Chapter 4

Introduction

Healthcare law in the United States is grounded in a multifaceted legal framework designed to ensure the delivery of safe, ethical, and equitable healthcare services. This framework encompasses various sources of law that collectively govern the rights, responsibilities, and operations within the healthcare system.

Primary Sources of Healthcare Law

1. Constitutions (Federal and State)

U.S. Constitution: Establishes the foundational legal structure, delineating the powers of federal and state governments. Key provisions impacting healthcare include the Commerce Clause, which allows federal regulation of interstate health services, and the Due Process and Equal Protection Clauses of the 5th and 14th Amendments, safeguarding individual rights in healthcare decisions.(CDC)

State Constitutions: May provide additional rights and frameworks for healthcare delivery within individual states.

2. Statutory Law (Legislation)

Federal Statutes: Enacted by Congress, these laws address nationwide healthcare concerns. Notable examples include:

Health Insurance Portability and Accountability Act (HIPAA): Protects patient health information privacy.

Affordable Care Act (ACA): Expands healthcare access and insurance coverage.

Medicare and Medicaid Acts: Provide healthcare coverage for specific populations.(libguides.americansentinel.edu)

State Statutes: Address local healthcare issues, including professional licensure, public health mandates, and facility regulations.

3. Administrative Law (Regulations)

Federal Agencies: Such as the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), develop regulations to implement and enforce healthcare laws. These regulations are compiled in the Code of Federal Regulations (CFR), particularly Title 42, which pertains to public health.(OU Guides)

State Agencies: State health departments and licensing boards issue regulations governing local healthcare practices and standards.

4. Common Law (Judicial Decisions)

Case Law: Judicial interpretations of statutes and regulations shape the application of healthcare laws. Landmark court decisions establish precedents in areas such as medical malpractice, informed consent, and patient rights.

Application in Healthcare Practice

These legal sources collectively influence various aspects of healthcare, including:

• Patient Rights: Ensuring informed consent, privacy, and access to care.
• Professional Conduct: Defining standards for licensure, scope of practice, and disciplinary actions.
• Healthcare Operations: Regulating facility accreditation, reimbursement procedures, and compliance requirements.

Healthcare professionals must navigate this complex legal landscape to provide compliant and ethical care. Staying informed about relevant laws and regulations is essential for protecting patient welfare and maintaining professional integrity.

Law can be systematically categorized based on various criteria, including the relationships it governs, its purpose, and its application. Understanding these classifications provides clarity on how legal systems function and how different laws interact.

Primary Classifications of Law

1. Public Law vs. Private Law

• Public Law: Governs the relationship between individuals and the state. It encompasses:
• Constitutional Law: Deals with the structure and function of government entities and the rights of individuals.
• Administrative Law: Regulates the activities of governmental agencies.
• Criminal Law: Pertains to laws that define offenses against the state and prescribe punishments. (UOLLB First Class Law Notes®, Wikipedia)
• Private Law: Focuses on legal relationships between private individuals or entities. It includes:
• Contract Law: Governs agreements between parties.
• Tort Law: Addresses civil wrongs causing harm or loss.
• Property Law: Relates to the ownership and use of property.
• Family Law: Covers matters such as marriage, divorce, and child custody. (Wikipedia)

2. Civil Law vs. Criminal Law

• Civil Law: Addresses disputes between individuals or organizations, typically involving compensation. Examples include contract disputes and personal injury claims.
• Criminal Law: Involves prosecution by the state of individuals or entities accused of committing crimes, with penalties including fines, imprisonment, or other sanctions.

3. Substantive Law vs. Procedural Law

• Substantive Law: Defines the rights and obligations of individuals and collective bodies. It determines how facts in the case will be handled and how the crime is to be charged.
• Procedural Law: Outlines the methods and means by which substantive laws are enforced, including the steps for conducting a legal action.

4. International Law vs. National (Municipal) Law

• International Law: Governs the legal relations between nations and includes treaties, conventions, and agreements.(mecle.org)
• National Law: Applies within a specific country and includes laws enacted by the national or local governments.

These classifications provide a framework for understanding the diverse and complex nature of legal systems, facilitating better navigation and application of the law in various contexts.

