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2-3 pages assignment

by | Jun 5, 2022 | fresh

You need to read the article assigned for week 1 and develop a 2-3-page paper reflecting your understanding and ability to apply the readings to your Health Care Setting. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page.
Originality: SafeAssign submission is required.

Reflections of the Past
Chapter 1

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History is relevant to understanding the Past, defining the Present, and influencing the Future.

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Who Am I?
© 2014 Jones and Bartlett Publishers
I was Created at the End of the Renaissance,
Watched Pirates Rule the Oceans,
As Ivan the Terrible Ruled Russia,
And witnessed the arrest of Galileo,
For Believing the Earth Revolved Around the Sun.
I AM HISTORY
3

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History, despite its wrenching pain,
cannot be unlived,
but if faced with courage,
need not be lived again.
−Maya Angelou

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We can learn from history how past generations thought and acted, how they responded to the demands of their time and how they solved their problems. We can learn by analogy, not by example, for our circumstances will always be different than theirs were. The main thing history can teach us is that human actions have consequences and that certain choices, once made, cannot be undone. They foreclose the possibility of making other choices and thus they determine future events.
—Gerda Lerner

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Those who cannot remember the past are condemned to repeat it.”
—George Bernard Shaw

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LEARNING OBJECTIVES
© 2014 Jones and Bartlett Publishers
Discuss how the conflicts of society due to politics, religion, and warfare have often impeded the growth of hospitals, as well as, contributed to their progress.
Explain how advances in medicine through the ages led to the rise of the modern day hospital and improving the quality of patient care.

7

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LEARNING OBJECTIVES
© 2014 Jones and Bartlett Publishers
Describe how knowledge gained from best practices (e.g., infection control) can lead to progress while at the same time result in patient harm if not consistently followed over time.

8

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Early Hindu & Egyptian Hospitals
6th century BC: Buddha appointed a physician for every 10 villages
built hospitals for the crippled & the poor;
Provided Fresh Fruits & Vegetables
Administered Medications
Provided Massages
Maintained Rules of Personal Cleanliness

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Hindu Physicians
© 2014 Jones and Bartlett Publishers
Took Daily Baths
Keep Hair & Nails Short
Wore White Clothes
Respected Confidence of Patients
10

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Egyptian Physicians
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Used Castor Oil & Opium
Used Wooden Mallet for Anesthesia
Surgery mostly limited to Fractures
Medical Care in the Home
Temples functioned as Hospitals
11

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Greek & Roman Hospitals
© 2014 Jones and Bartlett Publishers
Hospital derives from Latin word hospitalist, which relates to guests & their treatment
Early use of these institutions not merely as places of healing but as havens for the poor & weary travelers
Medical Practice Rife with Mysticism
12

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Greek Temple Medicine – I
© 2014 Jones and Bartlett Publishers
Hospitals first appeared in Greece as Aesculapia
named after Greek god of medicine
Patients Presented Gifts before Altar
Greek Temples – Refuge for Sick
Holistic Medicine – Body & Soul
Medications – Salt, Honey, Sacred Springs
Hot & Cold Baths
Sunshine, Sea Air, Pleasant Vistas
Libraries for Visitors
13

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Temple at Epidaurus
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1st Clinical records
Inscribed on columns of temple
Recorded
Patients Names
Brief Histories
Treatment Outcomes
14

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Hippocrates – The Physician
© 2014 Jones and Bartlett Publishers
Noted for:
Principles of Percussion & Auscultation
Performed surgery
Wrote about fractures
Described Epilepsy, TB, Malaria, & Ulcers
Maintained detailed records
15

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Hospitals of the Early Christian Era
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Hospitals Outgrowth of Religion
Care included – Magical & Religious Rites
Doctrines of Jesus – Love & Pity
Sick treated outside temples & churches
16

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Islamic Hospitals
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Luxurious hospital accommodations frequently provided School at Gundishapur
Medical care free
Gundishapur
home to world’s oldest known teaching hospital
17

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Persian Physician Rhazes
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Skilled in Surgery
Used Sheep Intestines for Suturing
Cleansed Wounds with Alcohol
1st descriptions of smallpox & measles
18

