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dc.contributor.author Record, Katherine L. en_US
dc.date.accessioned 2011-06-21T17:27:40Z
dc.date.available 2011-06-21T17:27:40Z
dc.date.issued 2010 en_US
dc.identifier.citation Record,Katherine L.. 2010. Wielding the Wand without Facing the Music: Allowing Utilization Review Physicians to Trump Doctors' Orders, but Protecting them from the Legal Risk Ordinarily Attached to the Medical Degree. Duke law journal 59(5): 955-1000. en_US
dc.identifier.issn 0012-7086 en_US
dc.identifier.uri http://hdl.handle.net/10161/4213
dc.description.abstract This Note identifies a discrepancy in the law governing the decisionmaking that directs patient care. Seeking treatment that a third party will pay for, a patient needs not only a physician-prescribed course of treatment but also an insurer's verification that the cost is medically necessary or otherwise covered by the patient's plan. Both of these decisions directly impact the ultimate care delivered to the patient, but are governed by two very different liability regimes. A patient who suffers an adverse outcome may sue his physician in tort, while a patient who suffers from a lack of coverage may generally sue his insurer only under contract. In other words, when a patient suffers from inadequate care, his potential remedies vary considerably depending on whether the physician or the insurer is the defendant. This discrepancy in liability is the consequence of the federal law governing the administration of employer-sponsored health plans, and its extensive preemption of related state law. Many commentators have called for legal reform to address the distortion of managed care liability that results, arguing that managed care liability must be consistent or that wronged beneficiaries must have access to meaningful remedies. This Note argues that the federal law governing managed care organizations is problematic for a different reason and that the first step toward reform may be more elementary than previously suggested. Specifically, it suggests that the law governing insurers' coverage decisions is inconsistent with the law governing treatment recommendations. Patients suffer the same harm from error in both contexts-but because they can recover substantially more from treating physicians, doctors are named as defendants even when the insurers make errors. Further, this Note argues that simply aligning these two standards might offer a gateway to reform. en_US
dc.language.iso en_US en_US
dc.publisher DUKE UNIV en_US
dc.relation.isversionof en_US
dc.subject managed-care en_US
dc.subject health-care en_US
dc.subject liability en_US
dc.subject systems en_US
dc.subject expenditures en_US
dc.subject preemption en_US
dc.subject insurance en_US
dc.subject safety en_US
dc.subject reform en_US
dc.subject era en_US
dc.subject law en_US
dc.title Wielding the Wand without Facing the Music: Allowing Utilization Review Physicians to Trump Doctors' Orders, but Protecting them from the Legal Risk Ordinarily Attached to the Medical Degree en_US
dc.title.alternative en_US
dc.description.version Version of Record en_US
duke.date.pubdate 2010-2-0 en_US
duke.description.endpage 1000 en_US
duke.description.issue 5 en_US
duke.description.startpage 955 en_US
duke.description.volume 59 en_US
dc.relation.journal Duke law journal en_US

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