"Systematizing" ethics consultation services.

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: (1) train-the-trainer, (2) local capacity-building, (3) circuit-riding, and (4) consolidated accountability. We note each model's benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations.

Fairness opinions in health care transactions--cause and effect: the emergence of private equity funds as a driving force in big and small transactions and the resulting increased use of fairness opinions.

The use of fairness opinions has become increasingly common with respect to the sale or merger of any company or division in a private equity funded or sponsored deal. The fairness opinion is often used to demonstrate that the value at which the transaction took place was a fair value to the selling company and thus did not improperly or unfairly leave the common holders with little consideration. This article covers rules and guidelines that should be adhered to in the issuance and review of fairness opinions.