Firearm Policy in the Hospital Setting-Recognizing Health Care as a "Sensitive Place".

Importance: Hospitals are hot zones of the US gun injury epidemic. To shelter these facilities from the dangers of gun violence, state legislatures have enacted laws to reduce the carrying of firearms on hospital premises. However, these efforts currently face serious Second Amendment challenges in federal courts. The ongoing legal battles, which have wide-ranging implications for patient and clinician safety as well as public health generally, are setting the stage for a Supreme Court case that may decide the fate of firearm regulations in US hospitals. A permissible pathway for advancing sensible gun regulation in hospitals is urgently needed. Observations: Since the Supreme Court established a new constitutional test for firearm laws in New York State Rifle & Pistol Association v Bruen (2022), states now face unprecedentedly high barriers to enacting health-protecting legislation regarding firearms. Post-Bruen, the Supreme Court requires that laws be consistent with "this Nation's historical tradition of firearms regulation." This means that states hoping to enact laws barring public carry of firearms in hospitals must demonstrate that hospitals are a "sensitive place" as a historical matter (ie, analogous to a location where firearms were traditionally restricted). By reasoning from analogy, it is clear several historical comparators exist for regulating firearms in hospitals. Although the hospital (as understood today) did not exist in the 1700s, it is sufficiently analogous to asylums and schools, to name a few examples. These settings all share a common denominator with the modern-day hospital: serving vulnerable populations or individuals who may be at heightened risk of misusing firearms. Conclusions and Relevance: The Supreme Court's interpretation of the Second Amendment right to bear arms is threatening democratically enacted laws seeking to shelter hospitals from firearm violence. However, it is clear that hospitals and other health care settings are a sensitive place with compelling historical analogies. Policymakers' strategic deployment of the sensitive places designation, along with its rightful judicial recognition in the hospital setting, are critical to upholding laws that protect health care facilities, patients, and professionals from firearm violence-a conclusion consistent with the US Constitution, history, medical ethics, and common sense.

The Scope and Legal Implications of Tracking Technologies on Hospital Websites.

This Viewpoint analyzes the scope and legal implications of tracking on hospital websites, including potential HIPAA and state privacy law violations, and suggests that hospitals limit such tracking.

Abortion Miscoding-Legal Risks for Clinicians and Hospital Systems.

This Viewpoint discusses the legal risks physicians and health care facilities may incur by miscoding a surgical or chemical abortion as a miscarriage to conceal an abortion procedure.

Resíduos de serviços de saúde em centro cirúrgico: adequações com mensuração do custo / Medical Waste in the surgical center: adjustments with cost measurement / Residuos de servicios de salud en centros quirúrgicos: adaptaciones con medición de costos

Objetivo: Identificar o custo das adequações necessárias a um centro cirúrgico para que este atenda à legislação brasileira vigente, que dispõe sobre resíduos de serviços de saúde. Método: Pesquisa exploratória, descritiva, de abordagem quantitativa na modalidade de estudo de caso do centro cirúrgico de um hospital universitário público. No protocolo, foi aplicada uma pesquisa documental, por meio de um check-list comparando a legislação brasileira vigente com a realidade encontrada, mapeou-se o processo com a técnica do mapa-fluxograma. Utilizou-se como método de custeio o custo direto médio. Resultados: Verificou-se o custo direto médio de R$ 7.891,25 para o hospital atender integralmente à legislação brasileira de resíduos de serviços de saúde, com adequações de infraestrutura e aquisições de longa permanência e um adicional no custo mensal de R$ 542,38. Conclusão: Para todos os grupos de resíduos de serviços de saúde do centro cirúrgico em estudo, são necessárias adequações a fim de atender à legislação, bem como articulação dos diversos gestores envolvidos no manejo e na mensuração dos custos relacionados aos resíduos para otimização de resultados econômicos em saúde.

Objective: To identify the cost of the necessary adjustments to a surgical center so that it meets the current Brazilian legislation, which provides for medical waste. Method: Exploratory, descriptive research with a quantitative approach in the modality of case study of the surgical center of a public university hospital. In the protocol, a documental research was applied, through a check-list comparing the current Brazilian legislation with the reality found, mapping the process with the technique of the flowchart map. The average direct cost was used as a costing method. Results: There was an average direct cost of R$ 7,891.25 for the hospital to fully comply with the Brazilian legislation on healthcare waste, with infrastructure adjustments and long-term acquisitions and an additional monthly cost of R$ 542.38. Conclusion: For all groups of waste from health services in the surgical center under study, adjustments are needed in order to comply with the legislation, as well as the articulation of the various managers involved in the management and measurement of costs related to waste to optimize economic results in health.

