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
Recommended Citation
Linda C. Fentiman,
Patient Advocacy and Termination from Managed Care Organizations: Do State Laws Protecting Health Care Professional Advocacy Make Any Difference?,
82 Neb. L. Rev.
(2003)
Available at: https://digitalcommons.unl.edu/nlr/vol82/iss2/6