In healthcare, tort law addresses civil wrongs that cause harm to individuals, providing a legal framework for patients to seek compensation when injured due to a healthcare provider’s actions or omissions. Negligence, a prevalent type of tort in this context, plays a significant role in shaping medical practice and patient safety.(The Law Offices of James L. Arrasmith)

Understanding Torts in Healthcare

A tort is a civil wrong—excluding breaches of contract—that results in harm or injury, leading to legal liability. In the healthcare setting, torts allow patients to pursue legal remedies when they suffer harm due to a provider’s conduct. The primary categories of torts relevant to healthcare include:

Negligent Torts: These occur when a healthcare provider fails to exercise the standard of care that a reasonably competent professional would under similar circumstances, leading to patient harm. Examples encompass misdiagnoses, surgical errors, or failure to obtain informed consent. (The Law Offices of James L. Arrasmith)

Intentional Torts: These involve deliberate actions that cause harm, such as assault, battery, or false imprisonment. In healthcare, this could include performing a procedure without patient consent.(The Law Offices of James L. Arrasmith)

Strict Liability Torts: Under strict liability, a party can be held responsible for damages without proof of negligence or intent. In healthcare, this often pertains to cases involving defective medical products or pharmaceuticals.(The Law Offices of James L. Arrasmith)

Elements of Negligence in Healthcare

To establish a negligence claim in healthcare, a patient (plaintiff) must prove the following elements:

Duty of Care: The healthcare provider had a legal obligation to provide care to the patient.

Breach of Duty: The provider failed to meet the established standard of care.

Causation: The breach directly caused injury or harm to the patient.

Damages: The patient suffered actual harm or losses as a result. (Wikipedia)

These components are essential in medical malpractice cases, a subset of negligence claims specific to healthcare professionals.

Impact of Negligence on Healthcare Practice

Negligence in healthcare can lead to significant consequences, including patient injury, loss of trust, and legal liability for providers. Common scenarios include:

Misdiagnosis or Delayed Diagnosis: Failing to identify a condition promptly, leading to worsened patient outcomes.

Surgical Errors: Performing incorrect procedures or operating on the wrong site.

Medication Mistakes: Administering incorrect dosages or drugs.

Such incidents not only harm patients but also expose healthcare providers and institutions to lawsuits, financial penalties, and reputational damage. (The Law Offices of James L. Arrasmith)

Mitigating Negligence Risks

Healthcare providers can reduce the risk of negligence claims by:

Adhering to Standard Protocols: Following evidence-based guidelines and procedures.

Effective Communication: Ensuring clear, informed discussions with patients about treatments and risks.

Continuous Education: Staying updated with medical advancements and best practices.

Comprehensive Documentation: Maintaining accurate and thorough patient records.

By upholding high standards of care and ethical practices, healthcare professionals can safeguard patient well-being and minimize legal exposure.

Contracts

A contract is a legally binding agreement between two or more parties that creates mutual obligations enforceable by law.

To break it down:

It involves an offer by one party and an acceptance by another.

Each party must agree to give something of value, known as consideration (like money, services, or goods).

The parties must have the intention to enter into a legal relationship.

If valid, a contract can be enforced in court if one party fails to meet their obligations (called a breach of contract).

Contracts can be written, verbal, or implied by conduct, though written contracts are easier to prove and enforce.

A physician-patient contract is an implicit or explicit agreement between a doctor and a patient that establishes the terms of their professional relationship. It is built on mutual trust, responsibilities, and obligations, and it can be either formal (written) or informal (implied by conduct).

Key Elements of a Physician-Patient Contract:

Mutual Consent
Both the physician and the patient must agree to enter into a professional relationship. This usually happens when a doctor agrees to diagnose or treat the patient, and the patient agrees to be treated.

Competence and Capacity
Both parties must be legally and mentally capable. The physician must be licensed and qualified, and the patient must be capable of making informed decisions (or have a legal guardian do so).

Consideration
While not always financial, this refers to the exchange—medical care in return for payment or another agreed form of compensation.

Legal Purpose
The care provided must be for a lawful medical purpose and within the scope of professional ethics and regulations.

Responsibilities of Each Party:

Physician:

• Provide competent and ethical medical care.
• Maintain confidentiality (HIPAA in the U.S.).
• Inform the patient of risks, benefits, and alternatives (informed consent).
• Refer or terminate care properly if needed.

Patient:

• Provide accurate medical history.
• Follow treatment recommendations.
• Show up for appointments or notify of cancellations.
• Pay for services as agreed.

