Frank, John Paul. 1991. Clement Haynsworth, the Senate, and the Supreme Court. Charlottesville, VA: Univ. of Virginia Press. Kotlowski, Dean J. 1996. “Trial by Error: Nixon, the Senate, and the Haynsworth Nomination.” Presidential Studies Quarterly 26, no. 1. v HAYS, WILLIAM HARRISON William Harrison Hays is mainly known for his establishment of the code through which motion picture producers regulated themselves, thereby avoiding outside CENSORSHIP. Hays was born in Sullivan, Indiana, on November 5, 1879, to John T. Hays and Mary Cain Hays. He first gained attention through a series of increasingly important positions within the Indiana REPUBLICAN PARTY. In February 1918 his party career culminated in his appointment as chairman of the Republican National Com- mittee. From that position he aided in the 1920 election of WARREN G. HARDING as president of the United States. As reward for his service, Hard- ing appointed Hays U.S. postmaster general in March 1921, after which Hays relinquished his position as Republican chairman. At this time a widely reported series of sex scandals contributed to a growing perception that the movie industry was out of control and out of step with U.S. society. With more than 30 state legislatures considering bills to censor movies, producers intervened to repair their image. In March 1922 they hired Hays, known as a teetotaler and an elder in the Presbyterian Church, to head the Motio n Picture Producers and Distributors of America (MPPDA) at $100,000 per year. With his high political profile, his personal moral characteristic s, and his connections with businesspeople, including Hollywood executives, Hays was seen as an outsider who could restore public confidence in the morality of the movie industry. The effort to head off federal or local cen- sorship through hiring Hays was successful. In 1930 the Hays Office, as it became commonly known, coordinated the Production Code among the producers of movies to provide rules for the film industry’s self-regulation. The 1930 code had no enforcement mechanism. Still, the hiring of Hays, the goodwill implied in the code, and a lack of cooperation and William H. Hays. CORBIS. William Harrison Hays 1879–1954 ❖ 1879 Born, Sullivan, Ind. ◆ 1900 Graduated from Wabash College; admitted to Indiana bar 1921–22 Served as U.S. postmaster general 1930 Developed and coordinated the motion picture Production Code 1918–20 Served as chairman of the Republican National Committee 1914–18 World War I 1954 Died, Sullivan, Ind. 1914–18 Served as chairman of the Indiana Republican state central committee 1939–45 World War II 1950–53 Korean War ▼▼ ▼▼ 19001900 18751875 19251925 19501950 ❖ 1910–13 Served as city attorney for Sullivan, Ind. ◆ 1922–45 Headed the Motion Picture Producers and Distributors of America ◆ 1934 Issued the Production Code of 1934, adding enforcement power to the code GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 228 HAYS, WILLIAM HARRISON agreement among reformers, mainly Protestant, dissipated any danger of censorship in the early 1930s. In 1934, with box office receipts down as the Great Depression widened, Hays responded to a renewed call for morality in the movies spear- headed by the Catholic Church’s Legion of Decency. Operating with support from parish priests, from the church hierarchy, and from Protestant and Jewish reform groups, the Legion avoided efforts at government legislated censor- ship. Rather, it threatened to call for boycott s of films that failed to satisfy its requirements for moral behavior. Hays issued the Production Code of 1934, which added enforcement power to his earlier code. Though the 1934 code provided for fines and suggested that scripts should be preapproved by the Hays Office, its real strength lay in requiring that a film receive the Hays Code Purity Seal of Approval in order to be shown in any movie theater owned by the studios. With the movie i ndustry vertically integrated, so that studios controlled both a large segment of film production and the most successful and profitable movie theaters nation- wide, even foreign and nonstudio films were submitted for code approval. The Hays code went through refinements and shifts in emphasis, both before and after the addition of enforcement in 1934. In general, it was designed to protect impressionable movie- goers by clamping down on sex, language, and violence on screen, with rules relating to sex being particularly stringent. One overarching rule was that sympathetic portrayals of sinners or criminals were prohibited; transgressors had to be punished appropriately for their sins by the end of each film. Hays maintained his partnership in Hays and Hays, a law firm begun by his father, throughout his tenure with the MPPDA. In 1945 he left his position as head of the MPPDA. He died in Indiana on March 7, 1954. FURTHER READINGS Bergman, Andrew. 