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Islamic Medicine – I
© 2014 Jones and Bartlett Publishers
Inhalation Anesthesia
Precautions against Adulterated Drugs
Origination of New Drugs
Asylums for Mentally Ill
Brilliant beginnings in Medicine
Promise that glowed in early medicine not fulfilled
Wars, Politics, Superstitions, stunted growth
19

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Early Military Hospitals – I
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Limestone pillar – 2920 B.C.
Pictures illustrating wounded
Moses laid down rules of Military Hygiene
Hippocrates – “war is the only proper school for a surgeon”
Under Romans, Surgery Advanced
Experience through military surgery

20

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Medieval Hospitals – I
Religion – dominant influence in hospitals
England built Municipal Hospitals
Military Hospitals during Crusades
Lazar Houses Established

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Hotel Dieu of Paris
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Provided rooms for various stages of disease
Provided room for Convalescents
Provided room for Maternity Patients
Two persons often shared 1 bed
Draperies not washed, infection spread
Patients often worked on hospital’s farm

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Dark Age of Hospitals
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Hospitals Commonly crowded patients into one bed
Monks preserved the writings of Hippocrates
Al-Mansur Hospital, built in Cairo in 1276
Equipped with separate wards for the more serious diseases
laid the groundwork for hospital progress to come in later centuries

23

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Hospitals of the Renaissance – I
© 2014 Jones and Bartlett Publishers
Building of hospitals continued
New Drugs
Anatomy – Recognized Study
New writings Printed
New writings Printed
Dissections Performed
Surgery was more scientific
Van Leeuwenhoek- Microscope
24

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Hospitals of the Renaissance – II
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16th Century
Hospitals associated with Catholic Church ordered by Henry VIII to be given over to secular uses or destroyed
Sick Turned into Streets
Hospitals conditions intolerable
St. Bartholomew’s restored
25

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Hospitals of the Renaissance – III
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Long robed surgeons
Trained in universities
Permitted to perform all surgeries
Royal College of Surgeons founded-1540
Short robed surgeons (barber-surgeons)
Generally allowed only to leech & shave

26

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Hospitals of the 18th Century
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Royal College of Physicians Establishes Dispensary
Medications Distributed at cost to Poor
Free Medical Care for Poor
Controversies & lawsuits
Untimely End to Early Clinic

27

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Westminster Charitable Society

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Established Similar Dispensary in 1715
Established Westminster hospital in 1719
Infirmary built – voluntary subscription
Staff provide services gratuitously
Deterioration of hospitals continues
28

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Early Hospitals in the U.S. – I
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Manhattan Island
1st account of hospital for sick soldiers
Philadelphia
1st Almshouse Established – Philadelphia
The Pennsylvania Hospital – 1st chartered
Williamsburg, VA
Site of 1st Psychiatric Hospital
29

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Early Hospitals in the U.S. – II
© 2014 Jones and Bartlett Publishers
Hotel-Dieu Paris, Dr. Jones wrote
3-5 patients placed in 1 bed
Convalescent patients placed with dying
Fracture cases placed with infectious cases
1/5th of 22,000 patients died each year
Patient wounds washed with same sponge
Infection rate said to be as high as 100%
Mortality after amputation as high as 60%

30

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Early Hospitals in the U.S. – III
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Increase in Surgical Procedures
Inappropriate Wound Care Administered
Wards Filled with Discharging Wounds
Nurses of that period are said to have used snuff to make conditions tolerable
31

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Late 19th Century Renaissance – I
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Nurses used Snuff to make Conditions Tolerable
OR Coats Worn for Months without Washing
Same Bed Linens Served Several Patients
Mortality from Operations 90 to 100%

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Late 19th Century Renaissance – II
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Florence Nightingale improves care
Considered 1st hospital administrator
Founded Nightingale School of Nursing – 1860
Crawford Long uses ether as anesthetic to remove small tumor
American Medical Association founded – 1847
Chloroform 1st used as an anesthetic – 1847
33

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Mass General Hospital – 1846
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W.T.G. Morgan Develops Sulfuric Ether
Morgan arranges for 1st operation under Anesthesia, using ether vapors
Surgery at Operating Theater – Mass General
34

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W.T.G. Morgan
© 2014 Jones and Bartlett Publishers
Morgan performed surgery with on looking skeptical audience
Audience Astonished
Patient did not Scream
“Gentlemen,” Dr. Warren proclaimed, “this is no humbug!”
Discipline of anesthesiology was born.

