Domain 2 Vocabulary Terms

Litigation

Litigation

the process of taking legal action

Judicial system

the court system which provides an avenue to enforce both rights and obligations

Legislative system

enacts laws and controls many activities related to industry (healthcare industry) via statutes

Statutes

often set forth required actions are laws created by legislative bodies

Administrative system

controls governmental administrative operations, operates through federal and state administrative agencies that enact regulations

Regulations

rules derived from or brought forward by administrative agencies subsequent (coming after) to the passage of statutes

Legal system

the mechanism through which members of society settle disputes; these disputes may occur between private individuals and organizations or between either of these entities and the government (can be state, federal, local, or a combination)

Common law (Judicial law)

judge-made law; case law; created by courts that resolve disputes

Precedent

binding force for future cases addressing the same issues

Persuasive authority

guidance using other systems precedents in analyzing a specific legal problem (ex. one state looking to another state’s precedent or lower court systems looking at higher level court)

Stare decisis

“let the decision stand”

• states that in lower court cases involving a fact pattern similar to that in a higher court within the same court system, the lower court is bound to apply the decision of the higher court

Statutory law (Legislative law)

written law established by federal and state legislators

• it may be amended, repealed, or expanded by the legislature

• may be upheld or found by a court to violate or conflict with the state or federal constitution

• may be found to conflict with a different state law or federal law

• may be revised by a court ruling in terms of its constitutionality and applicability since courts interpret laws in terms of how they apply to a given situation

• if legislature disagrees with the court’s interpretation it can revise the statute → the revision then becomes the law instead of the court’s revision based upon interpretation

Administrative law

branch of law that controls the government’s agencies or administrative operations

• administrative agencies include: licensing bodies, CMS, and other federal and state government programs

*additionally regulatory agencies can at times function in a legislative, adjudicative, and enforcement role regarding their own regulations

Federal Register

publication issued by the US Government Printing Office used to make agency rules, opinions, orders, records, and proceedings available to the public (required by the Administrative Procedure Act)

Code of Federal Regulations (CFR)

compilation of federal administrative regulations

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

initially focused on making it easier for employees to retain health coverage when they changed jobs or their family status changed

also addresses waste, fraud, and abuse in the healthcare system; created a single federal standard electronic claims format for electronic data exchange and focuses on simplifying the administration of health insurance

published in the Federal Register

Jurisdiction

the right to hear and decide the controversy in a given case

Subject matter jurisdiction

includes federal crimes and constitutional issues

Diversity jurisdiction

where parties do not live in the same state

Trial court

lowest level in the court system

• state civil and criminal cases are initiated at this level (has the authority to first hear a case on a given matter → original jurisdiction)

Original jurisdiction

authority to first hear a case on a given matter

Limited jurisdiction

may only hear certain types of cases (some trial courts have this)

General jurisdiction

hear cases of all types

Appellate court (a court of appeals)

(next level up from trial courts) decisions made in a trial court may be appealed to an intermediate court (appellate court)

Supreme court

highest level of court in state legal systems (each state has one)

• have general jurisdiction over all cases heard in state’s trial and appellate courts

• decisions coming from this level of court in the state hearing a case become the law of that state unless a state legislative process enacts a statute to override the court’s decision or overturned by another case

District courts

94 trials courts in the federal court system

• specialized federal courts have exclusive jurisdiction over certain matters such as bankruptcy, customs, and claims against the federal government (these cases of these matters cannot be filed in a state court)

Courts of appeals

appellate courts

• there are 13 at the federal level

• each of these courts covers a specific geographic region or circuit

Circuit

when the federal appellate courts cover geographic regions but are connected

Circuit courts

courts that review cases heard in federal district court within the court’s circuit

• review orders issued by certain administrative agencies

• issue original writs in cases as appropriate

Writs

written commands

Petition for writ of certiorari

a request for the US Supreme Court to consider a case

• supreme court will either grant certiorari (hear the case) or deny (declines to hear case)

• majority of requests are denied

Public law

involves the relationship between the government (at any level) and individuals or organizations; the government IS a party

purposes:

• defining

• regulating

• enforcing rights

Private law

involves the relationship between private entities or individuals; the government is NOT a party

Civil Law

addresses noncriminal legal matters and involves relationships among individuals, corporations, government entities, and other orgs

• most actions encountered in healthcare are based on civil law

Plaintiff

party bringing action or complaint in a civil case

Complaint

a legal document that sets forth the facts and claims

Summons

a notice served to the defendant in a civil case

Defendant

party accused of committing the wrong

Answer

defendant’s response to the complaint

Restitution

compensation

Evidence

supporting information

Burden of proof

requisite degree of belief to support the purported claims

• varies depending on the type of case

Counterclaim

when the defendant brings a claim back to the plaintiff

Cross-claim

one party may bring a claim against another party who is on the same side of the litigation

Joinder

defendant bringing a claim against an outsider as a co-defendant

Default judgement

when the plaintiff is in favor due to the defendant failing to file a timely answer

