Health Law: Ethics and Governance Issues for
Health Care Organizations
Syllabus
2008
David Orbuch, J.D.; David Schultz
Hamline University School of Law
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General Course Information
Course: Ethics and Governance Issues for Health Care Organizations
Credits: 2
Classroom: To be announced
Days:
Time:
Professors: David Orbuch, J.D., David Schultz, J.D.
Office Phone: (612) 775-8815; (612) 672.8399
E-mail: David.Orbuch@allina.com
David.Schultz@maslon.com
Course Description
Our health care system is plagued with high costs and inconsistent outcomes. This class
will focus on the role of Boards of Directors in meeting theses and other health care
challenges. In addition to outlining governance structure and responsibilities, the course
will review both the current state and federal laws that apply to our health care system, as
well as tax policy with respect to tax exemptions for charitable entities and detail how
that tax exemption is conferred. Special attention will be given to not-for-profit, as well
as for-profit entities and the unique ethical and governance issues presented by various
organizational structures. Additionally, the course will cover the Sarbanes-Oxley Act
and the new or enhanced standards for all U.S. public company boards and management.
We will examine the implications of tax -exempt status for boards and then look deeper
to explore whether these health care providers markedly differ from for-profit providers
in operations, attention to the benefit of the community, and levels of charity care. The
class will also address selected ethical issues that arise in governance as more and more
of our citizens cannot afford health insurance and close to half of the population suffers
from chronic disease.
Course Evaluation
We will base your course grade on two small group assignments, a final paper that will be
assigned during the class and class participation. Your course grade may be adjusted onehalf of a letter (up or down) based on class preparedness in accordance with Hamline
University Academic Rules 1-107C5 and 1-110. More specifically, we reserve the right to:
(1) raise your course grade by one-half of a letter if you participate substantially when not
called on or distinguish yourself when called on; or (2) lower your course grade by one-half
of a letter if you are not prepared when called on.
Course Schedule
First Class: Ethics and Governance Issues for Health Care – Laying the Foundation.
Reading Materials:
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An Enemy of the People by Henrik Ibsen
Handout: By the Numbers, Health Care Economics
Class Discussion: Come Prepared to discuss Dr. Stockmann’s actions and whether he was truly
an enemy of the people or an enlightened health care leader.
Second Class: Meeting the requirements of being a tax exempt organization under state law –
what does it mean to be a non profit in Minnesota.
Reading Materials:
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Internal Revenue Code Section 501 (c)(3)
Minnesota Const. art. X, Section 1
Minnesota Statute Section 272.02, subd. 4
Village of Hibbing v. Comm’r of Taxation, 14 N.W. 2d 923 (Minn. 1944)
State v. Fairview Hosp. Ass’n, 114 N.W. 2d 568, 571 (Minn. 1962)
Rainbow Child Care, Inc. v. County of Goodhue, 741 N.W.2d 880 (Minn. 2007)
Third/Fourth Class: Should Hospitals be Tax Exempt under state law: Challenging the status quo.
Reading Materials:
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Tax-Exempt Hospitals: Discussion Draft, Senate Committee on Finance
IRS preliminary report: Executive Summary
IRS preliminary report: Hospital Compliance Project
Nonprofit Ownership, Private Property, and Public Accountability, Health Affairs, 25 no
4 (2006)
Fifth Class: Fraud and Abuse in Health Care: Doing the right thing each and every time.
Organizational Structure and the Provision of Health Care: An examination of ethical and
governance issues presented in the for-profit world. An introduction to the Sarbanes-Oxley
Act.
1st small group assignment passed out in class
Reading Materials: TBD
Sixth Class: Crossing the Quality Chasm, Formulating New Rules to Redesign and improve care
Reading Materials:
Institute of Medicine: Crossing the Quality Chasm/To Err is Human
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Errors in Health Care: A leading Cause of death and injury.
Why Do Errors Happen
Improving the 21st-Century Health Care System
Seventh/Eighth Class: The Role of the Board in Non-Profit Health care: The Duties of being a
Trustee of the Organization
Reading Materials:
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An Integrated Approach to Corporate Compliance, United States Department of Health
and Human Services, Office of Inspector General and American Health Lawyers
Corporate Responsibility and Health Care Quality, United States Department of Health
and Human Services, Office of Inspector General and American Health Lawyers
Ninth Class/Tenth Class: Co-Creating Health - - the Role of the Hospital in the Community
2nd small group assignment passed out in class
Reading Materials:
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Advancing the Public Accountability of non profit health care organizations
Non Profit Hospitals and the Provision of Community Benefits, Congressional Budget
Office
Caring for our Uninsured Patients – Understanding and Meeting our Compliance
Obligations, Orbuch and Payne
3/26 – Spring break
Tenth Class/Eleventh Class: Relationships with Industry
Reading Materials: TBD
Twelfth/Thirteen Class: Ethical Decision Making in Health Care: From the Bedside to the Board
Room; Stewarding Health Care Dollars While Caring for Individual Patients.
Reading Materials:
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Book: Business Ethics in Health Care – Beyond Compliance – Leonard J. Weber
Guide for Ethical Decision Making – Allina Hospitals and Clinics
Final exam will be passed out prior to the final class