Objetivo: Identificar el costo de los ajustes necesarios a un Centro Quirúrgico (CQ), para que cumpla con la legislación brasileña vigente que prevé Residuos de Servicios de Salud (RSS). Método: Investigación exploratoria descriptiva con abordaje cuantitativo en la modalidad de estudio de caso de un CQ en un Hospital Universitario Público. En el protocolo se aplicó investigación documental, a través de un checklist de la legislación brasileña vigente con la realidad encontrada, se mapeó el proceso mediante la técnica de diagrama de flujo-mapa. Se utilizó el costo directo promedio como método de cálculo de costos. Resultados: Hubo un costo directo promedio de R$ 7.891,25 para que el hospital cumpliera plenamente con la legislación brasileña sobre RSS, con ajustes de infraestructura y adquisiciones de largo plazo y un costo mensual adicional de R$ 542,38. Conclusión: Para todos los grupos RSS del CQ en estudio, se necesitan ajustes para cumplir con la legislación. Existe la necesidad de articulación entre los distintos gestores involucrados en la gestión, medición de costos relacionados con los residuos para optimizar los resultados económicos en salud.

Trends in Hospital Lawsuits Filed Against Patients for Unpaid Bills Following Published Research About This Activity.

Importance: Suing patients and garnishing their wages for unpaid medical bills can be a predatory form of financial activity that may be inconsistent with the mission of a hospital. Many hospitals in the state of Virginia were discovered to be suing patients for unpaid medical bills, as first presented in a 2019 research article that launched 2.5 months of media attention on hospital billing practices and a grassroots public demand for hospitals to stop the practice. Objective: To evaluate the association of a research publication and subsequent media coverage with the number of hospital lawsuits filed against patients for unpaid medical bills. Design, Setting, and Participants: This cross-sectional study of Virginia hospitals that sued patients for unpaid medical bills used an interrupted time series analysis. Data on hospitals suing patients for unpaid medical bills were collected during a preintervention period (June 25, 2018, to June 24, 2019), an intervention period (June 25, 2019, to September 10, 2019), and a postintervention period (September 11, 2019, to September 10, 2020). Exposures: Publication of a research article and subsequent media coverage. Main Outcomes and Measures: The total number of warrant in debt and wage garnishment lawsuits filed by Virginia hospitals and the frequency of those lawsuits filed before, during, and after the intervention period on a weekly basis. Results: A total of 50 387 lawsuits, filed by 67 Virginia hospitals, were included; 33 204 (65.9%) were warrant in debt lawsuits, and 17 183 (34.1%) were wage garnishment lawsuits. From the preintervention period to the postintervention period, there was a 59% decrease in the number of lawsuits filed (from 30 760 lawsuits to 12 510 lawsuits), a 55% decrease in the number of warrant in debt cases filed (from 19 329 to 8651), a 66% decrease in the number of wage garnishments filed (from 11 431 to 3859), and a 64% decrease in the dollar amount pursued in court (from $38 700 209 to $13 960 300). During the study period, 11 hospitals banned the practice of suing patients for unpaid medical bills. The interrupted time series analysis showed a significant decrease of 5% (incidence rate ratio, 0.95; 95% CI, 0.94-0.96) in the total weekly number of lawsuits in the postintervention period. Conclusions and Relevance: The findings of this study suggest that research leading to public awareness can shift hospital billing practices.

Influence of the introduction of caseload requirements on indication for visceral cancer surgery in Switzerland.

BACKGROUND: In 2013 Swiss health authorities implemented annual hospital caseload requirements (CR) for five areas of visceral surgery. We assess the impact of the implementation of CR on indication for surgery in esophageal, pancreatic and rectal cancer. MATERIALS AND METHODS: Retrospective analysis of national registry data of all inpatient admissions between January 1st, 2005 and December 31st, 2015. Primary end-point was the age-adjusted resection rate for esophageal, pancreatic and rectal cancer among patients with at least one cancer-specific hospitalization per year. We calculated age-adjusted rate ratios for period effects before and after implementation of CR and odds ratios (OR) based on a generalized estimation equation. A relative increase of 5% in age-adjusted relative risk was set a priori as relevant from a health policy perspective. RESULTS: Age-adjusted resection rates before and after the implementation of CR were 0.12 and 0.13 (Relative Risk [RR] 1.08; 95%-Confidence Interval [CI] 0.85-1.36) in esophageal cancer, 0.22 and 0.26 (RR 1.17; 95%-CI 0.85-1.58) in pancreatic cancer and 0.38 and 0.43 (RR 1.14; 95%-CI 0.99-1.30) in rectal cancer. In adjusted models OR for resection after the implementation of CR were 1.40 (95%-CI 1.24-1.58) in esophageal cancer, 1.05 (95%-CI 0.96-1.15) in pancreatic cancer and 0.92 (95%-CI 0.87-0.97) in rectal cancer. CONCLUSION: Implementation of CR was associated with an increase of resection rates above the a priori set margins in all resections groups. In adjusted models, odds for resection were significantly higher for esophageal cancer, while they remained unchanged for pancreatic and decreased for rectal cancer.

