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What are the two parts of the U.S. Constitution? The main body and the amendments The U.S. Constitution is a grant of power from? The states to the federal government The first ten amendments are known as? The Bill of Rights Is the right to privacy included in the bill of rights? No (read into the 4, 5, 9, 14th amendments Is separation of church & state in the constitution? No, it’s read into the constitution. (What IS in the constitution = there can be no state religion) Is health care a constitutional right? No What did the 14th amendment do in 1870? Made the Bill of Rights applicable to the states What are the three branches of the government? Legislative (makes the laws), Executive (administers the laws), Judicial (interprets laws – supposedly don’t make law but it does) In the federal system, what courts are below Courts of Appeal? District Courts (Original Jurisdiction Trial Courts) What court is above the Courts of Appeal? The U.S. Supreme Court In the military system, what court is below the U.S. Supreme Court? The U.S. Court of Appeals for the Armed Services What court is below the U.S. Court of Appeals for the Armed Services? Court of Criminal Military Appeals for each branch of the military From the lowest to the highest, name the courts in a typical state system. Limited Jurisdiction Inferior Courts (small claims, traffic court) General Jurisdiction Trial Courts First Level Appellate Courts State Supreme Court How many appellate levels are in the military system? What are they? Three – Service specific Court of Military Criminal Appeals, U.S. Court of Appeals for the Armed Services, U.S. S.Ct. What kind of courts is equal to trial courts in each of the branches the military system? Service specific Courts-martial Which four courts can send cases directly to the Supreme Court? The Court of Claims and other Special Courts, Courts of Appeals, and State Supreme Courts Define law A system of rules that defines socially acceptable behavior and sets punishments for violations Statutory – enacted by legislation Common – case/judge made law (unwritten law of Old England) Administrative – rules/regulations Public – relationship of individual to government Private – people to people (between individuals) Substantive – “guts” of the law Procedural – lawyers use to guide cases Criminal – crimes and punishment Civil – everything else What is another name for Common Law? Judge made law What is the Common Rule and what type of law is it? Rule covering human subject research Administrative List three other types of administrative law DoD Regulations, OSHA Regulations, Army/Air Force/Navy/Marine Corps Regulations Ferris v. United States is what type of law? Common Law (judge made) What is the Uniform Anatomical Gift Act? Right to make gift while you are alive of a body part when you are dead Is the Uniform Code of Military Justice administrative or criminal law? Criminal What right does the Patient SelfDetermination Act give the patient? Right to information and self-directives What is the statute of limitations for torts? 1 to 2 ½ years What is the statute of limitations for contracts? 4 – 6 years Is clear and convincing evidence or preponderance of evidence required in civil or criminal court? Civil court (Beyond a reasonable doubt for criminal) Is trial by jury guaranteed in a criminal or civil court? Criminal Who is harmed in a criminal case and who is harmed in a civil case? Society is harmed in a criminal case; an individual is harmed in a civil case To what extent must someone be convicted in criminal court? Beyond a reasonable doubt Who decides to proceed with prosecuting a case in a rape case? District attorney or prosecutor What is “self help” and in what type of law is it applicable? Decision to pursue is the individual’s – Civil Is Tort Law criminal or civil? Civil List three other types of civil law Contract Law, Domestic Relations, Probate Law What are two types of criminal law? General Criminal Law and Military Law What is “Conflict of Laws”? Deals with questions arising out of jurisdiction (What law should be applied, what court has jurisdiction, or how laws of different jurisdictions shall be reconciled) Define a tort A non-contractual, civil wrong, committed against a person or his/her property for which a court may award a remedy in damages Describe the anatomy of a civil lawsuit in order. Briefly describe each component. Complaint - the plaintiff’s first pleading in a civil suit Describe the anatomy of a civil lawsuit in order (Cont.) Answer - the legal pleading through which a defendant responds to the allegations of the plaintiff Describe the anatomy of a civil lawsuit in order (Cont.) Discovery – the fact-finding