California State University, Chico




HCSV 332

Fall 2010

Laws, Ethics, and Regulations  in Health Services


Tuesday 6:00 to 8:50

Butte 113



Richard A. Narad, DPA, JD, FACHE

Phone:  (530) 898-5309

Butte 627

FAX: (530) 898-5107





Office Hours:  Tuesday 2-5, Wednesday 3-5, or by appointment


Learning objectives:  This course helps to meet the following objectives of the B.S., Health Science, Option in Health Services Administration:

The graduate in Health Services Administration will have knowledge, skills, and beliefs related to the health care delivery system and will:

·   Be able to apply laws and regulations that impact healthcare organizations (e.g., employment, antitrust, patient consent, confidentiality);

·   Discuss the major ethical issues that are affecting health care and be able to articulate their own beliefs.

The graduate in Health Services Administration will have competent communication skills, including written and spoken communication, use of electronic media, and formal presentations/business reports

·        Develop a variety of communication skills

·        Search websites

The complete objectives of the B.S. Health Science with an option in Health Services Administration are available at

Reading Materials:


·        Pozgar, George D. Legal Aspects of Health Care Administration, 10th Ed. (Sudbury, MA: Jones and Bartlett Publishers, 2007).

·        Morrison, Eileen E. Ethics in Health Administration : Practical Approach for Decision Makers, 2nd ed.  (Sudbury, MA: Jones and Bartlett Publishers, 2011).

Health administration core library:

·        Vergil Slee, Debora Slee, & HJ Schmidt (eds.). Slee's Health Care Terms, 5th Edition (St. Paul, MN: Tringa Press, 2008)—earlier editions are acceptable.

·        Diana Hacker. A Pocket Style Manual, 5th ed. (Boston: Bedford Books of St. Martin’s Press, 2008)—earlier editions are acceptable.

Other:  (posted on WebCT)

·        ACHE position papers

·        California Med-Mal Summary

·        Case: Tempchin v. Sampson

·        I will email other materials on topics that may arise during the semester.

Course Format:  Classes will combine lectures, discussions, guest speakers, and student presentations.  This course will be team taught, however each instructor will be responsible for the indicated section, including grading of all assignments.



·        Ethics case analysis............................................................................................. 200


·        Legal case analyses (2 @ 200) ......................................................................... 400


·        Regulations search............................................................................................... 200


·        Contract negotiation simulation (group exercise) ............................................ 200




·        Attendance:  50 points lost for every session missed.  One excused absence will be allowed.


·        Reading quizzes:  Up to eight reading quizzes will be given during the semester.  Failure to pass the quiz will result in 25 points being deducted from your total grade, but no additional points will be added.





A            930 - 1000

C+       770 - 799


A-           900 - 929

C         730 - 769


B+          870 - 899

C-        700 - 729


B            830 - 869

D+       660 - 699


B-           800 - 829

D         600 - 659


Projects and Activities:


·        Ethics  cases analysis:  Analysis of an ethical situation, applying ethics principles to the facts


·        Legal case analysis: Analysis of a legal fact pattern, applying legal rules to the facts.


·        Regulations search: A summary of the regulations impacting a specific health profession or a specific type of health organization


·        Contract negotiation simulation:  A simulated negotiation of a contract between a prospective surrogate mother and intended parent.


·        Class participation: Attendance is expected.  Participation means more than being present in class.  Students are expected to actively participate in class activities and discussions.


·        Standard:  This syllabus includes descriptions of each of the written assignments.  General standards are described below.  Students should ensure that papers and presentations include all of the required items and meet these standards.


Confidentiality:  During this course, the instructors, guest speakers, or students may share information regarding specific organizations or individuals.  Such information should be treated as confidential and not discussed outside of the classroom.  If you are in doubt regarding the confidentiality of any information, consult the instructor.


Plagiarism:  Students must ensure that appropriate credit is given for all materials.  Ideas taken from other persons must be properly cited.  Any direct quote must be enclosed in quotation marks and must be cited.  Any failure to follow these rules will result in no credit for the assignment and may result in further disciplinary action.


