Nina J. Crimm (St. John’s) has published Do Fiduciary Duties Contained in Federal Tax Laws Effectively Promote National Health Care Policies and Practices?, 15 Health Matrix: Journal of Law-Medicine 125 (Winter, 2005), as part of a Symposium on Health Care and Tax Exemption: The Push and Pull of Tax Exemption Law on the Organization and Delivery of Health Care Services.  Here is part of the Introduction:

The essay concentrates first on whether the fiduciary responsibilities of the governing board of a tax-exempt § 501(c)(3) hospital under current federal tax laws effectively promotes national health care policies and practices. Then it considers whether expansion of the duties imposed by federal tax statutes would further contribute to the advancement of our health care goals by promoting more publicly beneficial health care policies and practices of § 501(c)(3) hospitals. This issue is especially timely because, once again, Congress is debating whether to expand the IRS’s oversight role over the broad spectrum of tax-exempt § 501(c)(3) charitable organizations and their governing boards. Of particular note, Congress is considering legislation to create a new federal fiduciary duty of care for governing boards of § 501(c)(3) organizations based on a standard similar to the one contained in many state substantive nonprofit corporation statutes. Recent empirical evidence, however, suggests that current moral, social, and legal fiduciary duties suffice to ensure that governing bodies of § 501(c)(3) hospitals already seriously pursue their responsibilities to further their hospitals’ charitable health care missions, and consequently to advance national health care policy. With respect to § 501(c)(3) hospitals, the benefit of the proposed additional federal tax legislation is, therefore, highly questionable. As discussed below, in search of a largely non-existent problem in the § 501(c)(3) hospital industry, the proposed regulatory tool supplies an essentially redundant remedy outside the traditional competencies of the IRS.