stage in a lawsuit where the parties find out about each other’s case Describe the anatomy of a civil lawsuit in order (Cont.) Trial - pre-trial motions, opening statements, evidence presented, closing, verdict/judgment, post-trial motions Describe the anatomy of a civil lawsuit in order (Cont.) Appeal - complaint to superior court, which alleges an error committed or injustice wrought by inferior court What is a deposition and when is it taken during a lawsuit? A discovery tool, whereby one’s oral testimony is taken under oath in response to examination and cross-examination by the parties’ attorneys Depositions are taken during discovery What are interrogatories? A discovery tool in a civil lawsuit (question sets) What should a health care administrator do if asked to provide medical records during the motion to produce documents? Never give the medical record; give a certified copy. What is being argued at the appellate level? Law only – not the facts of the case What is the citation for the U.S. Courts of Appeal? F. What are the two citations for the Supreme Court? U.S. or S.Ct. How many Courts of Appeal are in the federal system? 13 What is the citation for U.S. District Courts? F.Supp What is the citation for U.S. Courts of Appeal for Armed Services? M.J. Explain the following citation: 649 So.3d. 636 Volume 639, Southern region, 3rd series, page 636 Explain the following citation: 272 F. Supp. 409 Volume 272, Federal District Court, page 409 Explain the following citation: 499 U.S. 160 Volume 499, U.S. Supreme Court, page 160 Which is the more recent citation? 1 F.3d. 14 or 11 F. 2d. 480 1 F.3d. 14 What does “Ann” mean in a citation? Annotated What does “CFR” stand for? Code of Federal Regulations What are two examples of Special Courts in the federal system? U.S. Court of Appeals for Armed Services and U.S. Court of Patents 17. citation: USC U.S. Code Which federal court cases are published? All In most states, which cases are published? Only Intermediate (Appellate) Court and State Supreme Court cases – trial court cases are not published. Describe the following: (a) 71 SE 769 (a) Volume 71, Southeastern Reporter, page 769 (State Appellate Court) (b) 10 USCA 980 (b) Title 10, U.S. Code Annotated, Section 980 (c) 56 F. 774 (c) Volume 56, Federal Court of Appeals, page 774 (d) 46 CFR 1388 (d) Part 46, Code of Federal Regulations, Section 1388 (e) Ross v. CIGNA (e) Case law (f) 14 M.J. 337 (f) Volume 14, Military Justice, page 337 (g) 12 F.Supp. 310 (g) Volume 12, Federal District Court, page 310 (h) 16 S.Ct. 954 (h) Volume 16, Supreme Court, page 954 Fl. Stat. Ann Florida State Code Annotated Much of contract law is a matter of common law, with the exception of? Government contracts What is the administrative law behind government contracts? Federal Acquisition Regulations (FAR) Government contracts favor? Small business, organized labor, veterans, and depressed areas What was government law originally called? Procurement laws Government contracts are a matter of administrative law but are enabled by _____ laws. Statutory What are the elements of a contract? Competent parties Legal subject matter Offer Acceptance Consideration Mutual agreement Required form What is required to be a competent party to enter a contract? Sufficient present mental ability and legal age Very seldom, if ever, does an advertisement qualify as a contract. The advertisement is merely? An invitation to deal What is consideration? The inducement for entering in a contract (given for something of value) In the military system, what court is below the U.S. Supreme Court? The U.S. Court of Appeals for the Armed Services What court is below the U.S. Court of Appeals for the Armed Services? Court of Criminal Military Appeals for each branch of the military From the lowest to the highest, name the courts in a typical state system. Limited Jurisdiction Inferior Courts (small claims, traffic court) General Jurisdiction Trial Courts First Level Appellate Courts State Supreme Court What is the Common Rule and what type of law is it? Rule covering human subject research Administrative List three other types of administrative law DoD Regulations, OSHA Regulations, Army/Air Force/Navy/Marine Corps Regulations What is the Uniform Anatomical Gift Act? Right to make gift while you are alive of a body part when you are dead List three other types of civil law Contract Law, Domestic Relations, Probate Law What are two types of criminal law? General Criminal Law and Military Law What is “Conflict of Laws”? Deals with questions arising out of jurisdiction (What law should be applied, what court has jurisdiction, or how laws of different jurisdictions shall be reconciled) Define a tort A non-contractual, civil