2007. We’re in the Money: Depression America and Its Films. Chicago: Dee. Christensen, Terry, and Peter J. Haas. 1987. Projecting Politics: Political Messages in American Films. Armonk, New York: Sharpe. Crisler, B.R. 1984. “Portrait of an Indiana Lawyer.” In The New York Times Encyclopedia of Film: 1937–1940. Edited by Gene Brown. New York: Times. Maltby, Richard. 1993. “‘Grief in the Limelight’. Al Capone, Howard Hughes, the Hays Code, and the Politics of the Unstable Text.” In Movies and Politics: The Dynamic Relationship, edited by James Combs. New York: Garland. Sklar, Robert. 1994. Movie-Made America: A Cultural History of American Movies. Rev. New York: Vintage. v HAYWOOD, MARGARET AUSTIN Margaret Haywood was a senior judge for the Superior Court of the District of Columbia. She also w as the first African American woman to attain a top leadership position in a biracial U.S. church, the United Church of Christ. MARGARET AUSTIN HAYWOOD was born October 8, 1912, in Knoxville, Tennessee. When she was eight, she and her parents moved to Washing- ton, D.C. Although she was aware of segrega- tion, her loving home life helped her to grow up feeling secure and self-confident. Haywood’s parents, Mayme F. Austin and J. W. M. Austin, were able to provide her with a relatively ▼▼ ▼▼ Margaret Austin Haywood 1912–2004 1905 1950 1975 2000 1925 ❖ ❖ ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆◆ ◆◆ 1912 Born Margaret Austin, Knoxville, Tenn. 1914–18 World War I 1920 Family moved to Washington, D.C. 1930 Graduated from business school 1940 Graduated from Robert H. Terrell Law School 1942 Admitted to D.C. bar 1953 Joined defense team in District of Columbia v. John R. Thompson 1939–45 World War II 1950–53 Korean War 1961–73 Vietnam War 1967–72 Served on District of Columbia Council 1972 Appointed associate judge for the Superior Court of the District of Columbia 1974 D.C. citizens gained right to limited home rule, including elected mayor and city council 1973 Elected moderator of United Church of Christ 2002 Retired from bench 2004 Died, Escondido, Calif. 1982 Became senior judge of the D.C. Superior Court 1980 Awarded Washington Bar Association's Charles Hamilton Houston Medallion of Merit for contribution to jurisprudence GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION HAYWOOD, MARGARET AUSTIN 229 comfortable childhood, although her father lost his job in 1929. After two years, he found another job with the Works Progress Adminis- tration, helping people obtain public assistance. Reading the letters people wrote to her father detailing their plights, Haywood learned that it was necessary to listen to people in order to help them. Haywood was always an independent deci- sion maker. While she was in high school, her teachers encouraged her to become a teacher, the best career option for black women in the 1930s. However, Haywood’s interests lay else- where, for reasons that were both practical and compelling. At the height of the Great Depres- sion, in 1930, she came out of business school with no job and no money for college. She married and had a daughter, but the marriage, as she described it, “was disastrous.” Before long, she found herself divorced and raising a child alone. “I wanted my daughter to have a good education, but I was earning only $15 a week as a secretary,” she said. “That’s when I began to think about going into law. ” Determined to provide economic security for her daughter and herself, Haywood enrolled in Robert H. Terrell Law School, an institution for African American students where she could attend classes at night and work during the day. During her first two years at Terrell, she was the only female student; during the last two years, she was one of two female students. This did not deter her, and she graduated from Terrell with her Bachelor of Laws degree in 1940. After her admission to the District of Columbia bar in 1942, Haywood joined a well-known African American law firm. She quickly realized that the firm expected her to specialize in domestic relations cases, whereas she was interested in practicing in other fields. Unwilling to compromise, she left the security of the firm and opened her own general practice, where she handled the full range of legal cases. In the early 1950s, she participated in the landmark CIVIL RIGHTS case District of Columbia v. John R. Thompson Co., 345 U.S. 921, 73 S. Ct. 784, 97 L. Ed. 2d 1353 (1953), which confirmed the validity of post–Civil War laws that prohibited segregation. For her efforts, Haywood received threats from the KU KLUX KLAN and was labeled a communist. Haywood had practiced law for more than 25 years before President LYNDON B. JOHNSON appointed her to a part-time post on the District of Columbia Council. She served in that capacity from 1967 to 1972, du ring a time when the governance of the district was being reevaluated and reorganized. The revamped system of government, including an elected mayor and