Running head: U.S. HEALTH CARE SYSTEM AND GOVERNANCE 1 U.S. HEALTH CARE SYSTEM AND GOVERNANCE 6 Health care administrator’s role and patient protection Student’s Name: Course Name and Number Instructor Institutional Affiliation Date: Abstract More rules and regulations have been proposed by government and various organizations in order to improve the overall health care system of the country. There is increasing compliant and requirement for high-quality health care system which can be provided only using the proper law, regulation and health care administrator. There are many issues faced by the people due to non-compliance and negligence which can be reduced only through proper governance. Health care administrator has more concern over the legal, ethical and code of conduct of the medical professionals. Effective laws governing the health care system cannot bring any changes in the entire system; it is the administrator who ensures that this system is performing as per the requirement of law. In this paper we will first discuss the role of health care administrator in the health care system and a brief discussion about the penalties in case of any violations. In the later part of paper, we will discuss about the basic elements required by the patients to prove the medical negligence and a brief discussion about non-compliance by the medical professionals. Health care administrator’s role and patient protection Health care administrator’s role: Healthcare system of the country compared with the other organization or any other community which is governed by various rules, regulations, principles, laws and ethics. Administrator must be aware of all the governing laws, ethical behavior, what are the roles and responsibilities, so that the entire system will get benefitted. About health care system, patients are given priority as a health care administrator one has to ensure that patients are not facing any difficulty at any point of time. Must immediately address any concerns of the patients, and any violation must immediately report. There are some problems identified in the governance of health care system, there are more gaps in the corporate and clinical governance, and they are not effectively managed (The Dowton Consulting International, 2011). The corporate side mainly concern with the rules, regulations, policies, laws, people and professionals. Next is a clinical side that mainly deals with the safety and security of the patient, patient care standards and creating an excellent environment for the patient (The Dowton Consulting International, 2011). As an administrator, it is essential to bridge the gap between these two in order to accomplish the desired result. As an administrator it is essential to governing the relationship between both the medical professional and patient, for providing the best service to the patients. Relationship with the patients, gaining their confidence, discharging the duty a ...

1. Running head: U.S. HEALTH CARE SYSTEM AND
GOVERNANCE 1
U.S. HEALTH CARE SYSTEM AND GOVERNANCE 6
Health care administrator’s role and patient protection
Student’s Name:
Course Name and Number
Instructor
Institutional Affiliation
Date:
Abstract
More rules and regulations have been proposed by government
and various organizations in order to improve the overall health
care system of the country. There is increasing compliant and
requirement for high-quality health care system which can be
provided only using the proper law, regulation and health care

2. administrator. There are many issues faced by the people due to
non-compliance and negligence which can be reduced only
through proper governance. Health care administrator has more
concern over the legal, ethical and code of conduct of the
medical professionals. Effective laws governing the health care
system cannot bring any changes in the entire system; it is the
administrator who ensures that this system is performing as per
the requirement of law. In this paper we will first discuss the
role of health care administrator in the health care system and a
brief discussion about the penalties in case of any violations. In
the later part of paper, we will discuss about the basic elements
required by the patients to prove the medical negligence and a
brief discussion about non-compliance by the medical
professionals.
Health care administrator’s role and patient protection
Health care administrator’s role:
Healthcare system of the country compared with the other
organization or any other community which is governed by
various rules, regulations, principles, laws and ethics.
Administrator must be aware of all the governing laws, ethical
behavior, what are the roles and responsibilities, so that the
entire system will get benefitted. About health care system,
patients are given priority as a health care administrator one has
to ensure that patients are not facing any difficulty at any point
of time. Must immediately address any concerns of the patients,
and any violation must immediately report.