wrong, committed against a person or his/her property for which a court may award a remedy in damages What is being argued at the appellate level? Law only – not the facts of the case Much of contract law is a matter of common law, with the exception of? Government contracts What was government law originally called? Procurement laws Very seldom, if ever, does an advertisement qualify as a contract. The advertisement is merely? An invitation to deal What is consideration? The inducement for entering in a contract (given for something of value) What does mutual agreement mean? The parties must be talking about the exact same thing for consideration (i.e. meeting of the minds as to the subject matter) What is meant by “required form”? What form is required for a contract – i.e. Is it required to be written or can it be an oral (spoken) contract? What question is answered by The Objective Theory of Contracts? If the intent is not clear in a contract, the judge will determine intent of the contract, in effect, by asking, “What would a reasonable person have intended?” What are the methods of classification of contracts? By means of formation By stage of performance By enforceability What are the ways in which contracts can be classified by means of formation? Unilateral or bilateral Express or Implied Formal or Informal What is the difference between unilateral and bilateral? Unilateral – acceptance requires performance Bilateral – acceptance requires only a promise What is the difference between expressed or implied contracts? Expressed – one in which all terms are clearly stated Implied – not every term or element was expressed; at least one term is inferred from the conduct of the parties What are the types of implied contracts? Implied-In-fact (all terms are clearly written out) Implied-In-law (at least on term is not clearly expressed in contract, however is implied in law) What is the basis for the obligation in an Implied-In-Fact contract? Based on conduct rather than an expressed agreement Describe the situation when the ImpliedIn-Fact contract is based on conduct rather than on expressed agreement The plaintiff furnished a service or property, the plaintiff reasonably expected to be paid; the defendant knew or should have known, the defendant had a chance to reject receipt of service or property and did not What is another name of an Implied-InLaw contract? Quasi-contract List three things that describe an Implied-In-Law or Quasi-Contract. A legal fiction (there is no contract at all) No mutual agreement Quantum meruit – “as much as he deserves” What are the underlying premises of quasi-contracts? One should not be unjustly enriched at the expense of another One should be recompensed what he deserves (quantum meruit) What is the difference in a formal and informal contract? Formal – Complies with stated requirements, such as to be in writing Informal – Has no stated requirements What are two examples of a formal contract law? Statute of Frauds – Requires that certain types of contracts be in writing to be enforceable (each state has one) Uniform Commercial Code – merchant’s contract of sale of good has to be greater than $500 What must be determined in classification of contracts by stage of performance? Has the contract been executed (completed) or not? What are the three types of contracts in classification by enforceability? What are they? Valid contract – one containing all of the required elements Void contract – no contract at all Voidable contract – a valid contract which one or both parties can get out of under certain circumstances What is another name of an Implied-InLaw contract? Quasi-contract What is the difference in a formal and informal contract? Formal – Complies with stated requirements, such as to be in writing Informal – Has no stated requirements What must be determined in classification of contracts by stage of performance? Has the contract been executed (completed) or not? What are the three types of contracts in classification by enforceability? What are they? Valid contract – one containing all of the required elements Void contract – no contract at all Voidable contract – a valid contract which one or both parties can get out of under certain circumstances What is an example of a void contract? A person judged to be incompetent can’t sign a contract. If he does, the contract is void. What is an example of a voidable contract? A minor can get out of a contract if he says he wants out or he can ratify when he reaches legal age. What is a “legal excuse” for not complying with a contract? Defense What is the Plain Meaning Rule? A rule of interpretation = the meaning of a contract’s words are to be given their ordinary meaning. How does the Plain Meaning