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Abstract

I. Introduction . . . . . 510

II. A Road Map . . . . . 512

III. What Is Advocacy? . . . . . 513

A. Fiduciary Duty . . . . . 513

B. Health Care Professionals’ Viewpoint . . . . . 515

C. Common Law Views on Health Care Professionals Duty to Advocate . . . . . 516

D. Advocacy - A Problem of Definitions . . . . . 519

E. How Common Is Health Care Professional Deselection? . . . . . 522

F. National Health Care Professional Data Banks . . . . . 525

IV. Statutory and Common Law Protections for Health

Care Professionals Who Advocate for Their Patients . . . . . 527

A. Legislative Action . . . . . 527

1. Explicit Protection of Advocacy . . . . . 527

2. Implicit Protection of Advocacy . . . . . 532

a. By Statutes . . . . . 532

i. Prohibition of Retaliation Based on Rendering Mandated Services . . . . . 532

ii. Statutes Prohibiting “Gag Clauses” . . . . . 534

iii. Statutes Establishing Procedural Due Process for Health Care Professionals . . . . . 535

iv. Statutes Prohibiting Financial Incentives to Control Costs . . . . . 540

b. Other Statutory Protections for Advocacy . . . . . 541

B. Common Law Protection for Advocacy . . . . . 542

1. Fiduciary Duty to Advocate . . . . . 542

2. Implied Covenant of Good Faith and Fair Dealing . . . . . 544

3. Common Law Right to Fair Procedure . . . . . 546

4. Additional Common Law Theories . . . . . 547

V. Barriers to Enforcement of Advocacy Protection Laws . . . . . 550

A . Federalism . . . . . 550

1. ERISA Preemption . . . . . 550

2. Medicare Managed Care Preemption . . . . . 562

3. Procedural Enforcement Obstacles . . . . . 564

a. Does the Statute Create a Private Cause of Action? . . . . . 564

B. Burdens of Production and Persuasion . . . . . 567

C. Discovery . . . . . 570

1. Practical Burdens of Litigation . . . . . 572

VI. How Effective Are Advocacy Protection Laws – Is More Needed? . . . . . 573

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