35

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Semmelweis Of Vienna
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Determined Deaths from Puerperal Fever of Maternity patients
due to infections transmitted by students leaving dissecting room to take care of maternity patients without washing hands.
36

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Civil War Days
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As many as 25 to 50 beds in ward
Little provision for segregation of patients.

37

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Roosevelt Hospital – 1871
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Built on lines of pavilion
small wards
set the style for new type of architecture
became know as the American plan

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Dr. W.G. Wylie – 1877
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Favored Roosevelt Hospital pavilion
Wylie advocated temporary structure
to be destroyed when it became infected.

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America’s 1st Nursing Schools
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Brigham and Women’s Hospital – 1872
Bellevue – 1873
Massachusetts General Hospital – 1873
40

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Medicine 1880 – 1890
© 2014 Jones and Bartlett Publishers
Tubercle Bacillus Discovered
Pasteur vaccinated against anthrax
Koch Isolates Cholera Bacillus
Diphtheria 1st treated with antitoxin
Tetanus Bacillus & Parasite of Malarial Fever Isolated
Rabies Inoculation Successful
Halstead & Rubber Gloves – 1890
Bergmann & steam sterilization – 1886
Roentgen discovers the X-ray – 1895

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19th Century Inventions
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Clinical Thermometer
Laryngoscope
Hermann Helmholtz Ophthalmoscope
42

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Medicine 1880 – 1890
© 2014 Jones and Bartlett Publishers
Hospitals crowded, patients suffering
Scarlet Fever
Diphtheria
Typhoid
Smallpox
Most Disorders Untreated for
Metabolism
Glandular Disturbances
Nutritional Diseases
43

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20th Century Progress
© 2014 Jones and Bartlett Publishers
Treatment of
Metabolic Diseases
Nutritional & Vitamin Deficiencies
Rickets with Ultra-Violet Light
Banting’s Introduction of Insulin
Treatment of Pernicious Anemia

44

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20th Century Inventions
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Einthoven invents Electro-cardiograph
Wassermann Test for Pancreatic Function
Introduction of Radium for Treatment of Malignant Growths
Increased use of Examination of Tissue
45

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Hospital Standardization – 1918
American College of Surgeons – development of “Minimum Standards” for Hospitals
Established Requirements for Care of Patients
First Survey Conducted – 1918
Today known as “The Joint Commission”

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1929 Trying Period for Hospitals

Critical economic conditions
Lowered bed occupancy
Decreasing revenues from endowments

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Latter Half of 20th Century
© 2014 Jones and Bartlett Publishers
Increased hospital competition
Notable advances in medical technology
CT, MRI, & PET scanners
For-profit chains spring up
Competing delivery systems
Many new medications introduced
48

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Healthcare in the 21st Century
Grading Hospital Safety
Translational Medicine
Minimally Invasive Surgery
Surgical Simulation Training
Social Media Impacts Caregivers

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Healthcare in the 21st Century – II
National Health Insurance
Boutique Medicine
Medical Errors Plague Hospitals

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History Challenges Us to Do Better
The maintenance of hospitals today is a result of the human emotions of fear, pity, and sympathy, together with civic consciousness and religious zeal. If society has changed, human nature has remained much the same, for it was with these fundamental emotions which led ancient peoples to build hospitals for their sick and injured. Malcolm T. MacEachern, MD., C.M., D.Sc., L.L.D.—

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Review Questions – I
© 2014 Jones and Bartlett Publishers
1. Who is often recognized as being the first hospital administrator?
2. Which invention attributed to Van Leeuwenhoek had a pronounced influence on the creation of the sciences of cytology, bacteriology, and pathology?
3. What issue did Florence Nightingale identify in the 1800s as being a major source/vehicle for the spread of infection and continues to be so today?
52

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Questions – II
© 2014 Jones and Bartlett Publishers
4. What data did Semmelweis collect? What was the significance of that data as related to performance improvement in the present-day hospital?
5. What were two of the greatest influences in the development of present-day hospitals?
6. Describe how you think history is repeating itself in todays health care system.
53

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Government, Law, and Ethics

“Laws are the very bulwarks of Liberty; they define every man’s rights, and defend the individual Liberties of all men.”