Evidências de poder expressas em projetos arquitetônicos do Hospital Santa Catarina (1974-2002) / Evidence of power expressed in architectural projects of the Hospital Santa Catarina (1974-2002)

Resumo A arquitetura hospitalar é um elemento disciplinador que contribui para a categorização, a classificação e a individualização dos atores sociais que compartilham esse espaço. Este estudo histórico analisou a trajetória da autoria dos projetos e do fluxo de pessoas, coisas e informação, além da disposição, da denominação e das dimensões dos compartimentos do Hospital Santa Catarina. Os achados foram interpretados à luz da literatura científica encontrada sobre o tema e do referencial teórico de Michel Foucault, o que permitiu compreender como se deram as disputas de poder por esses atores sociais. A enfermagem, um dos grupos presentes nesse espaço ao longo de todo o período estudado, ora ampliou ora teve reduzido o domínio sobre ele, pois ora a enfermagem foi destinada a esse espaço privativamente, ora foi deslocada para áreas onde a vigilância e a observação eram mais difíceis, ora passou a compartilhar espaços antes exclusivos. Essa dinâmica de disputa de poder impactou a qualidade da assistência prestada e as condições de trabalho dos profissionais de saúde.

Abstract Hospital architecture is a disciplinary element that contributes to the categorization, classification and individualization of social actors that share this space. This historical study analyzed the authorship trajectory of the projects, flow of people, things and information, in addition to the disposition, naming and dimensions of the compartments at the Hospital Santa Catarina. We used the academic literature on the matter as well as Michel Foucault's theoretical framework to interpret the results and understand the power disputes of these social actors. Nursing, one of the groups present in this space throughout the analyzed period, oscillated between increasing and decreasing control over the space. This occurs because their control was assigned privately at times, moved to areas where surveillance and observation were more difficult, or their previously confidential spaces started being shared. This power dispute dynamics affected the quality of care and the working conditions of the evaluated health professionals.

Liability of Health Care Professionals and Institutions During COVID-19 Pandemic in Italy: Symposium Proceedings and Position Statement.

BACKGROUND: On May 12, 2020, a symposium titled "Liability of healthcare professionals and institutions during COVID-19 pandemic" was held in Italy with the participation of national experts in malpractice law, hospital management, legal medicine, and clinical risk management. The symposium's rationale was the highly likely inflation of criminal and civil proceedings concerning alleged errors committed by health care professionals and decision makers during the COVID-19 pandemic. Its aim was to identify and discuss the main issues of legal and medicolegal interest and thus to find solid solutions in the spirit of preparedness planning. METHODS: There were 5 main points of discussion: (A) how to judge errors committed during the pandemic because of the application of protocols and therapies based on no or weak evidence of efficacy, (B) whether hospital managers can be considered liable for infected health care professionals who were not given adequate personal protective equipment, (C) whether health care professionals and institutions can be considered liable for cases of infected inpatients who claim that the infection was transmitted in a hospital setting, (D) whether health care institutions and hospital managers can be considered liable for the hotspots in long-term care facilities/care homes, and (E) whether health care institutions and hospital managers can be considered liable for the worsening of chronic diseases. RESULTS AND CONCLUSION: Limitation of the liability to the cases of gross negligence (with an explicit definition of this term), a no-fault system with statal indemnities for infected cases, and a rigorous methodology for the expert witnesses were proposed as key interventions for successfully facing future proceedings.

Promoting patients' rights through hospital accreditation.