the council on which Haywood served, was approved in 1974. In 1972 President RICHARD M. NIXON appointed Haywood as associate judge for the Superior Court of the District of Columbia, the district’s highest trial court. The following year, the United Church of Christ elected her its moderator, making her the first African Ameri- can woman to hold such a high position in a biracial U.S. church. As moderator, she presided over 728 delegates to the church’s ninth biennial general synod, or governing council. Her position with the church was a two-year unsalaried post, which she combined with her duties on the court. In 1982 Haywood achieved the rank of senior judge of the District of Columbia Superior Court. As a senior judge in the 2000s, Haywood continued to participate in judicial proceedings. Haywood received honorary degrees from several institutions, including Elmhurst College (1974), Carleton College (1975), Catawba Margaret A. Haywood. COURTESY OF MARGARET HAYWOOD. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 230 HAYWOOD, MARGARET AUSTIN College (1976), and Doane College (1979). In addition, she was the recipient of many honors and awards. These include a National Associa- tion for the Advancement of Colored People ( NAACP) trophy in 1950, the Women’s Bar Association’s Woman Lawyer of the Year award in 1972, induction into the District of Columbia Women’s Commissio n Hall of Fame, and the Washington Bar Association’s Charles Hamil- ton Medallion of Merit for contribution to jurisprudence in 1980. In October 2002 the Standing Committee on Fairness and Access to D.C. Courts presented Haywood with its Trailblazer Award for her contributions to her profession and her community and, in particu- lar, her continued commitment to ensuring equal access to the court system. Haywood died of renal failure on January 9, 2004, in Escondido, California, at the age of 91. FURTHER READINGS Berry, Dawn Bradley. 1996. The 50 Most Influential Women in American Law. Los Angeles: Contemporary Books. Drachman, Virginia G. 1998. Sisters in Law: Women Lawyers in Modern American History. Cambridge, Mass.: Harvard Univ. Press. Smith, Jessie Carney. 2002. Black Firsts: 4,000 Ground- Breaking and Pioneering Historical Events. Canton, MI: Visible Ink. v HAYWOOD, WILLIAM DUDLEY Labor leade r Bill Hayw ood was regarded as a radical in the growing labor movement in the United States. A public figure throughout most of his life, Haywood was the central figure in two famous court cases. Haywood was born in 1869 in Salt Lake City, Utah. In 1896, Haywood, a coal miner, became an active participant in the Western Federation of Miners. He rapidly rose to prominence in the federation, securing offices of leadership by 1904. His tactics were militant in nature, as was evidenced by the violence of the Cripple Creek strike that occurred in Colorado in 1904. In 1905 former Idaho Governor Frank Steunenberg was killed by an explosion caused by a bomb hidden in his home by Harry Orchard. Orchard admitted his guilt and implicated three leaders of the Western Federa- tion of Miners: President Charles H. Moyer, William Dudley Haywood 1869–1928 ❖ 1869 Born, Salt Lake City, Utah ◆ 1896 Became active in the Western Federation of Miners 1913 Led textile workers strike in Paterson, N.J. 1905 Former Idaho Governor Frank Steunenberg assassinated; Haywood, along with two other WFM leaders, charged; founded and became first director of the Industrial Workers of the World 1914–18 World War I 1928 Died, Moscow, Soviet Union ▼▼ ▼▼ 19001900 18751875 19251925 ❖ ◆◆ ◆◆ ◆ ◆ 1904 Elected secretary-treasurer of Western Federation of Miners 1912 Led textile workers strike in Lawrence, Mass. 1918 Accused of seditious activities during World War I; found guilty and sentenced to 20 years 1921 Jumped bail and fled to Soviet Union, where he sought and received asylum William D. Haywood. LIBRARY OF CONGRESS IT IS THE HISTORIC MISSION OF THE WORKING CLASS TO DO AWAY WITH CAPITALISM . —WILLIAM HAYWOOD GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION HAYWOOD, WILLIAM DUDLEY 231 Secretary-Treasurer Haywood, and retired leader George A. Pettibone. These men were abducted from Denver and taken to Boise, Idaho, to stand trial. The Haywood-Moyer-Pettibone case took on national significance for two reasons: (1) it involved a radical labor organization, and (2) eminent attorney CLARENCE DARROW acted as defense attorney. The three men were subse- quently acquitted (Pettibone v. Nichols, 203 U.S. 192, 27 S. Ct. 111, 51 L. Ed. 148 [ 1906]). The INDUSTRIAL WORKERS OF THE WORLD (IWW) was established in 1905, and Haywood was the founder and director of this labor organization. He was a proponent of group action and class struggle, and he abhorred compromise. He continued to use violence in his fight for labor, and led two infamous textile workers’ strikes in Lawrence, Massachusetts (1912), and in Paterson, New Jersey (1913). Haywood and other members of his IWW organization attempted to become members of the SOCIALIST PARTY but were rejected for their theories of violent action. In 1918 Haywood was again on trial. One hundred sixty-five IWW leaders, including Haywood, were accused of seditious activities during WORLD WAR I. Haywood was found guilty and sentenced to spend the next 20 years in prison. Haywood was free on bail in 1921, pending the date of a new trial, when he escaped and sought asylum in the Soviet Union. He died in Moscow seven years later. H.B. See HOUSE BILL. HEAD OF HOUSEHOLD An individual in one family setting who provides actual support and maintenance to one or more individuals who are related to him or her through adoption, blood, or marriage. The designation head of household, also termed head of family, is applied to one whose authority to exercise family control and to support the dependent members is founded upon a moral or legal obligation or duty. Head of household is also a filing status for federal income taxpayers. There are five basic categories of tax statuses: (1) single persons; (2) heads of households; (3) married taxpayers filing joint returns; (4) married taxpayers filing separate returns; and (5) surviving spouses. Each of these persons pays at different rates. The tax rates fo r single persons are ordinarily higher than rates for heads of household, while rates for a husband and wife filing a joint return are lower. In order for an individual to qualify as head of household for income tax purposes, the person need not be unmarried all year as long as the per son is unmarried on the final day of the tax year. In addition, the person must support and maintain a household to the extent that his or her monetary contribution exceeds one-half of the total cost of maintenance. The person’s home must be the main place of residence of one relative, with the exception of a mother and father, for the whole year. Relatives include children, grandchildren, stepchildren, brothers and sisters, half brothers or half sisters, and stepbrothers and stepsisters. The individual’s parents need not reside in the same home as the taxpayer for him or her to claim this status, provided the person meets the support require- ments specified. Homestead exemption statutes, which have been passed in a majority of jurisdictions, permit a head of household to designate a house and land as a homestead and exempt it from execution for general debts in the event of BANKRUPTCY. In addition, some states make available property tax exemptions for home- stead property. Such statutes often require the formal recording of a declaration of homestead. HEADNOTE A brief summary of a legal rule or a significant fact in a case that, among other headnotes that apply to the case, precedes the full text opinion printed in the reports or reporters. A syllabus to a reported case that summarizes the points decided in the case and is placed before the text of the opinion. Each jurisdiction usually determines wheth- er headnotes are part of the law or only an editorial device to facilitate research. Mos t headnotes are included by private publishers and do not constitute a part of an opinion. The most notable publisher that employs headnotes is the West Group in the National Reporter System, which publishes cases from practically every jurisdiction. Use of headnotes in the National Reporter System is generally consis- tent, regardless of the jurisdiction. The Reporter GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION 232 H.B. of Decisions for the United States Supreme Court also prepares a syllabus for Supreme Court decisions, when feasible, at the time an opinion is issued. The syllabus summarizes the points of law addressed in each case, but does not constitute a part of the opinion and does not constitute BINDING AUTHORITY. HEALTH AND HUMAN SERVICES DEPARTMENT The Department of Health and Human Services (HHS) is the cabinet-level department of the EXECUTIVE BRANCH of the federal government most involved with the health, safety, and welfare of the U.S. population. A wide variety of HHS agencies administer more than 300 programs, which focus on such initiatives as providing financial assistance, health care, and advocacy to those in need; conducting medical and social science research; assuring food and drug safety; and enforcing laws and regulations related to human services. The HHS originated in the Department of Health, Education, and Welfare (HEW), which was created in 1953. In 1980, the DEPARTMENT OF EDUCATION Organization Act (20 U.S.C.A. § 3508) redesignated HEW as the Department of Health and Human Services. The secretary of HHS advises the president of the United States on the federal government’s health, welfare, and income security plans, policies, and programs. He or she directs HHS staff in carrying out department programs and activities and promotes public