Expectations: You should be aware that this class will be harder than most classes that you have taken.  Assignments should be of the same quality that is expected of an employee in a professional position in the healthcare field.  That means that grammar and spelling will be considered in grading assignments.  It means that due dates and project specifications are taken seriously.  It means that attendance is expected.


Written papers:  All papers turned in for this course must comply with the following:


·      You must turn in a hardcopy (printed) version of your term paper (which I will grade and return to you).  You must also submit an electronic version to "" using the link available on the class WebCT Vista page.

·      Use 81/2" x 11" paper, with one-inch margins on all sides.

·      Papers should be typed, with all text, double-spaced.

·      Do not use covers or cover pages.

·      Use Courier or Courier New 12 font

·      Do not exceed the maximum length for the assignment.

·      Papers should be free of typographical and spelling errors and should be grammatically correct


Papers not meeting these standards may be returned for rewriting before they are graded.  Any rewrite will result in a reduction of one grade


On-line resources:  This class requires the use of WebCT.  Class handouts and case study links will be placed on the site.  Other materials and relevant linkages can be found there.


Disclaimer:  Nothing presented in this class, including readings and discussion, should be considered as legal advice.  If you have a legal concern, you should consult an attorney.




Course Schedule and Assignments



Readings/ Assignments



Ethics perspectives




Professional/organizational ethics

Morrison-1, 2, 3, 4, 9


·      Ethical Decision Making for Healthcare Executives

·      Impaired Healthcare Executives

·      Creating an Ethical Environment for Employees


Healthcare ethics committees

Codes of ethics

Morrison-5, 7, 10, 14

ACHE Code of Ethics


The legal system/Healthcare law

Anatomy of a lawsuit

Pozgar-2, 6;

Ethics case study due


Duty to provide healthcare


Pozgar-12, 15




Pozgar-pp. 27-37; Ch. 18, 22

California Med-Mal Summary

Tempchin v. Sampson


Organizational liability

Pozgar-8, 9,10, 23



Product liability

Intentional torts/Criminal law

Pozgar-pp. 37-50; Ch. 4


Legal case study 1 due



Pozgar- pp. 71-81


Contracts (cont)

Business organizations

Pozgar- 7



Fraud and abuse/ Compliance


Pozgar- pp. 82-90

Legal case study 2 due


Privacy and confidentiality

Licensure and credentialing regs.

Pozgar-11, 13



3rd party payers

Bioethics overview


Regulations search due






End of life decisions


ACHE:  Decisions Near the End of Life


Final meeting

Contract negotiation simulation due


Ethics analysis

Assignment:  Analyze an ethical issue and provide a recommendation 


1.  Ethics question (use one of the following formats):

·      Given [uncertainty or conflict about values], what decisions or actions are ethically justifiable?

·      Given [uncertainty or conflict about values], is it ethically justifiable to [decision or action]?

2.  Options available

·      Describe the options that are available.

·      Explain why each option is (or is not) deemed ethically justifiable and why (or why not).

·      Is an option(s) available that all parties will agree is ethically justifiable?  If so, what is it?  If so, what factors exists that will or may block implementation of this option?

3.  What do you recommend?  How should this be implemented (who, what, when, where, why)?

Papers will be a maximum of three pages (plus endnotes, if any). 


Legal case analyses

Assignment:  Analyze a case  that will be provided, using the “IRAC” format (Issue, Rule, Application, Conclusion). 


1.      Identify the parties to the case.

2.      Identify the issue(s) in the case.

3.      For each issue, state the appropriate legal rules

4.      Analyze  the case, applying the facts of the case to each element of the legal rule.

5.      State your conclusion as to the issue(s) based on your analysis of the facts and their application to the rule.

You must address each of the elements of the cause of action:

·      Torts: Duty/standard of care, breach of duty, damages, actual and proximal causation

·      Contracts: Offer, acceptance, consideration

Don’t forget to identify possible defenses.

