible
candidates. These potential clients are ethnically diverse and are
struggling with psychological disorders, which may require
medication.
During the course of this project you will:
· Evaluate client information.
· Review possible assessment techniques.
· Offer a diagnostic impression.
· Review various behavioral and pharmacological treatments.
· Discuss the legal and ethical ramifications of the disorder and
proposed treatments.
· Review the impact of diversity issues on various disorders and

their treatments.
· Develop a suggested treatment plan for the client.
You will select one of the case studies presented on the next
page of this presentation as your client for this treatment plan
project. Then you will use the Case Study Treatment Plan
Template, provided in the Resources to complete your
assignments for this project. Each section of the template
includes a description of the type of information you will need
to include. You should type your paper directly into this
template, save it as a Word document with your name, and then
submit it to the assignment area.
Stella's Case Study
Stella is a 38 year old biracial (African American and Native
American) woman who has just been assigned to you as a client.
You are currently working as a counselor for your county
community mental health agency. You received the following
information about her as background and history.
Stella is the only child of a Caucasian couple who are now
deceased. She was adopted as an infant in a closed adoption, so
that none of her birth parents' records are available. The only
informal information that Stella remembers her parents telling
her is that her mother was 16 years old at the time of Stella's
birth and had been raped while at a high school football game.
Stella currently lives in a small city of 150,000 people where
she is employed as a book-keeper for the local meat packing
plant. She has worked there for 3 years. Her educational
background includes an associate's degree in accounting and
continuing education in tax preparation. Before working for this
plant, she was employed as a tax preparer for a national
company. She enjoys her work, saying that numbers are easier
to get along with than people.
Oscar's Case Study

Oscar is a 19-year-old Hispanic male who is the oldest of 5
children. His family has been farming the same land for 4
generations. Currently they grow vegetables for the regional
grocery chain's produce departments. They live in a rural area
of the county. Three generations live in two separate houses on
their land. They are fiercely independent and have little to do
with people in town, although the family itself is extremely
close knit.
Oscar is currently a freshman at the same college his father
attended, majoring in agriculture. When he came home for
spring break, his parents noticed significant changes in his
appearance. He had lost weight, looked haggard, wasn't sleeping
and seemed irritable and argumentative. He told his parents that
he did not want to return to college after the break. He went on
to say that his roommate had placed cameras in the room so he
could record everything Oscar did while the roommate was
absent. His grades were poor and he expressed that he believed
his instructors were prejudiced against him. This poor
performance was in stark contrast to his performance in high
school, where he was in the top 10% of his class. Within days of
coming home he had stopped showering and began wearing
multiple layers of clothes (3 pairs of jeans and 4 t-shirts). He
became essentially non-communicative, responding to questions
with one-word answers and not initiating conversation. Oscar
seemed unhappy or irritable whenever he encountered a member
of his family and began spending all his time in his room. He
even refused to talk with his youngest brother, with whom he
had always been close. He did not take meals with his family, a
long-standing tradition in his family, and left his room only in
the middle of the night. He could then be heard opening drawers
in the kitchen, going into his siblings' rooms and leaving the
house for long periods of time.
The family (parents and grandparents) became very disturbed
and consulted their priest. The priest recommended that the