rule affect enforcement of the contract? The contract will be enforced without interpretation. What is the Common Meaning Rule? Apply the common meaning of terms unless it is obvious to the average person that a special technical meaning applies (Is a bridge a structure over water or is it dental work?) In the Rule of Conflicting Provisions, what governs? The specific will govern over the general The handwritten will govern over the typed/printed (almost obsolete) What is the Mirror Image Rule? The acceptance in a contract must meet the offer exactly. Consideration is “something of value for something of value”. What are 4 examples of “something of value”? A promise (this is an enforceable considerable) Money A service Or detrimental reliance Consideration is insufficient when ….? Preexisting duty Moral obligation only Promised thing has occurred What is the General Rule in contracts? The rights and duties arising from a contract affect only those party to it. What are the exceptions to the General Rule? Third party beneficiary contracts Assignments of rights Delegations of duties After assignment, what happens with regard to the assignor’s rights and duties? The assignor’s rights are extinguished, but the duties remain. What is an expressed condition in a contract? Condition stated in the agreement (If, when, provided that) Covenants not to compete or restrictive covenants are frowned upon but are judged based upon their _____? Reasonableness (in regards to time and distance) Name & describe three breaches of contract. Minor - performance is “close” so performance is at least substantial Anticipatory - when a party announces refusal to perform in advance of obligation to do so Material – when performance is less than substantial Rescission is an action to undo a contract because of? Fraud, mistake, duress, undue influence, misrepresentation, or lack of capacity What is the definition of a tort? A non-contractual, civil wrong committed against a person or his property for which a court may award a remedy in damages What are the types of torts? What is the main premise of each? Torts of strict liability – Liability imposed apart from any theory that the defendant was negligent (unleashed a dangerous instrumentality & it hurt someone --- doesn’t matter if it was negligent.) What are the types of torts? (Cont) Intentional torts – The person intended the action but did not intend harm What are the types of torts? (Cont) Negligent torts – The person failed to exercise care to a degree that a reasonable and prudent person would typically exercise under similar circumstances What are the four elements of legally actionable negligence? Duty Negligent breach of duty Injury Causation What is the difference between contributory negligence, comparative negligence, modified negligence? Contributory negligence - if the plaintiff negligence has contributed to the injury alleged, he can’t recover anything. Comparative negligence - if the plaintiff is partially to blame, his award is reduced (think of the person who is DUI killing someone who was not wearing a seatbelt). Modified comparative negligence – If the plaintiff is 50% or more at fault, recovery is barred. What is the basis for determining personal injury damages? The plaintiff’s condition immediately prior to the negligent event What is the key issue to consider in aggravation? What would have been the result had everything went well except for the negligence? (i.e. what about the care aggravated the situation?) Name four damages in tort. Briefly describe each. Special damages – those damages awarded in tort for economic loss. There is an objective basis to determine them. (lost wages) General damages – those damages award in tort for noneconomic loss. These are very subjective (loss of pleasures of life). Nominal damages – awarded for a technical wrong & very little money recovered (rarely seen) Punitive damages – damages awarded to punish the defendant for willful, wanton, or grossly irresponsible activity and to deter similar situations What is the Medical Standard of Care? To act as a reasonable and prudent _____________ would act under the same or similar conditions. (compares 1 OB nurse to another, 1 cardiologist to another, etc.) What two cases are important to remember with regard to the application of the standard of care? Which rule or standard did each establish? Small v. Howard - The locality rule or standard Brune v. Belinkoff - National or professional rule or standard What are the four elements of legally actionable negligence? o o o o Duty Negligent breach of duty Injury Causation What are the 2 types of negligence? Personal (individual) and corporate How do you identify corporate negligence? Look for the duty. If