understanding of HHS goals, programs, and objectives. The secretary administers these functions through the Office of the Secretary and the individual agencies of the HHS: the Administration on Aging; Administration for Children and Fami- lies; the CENTERS FOR MEDICARE & MEDICAID SERVICES ; the Agency for Healthcare Research and Quality; the Centers for Disease Control and Prevention; the Agency for Toxic Sub- stances and Disease Registry; the FOOD AND DRUG ADMINISTRATION ; the Health Resources and Ser- vices Administration; the Indian Health Service; the National Institutes of Health; the SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION ; and the Program Support Center. The Social Security Administration, once located within HHS, became an independent agency in 1995. Office of the Secretary The Office of the SecretaryoftheHHS includes the offices of the assistant secretaries, the inspector general, and the general counsel. Individuals in these offices, along with other senior officials at HHS, assist the secretary with the overall manage- ment responsibilities of the HHS and aid in the day-to-day operations of the department. For example, the Program Support Center (PSC), which is part of the Office of the Assistant Secretary for Administration and Management, offers support services in such areas as human resources and financial management. In addition, the Office for Civil Rights admin- isters and enforces laws that prohibit discrimina- tion in federally assisted health and human services programs. These laws include Title VI of the Civil Rights Act of 1964 (42 U.S.C.A. § 2000d et seq.), which prohibits discrimination with regard to race, color, or national origin i n programs and activities receiving federal financial assistance; the Age Discrimination Act of 1975 (42 U.S.C.A. § 6101 et seq.); and the Americans with Disabilities Act of 1990 (42 U.S.C.A. § 12101 et seq.). The secretary is accountable to Congress and to the public for departmental expenditures of taxpayers’ money. Thus, the secretary and other members of the HHS staff often testify before congressional committees, make speeches before national organizations interested in and affected by HHS policy, and meet with the press and the public to explain HHS actions. The secretary and the HHS staff also prepare special reports, sometimes at the request of the president, on national problems related to health and human services. In addition, the secretary is required by law to submit to the president and to Congress periodic reports that explain how tax money was spent to address and solve a particular problem and whether progress on the problem was achieved. The headquarters of the HHS department is located in Washington, D.C., and ten regional HHS offices are located throughout the United States. The regional directors of these offices represent the secretary in any official HHS dealings with state and local government organizations. They promote a general under- standing of HHS programs, policies, and objectives; advise the secretary on the potential local effects of HHS policies and decisions; and provide administrative services and support to HHS programs and activities in the regions. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION HEALTH AND HUMAN SERVICES DEPARTMENT 233 Administration on Aging The Administration on Aging (AOA) is the principal agency of the HHS designated to carry out the provisions of the Older Americans Act of 1965, as amended (42 U.S.C.A. § 3001 et seq.). The Older Americans Act was enacted to promote the well-being of older U.S. citizens by providing services and programs designed to help them live independently in their homes and communities. The act also empowers the federal government to distribute funds to the states for supportive services for older people. The AOA advises the secretary and other federal departments and agencies on the characteristics, circumstances, and needs of older citizens; develops policies and programs to promote Health and Human Services Department The Secretary Deputy Secretary Agency for Toxic Substances and Disease Registry (ATSDR)* Centers for Disease Control and Prevention (CDC)* Food and Drug Administration (FDA)* Indian Health Service (IHS)* National Institutes of Health (NIH)* Office of Intergovernmental Affairs & Regional Representatives Office of the Assistant Secretary for Public Affairs (ASPA) Office of the Assistant Secretary for Legislation (ASL) Office of the Assistant Secretary for Preparedness and Response (ASPR)* Office of the Assistant Secretary for Planning and Evaluation (ASPE) Office of the Assistant Secretary for Resources and Technology (ASRT) Office of the Assistant Secretary for Administration and Management (ASAM) Office of Public Health and Science (OPHS)* Administration for Children and Families (ACF) Centers for Medicare & Medicaid (CMS) Administration on Aging (AOA) Agency for Healthcare Research and Quality (AHRQ)* Health Resources and Services Administration (HRSA)* Substance Abuse and Mental Health Services Administration (SAMHSA)* *Designates components of the Public Health Service Office of the General Counsel (OGC) Office of Medicare Hearings and Appeals (OMHA) Office for Civil Rights (OCR) Office of Global Health Affairs (OGHA)* Departmental Appeals Board (DAB) Office of the National Coordinator for Health Information Technology (ONC) Center for Faith-Based and Community Initiatives (CFBCI) Chief of Staff The Executive Secretariat Office of Inspector General (OIG) Program Support Center ILLUSTRATION BY GGS CREATIVE RESOURCES. REPRODUCED BY PERMISSION OF GALE, A PART OF CENGAGE LEARNING. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3 RD E DITION 234 HEALTH AND HUMAN SERVICES DEPARTMENT the welfare of older citizens and advocates for their needs in HHS policy development and planning; and administers to the states grants that establish at the state and local levels programs providing services to older citizens, such as group meals and nutrition education. The AOA also administers programs providing legal and protective services for older people. Administration for Children and Families The Administration for Children and Families (ACF) was created in 1991 and is headed by the assistant secretary for children and families, who reports to the secretary of the HHS. The ACF consists of several component administra- tions, including the Administration on Chil- dren, Youth, and Families (ACYF), which advises the secretary, through the assistant secretary, on matters relating to the welfare of children and families, and administers grant programs to help the states provide child welfare services as well as foster care and adoption assistance. The ACYF also administers state grant programs for the prevention of CHILD ABUSE ; the Head Start Program, which appro- priates funds for health, education, nutrition, social, and other services to economically disadvantaged children and their families; and programs providing services to prevent drug abuse among youth. In addition, the ACYF supports and encourages in the private and voluntary sectors programs for children, youth, and families. Other components of the ACF include the Administration on Developmental Disabilities (ADD) and the Administration for Native Americans (ANA). ADD advises the secretary of the HHS on matters relating to persons with developmental disabilities and their families and helps provide services to such individuals. ADD also helps the states provide services at the local level through grants and other programs. ANA represents the concerns of Native Americans and serves as the focal point within the HHS for providing developmental, social, and economic strategies to support Native American self- determination and self-sufficiency. ANA admin- isters grant programs to Indian tribes and other Native American organizations in both urban and rural areas and acts as a liaison with other federal agencies on Native American affairs. Another component of the ACF is the Office of Child Support Enforcement (OCS E), which advises the secretary on matters relating to child support enforcement and provides direction and guidance to state offices for child enforce- ment programs. The OCSE helps states develop programs establishing and enforcing support obligations by locating absent parents, establish- ing paternity, and collecting child support payments. Medicare and Medicaid The Centers for Medicare & Medicaid Services (CMS) replaced the former Health Care Financ- ing Administration in 2001. It was created to oversee the Medicare Program and the federal portion of the Medicaid Program. Medicare provides HEALTH INSURANCE for U.S. citizens age 65 or older, for younger people receiving Social Security benefits, and for persons needing dialysis or kidney transplants. Medicaid covers healthcare expens es for recipients of Temporary Assistance for Needy Families (formerly Aid to Families with Dependent Children), as well as for low-income pregnant women and other individuals whose medical bills qualify them as medically needy. Through these programs, the HCFA serves 68 million older, disabled, and poor U.S. citizens. In addition, a quality assurance program admi nistered by the CMS develops health and safety standards for provi- ders of healthcare services authorized by Medicare and Medicaid legislation. Public Health Service Agencies The Office of Public Health and Science (OPHS) oversees 12 civilian offices and the Commis- sioned Corps of the U.S. PUBLIC HEALTH SERVICE. The Public Health Service was first established in 1798 to create hospitals to care for U.S. merchant seamen. OPHS provides assistance in implementing and coordinating decisions for the Public Health Service and coordination of population-based health, clinical divisions; It also provides oversight of research conducted