parents take Oscar to see a fellow parishioner who is also a
counselor. This counselor was also disturbed with Oscar's
presentation and recommended hospitalization. The family was
very reluctant, but eventually agreed. By the time they got to
the hospital, Oscar was essentially non-communicative, only
nodding or shaking his head in response to direct questions.
The parents provided history that indicated Oscar had been a
good student in high school and had participated in the school's
FFA club. He has always wanted to carry on the family tradition
of farming. He did not have many friends, but the family
attributed that to their living in the country.
The psychiatrist diagnosed Oscar with major depressive
disorder, single episode, severe with psychotic features and
prescribed anti-depressants. He was released three weeks later,
with some improvement. One week later he was readmitted,
with the same presentation he had at the previous admission.
This time, though, his father reported that he had found a cache
of knives in the barn, some from the house, some from the
grandparent's house and some from the barn itself. When he
asked Oscar about them, Oscar responded that he needed them
to protect himself from attacks. When his father asked from
whom, Oscar responded that he had seen one of his college
professors in the field of broccoli. That same day, Oscar's
mother found notes stuffed between Oscar's mattress and box
springs in Oscar's handwriting. The content of them was Oscar
arguing with someone about killing his younger siblings. One
side did not want to do it and begged to not have to; the other
side ordered the killings, saying that was the only way to keep
them safe. In light of these two events, both parents were afraid
for Oscar to remain at the house. Oscar swore that he would
never hurt any of his family and said that was why he had been
keeping away from them. His parents could not be sure that no
harm would come and were unable to watch Oscar day and
night. Therefore, they readmitted him to the hospital.
During this admission, Oscar was more forthcoming with his
treatment team. Once they had this additional information, the

team realized that Oscar's initial diagnosis had been wrong.
They began a re-assessment. Oscar acknowledged that the
problems began about the time of the new semester. He was
unable to complete his school work, as he was "consumed" with
the need to follow instructions that were being given to him.
These instructions actually began with a buzzing in his head,
which quickly evolved into specific directions. When pressed,
he acknowledged that he did not know who was giving him the
directions, though he sometimes thought it might be Jesus.
These instructions were for him to keep a log of every time he
heard a door close on his hallway in the dorm. Oscar came to
believe that doing this was the only way to keep his family safe
from dark angels. Oscar tried to keep these voices quiet by
smoking marijuana on a daily basis. While this helped in the
short term, it also made it more difficult for him to complete
any of his school work. By the time for spring break, the
messages had begun to change. He was no longer able to keep
his family safe by keeping a list; the voices told him he would
have to kill them. Oscar knew that he did not want to kill his
family. He could also not avoid going home for spring break.
Therefore, he devised the plan to isolate himself.
Once the family recovered from their initial shock and as Oscar
began to show some improvement with his new, anti-psychotic,
medication, his parents and grandparents wanted to take him
home to the farm. They believed that life on the farm, being
outside and with hard, physical labor would cure Oscar. Finally,
Oscar agreed to tell them what has been happening with him. At
that point, the family agreed to residential treatment for Oscar.
When asked if anyone else in the family has ever had symptoms
like this, the grandfather acknowledged that he had a brother
(Oscar's uncle) who had religious visions. This brother left the
family and became a monk. Later the family heard that he had
died under mysterious circumstances. One of the other monks at
the monastery told Oscar's grandfather that his brother had died
from engaging in a prolonged fast. The family is very lucky on
two counts: 1) they have their medical insurance through the

farmer's co-op and it includes coverage for residential treatment
for up to a year, and 2) this hospital has a residential treatment
unit for late adolescents and young adults. You are working as a
counselor at the Residential Treatment facility where Oscar has
been placed. He will be here for a minimum of 6 months and as
long as one year. Professional staff at this facility includes 3
counselors, an addictions counselor, a social worker (currently
on maternity leave), a psychologist, and 2 nurses on every shift.
Oscar's psychiatrist is also on staff and will continue to follow
his care.
The social worker usually coordinates clients' treatment plans;
however she is currently away on maternity leave so you will be
the lead therapist who is coordinating Oscar's treatment during
the next 45 days. Once she returns, you will collaborate with
her for developing Oscar's post-residential treatment and
resources for him and his family.
Next »« Back
Case
Study
Treatment
Plan
INTRODUCTION
one case study subject that
you
select from two possible candidates. These potential clients are

ethnically diverse and are
medication.
During
the
course
of
this
project
you
will:
·
Evaluate client information.
·
Review possible
assessment techniques.
·
Offer a diagnostic impression.
·

