The reality of litigation in managed care.
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The Americans with Disabilities Act of 1990 (ADA) is considered the most sweeping civil rights legislation since the Civil Rights Act of 1964. The two parts of the ADA that apply most directly to healthcare providers are the prohibitions on employment discrimination and the requirements for provision of services to persons with disabilities. The ADA states that a person's disability should not be an adverse factor in employment decisions. Employers must make "reasonable accommodations" to the qualified person's known impairment so that person can perform his or her job more easily. The ADA also prohibits private entities from discriminating against persons with disabilities in the full and equal enjoyment of services (i.e., "public accommodations"). Providers will have an affirmative duty to remove (in existing buildings) architectural elements proven to be barriers to persons with disabilities. Public access requirements apply to new building construction as well. Healthcare providers must also install wheelchair lifts in shuttle bus systems they operate. Healthcare providers, both as employers and providers of public services, now have just a matter of months in which to respond to these new requirements. Planning efforts to ensure compliance should begin immediately.
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Most hospitals and health systems perceive and treat the year-2000 faulty computer code as a technical problem, but it is a high-level management problem. If hospitals don't start preparing comprehensively, they will face a host of consequences. Experts say spillover will extend into business issues, finances and liability. But providers must choose their most important priorities and develop contingency plans.
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Although studies have shown that most emergency department visits are not true emergencies, hospitals must be cautious of refusing admission to a patient. Courts tend to examine the patient's condition with the benefit of hindsight to determine if an emergency had existed at the time of refusal. Clear definition of the extent of emergency services provided at a hospital can help to ease the excess usage of the department.