BACKGROUND: Over the past decade, hospitals in many countries, including Israel, have undergone an accreditation process aimed at improving the quality of services provided. This process also refers to the protection and promotion of patients' rights. However, reviewing the criteria and content included in this category in the Israeli context reveals definitions and implications that differ from those presented by the law - specifically the Patient's Rights Act 1995. Moreover, the rights included in it are not necessarily equally represented in other legislation. METHODS: This study seeks to examine the question of whether and to what extent the scope, contents, and definitions of patients' rights in the JCI Standards are similar to or different from patients' rights as they are addressed and protected in national legislation. The article provides a comparison and examination of the different regulatory frameworks of patients' rights, especially those in the accreditation of healthcare institution and legislation, analyzes the gaps between such frameworks, and suggests possible implications on our understanding of the concept of patients' rights. RESULTS: The patients' right chapter in the accreditation process introduces and promotes the concepts of patient and family rights, increases the awareness and compliance of such concepts, and may create greater consistency in their introduction and application. CONCLUSIONS: Discussion of the Israeli case not only demonstrates how regulatory frameworks are instrumental - for broader policy purposes, especially in the area of patients' rights and the rights of patients' families - but also calls for a more general examination of the concept of patients' rights in health policies and its contribution to the quality of health services. Reference to patients' rights in accreditation of healthcare institutions may promote and enhance this concept and contribute to the delivery of care, thereby complementing a lacuna in the law.

Holding powers in hospitals under the Mental Health Act 1983.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the holding powers available under the Mental Health Act 1983 and why their use is prone to error.

The medico-legal implications in medical malpractice claims during Covid-19 pandemic: Increase or trend reversal?

The Covid-19 pandemic caused a marked increase in admissions to intensive care units. The critically ill patients' condition from the infection resulted in their deaths. The healthcare facilities have got into trouble because of the pandemic. In fact, they had to create additional beds in a very short time and to protect health workers with personal protective equipment. Healthcare professionals fear that there will be an increase in complaints and medico-legal malpractice claims and hence they have urged politicians to discuss this. The Italian Parliament recently debated the topic of medical liability and passed the Decree-Law no. 18 of 17 March 2020 (DL - so called Cura Italia) by which they want to extend the concept of "gross negligence" to healthcare facilities. Several Extended Care Units have suffered from outbreaks of Covid-19, so the Prosecutor's Office of several cities initiated investigations against them. This situation has reached Sicily, where the Prosecutor's Office of Palermo has opened an inquiry against an Extended Care Unit. Simultaneously, the Covid-19 pandemic may change patients' attitudes towards healthcare professionals, who are risking their lives daily. So the Italian medico-legal community is debating these questions, with one last pending question remaining: is the number of medico-legal claims likely to increase or trend down?

Patient perceptions of tobacco control after smoke-free hospital grounds legislation: Multi-center cross-sectional study.

OBJECTIVE: To examine patient perceptions of the role of health care providers in tobacco control and tobacco-related services they should provide after the introduction of national smoke-free hospital grounds legislation in Spain. DESIGN: Multi-center cross-sectional study. SETTING: Thirteen hospitals in Barcelona province in 2014-2015. PARTICIPANTS: A total of 1,047 adult hospital patients, with a stay ≥ 24 h were randomly selected. METHOD: We explored participants' perceptions of the role of health professionals and hospitals in tobacco control by asking about their agreement with several statements after the introduction of national legislation on smoke-free hospital grounds: (i) health professionals "should set an example and not smoke" and "should provide smoking cessation support"; (ii) hospitals "should provide smoking cessation treatments" and are "role model organizations in compliance with the smoke-free legislation", and (iii) "hospitalization is a perfect moment to quit smoking". Responses were described overall and according to participant and hospital characteristics: patient sex and age, type of hospital unit, number of beds, and smoking prevalence among hospital staff. RESULTS: The majority of participants considered that health professionals should be role models in tobacco cessation (75.3%), should provide smoking cessation support to patients (83.0%), and that hospitalization is a good opportunity for initiating an attempt to quit (71.5%). Inpatients admitted to general hospitals where smoking cessation was not given as part of their portfolio, with a low level of implementation in tobacco control, and who stayed in surgical units had higher expectations of receiving smoking cessation interventions. CONCLUSIONS: Inpatients strongly support the role of hospitals and health professionals in tobacco control and expect to receive smoking cessation interventions during their hospital stay. Systematically providing smoking cessation services in hospitals may have a relevant impact on health outcomes among smokers and on health care system expenditures.

Compliance with statewide regulations for communication of patients' multidrug-resistant organism and Clostridium difficile status during transitions of care.

In 2014, Oregon implemented an interfacility transfer communication law requiring notification of multidrug-resistant organism status on patient transfer. Based on 2015 and 2016 statewide facility surveys, compliance was 77% and 87% for hospitals, and 67% and 68% for skilled nursing facilities. Methods for complying with the rule were heterogeneous, and fewer than half of all facilities surveyed reported use of a standardized interfacility transfer communication form to assess a patient's multidrug-resistant organism status on transfer.