or supported by the department. In addition, it implements several programs to provide population-based public health services; OPHS provides direction and policy oversight, through the SURGEON GENERAL, for the Commissioned Corps. Over time legislation has substantially broadened the number and scope of agencies that deal with public health. These include the Agency for Healthcare Research and Quality, which produces and disseminates information GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION HEALTH AND HUMAN SERVICES DEPARTMENT 235 about the quality, medical effectiveness, and cost of health care, and the Centers for Disease Control and Prevention (CDC), which provides leadership in the prevention and control of disease outbreak and responds to public health emergencies. Other agencies dealing with public health include the Agency for Toxic Substances and Disease Registry, which carries out the health- related responsibilities of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) (42 U.S.C.A. § 9601 et seq.), as well as the Food and Drug Administration (FDA), which is charged with protecting the health of the nation against unsafe foods, drugs, cosmetics, and other hazards. The Health Resources and Services Admin- istration (HRSA) focuses on ensuring that people w ithout resources or living in under- served areas (e.g., rural areas) receive quality health care. There are more than three thousand HRSA-funded centers throu ghout the United States. The health status of Native Americans and Alaska Natives is the concern of the Indian Health Service. The Indian Health Service administers a comprehensive healthcare deliv- ery system for these groups, developing and managing programs to meet their health needs. The National Institutes of Health (NIH) is the principal biomedical research agency of the federal government. Included within the NIH are the National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute of Child Health and Human Develop- ment; and other institutes conducting research in the areas of alcohol and drug abuse, mental health, communication and neurological dis- orders, and aging. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides national leadership in the prevention and treatment of addictive and mental disorders, through programs and services for individuals who suffer from these disorders. Within SAMHSA are several component centers desig- nated to carry out its purposes, including the Center for Subs tance Abuse Prevention, Center for Substance Abuse Treatment, and Center for Mental Health Services. SAMHSA is also served by the Office of Management, Planning, and Communications, which is responsible for the financial and administrative management of SAMHSA components, monitors and analyzes legislation affecting these components, and oversees SAMHSA public affairs activities. FURTHER READINGS “Health and Human Services Department.” The New York Times (September 4, 2009). Available online at http:// topics.nytimes.com/topics/reference/timestopics/orga- nizations/h/health_and_human_services_department/ index.html; website home page: http://topics.nytimes. com (accessed September 4, 2009). U.S. Department of Health and Human Services. Available online at www.hhs.gov (accessed December 21, 2009). U.S. Government Manual. Available online at www.gpoac- cess.gov/gmanual (accessed December 21, 2009). HEALTH CARE FINANCING ADMINISTRATION See CENTERS FOR MEDICARE & MEDICAID SERVICES. HEALTH CARE LAW Health care law involves many facets of U.S. law, including torts, contracts, antitrust, and insurance. According to statistics from the California Health Care Foundation (CHCF), health care expenditures reached $2.2 trillion dollars in 2007, or $7,421 per person in the U.S. Per-person costs jumped 81 percent between 1997 and 2007. If costs are not controlled, the CHCF estimates that health spending will reach 20 percent of the count ry’s gross dom estic product by 2018. U.S. Health Expenditures, 1960 to 2006 148 356 7,026 4,790 2,813 1,100 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 1960 1970 1980 1990 2000 2006 Year Dollars per capita SOURCE: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2008. ILLUSTRATION BY GGS CREATIVE RESOURCES. REPRODUCED BY PERMISSION OF GALE, A PART OF CENGAGE LEARNING. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3 RD E DITION 236 HEALTH CARE FINANCING ADMINISTRATION Medical Malpractice One major area within health care law is MEDICAL MALPRACTICE , which is professional misconduct or lack of skill in providing medical treatment or services. The victims of medical MALPRACTICE seek compensation for their physical or emotional injuries, or both, through a NEGLIGENCE action. A DEFENDANT physician may be found liable for medical malpractice if the PLAINTIFF patient can establish that there was in fact a patient- physician relationship; that the physician brea- ched (i.e., violated or departed from) the accepted standard of medical care in the treatment of the patient; that the patient suffered an injury for which he or she should be compensated; and that the physician’s violation of the standard of care w as the cause of the injury. To protect themselves against the massive costs of such claims, physicians purchase malpractice insurance. Physicians’ malpractice premiums total billions of dollars each year and add substantially to the cost of health care in the United States. In some specialties, such as obstetrics, 50 percent of the cost for medical services goes for the provider’s malpractice premiums. Many physicians, faced with the rising tide of malpractice premiums, practice “defensive medicine” by ordering tests and procedures that might not be necessary, so that the records will show that they did all they could. Several studies have estimated the cost of defensive tests and procedures at tens of billions of dollars per year. Medical malpractice liability can extend to hospitals and even to health maintenance organizations (HMOs). In the case of severe injuries, this can provide a plaintiff patient with an additional source of compensation. One complicating element is a historical doctrine that disallows the corporate practice of medi- cine—which in effect, and sometimes in actuality through statutes, prohibits the em- ployment of physicians. In states that disallow the corporate practice of medicine, plaintiffs may not bring medical malpractice claims against HMOs or hospitals based on a physi- cian’s treatment, because the doctors are not considered employees. Because every state prohibits the practice of medicine without a license, and because a corporate or business entity may not obtain a license to practice medicine, the historical model provided that all physicians were inde- pendent contractors (i.e., separate econom ic entities), even in their role on the medical staff of a hospital. Without an explicit employer- employee relationship, the liability of a physi- cian for malpractice most likely could not be imputed (i.e., passed along to) a hospital. The legal theory of respondeat superior holds an employer liable for the negligent acts of an employee who acts within the SCOPE OF EMPLOY- MENT . Historically, as most physicians were not employees, this theory of liability was often defeated in medical malpractice suits. Today, however, most courts look beyond the title given to the relationship, and to the control that the hospital or health care organization exerts over the physician in question, to determine whether the relationship is more like that of an employer and employee (e.g., where the processes and treatment decisions are tightly prescribed by the organization, and liability may be imputed) or whether it is truly that of an independent contractor and a client (e.g., where the physician acts alone to accomplish a particular end result, and liability may not be imputed). The legal theory of ostensible agency can also attach liability to a hospital or health care organization for an individual physician’s mal- practice. No employer-employee relationship needs to be shown here. Ostensible agency liability is created where the principal (the hospital or health care organization) represents or creates the appearance to third persons that the physician is an agent of the principal, subject to the principal’s control. This theory focuses on the reasonable expectations and beliefs of the patient, based on the condu ct of the hospital or health care organization. The actual relationship of the physician and the hospital or organization is immaterial. Most states have enacted legislation that modifies the common law action of medical malpractice, in an attempt to stem the rising tide of lawsuits. Restrictions on plaintiff patients include shorter statutes of limitations (i.e., times within which a lawsuit must be filed after injury) than those provided for in common law actions, and a required affid avit from a physi- cian expert witness, certifying that the applica- ble standard of care in the particular case was violated by the defendant physician and that the violation caused the plaintiff patient’s injuries. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3RD E DITION HEALTH CARE LAW 237 . War ▼▼ ▼▼ 19001900 18 751 8 75 19 251 9 25 1 950 1 950 ❖ 1910–13 Served as city attorney for Sullivan, Ind. ◆ 1922– 45 Headed the Motion Picture Producers and Distributors of America ◆ 1934 Issued the Production Code of. in 19 95. Office of the Secretary The Office of the SecretaryoftheHHS includes the offices of the assistant secretaries, the inspector general, and the general counsel. Individuals in these offices,. RESOURCES. REPRODUCED BY PERMISSION OF GALE, A PART OF CENGAGE LEARNING. GALE ENCYCLOPEDIA OF AMERICAN LAW, 3 RD E DITION 234 HEALTH AND HUMAN SERVICES DEPARTMENT the welfare of older citizens and advocates