– J.G. Holland (1819-1881)

Chapter 2

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1

LEARNING OBJECTIVES
Discuss 3 branches of government, & importance of separation of powers.
Describe organization structure of Department of Health and Human Services.
Explain the development and sources of law.

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LEARNING OBJECTIVES – II
Describe the function of various government ethics committees herein presented.
Explain the term political malpractice and give an example of how it might apply to government officials.

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Government Organization
Executive Branch
Legislative Branch
Judicial Branch

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Branches & Powers of Government

Legislative Executive Judicial

Write laws Implement & Enforce Laws Interpret Laws

Enact, amend, or repeal Laws Veto Laws Apply Laws

Declare War
Confirm Justices Commander-in-Chief Armed Forces Declare laws unconstitutional

Enact Taxes & set the budget Appoint Justices
Compel Testimony

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Scarcely any political question arises in the United States that is not resolved, sooner or later, into a judicial question.

−Alexis de Tocqueville (1805–1859)

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Judicial Branch
When government bureaus & agencies go awry, which are adjuncts of the legislative or executive branches, the people flee to the third branch, their courts, for solace & justice.

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Federal Court System
District Courts
U.S. Circuit Court of Appeals
Supreme Court

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U.S. District Court
Trial courts of the Federal System
96 Courts
Jurisdiction over all categories of federal cases
including civil & criminal matters

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U.S. Court of Appeals
Created to help reduce workload of U.S. Supreme Court
12 Regional Court
1 Judicial Circuit in DC
Reviews
District court decisions
Administrative agency decisions

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U.S. Supreme Court
Highest federal court
Only court created by federal constitution
Comprised of 8 Associate & 1 Chief Justice

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“As I have said in the past, when government bureaus and agencies go awry, which are adjuncts of the legislative or executive branches, the people flee to the third branch, their courts, for solace and justice.”

−Justice J. Henderson, Supreme Ct. of S. D.

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Separation of Powers
Model for Government
Under this model government is divided into branches
Each branch
has separate & independent powers
areas of responsibility
each branch is also able to place limited restraints on the power exerted by the other branches.
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Dept of Health & Human Services
Centers for Medicare & Medicaid
Public Health Service
National Institutes of Health
Centers for Disease Control and Prevention
Food & Drug Administration
Health Resources & Services Administration

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Public Health Service includes
Agency for Healthcare Research and Quality
Agency for Toxic Substances & Disease Registry
Indian Health Service
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Laws
Govern the relationships between private individuals and organizations; and between both of these parties and government.
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Categories of Law
Public Law
Deals with the relationships between government and individuals.
Private Law
Deals with relationships among individuals.
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Sources of Law
Common Law
derived from judicial decisions.
Statutory Law
written laws
Administrative Law
public law, rules & regulations issued by administrative agencies to direct the enacted laws of the federal and state governments.

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Common Law in U.S.
Body of principles that has evolved and expanded from judicial decisions.
Origins in English Common Law.
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Common Law Principles
Precedent:
a judicial decision that may be used as a standard in subsequent similar cases.
Res Judicata:
means the thing is decided—refers to that which has been previously acted on or decided by the courts.
Stare Decisis:
common-law principle meaning let the decision stand.
based on similar cases and fact patterns.

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Statutory Law
Written law emanating from a legislative body.
Hierarchical Order
U.S. Constitution: highest in hierarchy of laws
State Constitution

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Constitution: Article VI
This Constitution and Law of the United States . . . Shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby . . . .
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Administrative Law
Extensive body of public law issued by administrative agencies to direct enacted laws of federal & state governments.
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Administrative Procedures Act – I
Describes different procedures under which federal administrative agencies must operate.
Prescribes procedural responsibilities & authority of administrative agencies.
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Administrative Procedures Act – II
Provides legal remedies for those wronged by agency actions.
Rules & regulations established by administrative agency must be administered within scope of authority delegated Congress.
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Conflict of Laws
When state & federal laws conflict
Resolution sought in appropriate federal court.
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GOVERNMENT ETHICS
Executive Branch: Office of Government Ethics
House of Representative Committee on Ethics
U.S. Senate Select Committee on Ethics
Judicial Branch: U.S. Judical Code of Conduct
Office of Congressional Ethics

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Political Malpractice
Negligent conduct by an elected or appointed political official
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The tragedy of society is not the noisiness of the so-called bad people, but the appalling silence of the so-called good people.