Review various behavioral and pharmacological treatments.
·
Discuss the legal and ethical ramifications of the disorder and
·
Review the impact of diversity issues on various disorders and
their treatments.
·
Develop a suggested treatment plan for the client.
page of this presentation as your
client for this treatment pl
an project. Then you will use the Case Study Treatment Plan
Template,
provided in the Resources to complete your assignments for this
project. Each section of the
template includes a description of the type of information you
will need to include. You shou
ld
type your paper directly into this template, save it as a Word
document with your name, and then
STELLA'S CASE STUDY
American) woman who has just
been assigned to you as a client. You are currently working as a

counselor for your county
community mental health agency. You received the fol
lowing information about her as
background and history.
INTRODUCTION
one case study subject that you
select from two possible candidates. These potential clients are
ethnically diverse and are
medication.
During the course of this project you will:
and
and their treatments.
page of this presentation as your
client for this treatment plan project. Then you will use the
Case Study Treatment Plan Template,
provided in the Resources to complete your assignments for this
project. Each section of the
template includes a description of the type of information you
will need to include. You should
type your paper directly into this template, save it as a Word
document with your name, and then
STELLA'S CASE STUDY

American) woman who has just
been assigned to you as a client. You are currently working as a
counselor for your county
community mental health agency. You received the following
information about her as
background and history.
Chapter 11:
Health Care Quality
Policy and Law
Chapter Overview
• Discuss licensure and accreditation in the context of health
care quality
• Describe the scope and causes of medical errors
• Describe the meaning and evolution of the medical
professional standard of care
• Identify and explain certain state-level legal theories under
which health care professionals and entities can be held liable

for medical negligence
Chapter Overview
• Explain how federal employee benefits law often preempts
medical negligence lawsuits against insurers and managed care
organizations
• Describe recent efforts to measure and incentivize high quality
health care
Quality Control Through
Licensing and Accreditation
• Licensing of health care professionals and institutions
is an important function of state law, as it filters out
those who may not have the requisite knowledge or
skills to practice medicine
• State licensure laws define the qualifications required
to become licensed and the standards that must be
met for purposes of maintaining and renewing

licenses
• Important as the licensing function is, historically it has been
used in the promotion of health care quality in only the
bluntest sense. This is because the only method by which to
promote quality through licensure is the granting or denial of
the license to practice medicine—no real middle ground
• However, private professional and industry ethical and
practice standards also exist, though their effect on day-to-day
quality is debatable
• Also, state licensing schemes were designed not with health
care quality per se in mind, but rather with an eye toward
protecting the medical professions from unscrupulous or
incompetent providers and bad publicity

• Finally, licensure plays an important role in defining
the permissible “scope of practice” of the various
types of health care providers.
• It is one thing for state legislators to define the
meaning of practice for various broad medical fields,
but quite another for legislators to define, for
example, the lawful activities of doctors as compared
to physician assistants as compared to nurses.
Medical Errors
• Although medical errors are not a new
problem, framing the issue as a public health
problem is a relatively new phenomenon.
• Overall, more people die each year from
medical errors than from motor vehicle
accidents, breast cancer, or AIDS.

Medical Errors
• Causes of medical errors may include: failure to
complete an intended medical course of action,
implementing the wrong course of action, using
faulty equipment or products in effectuating a course
of action, failing to stay abreast of one’s field of
medical practice, health professional inattentiveness,
the fact that optimal treatments for many illnesses are
not yet known, and the culture of medicine itself.
Medical Errors
• Policy makers have begun shifting their attention to
medical error reforms that are less reactive and more
centered on error prevention and patient safety
improvements.
• Two primary objectives of these reforms: to redesign
health care delivery methods and structures to limit
the likelihood of human error, and to prepare in

advance for the inevitable errors that will occur in
health care delivery regardless of the amount and
types of precautions taken.
Promoting Health Care Quality Through
the Standard of Care
• The professional standard of care is the legal standard
used in medical negligence cases to determine
whether health professionals and entities have
adequately discharged their responsibility to provide
reasonable care to their patients.
• A patient seeking to hold a health professional
responsible for substandard care or treatment must
demonstrate (1) the appropriate standard of care,
(2) a breach of that standard by the defendant, (3)
measurable damages, and (4) a causal link between
the defendant’s breach and the patient’s injury.
• The standard has its origins in 18th century English
common law.
• Courts in England established that a patient looking
to hold a physician legally accountable for