Termination of the Contract:

The physician-patient relationship can end if:

• The patient is cured or the treatment is completed.
• The patient fails to comply with treatment.
• The physician properly withdraws with adequate notice.
• Either party decides to end the relationship under acceptable conditions.
• Wrongful termination (abandonment) without proper notice or referral can lead to medical malpractice claims.

Expressed Contracts

An expressed contract (or express contract) is a type of agreement in which the terms are clearly stated and agreed upon by all parties, either orally or in writing.

Key Features of Expressed Contracts:

• Clear Offer and Acceptance
  The parties explicitly communicate their intentions to enter into a contract and agree to its terms.
• Definite Terms
  The obligations, rights, and expectations of each party are specifically outlined.
• Can Be Written or Oral
  • Written example: A signed lease agreement.

Expressed vs. Implied Contract:

Feature	Expressed Contract	Implied Contract
Terms	Clearly stated (oral or written)	Inferred from actions or circumstances
Example	Signed treatment agreement	Patient visits a doctor and receives care

Termination of a Contract Between a Patient and a Physician

The physician-patient relationship is a professional contract that can be terminated by either party under appropriate circumstances. However, termination must be handled carefully to avoid legal or ethical issues, such as patient abandonment.

Ways the Contract Can Be Terminated

• Mutual Agreement
  Both physician and patient agree to end the relationship—for example, if the patient moves or switches providers.
• Patient-Initiated Termination
  A patient can leave the care of a physician at any time, with or without stating a reason.
• Physician-Initiated Termination
  A doctor may terminate the relationship only if proper notice and care transition are provided. Valid reasons may include:
  • Repeated missed appointments
  • Noncompliance with medical advice
  • Abusive or threatening behavior
  • Failure to pay bills

Completion of Treatment
When care is completed (e.g., a short-term procedure or episode of illness), the relationship ends naturally.

Physician’s Inability to Continue
Examples: Retirement, relocation, illness, or loss of medical license.

To Avoid Patient Abandonment (a form of medical malpractice)

When a physician ends the relationship, they must:

1. Provide written notice to the patient (preferably 30 days in advance)
2. Offer emergency care during a transition period
3. Recommend alternative providers or referrals
4. Transfer medical records upon request

Laws Governing Payment of Fees at Fulfillment of a Contract

When a contract is fulfilled—meaning all agreed services or obligations have been completed—payment of fees is typically governed by contract law, which is influenced by national and local statutes. Here’s a breakdown of key principles and laws involved:

1. Contract Law Principles

Under general contract law:

• Payment is due upon fulfillment of the agreed terms, unless otherwise specified in the contract (e.g., payment in advance or in installments).
  • If a contract includes a payment clause, the timing, method, and amount of payment must follow those terms.
  • If not specified, courts usually interpret that payment is due at the time of service completion.

2. Express vs. Implied Payment Terms

• Express Contract: The payment terms (due date, amount, penalties for late payment) are clearly stated and enforceable.
• Implied Contract: Even if not written, the law assumes a reasonable payment is owed after services are performed (e.g., in a physician-patient relationship).

3. Relevant Laws (Depending on Jurisdiction)

Depending on your location, payment obligations are enforced under:

• Contract Acts (e.g., Contracts Act 1872 in India)
• Uniform Commercial Code (UCC) – U.S. (for goods; Article 2)
• State Civil Codes or Consumer Protection Acts
• Medical Billing Regulations – In healthcare, especially in the U.S., federal and state laws (e.g., Truth in Lending Act, Fair Debt Collection Practices Act) may also apply.

4. Breach of Payment Terms

If a party fails to pay as agreed after fulfillment:

• The service provider can issue a demand for payment.
  • If unpaid, they can sue for breach of contract or refer the debt to collections.
  • Interest or late fees may apply if specified in the contract or allowed by law.

Legal Principles Governing Payment in Medicine (After Contract Fulfillment)

1. Legal Basis of Payment Obligation

Once a physician has provided care (consultation, procedure, treatment), the patient is legally obligated to pay under:

Contract Law (express or implied contract)

Medical billing laws and professional codes

Sometimes, insurance agreements (if applicable)

Even if there is no written contract, courts often recognize an implied contract when:

• A patient seeks treatment.
• A physician provides care.
• Payment is a reasonable and expected result.

