Topics: Medicine, Health care, Physician Pages: 90 (29029 words) Published: December 12, 2012
Class notes
Thursday, January 13, 2011
4:01 PM

1. Dunbrook #: 860-874-6858
2. Final
a. 3 sections
i. 1 worth 50 pts : fact pattern-spot issues and apply laws
i i. 2 worth 25 pts: opinion letter to client - issue given to us i ii. 3 worth 25 pts: hypothetical future occurrence and a statute and if statute will stand 1) Case to look at given to us
b. Do not need to no ERISA or anti trust- look at highlighted areas c. No page limit
3. Introduction
i. The Deadly Choices at Memorial by Sheri Fink
1) Principal of double effect: give morphine ( to alleviate pain) to the point where it i nduces death
a. Defining Sickness: Defining Health
i . Important to define health, because quality of care relates to healthiness. Go to get care for preventive reasons and also to get healthy
ii. Definition of health
1) Class discussion
a) Physically fit
b) Disease free
c) The norm in regards to blood pressure, cholesterol, weight, etc. i) Who defines normal
i i) Does the norm change?
d) Organs are healthy
2) World Health Org: defines health as "a state of complete physical, mental and social well -being and not merely the absence of disease or infirmity" a) High threshold
b) What about the government providing public health care with this definition? Is i t possible?
i) Social indicia have as much as an impact on health as medical services One. This becomes complex
3) Limited definition: the performance by each part of the body of its "natural" function a) What is the range of normal function?
i) Is it statistically?
ii) What about fertility? Is infertility a disease? At some point men and women all become infertile so at what age is it considered a disease? iii) Can also be temporally defined: depends on timing if it, example -PMS iii. Katskee v. Blue Cross/Blue Shield of Nebraska (1994)

1) Facts: P's Dr diagnosed P as suffering from a genetic condition called breast -ovarian carcinoma syndrome and recommended that she undergo an operation to remove her uterus, ovaries, and fallopian tubes. Even though Katskee was diagnosed with a genetic condition with a high risk for developing cancer, Katskee did not have cancer. Her insurance provider, D, would not pay for the surgery bc they did not think it was necessary. The K that D and P had said that D would decide if the treatment for i llness (bodily disorder or disease) was medically necessary. P had the surgery and brought claim against D her insurance provider for breach of K. a) Class notes: before 1994 there was no test for the disorder, it was based on family history. In 1994 tests were developed

2) Procedural history: D filed a motion for summary judgment saying that P did not have a disease, she had a genetic disorder. And under the K they could decide what was medically necessary. DC approved motion. P filed appeal.

Notes Page 1

medically necessary. DC approved motion. P filed appeal.
3) Issue 1: Will an ambiguous term contained in an insurance policy be construed in favor of the insured?
4) Holding/Rule : Yes, An ambiguous term contained in an insurance policy will be construed
in favor of the insured.
5) Reasoning: If the contract is ambiguous, the court will look beyond the terms and l anguage of the contract to ascertain the intention of the parties. An ambiguous policy will be construed in favor of the insured. The plain meaning of “bodily disorder” and “disease” in Katskee’s insurance policy is unambiguous and encompasses any abnormal condition of the body that would problematic if untreated or a deviation from the healthy state of the individual.

6) Issue 2: whether Katskee had an “illness” that would be covered by her insurance policy.
7) D argument: P had a predisposition to cancer, not the disease itself. 8) Holding: Yes, the illness would be covered
9) Reasoning: Katskee’s genetic condition increased her risk of developing breast and/or ovarian cancer. Katskee’s condition is a deviation from what is considered a normal, healthy...
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