Legal Aspects of Health Care Administration, 8th ed.

Pozgar GD. Gaithersburg, MD 20878, Aspen Publishers Inc, 2002, hardcover, 500 pp, ISBN: 0-8342-1911-5, $69.

By examining common legal issues that arise during the course of patient care, this book helps to lay a strong health law foundation for health care providers. The author's intent is to encourage health care providers to increase their awareness of the legal, ethical, social, and economic implications of their actions. After the usual disclaimer that the text is educational and not a substitute for legal advice, he leads the reader on this long and challenging journey.

Acknowledging that the subject matter may be tough going for health care providers, the author uses a number of techniques to engage the reader. He starts each chapter with a section called "It's Your Gavel," in which he presents the facts of an actual court case. After reading the case and related materials, the reader is invited to form a decision and then compare it with the court's decision, which is revealed at the end of the chapter.

In addition, several legal case reviews are presented in each chapter. Each review is structured with a descriptive title, the citation (with an explanation of what each part means and how to find it in a law library), the facts of the case, the issues, the holding (what the court decided), the reason, and discussion. Readers can adapt this useful format to conduct further research if they desire. Each chapter ends with a summary and discussion questions. This book is dominated by text and contains few illustrations, charts, or tables.

Chapter 1 provides a valuable introduction to law and includes a civics lesson (we all could use a review) covering the development of American law, the function of the legal system, and the roles of the branches of government. Several Latin terms used in legal matters are defined and explained as are the basic types of law (ie, statutory, administrative, rules and regulations). The chapter covers important information specific to health care, such as how the US Department of Health and Human Services, Medicare, and Medicaid are governed. The only charts in the book can be found in this chapter, and they are quite helpful. The basic concepts covered in this chapter are essential for all health care providers.

Chapter 2 covers tort law, which is the basis for malpractice litigation, including intentional malpractice, degrees of negligence, and standards of care. The case reviews discuss use of restraints, invasion of privacy, and product liability, all of which are a concern to physical therapists. Again, this is very enlightening and important information for all practitioners.

Chapter 3 discusses criminal aspects of health care. The case reviews in this chapter touch on falsification of records, various types of fraud and abuse, kickbacks, and falsified claims. These topics are at the heart of corporate compliance programs that organizations have adopted in recent years and are another necessary knowledge base for providers today. This chapter also covers the abuse and neglect of patients up to and including murder.

Chapter 4 is titled "Contracts and Antitrust." The opening case outlines the breach of a noncompete contract clause. That topic, along with a discussion of the various elements of contracts, makes this chapter very useful for physical therapists who are involved in negotiating contracts. One element missing from this chapter is a discussion of the contractual requirements of business partners regarding protected health information in the Health Insurance Portability and Accountability Act (HIPAA). Although cases have yet to be tried, it is a high-risk task looming over many health care providers in the next couple of years. HIPAA is discussed in the previous chapter from the fraud and abuse angle, but not from the pending privacy and security angle.

Chapter 5 is titled "Civil Procedure and Trial Practice" and gives the reader a glimpse of the workings of the law up to and including courtroom action. This chapter would be useful to those facing legal proceedings or those with an interest in the law.

The remaining 19 chapters contain topics of interest for physical therapists, but the text rarely refers to the profession of physical therapy directly. For example, one chapter titled Liability by Departments and Health Care Professionals" mentions physical therapy in only 3 paragraphs of its 33 pages. The case describes a physical therapist who was charged with neglect because she did not allow a nursing home patient to use the bathroom before starting therapy.

Other chapters cover patient rights and responsibilities, patient consent, health care ethics, malpractice insurance, information management, and legal reporting requirements. Although these do relate to physical therapy, the discussion in the text is focused on physicians and hospital practice.

The remaining chapters contain information that would be of interest primarily to those pursuing a management career in a medium-to-large, public or private hospital or multispecialty practice. The topics include corporate liability, medical staff, nursing and the law, issues of procreation, AIDS, labor relations, managed care, organizational restructuring, employment, discipline and discharge, and tort reform.

The final chapter, titled "Zero Tolerance," is based on the premise that organizations should not tolerate poor judgment and careless mistakes. The answer, according to the author, is to design systems within an organization to minimize risk and maximize quality. To that end, the author poses a series of questions in a checklist format designed to lead the reader to inquire deeper into these systems. Rehabilitation services are included in a short section, and overall, the book is a useful tool for any organization.

In summary, the book is well organized, comprehensive, and full of concrete examples. Despite the author's pledge to guide the reader on a "comfortable and easily understood tour through the complicated maze of the legal system ...," he occasionally slips into the double negative and the convoluted syntax of legalese such as this conclusion to a case discussion, "The court did not consider this enough to countermand the conclusion that these claims are not preempted." Sentences such as this, combined with the density of the text and only tangential references to physical therapy, make this a difficult read for all but the most driven readers who are pursuing a career in senior management, physician practice management, corporate compliance, risk management, or human resources. Those contemplating a degree in law would also benefit from perusing this text before making the leap.

This is the eighth edition of this text, and the author appears to have kept up to date with current legal issues. This text would be most appropriate for public health master's degree programs or MBA programs with an emphasis on health care rather than for physical therapist education programs. Nevertheless, there is substantial information in the first 4 chapters that should be incorporated into all physical therapist curricula. If this book were used, group discussions led by a faculty who have a solid law foundation would be most helpful and enlightening. As a single reader, it is difficult to fully digest the breadth and depth of information.

Ann M York, PT, PhD Robinson, Ill

Dr York holds a senior management position at Crawford Memorial Hospital. She serves as Compliance Officer, HIPAA Privacy Officer, and oversees Human Resources and Outpatient Services. She is also an adjunct faculty member at Lincoln Trail College teaching courses in psychology and communication.