2. Timing of Payment

Payment is typically due at the time of service or upon receipt of a bill, depending on clinic policies.

If the contract specifies a payment plan, the patient must follow it.

3. Relevant Laws in the U.S. (as an example)

• Truth in Lending Act (TILA): If the provider allows payment in installments and charges interest, a written agreement must disclose terms.
• Fair Debt Collection Practices Act (FDCPA): Regulates third-party collections.
• HIPAA: Governs how billing information is shared—protects patient privacy.

In other countries, similar legal frameworks apply:

UK: NHS treatment is usually free at the point of care, but private care follows contract law.

India: The Contracts Act, 1872 governs obligations, and the Medical Council of India (MCI) guidelines may apply.

Canada: Public healthcare doesn’t involve fees directly from patients, but private or uncovered services fall under provincial contract law.

4. Non-Payment Remedies

If a patient fails to pay:

• The provider can issue a demand letter.
• Late fees or interest can be charged if disclosed beforehand.
• The provider can engage a collection agency (subject to local laws).
• Legal action can be taken for breach of contract.
• Important: A physician must avoid “patient abandonment.” Care must continue until proper notice or referrals are made—even if bills are unpaid.

Summary for Medical Practice

Implied Contracts in Medicine

An implied contract in medicine is a legally recognized, unwritten agreement that arises from the behavior and circumstances of the physician and patient. It does not require written or verbal consent to be valid—the agreement is “implied” by actions.

Key Features of Implied Contracts in Medicine:

Mutual Consent by Conduct

The patient seeks care (e.g., schedules an appointment or walks into a clinic).

The physician provides diagnosis or treatment.

• This mutual interaction implies a contract to provide and pay for medical services.

Legally Binding
Courts generally recognize that if:

• A licensed provider renders care.
• The patient accepts that care.
• There is an expectation of payment.
  • Then an implied physician-patient relationship (i.e., contract) exists.

No Need for Express Agreement
Even if nothing is said or signed, the obligation to pay, and the duty to provide competent care, are in force.

Legal and Ethical Duties Under Implied Contracts:

Physician’s Obligations:

• Provide competent and ethical care
• Maintain confidentiality
• Inform the patient about treatment risks/benefits
• Avoid abandonment (must give notice before ending care)

Patient’s Obligations:

• Follow instructions and attend appointments
• Pay for services rendered (even if not discussed in detail)
• Provide accurate medical history

When Implied Contracts Do NOT Apply:

• If the physician explicitly declines to treat the patient before any care is given
• If there’s no interaction or duty initiated
• If the patient is under the care of another provider without the current physician’s involvement

Summary:

Element				Implied Contract in Medicine
Written or Verbal?				No – Based on actions
Legal?				Yes – Enforceable under law
Typical Situations				Walk-ins, ongoing care, emergencies
Key Risks				Patient abandonment if improperly terminated

 

Summary:

Express Contracts are clear and offer legal protection through documentation.

Implied Contracts are common in everyday medical practice and still legally binding, but less defined—so providers must maintain good records and professional conduct.

Feature	Express Contract	Implied Contract
Definition	Terms are clearly stated (written or spoken).	Terms are inferred from the conduct of the parties.
Form	Verbal or written agreement.	Unwritten, based on behavior or circumstances.
Creation	Intentionally agreed upon by both parties.	Arises automatically when a patient seeks care and the physician provides it.
Example	Signed consent form for surgery.	Walk-in patient receives treatment without a formal agreement.
Documentation Required	Often documented in records or signed forms.	No formal documentation, but treatment is recorded.
Legal Validity	Fully enforceable by law.	Fully enforceable by law.
Clarity of Terms	Clearly defined (fees, duties, procedures).	General obligations are understood but not stated.
Used in Situations Like	Elective procedures, treatment plans, and billing contracts	Emergency care, general visits, informal follow-ups
Risk to Provider	Lower terms are documented	Higher- misunderstandings or disputes may arise

Physician–Patient Contracts and Managed Care

In modern healthcare systems, especially in the United States and other countries with insurance-based models, physician-patient contracts are often influenced by managed care arrangements. These relationships can be more complex than traditional fee-for-service models due to involvement from insurance companies, HMOs, and PPOs.