−Martin Luther King, Jr.

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Review Questions – I
1. Define the term law and describe the sources from which law is derived.
2. Define the legal terms:
precedent
res judicata
stare decisis
original jurisdiction
appellate jurisdiction

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Review Questions – II
3. Describe the function of each branch of government.
4. What is the meaning of separation of powers?
5. What is the function of an administrative agency?

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Review Questions – III
6. Describe the responsibilities of the DHHS.
7. Describe how ethical issues are addressed in the Executive, Legislative, and Judicial branches of government.

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Tort Law and Reform
Chapter 3

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LEARNING OBJECTIVES
Describe what a tort is and the purpose of tort law.
Describe the elements of negligence.
Identify various intentional torts and their application in the healthcare setting.
Explain the theories a plaintiff could use in pursuing a products liability case.

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LEARNING OBJECTIVES – II
Describe the meaning of defensive medicine.
Describe various programs designed to lower the cost of malpractice insurance.
Describe the various ways to reduce the number of negligence claims.

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Tort
A civil wrong, other than a breach of contract, committed against a person or property for which a court provides a remedy in form of an action for damages.
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Objectives of Tort Law
Preservation of peace between individuals.
Find fault for wrongdoing.
Deterrence by discouraging the wrongdoer from committing future tortious acts
Compensation to indemnify injured person/s.
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Categories of Tort Law
Negligence
Intentional
Strict liability regardless of fault
e.g., products liability
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Negligence
Commission or omission of an act that a reasonably prudent person would or would not do under given circumstances.
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Commission of an Act
Administering the wrong medication
Administering the wrong dosage of a medication
Administering medication to the wrong patient
Performing a surgical procedure without patient consent
Performing a surgical procedure on the wrong patient
Performing the wrong surgical procedure

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Omission of an Act
Failing to conduct a thorough history & physical examination
Failing to assess & reassess a patient’s nutritional needs
Failing to administer medications
Failing to order diagnostic tests
Failing to follow up on abnormal test results
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Malpractice
Negligence of a professional person
surgeon who conducts a surgical procedure on wrong body part
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Criminal Negligence
Reckless disregard for safety of another.
Willful indifference to injury that could follow an act.

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Forms of Negligence
Malfeasance
Execution of an unlawful or improper act, i.e., performing a partial birth abortion when prohibited by law
Misfeasance
Improper performance of an act, i.e., wrong sided surgery.
Nonfeasance
Failure to act when there is a duty to act, i.e., failing to prescribe medications that should have been under the circumstances

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Degrees of Negligence
Slight
Minor deviation of what is expected under the circumstances.
Ordinary Negligence
Failure to do what a reasonably prudent person would or would not do.
Gross Negligence
Intention or wanton “omission of care” that would be proper to provide or the “commission of an act” that would be improper to perform.

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Elements of Negligence
Duty to Use Due Care
Standard of care
Breach of Duty
Injury/Actual Damages
Proximate Cause/Causation
Foreseeability
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I. Duty to Care
Obligation to conform to a recognized standard of care.
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Standard of Care
Describes the conduct expected of an individual in a given situation.
Describes how a “reasonably prudent person” would or would not act under “similar circumstances”.
Measuring stick for properly assessing actual conduct required of an individual.
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Reasonably Prudent Person
A nonexistent – hypothetical person who is put forward as community ideal of what would be considered reasonable behavior.
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Similar Circumstances
Circumstances at the time of the injury.
Circumstances of the alleged wrongdoer/s at the time of injury.
Age
Physical condition
Education & training
Licenses held
Mental capacity, etc.

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Determining Standard
Established by legislative enactment or administrative regulation.
Adopted by the court from a legislative enactment or administrative regulation.
Established by judicial decision.
Applied to the facts of the case by the trial judge or jury, if there is no such enactment, regulation or decision.
courts often rely on testimony of an expert witness as to the standard of care required.