3. There are some problems identified in the governance of health
care system, there are more gaps in the corporate and clinical
governance, and they are not effectively managed (The Dowton
Consulting International, 2011). The corporate side mainly
concern with the rules, regulations, policies, laws, people and
professionals. Next is a clinical side that mainly deals with the
safety and security of the patient, patient care standards and
creating an excellent environment for the patient (The Dowton
Consulting International, 2011).
As an administrator, it is essential to bridge the gap between
these two in order to accomplish the desired result. As an
administrator it is essential to governing the relationship
between both the medical professional and patient, for
providing the best service to the patients. Relationship with the
patients, gaining their confidence, discharging the duty as per
the requirement has to be strictly monitored and governed by
the administrator.
Ramifications due to violations:
There is a list of code of ethics provided by the American
Medical Association, which is expected to be followed by the
medical professionals (ACAAI, n.d.). Similarly, more laws,
rules and regulations have been proposed by the HIPAA (Health
Insurance Portability and Accountability Act), if they are
breached and being proved then it may lead to civil or criminal
liabilities.
These medical associations cannot tolerate any violation, and
punish the medical professionals for their mistakes (AMA,
n.d.). They provided more detailed information as which
negligence will fall under the civil and criminal charges. It
provides more details about ramification of all the violations.
If medical professionals commit any mistake unintentionally,
and they are rectifiable then they will fall under civil charges,
and others will categorize as criminal.

4. Medical professionals have to follows the rules and regulations
of following: RHIO (Regional Health Information
Organization), HIE (Health Information Exchange), HIMSS
(Healthcare Information and Management Systems Society),
AHIMA (American Health Information Management
Association), HIPAA and CMS (Centers for Medicare &
Medicaid Services).
Even a small violation in any of the rules, policies, cannot be
tolerated in the health care industry (AMA, n.d.). In medical
industry, ethical values are more dominant and most of the
professional cross their limitation in order to boost the patient’s
confidence by providing false promises (AMA, n.d.). A medical
professional is not expected to give any false commitment out
of courtesy that may have any adverse effect in the minds of
patients. Patients trust the medical professionals and any breach
will result in serious consequences.
Four essential elements for proving negligence:
It is essential to prove any mistake or charges in order to get the
justice. The most common cause of the mistake in the medical
field is a medical negligence. But such negligence is
punishable. There are four essential elements to be proved by
the plaintiff: Injury, Causality, Breach of a required duty and
Duty of care (Showalter, 2011, p. 81). Providing care is an
essential and basic expectation from the medical professional.
Lack of such due care is the main reason for medical
malpractice. Plaintiff is responsible in proving the medical
malpractice.
Through the existing relationship between the patient and the
medical practitioner; it is essential to prove the violations
associated with the standard of care and failure in meeting the
required standards (Gittler & Goldstein, 1996, p. 2). Breach of
duty is when the medical professionals fail to provide
appropriate care or required treatment on time to the patient. It
also includes the professional requirement in diagnosing the
problem, making more research about the case before initiating
any treatment and so on. Due to these reasons there must be a

5. real injury either physical or mental to the patient, and must
prove.
Finally, one has to prove that the injury to the patient is mainly
due to the negligence of a doctor, and it has resulted in
causality (Feeley & Mariner, 2000). Plaintiffs have due
preference in proving the negligence that they faced in order to
obtain justice for the injury suffered by them. It is essential to
prove the mistake in order obtain justice. There is no ignorance
of any patient's complaints as they may lead to adversity in the
future. Severe punishments and penalties are lived for
negligence in order to avoid their occurrence in the future.
Non-compliance in the medical industry:
With the growth in technology, all records are expected to be
maintained only using the electronic form. Privacy in the
medical industry is more crucial and critical. Patients medical
records have to be maintained with due care in order to avoid
any breach in the law. Maintaining all electronically is a costly
affair for the medical professionals but it will enable them in
reducing the consequences of non-compliance (Fiegl, 2012).
Federal law will reduce the Medicare rates for those physicians
who are not part of e-prescription and maintaining health
records electronically.
Thus, EHRs are mandatory and must establish a connection with
the HIO to get detailed information (HIMMS, 2011). Affordable
Care Act requires medical professional to follow various rules
and regulation in order to obtain the claim and in discharging
their duties according to the requirement of law (Treumann,
2013). Non-compliance to the ethics and law is a major problem
in this industry that is reducing the quality of service and the
confidence of people over the medical industry.
Any non-compliance by the medical professional is punishable
as patients are given first importance. First it is essential to
protect the patients and then to provide the best service to them