1. What is Managed Care?

Managed care is a system where a third-party payer (like an insurance company or Health Maintenance Organization – HMO) manages:

• Cost
• Quality
• Access to healthcare

It affects physician-patient contracts because physicians must abide by payer network rules, and patients are typically restricted to a network of providers.

2. Physician–Patient Contracts in Managed Care

Element	Description
Nature of Agreement	A triangular contract often exists between the patient, physician, and insurer.
Express or Implied?	Often implied through insurance enrollment and provider participation.
Key Feature	Patients agree to receive care within the network, and physicians agree to follow insurer rules.
Payment Terms	Reimbursement rates, copayments, and service limitations are dictated by the managed care plan.
Limits on Services	Some treatments may require preauthorization or be denied coverage.

3. Obligations of Physicians Under Managed Care Contracts

Physician Must	Explanation
Follow payer rules and formularies	Prescribe drugs and treatments per insurer-approved list
Accept discounted payment rates	Lower than private-pay or out-of-network rates
Obtain prior authorizations when needed	For surgeries, tests, referrals
Submit to utilization and quality review	May affect bonuses or continued participation in the network
Provide standard of care	Regardless of cost constraints or coverage limitations

Impact on the Physician–Patient Relationship

Pros:

• Lower costs for patients
• Coordinated care
• Incentives for preventive care

Cons:

• Restricted provider choices
• Delays in care due to authorizations
• Potential ethical conflicts between cost control and optimal care

Best Practices for Physicians in Managed Care

Inform patients of any coverage limits or out-of-pocket costs.

Stay updated on the plan’s policies and drug formularies.

Document care decisions clearly, especially when a service is denied by the plan.

Advocate for patients when coverage disputes arise.

Patients’ and Physicians’ Rights and Responsibilities

Physician Rights and Responsibilities

In the physician–patient relationship, physicians hold both rights and professional responsibilities, governed by medical ethics, law, and regulatory standards. These guide how they provide care, interact with patients, and protect their own legal and professional standing.

1. Physician Responsibilities

Responsibility	Explanation
Provide Competent Medical Care	Physicians must deliver care that meets the standard of practice in their field.
Maintain Patient Confidentiality	Patient information must be kept private (e.g., under HIPAA in the U.S.).
Obtain Informed Consent	Patients must be informed about the nature, risks, and alternatives of treatments.
Treat Patients with Respect	Care must be given without discrimination or prejudice.
Maintain Professional Boundaries	Physicians must avoid inappropriate personal, financial, or emotional relationships with patients.
Keep Accurate Medical Records	Records must be complete, clear, and timely.
Follow Up on Care	Physicians should ensure continuity and follow-up after treatment or referral.
Stay Competent Through Education	Physicians must stay up to date with medical advancements and continuing education.

2. Physician Rights

Right	Explanation
Right to Choose Patients	Except in emergencies or discriminatory exclusions, physicians can choose whom to treat.
Right to Terminate Relationships	Physicians may end the patient relationship with proper notice and handoff (avoiding abandonment).
Right to Refuse Inappropriate Care	They may decline to provide care that is outside their expertise or ethically objectionable.
Right to Be Paid	Physicians have the right to receive compensation for services rendered.
Right to Legal Protection	Protection against false claims, harassment, or violence in the workplace.
Right to Confidentiality	Like patients, physicians are also entitled to privacy and protection of their personal information.

Ethical and Legal Oversight

Physician rights and responsibilities are enforced and monitored by:

• Medical licensing boards
• Professional organizations (e.g., AMA, GMC, MCI)
• Hospital ethics committees
• Legal systems (malpractice law, patient rights statutes)

Summary Chart

Category	Responsibilities	Rights
Clinical	Provide standard care, follow-up	Refuse care outside expertise
Legal/Ethical	Informed consent, confidentiality	Choose patients, terminate with notice
Professional	Ongoing education, accurate documentation	Confidentiality, workplace safety
Financial	Transparent billing	Right to compensation

Patient’s Rights and Responsibilities

Patients play an essential role in the healthcare system. Recognizing their rights ensures respectful, ethical treatment, while understanding their responsibilities fosters a cooperative and effective patient–provider relationship.

