In this full-length Foreword, John Norris and David Szabo discuss the trend towards the development of substantially integrated and automated multi-institutional health care delivery systems. The authors then address the legal, economic, and policy implications of regulating medical computer systems. They conclude by noting that the rational allocation of costs and risks is a necessary step in developing new systems for health care delivery.

During the past ten years, the use of computer programs in medicine has become increasingly prevalent. As these programs proliferate, however, their potential to injure patients also increases. Although the question of liability for personal injuries caused by defective medical computer programs has not been addressed by the courts, it is inevitable that this question will arise in a judicial forum.

In this Article, the authors examine the questions a court will face when addressing this novel cause of action. They attempt to resolve some of these questions by exploring the relevant characteristics of medical computer programs and examining their relationship to the tort law doctrines of negligence and strict products liability. The authors conclude that medical computer programs will be treated as products by the courts, subjecting their manufacturers to strict liability in tort for any defects in the program that cause injury. As a result, the authors contend, hospitals are likely to face a new source of liability for patient injuries if, under the particular circumstances, they are deemed to be the manufacturer or the distributor of a medical computer program that causes an injury.

This Article argues that many seemingly disparate questions in health law are related to the issue of how experts are to be held accountable to nonexperts—show the principle that decisions should be made by those most affected is to be reconciled with the principle that decisions should be made by those with experience and training in the area. The basic subject matter of health law comprises a number of relationships between medical professionals, on the one hand, and laymen, on the other. In dealing with the proper allocation of decision-making authority within these relationships, the Article considers the social role of medical profession, the theoretical issues in the accountability of expertise, and the nature of medical expertise. On the basis of this discussion, the Article develops principles that can be applied throughout health law.

“Guilty but mentally ill” legislation responds to the increasing outbreak of violent crimes and to public skepticism concerning the ability of psychiatrists to determine the advisability of a criminal's return to society. Under this alternative to the traditional insanity defense, once the defendant chooses to plead not guilty by reason of insanity, the trier of fact may elect to find him guilty, but mentally ill. This may occur when it is determined that the defendant's mental illness is not severe enough to negate culpability. The court must then sentence the defendant to a term in prison instead of committing him to a psychiatric institution.

This Note discusses the origins of the guilty but mentally ill verdict and outlines the development of commitment standards for civil patients and insanity acquittees. While these standards appeared to be merging for a period of time the more recent trend has been to treat civil patients and insanity acquitees differently. This Note maintains that the guilty but mentally ill verdict involves an unnecessarily severe curtailment of the mentally ill offender's constitutional rights.

The Note delineates a proposal critiquing the misconceptions on which the statute is based and the excessive restraints on liberty it causes. The proposal examines the reasons for the public's misgivings with the insanity defense and suggests that the threat to the public's safety may not be as serious as it appears. Furthermore, it indicates that while problems remain with the existing insanity defense, the solution to those problems provided by the guilty but mentally ill statute outweighs the risk that insanity acquittees pose to the public.