corporate duty is breached, then there is corporate liability based on corporate negligence. What is an ostensible agent? Someone who hasn’t explicitly made your agent but is still acting as your agent. How is expert medical testimony used in a medical malpractice case? To establish the Medical Standard of Care What are the 3 conditions for res ipsa loquitur? The event would not ordinarily occur absent negligence Apparent/presumptive cause was within exclusive control of defendant No negligence on the part of the plaintiff What doctrine is applied by the FTCA? Respondeat Superior (“Let the master beware”) What are the FTCA rules? In-scope torts of agents and employees (Must be within the scope of one’s employment – what the employee is generally supposed to be doing) Must have occurred in the U.S. (NOT overseas) Applying state law Two-year statute of limitations (from the point of discovery) Trial by judge alone (NO jury) Trial is held in U.S. District Court (NOT state court – always F.Supp) No limit on damages No punitive damages may be awarded What are the FTCA exceptions? Intentional torts, except of law enforcement officers (and, IAW the Gonzalez Act, of DoD healthcare providers) In foreign countries Involving combatant activities What is important to remember about the Feres case? The government is not liable under the FTCA for injuries to service-members when those injuries arose out of, or were in the course of, activities incident to service. How much time can elapse before a claim is filed and the statute of limitations runs out? 2 years What is the Feres rationale? A system of compensation exists Necessary to maintain military discipline Necessary to prevent applicability of state law Informed Consent is a two sided coin and includes: Informed Consent Informed Refusal A process of informed decision-making T or F Assent is used to mean consent sufficient to be legally binding. False Consent = the term used to mean sufficient to be legally binding, sometimes called “informed consent” Assent = sometimes used to mean acquiescence or agreement that is not legally sufficient What is the basis for surrogate decisionmaking? And what is meant by each? Patient’s best interests What surrogate thinks would be in the patient’s best interests Surrogate’s substituted judgment Surrogate decides based on what he thinks the patient would have wanted Examples of substituted consent (judgment) identified by state statutes Spouse Adult child with consent of others Majority of children Parents Designated individuals Closest other relative Member of the clergy When is consent not required? Emergency (and can’t be reasonably obtained) Therapeutic privilege Treatment ordered by a court – “judicial permission” Treatment required by law Nonconsensual treatment permitted by law – military How is the disclosure standard set? The amount of information to be disclosed is to be a reasonable patient centered standard rather than a physician centered standard. It should be based on what a patient would think is important – not what a physician would What are the three types of advance directives? DNR orders Living Will Durable Powers-of-Attorney Note: If only asked for two, then give durable powers-of-attorney and living wills. What is a type of advance directive by which a competent adult retains, or attempts to retain, control over his own medical care during periods of incapacity through prior designation of an individual to make health care decisions on his behalf? Durable power-of-attorney What are three elements of a durable power-of-attorney? Takes effect upon loss of decision-making capacity Employs a named agent Grants decision-making power for any medical situation The Patient Self-Determination Act pertains to information about? Right to refuse care Right to execute an advance directive The institutions policies regarding such rights (how, when, etc.) Under the Patient Self-Determination Act, covered organizations must: Comply with state law about advance directives Not condition care on execution or failure to execute an advance directive Educate staff and community about advance directives According to the Harvard criteria brain dead is dead. Is a persistant vegetative state considered dead? PVS is not dead because there is still brain activity. What are the two state laws for organ and tissue donation? Uniform Anatomical Gift Act Coroner Unconsented Anatomical Donations What law governs the gift of a person’s body parts after death? The Uniform Anatomical Gift Act Four Privacy Interests Physical and mental solitude Personal information Freedom from false publicity Name or likeness 4 infringements on privacy Intrusion upon physical or mental solitude or seclusion Public disclosure of private