1. Patient Rights

Right	Explanation
Right to Quality Care	Receive safe, competent, and respectful care regardless of race, gender, or background.
Right to Informed Consent	Know about their diagnosis, treatment options, and give voluntary consent.
Right to Privacy and Confidentiality	Medical information must be kept private (e.g., HIPAA in the U.S.).
Right to Emergency Care	Access emergency services when and where needed.
Right to Know Healthcare Providers	Know the identity and qualifications of caregivers.
Right to Refuse Treatment	Decline any treatment (except where legally limited, such as with public health risks).
Right to Access Medical Records	View or obtain copies of their health information.
Right to Voice Complaints	File grievances about care or services without fear of discrimination or retaliation.

 

2. Patient Responsibilities

Responsibility	Explanation
Provide Accurate Information	Share complete health history and symptoms with providers.
Follow Prescribed Treatment Plans	Adhere to instructions and medications as directed.
Respect Health Professionals	Treat staff and other patients with courtesy and respect.
Understand the Care Plan	Ask questions when unclear about diagnoses, treatments, or risks.
Keep Appointments	Show up on time or provide advance notice if canceling.
Pay Medical Bills Promptly	Settle charges as agreed or communicate financial issues.
Follow Rules and Regulations	Observe hospital/clinic policies and safety rules.
Advocate for Their Own Health	Take an active role in maintaining and improving personal health.

Summary Chart

Category	Patient Rights	Patient Responsibilities
Care	Right to competent care	Follow treatment and care plans
Communication	Right to be informed and ask questions	Provide honest, full medical information
Autonomy	Right to refuse treatment or choose options	Understand the consequences of choices
Privacy & Access	Right to confidentiality and records	Respect others’ privacy in care settings
Logistics	Right to fair billing and grievance process	Keep appointments, settle bills, and follow rules

Leaving Against Medical Advice

Leaving Against Medical Advice (AMA) refers to a situation where a patient chooses to leave a healthcare facility before the treating physician recommends discharge.

Key Points about Leaving AMA:

What It Means

The patient voluntarily chooses to end care, often despite being informed of the potential medical risks.

This decision can involve inpatient, emergency, or outpatient settings.

Common Reasons Patients Leave AMA:

• Financial concerns
• Family obligations
• Dissatisfaction with care
• Desire for alternative treatment or facility
• Perceived improvement in condition

💡 Responsibilities of Healthcare Providers:

Inform the patient of risks associated with leaving.

Document the conversation thoroughly.

Offer continued care options or follow-up instructions.

Ask the patient to sign an AMA form (as provided above).

🩺 Risks of Leaving AMA:

Worsening condition

Complications or delayed treatment

Readmission or emergency return

Legal or insurance implications (though leaving AMA does not always void coverage)

📝 Best Practices for Handling AMA Situations:

Remain respectful and non-confrontational.

Involve case management or social work if needed.

Try to resolve patient concerns.

Ensure the patient has the mental capacity to make decisions.

Chapter 4 Summary

⚖️ 1. The Law in Medicine

Medical law governs the responsibilities and rights of healthcare providers and patients. It ensures ethical, safe, and legal care delivery.

Key Types of Law:

Constitutional Law: Guarantees patient rights (e.g., privacy, due process).

Statutory Law: Written laws (e.g., licensure acts) passed by legislatures.

Administrative Law: Rules by government agencies (e.g., CMS, state medical boards).

Common Law (Case Law): Court decisions that establish precedents.

🏛️ 2. The Court System

The courts interpret and enforce laws in medical cases.

Levels of Courts:

Trial Courts: First to hear cases (civil and criminal).

Appellate Courts: Review lower court decisions.

Supreme Court: Final authority (state or federal level).

Types of Cases in Healthcare:

Civil cases: Malpractice, breach of contract, negligence.

Criminal cases: Fraud, abuse, or illegal practice.

Administrative hearings: Licensure disputes or disciplinary actions.

📜 3. Contracts in Medicine

Contracts legally bind parties (e.g., physician-patient relationships).

Essential Elements of a Valid Contract:

Offer: One party proposes an agreement.

Acceptance: The other party agrees to the terms.

Consideration: Something of value exchanged (e.g., service for payment).

Legal Capacity and Purpose: Parties must be competent; purpose must be lawful.

Types of Contracts:

Expressed Contract: Clearly stated verbally or in writing.

Implied Contract: Established by actions or circumstances (e.g., emergency care).

⚠️ Breach and Termination

A breach occurs when one party fails to meet the terms.

A physician may terminate a contract if proper notice is given and continuity of care is ensured.