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Community v. National Standard
Community Standard
hometown standard (we want to do things our way).
National Standard
most currently accepted standard of care on a national basis.
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Case: Hiring Practices
Nurse hired sight unseen over telephone.
Applicant falsely stated in an employee application that he was licensed as an LPN.
His license was not verified by the employer.
He had committed 56 criminal offenses of theft.
He assaulted a resident a resident & broke his leg.

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Case: Hiring Practices
Duty
Standard expected:
Employer had a “duty” to validate the nurse’s professional license.

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II. Breach of Duty
Deviation from the recognized standard of care.
Failure to adhere to an obligation.
Failure to conform to or the departure from a required duty of care owed to a person.
Occurs when
a physician fails to respond to his/her on-call duties.
an employer fails to adequately conduct a pre-employment check (e.g., licensure, background check).

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Case: Hiring Practices
Breach of Duty

The employer failed to verify the applicant’s licensure.
A more thorough background check should have revealed this employee’s previous criminal conduct.

© 2014 Jones and Bartlett Publishers

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III. Injury
Actual damages must be established.
If there are no injuries, no damages are due.
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Case: Hiring Practices
Injury

The resident suffered a broken leg.
Hospital vicariously liable for nurse’s conduct.
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IV. Causation
Proximate cause
breach of duty was the proximate cause of the injury
But-for Rule
the defendant’s action, the injury would not have occurred

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Case: Hiring Practices
Causation
Reasonable anticipation that harm or injury was likely to occur.
The patient suffered a broken leg
Departing from recognized standard of care
failure to verify licensure & conduct an adequate background check
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Hiring Practices – III
Injury resulted from the breach of duty.
Injury was foreseeable.
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Failure to Hydrate
Causation
Failure to administer proper hydration.
Not unreasonable to conclude that one’s dehydration can be caused by failing to provide water.
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Foreseeability
Reasonable anticipation that harm or injury is likely to result from an act or an omission to act.
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Test for Foreseeability
The test for foreseeability is whether a person of ordinary prudence and intelligence should have anticipated danger to others caused by his or her negligent act.
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Case: Hiring Practices
Foreseeability
A person of ordinary prudence and intelligence should have anticipated the danger to the resident caused by the employer’s negligent act.
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Hot Radiator
Foreseeability
A patient’s left foot came in contact with a radiator and she suffered third-degree burns.
The defendant had knowledge of the plaintiff’s condition.
The defendant should have shielded the radiator or not placed the plaintiff next to it.

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Sponge & Instrument Count
Dr. Smith owns the local Outpatient Surgery Center.
He instructs employees to count all instruments & surgical sponges following a surgical procedure, prior to closing the surgical site.
Annie, an employee, failed to conduct the count following Bills surgery.
Two months later, Bill, suffering from extreme abdominal pain, was noted to have several sponges and an instrument in his abdomen.
He had developed a massive infection.
Was the doctrine of Vicarious liability applicable in this case?

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YES
Even though Annie had strict instructions to count the sponges & surgical instruments prior to closing the surgical site, she failed to do so.
To determine otherwise would undermine the doctrine of vicarious liability, since employers would almost always escape liability by presenting evidence that employees were given careful instructions.

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Failure to Follow Instructions
Sarah has a minor surgical procedure under general anesthesia at ABC Surgery Center.
She was instructed not to drive home after release. Her daughter Leslie picks her up.
On the way home Leslie stops for a donuts. Meanwhile, her mother moves to the driver seat.
Upon leaving the parking lot, Sarah hits Carol’s car.
Carol sustains a broken arm & sues ABC for releasing Sarah before she is completely recovered from the anesthesia.
Was the hospital liable for Sarah’s injuries?

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NO!
Sarah was negligent, not the hospital. She failed to adhere to both verbal & written instructions not to drive following anesthesia.
It was Sarah’s duty not to drive and her breach of that duty that caused Carol’s injury.
© 2014 Jones and Bartlett Publishers

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Remember
The four elements of negligence must be presented in order for the plaintiff to recover damages caused by negligence.
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Intentional Torts
Assault and Battery
False Imprisonment
Defamation of Character
Fraud
Invasion of Privacy
Intentional Infliction of Mental Distress
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Assault
Deliberate threat, coupled with apparent ability to do physical harm to another. Actual contact not necessary.
Person attempting to touch another unlawfully must possess apparent present ability to commit battery.
Person threatened must be aware of or have actual knowledge of an immediate threat of a battery and must fear it.