facts “False light” publicity Appropriation of name or likeness for financial benefit or other gain 3 Purposes of Privacy Act To let individuals know what info the gov’t maintains on them To allow them to correct erroneous info To keep the info from those whom it does not pertain Privacy Act Who can deny a request for information – Access and Amendment Refusal Authority • AARA What are the codes that provide international guidance on human research? Nurnberg Code Declaration of Helsinki CIOMS/WHO guidelines The Common Rule The Declaration of Helsinki includes the same principals as the Nurnberg code. Additionally, it permits (5): Substituted consent permitted Committee review of all protocols Subject’s right to privacy Accurate reporting of results Distinction between clinical and non-clinical research The Common Rule applies to what type of research? It applies to all research involving human subjects conducted, supported, or otherwise subject to regulation by the federal government What is the purpose of an IRB as set forth by the Common Rule? To review and approve research IAW the Common Rule What are the “protected classes” according to the Common Rule? Incompetents Pregnant women Prisoners A IRB expedited review is for research activities that_____________. Research activities involving no more than minimal risk and in which only involvement of human subjects is limited to certain categories of research as defined by the Common Rule Under 10 USC 980 (as originally written), use of DoD funds for human experiments may not be used for research involving a human being unless___________. Informed consent is obtained in advance; or In the case of research intended to be of beneficial to the subject, the informed consent of the subject or a legal representative of the subject is obtained in advance What changes did the 2001 amendment to 10 USC 980 bring? Placebos were authorized for use Which Act was not intended to restrain state action or official action directed by a state? Sherman Act. (Parker vs. Brown) What is the purpose of Section 1 of the Sherman Act? How do you prove it? Prohibit restraints on trade. Demonstrate restraints on trade thru contract or conspiracy, or both. What is the purpose of Section 2 of the Sherman Act? How do you prove it? Prohibit monopolies. Possession of monopoly power with willful acquisition above normal growth. What are examples of problem areas in managed care? Contracts Torts Vicarious liability Human resource management What are examples of problem areas in contracts in managed care? Wording of contracts Personal vs. non-personal services FAR & fiscal system in federal system What are possible problem areas in torts in managed care? Interlocking relationships (multiple players) Vicarious liability What are two types of corporate liability? Corporate negligence (Corporation had duty, breached it, and injury resulted) Vicarious liability (Read as Agent) Scholendorff v. Society of the City of New York Hospitial 1914 Judge Cardozo “Every human being of adult years and sound mind has the right to determine what shall be done to his own body.” Emphasized autonomy Basis of informed consent FEDERAL TORTS CLAIM ACT (FTCA) (1946) Allows Federal government to be sued, partially doing away with sovereign immunity. Applied to negligent in-scope torts of agents and employees. We consider Red Cross volunteers agents. Typically employees are paid whereas agency can be authorize volunteers. Statute of limitations is 2 years Must file claim before filing lawsuit No jury trial No punitive damages No limitation on damages Does includes application of substantive state law US only Not negligence as a result of war or combatant activity. Feres Doctrine (1950) Military member can not sue the government for negligence when the injury arises during: – The course or duty or – Exercising a military benefit Is an exception to th Federal Tort Claims Act (FTCA) Canterbury v. Spence (1972) Informed consent case. Not required for: – Therapeutic privilege. – Emergency. – Treatment ordered by court. – Treatment required by court. Matter of Fosmire v. Nicholeau (1989) Right to die case. 4 state interests: – Preservation of life. – Prevention of suicide. – Protection of innocent third parties. – Preservation of the ethical integrity of the medical profession. Matter of Quinlan (1976) Right to die, right to terminate. Persistent Vegetative State (PVS) introduced. Used preponderance of evidence to determine matter. First to suggest ethics committees. Cruzan v. Director, Missouri Department of Health (1990) Right to die, right to terminate care, also states rights. One of the few modern states rights cases (Missouri). Used clear and convincing evidence to determine matter. State