A Legal Primer

July 10, 2018 | Healthcare Risk, Quality, & Safety Guidance

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The role of the healthcare risk manager, trained and educated to identify risk exposures for the organization in clinical and nonclinical areas, continues to evolve and expand in scope and complexity. Risk managers must become familiar with a wide range of legal issues that affect their organizations' employees, patients and their families, staff, and visitors. They may be involved in reviewing and managing contracts; assessing claims; assisting legal counsel in responding to discovery requests in medical liability cases; developing policies to ensure compliance with numerous federal, state, and local statutes, regulations, and codes affecting healthcare; interacting with criminal law enforcement; responding to federal or state investigations; and remaining aware of statutes of limitations for medical negligence. They should also monitor court opinions and current federal and state legislative activities that may affect the provision of healthcare services.

Risk managers may be directly involved with the legal system. For example, the risk manager may be required to testify about an event report or quality improvement records when the discoverability of such documents is contested. Although many legal issues are common to all healthcare providers, the specific legal issues that a risk manager may encounter will vary according to his or her defined role, the governance of the organization, and the type of healthcare facility (e.g., acute care, ambulatory care, or long-term care).

Familiarity with basic legal concepts and terminology, combined with a general knowledge of the workings of the courts and administrative agencies, supports effective communication among risk managers, compliance officers, and the organization's legal counsel. This guidance article provides information about the basic framework of the U.S. legal system (see Figure 1. U.S. Federal Legal System​) and discusses the process of litigation in civil courts; the basic workings of federal and state administrative agencies; and legal issues that are most commonly encountered in healthcare. It also provides:

In-depth discussions of many legal issues that are introduced in this guidance article are available in resources identified throughout the article.

Glossary of Legal Terms​

Law in the United States consists of the U.S. Constitution, state constitutions, federal and state statutes, regulations promulgated by federal and administrative agencies that are charged by Congress or state...

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