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Battery
Intentional touching of another’s person in socially impermissible manner without person’s consent.
Failure to obtain consent prior to surgery.
Administering blood against patient’s express wishes.
Physically restraining one who refuses to eat.

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False Imprisonment
Unlawful restraint of individual’s personal liberty or unlawful restraining or confining an individual.
Restraining patient without cause.
Locking patient in secluded room for failing to attend therapy session.

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Legal Justification for Restraint or Seclusion
Person represents a danger to self or others.
Criminal conduct.
Persons with highly contagious diseases, as provided by state or federal statutes.
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Reducing Use of Restraints – I
Development of policies and procedures that conform to state & federal guidelines
Education & orientation of staff
Education for patients & families
Sound appraisal of need for restraints
Application of least restrictive restraints
Continuous monitoring of patients to determine continuing need for restraints

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Defamation of Character
The offense of injuring a person’s character, fame, or reputation by false & malicious statements.
False oral or written communications to someone other than person defamed that tends to hold that person’s reputation up to scorn or ridicule in eyes of others.
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Defamation of Character
Libel – written form of defamation
Signs
Letters
Photographs
Cartoons
Slander – oral form of defamation
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Proof of Defamation
A false & defamatory statement.
Communication of a statement to a person other than the plaintiff.
Fault on the part of the defendant.
Special monetary harm.

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Proof of Harm Not Required
to recover damages when:
Accusing a person of a crime.
Accusing a person of having a loathsome disease.
Using words are harmful to a person’s profession or business.
Calling a woman unchaste.

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Libel – Performance Appraisals
Performance appraisals are not meant for general publication.
To recover damages, the appraisal must be published in defamatory manner that injures one’s reputation.
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Cartoon – I
Jack draws a cartoon depicting Paul having a rendezvous with a new grad nurse in an empty patient room. The incident in fact never occurred.
Can a defamatory statement can take the form of a cartoon?
Yes, a defamatory statement can take the form of a cartoon because it is capable of adversely affecting a person’s reputation.
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Newspapers Articles
Newspaper editorial cartoon depicting 3 persons resembling gangsters in dilapidated building, identified as particular facility that had been closed by state order, was an expression of pure opinion and was protected by 1st Amendment.

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Accused of an Affair
Nurse Rachet suggests to Dr. Smith that he should leave his wife Sharon because she is having an affair with Dr. Doe. Dr. Smith writes a letter to Mrs. Doe, repeating Rachet’s statement.
Assuming Dr. Smith’s letter is defamatory, is it libel or slander?

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Accused of an Affair
It is libel, even though Dr. Doe is repeating a slanderous statement.
The reverse is not true – the spoken repetition of a written defamation is still considered libel.
The rule is: once libel, always libel.
© 2014 Jones and Bartlett Publishers

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Slander
Person who brings suit must prove special damages.
When defamatory words refer to person in professional capacity, professional need not show that words caused damage.
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Defenses to a Defamation Action
Truth – no liability for defamation if it can be shown that statement is true.
Privilege
Absolute
Qualified
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Absolute Privilege
Statements made during judicial & legislative hearings
Confidential communications between spouses
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Qualified Privilege
Statements made as result of a legal or moral duty to speak in interests of 3rd persons
Statements must be without malice
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Public Figures
Vulnerable to public scrutiny
Suits generally dismissed in absence of
malice
actual knowledge statements are false
recklessness as to truth
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Proof of Fraud
Misrepresentation by the defendant.
Knowledge of falsity.
Intent to reduce reliance on misrepresentation.
Justifiable reliance by the plaintiff.
Damage to the plaintiff.
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Health Care Fraud
Billing Tradename Drugs/Issuing Generic
Office Visits/Double Billing
Billing for Services not Rendered
Accepting referral fees
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Invasion of Privacy
The right to
be left alone
be free from unwarranted publicity
be free from exposure to public view
be free from unwarranted intrusions into a one’s personal affairs
personal privacy
have records/kept confidential

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Intentional Infliction
of Mental Distress
Conduct that is so outrageous that it goes beyond bounds tolerated by decent society.
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Mental Distress
Grief
Shame
Public humiliation
Despair
Shame
Human pride