substandard care had to prove either that the doctor
violated the customs of his own profession as
determined by others within the profession (i.e., the
“professional custom rule”) or that the testimony
provided on behalf of a patient as to whether a
physician’s actions met the standard of care could
only come from physicians who practiced within the
same or similar locality as the physician on trial (i.e.,
the “locality rule”)
• Over time, the standard was updated by courts:
• Generally, courts now consider a range of relevant evidence
in addition to custom and today determine whether a health
professional’s treatment of a particular patient rose to the
standard of care is whether it was reasonable given the
“totality of circumstances”
• Furthermore, a physician’s actions are now measured
objectively against those of a reasonably prudent and
competent practitioner under similar circumstances, not
against the actions of physicians who practice within a

particular defendant’s locality.
Tort Liability of Hospitals, Insurers, and
Managed Care Organizations
• Vicarious liability: where one party can be held
legally accountable for the actions of another party
based solely on the type of relationship existing
between the two parties.
• Vicarious liability is premised on principles of
“agency” law, under which one party to a relationship
effectively serves as an agent of another party.
• The general rule is that employers are not vicariously
liable for the improper actions of independent
contractors; however, courts have developed
exceptions to this rule—e.g., actual agency and

apparent agency—that are more concerned with the
scope of a relationship than with the formal
characterization of the relationship as determined by
the parties.
• Corporate liability: holds entities accountable for
their own “institutional” acts or omissions when their
negligence causes or contributes to an injury.
• Several general areas give rise to litigation around
entities’ direct quality of care duties to patients:
failure to screen out incompetent providers; failure to
maintain high quality practice standards; failure to
take adequate action against clinicians whose
practices fall below accepted standards; and failure to
maintain proper equipment and supplies.

Federal Preemption of State Liability Laws
Under ERISA
• ERISA was established in 1974 to protect the
employee pension system from employer
fraud.
• However, the law was drafted in such a way as
to extend to all employee benefits offered by
ERISA-covered employers, including health
benefits.
Under ERISA
• ERISA implicates two different types of preemption:
– “Conflict preemption” occurs when specific
provisions of state law clearly conflict with federal
law, in which case the state law is superseded.
– “Field preemption” occurs when courts interpret
federal law to occupy an entire field of law (e.g.,

employee benefit law), irrespective of whether
there are any conflicting state law provisions.
Under ERISA
• ERISA’s conflict preemption provisions (the
preemption clause, the insurance saving
clause, and the deemer clause) are more
sweeping than any other federal preemption
provisions and have engendered an enormous
amount of litigation.
Under ERISA
• The U.S. Supreme Court has interpreted ERISA’s
field preemption provisions to be the exclusive
remedy for negligent administration of an employee
benefit plan covered by ERISA.

– This means that all other state remedies generally
available to individuals to remedy corporate
negligence are preempted (and thus not available)
to employees whose health benefits are provided
through an ERISA-covered plan.
Measuring and Incentivizing Health Care
Quality
• As the single largest payer in the U.S. health system,
Medicare is a major national driver of policy in other
markets (both public and private). Therefore, how
the Medicare program addresses issues pertaining to
quality is not only important to Medicare
beneficiaries and providers, but also to other
purchasers/insurers whose policies and procedures
are often driven by Medicare policy

Quality
• All payment systems (public and private) tend to
incentivize something, whether indiscriminant
increases in the volume of treatments and services or
indiscriminant reductions in volume.
• Whatever the payment arrangement, the challenge is
to promote both quality and value while also
apportioning financial risk appropriately.
Quality
• Congress has passed a series of laws (including the
ACA) designed to move the Medicare program from
a passive purchaser of volume-based health care to an
active purchaser of high quality, high value health
care
• The ACA’s vision for improving quality focuses on:
quality measure development; quality measurement

(including payment incentives); public reporting; and
value-based purchasing
Quality
• The ACA also requires the development of a National
Quality Strategy to improve the delivery of health
care services, patient health outcomes, and population
health.

Chapter 12Public Health Preparedness Policy.docx

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