Trier of fact

a judge or jury

Settlements

official agreements

Arbitration

where an impartial third party makes a binding decision

Mediation

an objective third party hears a dispute and brings the parties to a mutual agreement

Discovery

consists of both the pretrial period and and the activities by which both the plaintiffs and defendants will obtain information held by other parties to assess the strengths and weaknesses of each parties case

Depositions

sworn statements from the witness

Interrogatories

formal questions

Requests for production

legal request for documents from the opposing party ; requesting a mental and physical examination of a party

Subpoenas

directives to attend or respond to legal proceedings

Motions for summary judgement

both parties argue either that there are or there are not any facts remaining in dispute and that one or the other is or is not entitled to a judgement being entered without the intervention of a trier of fact (judge or jury)

both parties present this

Preponderance of evidence

the plaintiff must prove their case by the burden of proof

Damages

amount of money awarded due to the liability

Adjudicated

formally decided, through the trial court

Res judicata

the same parties may not pursue the case again

Criminal law

addresses crimes or wrongful acts against public health, safety, and welfare

• encompasses both conviction and punishment

Conviction

declaration that a party is guilty

Felony

more serious crime (murder and other homicides, rape, assault, and thefts of items or cash in excess of a certain value set by statute

• information theft can also be a part of this depending on the case

Misdemeanor

lesser offense

• includes:

  • disorderly conduct

  • theft of small amounts of property

  • information theft

Prosecutor

state or district attorney or federal = US attorney

• they file charges against the defendant on behalf of the governemnt if enough evidence is found

Grand jury

• the jury that in some states must return an indictment for a felony crime to be prosecuted

• has the authority to issue subpoenas for its investigative process

• all evidence considered by the grand jury remains confidential unless an indictment is issued

Indictment

formal charge

Arraigns

in criminal cases, when a defendant is called before the court and charges are brought by the prosecutor against the defendant

Beyond a reasonable doubt

the burden of proof that the government must meet to establish the defendant’s guilt

Acquittal

when a defendant is found not guilty and then charges are dismissed

Hung jury

if all individuals of a jury cannot agree on defendant’s guilt or lack of proven guilt

Tort

a civil wrong

Tort law

actions brought when one party believes another party caused harm through wrongful conduct

Negligence

acting in an unreasonable manner or failing to act a reasonably prudent person would in similar circumstances

• can also be when an individual has evaluated the alternatives and the consequences of those alternatives and has not excised their best possible judgement

Standard of care

what an individual is expected to do or not to do in a given situation

• established in a variety of ways:

  • accrediting bodies or professional associations

  • statute or regulation

  • by practice

Malfeasance

the execution of an unlawful or improper act

Misfeasance

improper performance of an act resulting in injury to another

Nonfeasance

failure to act when there is a duty to act as a reasonably prudent person would act in similar circumstances

Ordinary negligence

failure to do what a reasonably prudent person would do or doing something that a reasonably prudent person would not do in the same or similar situation

Gross negligence

extreme departure from the ordinary standard of care that shows a reckless disregard toward others

Criminal negligence

if gross negligence is defined by a criminal statute

Duty of care

an obligation to meet a standard of care within the relationship

Breach of duty of care

plaintiff must present evidence that the defendant acted unreasonably under the circumstances

• (failure to follow a standard of care or deviation from standard of care)

Injury or harm

must demonstrate that they suffered an injury or harm as a result of defendant’s negligent act or failure to act

• doesn’t just include physical injury but also mental suffering, pain, loss of income or reputation, loss of consortium, and invasion of patient rights and privacy

Causation

must show that defendant’s conduct caused the harm

Actual causation

defendant’s conduct ACTUALLY caused harm

Proximate causation

breach was foreseeable cause of harm

Res ipsa loquitur

“the thing speaks for itself”

element applied in this doctrine:

• injury that does not ordinarily occur in the absence of negligence

• injury caused by agency or Instrumentally in defendant’s exclusive control

• injury not due to voluntary action or contribution of the plaintiff

Intent

person committed an act purposely or knowing that harm would likely occur

Assault

conduct along with apparent ability causing apprehension that physically harmful or offensive contact will occur

(the harm does not actually need to occur for it to be considered assault)

Battery

intentional and nonconsensual touching of another person’s body

False imprisonment

intentional confinement of someone against their will

• includes defendant’s lack of legal authority or justification to confine a person

Discharge against medical advice (AMA)

form signed by patient when patient insists on leaving the facility against medical advice and then releases the facility from responsibility

Defamation of character

false communication about someone to a person other than the subject that may injure a the subject’s reputation

Slander

spoken false communication that hurts the subject’s reputation

Libel

Written communication that hurts the subject’s reputation

Fraud

an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to themself or some other person

Invasion of privacy

intrusion upon one’s solitude

Right to privacy

the right to be “let alone”

includes:

• rights to be free from surveillance and interference

• right to keep one’s information from being disclosed

Infliction of emotional distress

intentional or reckless; mental suffering resulting from despair, shame, grief, and public humiliation

• ex. plaintiff shows that the defendant intended to cause mental distress and knew or should have known that their actions would do so