Papers will be a maximum of three pages (plus endnotes, if any). 


Regulations search

Assignment:  Select either a health profession or a health organization from this list.  Develop a paper summarizing the regulatory requirements for this profession or organization in California.


Health professions

1.      Acupuncturist

2.      Dentist

3.      Doctor of Chiropractic

4.      Emergency Medical Technical –Paramedic

5.      Licensed marriage and family therapist

6.      Licensed midwife (non-RN)

7.      Licensed vocational nurse

8.      Occupational therapist

9.      Optometrist

10. Osteopathic physician and surgeon

11. Pharmacist

12. Physical therapist

13. Physician and surgeon

14. Physician assistant

15. Podiatrist

16. Radiological technician

17. Registered nurse

18. Registered dental hygienist

Health organizations

1.      Acute care hospital

2.      Adult day health center

3.      Alternative birthing center

4.      Ambulance service

5.      Ambulatory surgery center

6.      Assisted living facility

7.      Blood bank

8.      Chemical dependency recovery hospitals

9.      Congregate care facility

10. Correctional treatment center

11. Chronic dialysis clinic

12. Home health agency

13. Hospice

14. Medical laboratory

15. Neonatal intensive care unit

16. Pharmacy

17. Primary care clinic

18. Psychology clinic

19. Skilled nursing facility

20. Telephone medical advice services

21. Trauma center


Health professions


For the profession that you select, answer the following questions:

1.      What is the legal name used for the profession in California?

2.      What sections of California statute and regulations apply?

3.      Who grants the license or certificate?

4.      What training and testing is required?

5.      Summarize the scope of practice.  Are there any specific limits?

6.      Is supervision or authorization required to provide care?  If so, by whom?

7.      What continuing education requirements exist?

Health organizations

For the profession that you select, answer the following questions:

1.      What is the legal name used for the organization in California?

2.      What sections of California statute and regulations apply?

3.      Who grants the license?

4.      What types of inspections are used?

5.      Summarize the scope of operation.  Are there any specific limits?

6.      What types of staffing are required?

7.      What types of equipment are required

The only sources allowed are California statutes, the California Code of Regulations, and websites operated by the regulatory agency identified in your paper.  Links to the statutes and codes are provided in WebCT.

Papers will be a maximum of two pages (plus endnotes). 

Contract negotiation simulation

In this exercise, pairs of individuals will role play as parties in a potential surrogate parenting arrangement and will negotiate a contract.  The two roles are the intended parents and the surrogate mother.


  1. You will be assigned to a group and to one of these specific roles. 
  2. The two members of each group will jointly negotiate a contract.
  3. A summary of negotiating goals will provided to each party.
  4. Each contract must address:

·        The duties of each party under the contract

·        The intent of the parties as to parental rights.

·        Payment by the intended parents to the surrogate

·        Payment for medical expenses

·        Payment for non-medical expenses

·        Intended parents’ legal and financial responsibility for the child in case of any problems

·        Medical testing of the parties

·        Potential termination of the pregnancy

·        Maintenance of health and life insurance policies by the parties

Use the contract template provided on Vista.

  1. Each person will also submit an evaluation of the negotiation experience


  1. The prospective parents, who have failed to conceive a biological child have contacted a surrogacy agency.  They reviewed the agency’s list of potential surrogates and selected one.  The agency brought the two together to negotiate a mutually acceptable contrac.
  2. The prospective parents anticipate using the father’s sperm which will be used to artificially inseminate the surrogate mother.  Immediately after the birth, the child will be surrendered to the intended parents.  The surrogate mother will relinquishing all rights and the intended mother will then legally adopt the child.
  3. This would be the first time that the prospective surrogate has acted as a surrogate mother.  She is divorced and has two children of her own.  The pregnancies were problem free.  As required by the agency, she has met with a psychologist and no issues were found.  She is employed as assistant manager of a retail store and receives health insurance from her employer.