has right to have stricter evidence rule. Vacco v. Quill Right to die and physician assisted suicide. There is no right to physician assisted suicide in the U.S. Constitution, however states are not precluded from having laws to allow it. Oregon allows physician assisted suicide. Washington v. Glucksburg Right to die. Physician can not intentionally write a prescription for medicine to allow a patient to commit suicide. Roe v. Wade Legalized abortion. Established 3 stages and 3 rules for abortion. What are the 3 stages of Roe v. Wade? Stage 1 – from conception to the end of the 1st trimester. Stage 2 – end of 1st trimester to fetal viability. Stage 3 – viability of birth. What are the 3 rules of Roe v. Wade? Rule 1 – decision is up to woman and her physician. Rule 2 – state may regulate abortion to protect the mother’s health. Rule 3 – state may regulate except when necessary for the woman’s health or life. Maher v. Roe Dealt with abortion. Specifically dealt with states paying for 1st trimester abortions. States have the right to determine how it will spend its money (whether from federal or state). State is not legally compelled to use public funds to offer 1st term abortions. States MAY do so if they desire. U.S. v. Karl Brandt Nurenburg doctors’ trial or medical trial. Nurenberg code for ethics. Established the modern rules of medical treatment. 10 points made of significance for experiment. (next question) 10 Points of U.S. v. Karl Brandt 1. Voluntary, informed consent of subjects 2. Scientific merit for good of society which can’t be gained by other method(s). 3. Based on results of animal experimentation, knowledge of disease/problem under study, anticipated results justify the experiment. 4. Avoidance of physical and mental suffering during conduct. 5. No experiment if possibility of death or disablement. 6. Reasonable risk – benefit ratio 7. Proper preparation and adequate facilities to prevent even remote possibilities of injury, disability, or death 8. Qualified researchers 9. Experimentee may terminate at his/her discretion 10. Experimenter must be prepared to terminate if reason to belive continuation result in injury, disability, or death Moore v. Regents University of California Research – conversion case Profiting from patient without consent Tarasoff v. Regents University of California (1976) “Protective privilege ends where public peril begins” Psychiatrist has duty to inform threatened person or authorities if patient states intent to harm an identifiable individual. Threat to the public must be: 1. Believable 2. Plausible 3. Identifiable Not true in state of Texas Goldfarb v. Virginia State Bar (1975 Antitrust – price fixing Supreme Court ruled the learned professions (e.g., law, medicine, theology) are not exempt from the requirements of antitrust and restraint of trade laws and are therefore subject to the Sherman Act. Parker v. Brown “The Sherman Act was not intended to restrain state action or official action directed by a state.” Private party can act in violation of anti-trust law if it meets both parts of Parker test: 1. Clearly expressed policy – private entity’s actions must be execution clearly expressed state policy 2. Active regulation – state must be actively supervising private entity’s execution. (active supervision hardest to prove) PLANNED PARENTHOOD v. CASEY (1992) A. Supreme Court ruled that a state (Pennsylvania) could regulate abortion during any stage of pregnancy, as long as the regulation did not place an “undue burden” on the women’s ability to obtain an abortion. 1. An undue burden exists if the purpose or effect of a law is to place a substantial obstacle in the path of a woman seeking an abortion before viability. 2. Specifically, the court found that Pennsylvania’s requirement for a woman to notify a spouse of the abortion before it occurs was an undue burden. B. Note: the court allows requirements for parental consent for minors, only if the state allows for a judicial bypass option allowing a minor to get a court ruling stating parental consent is not required GONZALEZ ACT (1976) Written in conjunction with FTCA to protect DOD health care providers by immunizing them from liability for inscope personal negligent torts. Provided for transfer of cases to Federal court and substitution of the U.S. government as the defendant. Hole in Gonzalez Act...what about military physicians overseas or physicians in civilian residencies? Gonzalez Act did not clearly include these groups...thus those people needed to get their own coverage. The SMITH case plugged the loophole. Ultimately superseded by the Westfall Amendment. Made FTCA exclusive remedy for those seeking damages for allegedly improper medical treatment by military HC providers