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Posted on March 27th, 2013, by

It is of no doubt that health care is one of the most dangerous spheres where you always walk on the razor’s edge, play with fire, and risk to violate the law. Medical professionals often risk the lives of their patients and thus risk their licenses, careers and freedom. They have to deal with controlled medicine and to take uneasy decisions. Sometimes ethic considerations come into conflict with doctor’s will to earn for living. The same happened to Dr. Williams. Being restricted essentially in his professional fulfillment, Dr. Williams decided to open his own clinic providing abortion services. In the United States abortion is not forbidden, still it stays one of the most controversial issues for the society. And, naturally, it is a hazardous zone of high risks.

Finally, Dr. Williams got into trouble leaving severe injuries to his patient Joan. It would be reasonable for her to sue with him and to receive moral compensation and means to improve her health. As medical professionals are always at risk, they usually pay medical malpractice insurance. The insurance premiums are paid to cover payments for awards appointed as a result of a lawsuit. It goes without saying that insurance premiums are not cheap; they vary by specialty and location, with gynecology being one of the most expensive specialties as risks of complications are rather high. It is not said whether Dr. Williams has got such insurance, and there is highly any chance for him to win the suit. He will be accused of professional negligence. As a medical care provider, he has conducted some medical mistake, and the assistant will have to testify against him. It is obvious that through this tort case Dr. Williams has violated the state standards of healthcare.

The question is what kind of punishment he will be sentenced to. Compensatory damages are of no doubt, but punitive damages may come out as well. Though, by law, the case is not requiring criminal penalties, Dr. Williams may have violated Title II of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This document protects the security and privacy of health information. So, there are certain restrictions in health data distribution and transmission. Dr. Williams has disclosed information about his patient Joan to his fellow colleague. Title II of HIPAA defines certain criminal penalties for such unprofessional behavior. There is a point on state criminal convictions connected with the health care items. Section 264(c)(2) of the Act protects the privacy of individually identifiable health information. Privacy Rule establishes a list of regulations for the use or disclosure of Protected Health Information. Only when it is required by law, patient’s medical records may be disclosed by covered entities, and still the minimum necessary data is recommended to be disclosed. The HIPAA act is rather stiff in its regulations and penalty requirements, therefore many health care providers tend to doubt on their legal privacy responsibilities.

Besides, D. Williams may be accused of breach of fiduciary responsibility as a kind of health care fraud, for which there is a conviction in Section 211 of the HIPAA. Further, there is Section 8 that relates to the unintentional lapse that may be seen in the actions of Dr. Williams. Unintentional failures are overall limited and justified for reasonable cause or evidently not willful neglect. In section 24 there are definitions of Federal health care offenses, and there is is written that any private health plan having some commercial affects with any medical benefit or service provided to a patient, is referred to as a health care benefit program. There are several subsections on violation and conspiracy in terms of health care benefit programs.

Finally, sections 245 and 1518 of the Health Insurance Portability and Accountability Act warns against obstruction of criminal investigations of health care offenses. It is said that “Whoever willfully prevents, obstructs, misleads, delays or attempts to prevent, obstruct, mislead, or delay the communication of information or records relating to a violation of a Federal health care offense to a criminal investigator shall be fined under this title or imprisoned not more than 5 years, or both”ť (HIPAA, 1996, sec. 1518a). It means that if Dr. Williams tries to hide or delete documentation on his patient Joan, or if he tries to fabricate health plan in order to confuse the court, he will make matter even worse and will risk to get into prison.

So, if we take into account all the points of the case and keep in mind all the correlating abstracts from the United States criminal legislation, we will come to the conclusion that Dr. Williams has violated several federal and state legal acts. In particular, Dr. Williams has violated the Health Insurance Portability and Accountability Act of 1996. Therefore, he may become subject to criminal prosecution. At least he will have to pay compensation to the patient, but he may be also accused not only of malpractice, but also of disclosure of Protected Health Information, and thus be charged by several articles.

Department of Health and Human Services (1996). Health Insurance Portability and Accountability Act of 1996.

Phillips R. L., Bartholomew L. A., Dovey S. M., Fryer G. E., Miyoshi T. J., & Green L. A. (2004). Learning from malpractice claims about negligent, adverse events in primary care in the United States. Qual Saf Health Care, 13 (2), 121”“126.

Shah I, A. E (2009). Unsafe abortion: global and regional incidence, trends, consequences, and challenges. Journal of Obstetrics and Gynaecology Canada, 31 (12), 1149”“1158.


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