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Mental Distress
Mother shown premature infant in a jar.
Johnson v. Womens Hospital
Verbally abusive physician to patient and/or spouse.
Greer v. Medders
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Fraud
Willful & intentional misrepresentation that could cause harm or loss to person or property.
e.g., purposeful concealment from patient of the presence of surgical sponges in his/her abdomen following surgery.
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Products Liability
Liability of a manufacturer, seller, or supplier of chattels to a buyer, or other third party for injuries sustained because of a defect in a product.
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Products Liability Legal Theories
Negligence
Breach of warranty
Express
Implied
Strict liability
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Negligence
Duty
Product manufactured by the defendant
Breach
Product defective when it left the manufacturer
Injury
Plaintiff/s injured by the product
Causation
Product proximate cause of injury
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Defective X-ray Unit – I
Mindy places Candice on the table of the hospital’s newly manufacturer-installed x-ray unit.
While in the control room, Mindy hears a crash.
She rushes to the patient & finds that a section of the x-ray unit fell on Candice, further injuring her already broken leg.
Candice sues the manufacturer for negligence.
Can the manufacture be held liable for the plaintiff’s injuries?
© 2014 Jones and Bartlett Publishers

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YES!
Duty: manufacturer to properly install the x-ray unit.
Breach: failure to properly install the x-ray unit.
Injury: plaintiff suffered injury.
Causation: improper installation was the proximate cause of the plaintiff’s injury.
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Express Warranty
Includes specific promises or affirmations made by seller to buyer.
e.g., drug manufacturer represents the product as free from addiction & is not
Crocker v. Winthrop Laboratories

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72

Implied Warranty
A warranty that exists by operation of the law as a matter of “public policy” for protection of the public.
e.g., consumers have right to assume that food is not contaminated
Jacob E. Decker & Sons v. Capps

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Strict Liability
Liability without fault
Elements required to establish strict liability
Product manufactured by defendant
Product defective at time it left manufacturer
Plaintiff injured by product
Defective product proximate cause of injuries
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Wrong Medication – I
Stanley refills his drug prescription at D Drugs, where he has been a customer for 10 years.
Prior to taking his nightly dosage, he noticed the pill appeared larger than normal.
He phoned D Drugs & explained his concern.
The Pharmacist assured Stanley generic drugs sometimes are larger because of formula fillers but that the medication dosage in his drug was correct.
© 2014 Jones and Bartlett Publishers

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Wrong Medication – II
Stanley took the drug & never woke up; the dosage given was 5 times that which had been prescribed.
The container from which the pharmacist filled Stanley’s prescription had been mislabeled by the manufacturer.

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Wrong Medication – III
Court’s Decision
Product was manufactured by the defendant
Product defective at time it left manufacturer
The drug was placed in a mislabeled container.
Plaintiff injured by the product
Stanley passed away in his sleep.
Defective product proximate cause of injuries
The mislabeled container was the proximate cause of Stanley’s death.

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Products Liability
Res Ipsa Loquitur
Must establish
Product did not perform in way intended
Product not tampered with by buyer/3rd parties
Defect existed at time it left defendant
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Products Liability Cases
Tainted Tylenol Capsules
Elsroth v. Johnson & Johnson
Manufacture of unsafe drugs
Merck’s Vioxx
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Products Liability Defenses – I
Assumption of the Risk
voluntary exposure to risks: Smoking, radiation therapy, Chemotherapy
Intervening Cause
an IV solution contaminated by product user
Contributory Negligence
use of product in a way it was not intended to be used.

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Products Liability Defenses – III
Comparative Fault
injury due to concurrent negligence of both manufacturer & plaintiff.
Disclaimers
manufacturers inserts

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Review Questions – I
Describe the objectives of tort law.
Discuss the distinctions among negligent torts, intentional torts, and strict liability.
What forms of negligence are described in this chapter?
How does one distinguish between negligence and malpractice?
What elements must be proven in order to be successful in a negligence suit? Illustrate your answer with a case (the facts of the case can be hypothetical).
© 2014 Jones and Bartlett Publishers

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Review Questions – III
Can a “duty to care” be established by statute or contract? Discuss your answer.
Describe the categories of intentional torts.
How …

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