6. in order to avoid any adversity. In the case of any violation, the
maximum penalty that is imposed by HIPPA is $1.5 million, and
penalizing medical professionals in case of serious violation
(Nyu.edu, 2011). OCR (Office for Civil Rights) provides more
protection to patients and takes care of any violation.
Non-compliance of rules related to privacy results in a
punishable offense. There is various information that is required
to be protected due to various reasons. It results in both civil
and criminal penalties which even led to imprisonment (HHS,
2003, p. 17-18). Compliance can be effective, and non-
compliance can be avoided only if proper training is being
provided to all the medical professionals in effective manner.
More training must be given into those areas that require special
attention and areas where majority of the organization tend to
commit more mistakes in order to avoid future risk and
adversity (HHS, 2003, p. 8). Any change in the laws or rules or
regulations along with an update must be informed to the
medical professionals in order to avoid any adversity in the
future. These are the major responsibilities of the health care
administrator.
References

7. ACAAI. (n.d.). American Medical Association Code of Ethics.
Retrieved from http://www.acaai.org/about/pages/code-of-
ethics.aspx
AMA. (n.d.). HIPAA Violations and Enforcement. Retrieved
from
http://www.ama-assn.org/ama/pub/physician-
resources/solutions-managing-your-practice/coding-billing-
insurance/hipaahealth-insurance-portability-accountability-
act/hipaa-violations-enforcement.page?
AMA. (n.d.). Opinion 1.02 - The Relation of Law and Ethics.
Retrieved from
http://www.ama-assn.org/ama/pub/physician-resources/medical-
ethics/code-medical-ethics/opinion102.page?
Feeley, F. G., & Mariner, W. K. (2000). Basic Elements of the
Legal System of Physician Liability For Negligent Patient
Injury in the United States with Comparisons to England and
Canada. Retrieved from Boston University School of Public
Health website:
http://dcc2.bumc.bu.edu/russianlegalhealthreform/projectdocum
ents/n740.iig.bkgd.pdf
Fiegl, C. (2012, November 12). Decisions doctors must make to
avoid Medicare penalties - amednews.com. Retrieved from
http://www.amednews.com/article/20121112/government/31112
9954/4/
HHS. (2003). Summary of the HIPAA Privacy Rule - HIPAA
Compliance Assistance. Retrieved from Office of Civil Rights
website:
http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/p
rivacysummary.pdf
HHS. (2003). Corporate Responsibility and Corporate
Compliance: A Resource for Health Care Boards of Directors.
Retrieved from
https://oig.hhs.gov/fraud/docs/complianceguidance/040203Corp
RespRsceGuide.pdf
HIMMS. (2011). The Legal Electronic Health Record. Retrieved
from

8. http://www.himss.org/files/HIMSSorg/content/files/LegalEMR_
Flyer3.pdf
Nyu.edu. (2011). HIPAA Security: Harsh Fines, Penalties Are a
Wake-up Call to Us All | Internal Audit, Compliance &
Enterprise Risk Management. Retrieved from
http://compliance.med.nyu.edu/news/documenting-inpatient-
admissions
Gittler, G. J., & Goldstein, E. J. (1996). Medicolegal Case
Reviews - The Elements of Medical Malpractice: An Overview.
Retrieved from The University of Chicago website:
http://cid.oxfordjournals.org/content/23/5/1152.full.pdf
Showalter, J. S. (2011). Negligence. In The law of healthcare
administration (6th ed., pp. 81-88). Chicago, IL: Health
Administration Press.
The Dowton Consulting International. (2011). Governance in
Healthcare – Linkages, Boundaries and the Problems between
Corporate and Clinical Governance | Dowton Consulting
International. Retrieved from
http://www.dowton.com/journal/2011/06/governance-in-
healthcare-%E2%80%93-linkages-boundaries-and-the-problems-
between-corporate-and-clinical-governance/
Treumann, J. E. (2013, March 25). Sunshine Act: 7 things you
need to know | Medical Economics. Retrieved from
http://medicaleconomics.modernmedicine.com/medical-
economics/news/modernmedicine/modern-medicine-feature-
articles/sunshine-act-7-things-you-nee?page=full