Law Commons^™

Legislative "Subterfuge"?: Failing To Insure Persons With Mental Illness Under The Mental Health Parity Act And The Americans With Disabilities Act, Christopher A. Jones

Vanderbilt Law Review

The two primary problems with providing health care in the United States are cost and access., The cost of health care rose dramatically during the 1970s and 1980s and continues to increase, making coset containment crucial to the availability of care. In addition, many Americans are either entirely without health insurance or are underinsured for catastrophic illness. While individually these two issues are important, equally problematic is the tension that exists between them. Providing greater access to additional services results either in a cost increase or the loss of other services. Ultimately, however, a general plan to contain costs can …

Tax Exemption And The Health Care Industry: Are The Challenges To Tax-Exempt Status Justified?, Kevin B. Fischer

Vanderbilt Law Review

The provision of health care has traditionally been deemed a charitable function.' Therefore, hospitals and other health care institutions have been afforded the benefits of tax exemption. As a standard for determining which entities merit the tax exemption and which do not, the Internal Revenue Service ("IRS" or "Service") developed what has come to be known as the community benefit test. At the federal level, this test has been the basis for awarding tax- exempt status to hospitals and other health care entities State legislatures have traditionally followed the federal government's standards for tax exemption and have thus allowed health …

Firing The First Lady: The Role And Accountability Of The Presidential Spouse, Carl D. Wasserman

Vanderbilt Law Review

The First Lady is asked by her husband to head a task force to assist him in developing health care policy. The fear of outside influence sparks the task force to meet in secrecy. The Federal Advisory Committee Act, however, forbids closed meetings of this type unless all members of the committee are officers or employees of the federal government. May the meetings be kept secret despite the First Lady's presence?

Immediately after leaving the White House, the First Lady is hired to lobby for Columbia/HCA, a major health care corporation. Illegal?

The chairman of a large corporation meets with …

The Protection Of Privacy In Health Care Reform, Paul M. Schwartz

Vanderbilt Law Review

Legal regulation of the privacy of medical information is now at a critical stage. Americans are highly concerned about the processing and use of their personal data. Over three-quarters of the public currently believes that the individual has lost control of how personal information is circulated and applied by companies., Indeed, a recent poll reveals that those who know the most about the current protection of medical information-physicians, heads of medical societies, health insurers, and hospital CEOs-are also the most concerned about threats to personal privacy.

Social concern about the threat to informational privacy has resulted in strong approval for …

In Search Of A Bright Line: Determining When An Employer's Financial Hardship Becomes "Undue" Under The Americans With Disabilities Act, Steven B. Epstein

Vanderbilt Law Review

The employment provisions of the Americans with Disabilities Act have been fully effective since July 26, 1994. These provisions require all employers with fifteen or more employees to reasonably accommodate the disabilities of job applicants and employees. Reasonable accommodation can be very expensive: one in every twenty accommodations now being made costs more than $5,000. Although the ADA permits employers to refuse to make accommodations that would cause an "undue hardship," neither the statute nor its implementing regulations provide meaningful guidance regarding how great an accommodation expense must be before the point of "undue hardship" is attained. Consequently, neither employers …

The Emerging Trend Of Corporate Liability: Courts' Uneven Treatment Of Hospital Standards Leaves Hospitals Uncertain And Exposed, David H. Rutchik

Vanderbilt Law Review

Under the doctrine of hospital corporate liability, a hospital has a nondelegable, direct duty to provide adequate care to all of its patients.' This duty is not a product of a master-servant or a principal-agent relationship, nor is hospital tort liability predicated on a showing of vicarious liability, because the hospital's liability flows directly from the hospital to its patients. Consequently, a hospital may be liable for the negligent act of an independent staff physician, even if that physician is an independent contractor. The corporate liability, or corporate negligence, doctrine thus extends potential liability beyond the sphere of respondeat superior. …

Reverse Informed Consent: The Unreasonably Dangerous Patient, A. Samuel Oddi

Vanderbilt Law Review

Latrogenic injuries'-those caused by health care professionals (HCPs) in the course of treating patients-raise significant ethical, legal, and public policy issues.' With the advent of the AIDS epidemic, these issues become even more difficult when the iatrogenic injury results not from the patient's having received treatment below the professional standard of care (which is the usual grist for the malpractice mill) but from an infectious condition of the HCP. Considerable public attention has been directed to patients who have been exposed to the risk of AIDS by HIV-positive HCPs.6 It is difficult to be unmoved by the tragic example of …

Help! We've Fallen And We Can't Get Up: The Problems Families Face Because Of Employment-Based Health Insurance, Jeffrey R. Pettit

Vanderbilt Law Review

Steve Tilghman of Birmingham, Alabama knows first-hand the health insurance problems American families face.' Steve's family had adequate health insurance until Steve decided to change careers. After expiration of the eighteen-month extension period COBRA provides, Steve's family could not afford the one thousand dollar monthly premiums necessary to maintain their policy. Steve's epileptic son further complicated his ability to find adequate health insurance. After having no insurance for two months, Steve ultimately was able to find health insurance for only part of his family. Steve had to acquire a separate, unrated policy for his epileptic son. Steve is uncertain about …

Introduction: Caring For The Nation--Current Issues In Health Care Reform, Susan E. Powley

Vanderbilt Law Review

Health care reform is once again on the "front burner" of American politics. With health care costs in the United States rising at three times the rate of inflation and an increasing portion of the population falling through the cracks of the current health care delivery system,' legislators, health care professionals, and the population at large now have little difficulty agreeing that the system is badly in need of reform. This consensus, however, falls apart when discussion turns to what needs to be fixed and how to fix it. Federal legislators currently have over twenty health bills pending before them, …

The Disfranchisement Of Fertile Women In Clinical Trials: The Legal Ramifications Of And Solutions For Rectifying The Knowledge Gap, L. Elizabeth Bowles

Vanderbilt Law Review

Twice as many women as men receive treatment for clinical depression, yet men benefit more than women from antidepressant drug treatment. Likewise, women use more prescription drugs than men, but suffer proportionally more side effects.' Such disparities stem from the traditional attitude of pharmaceutical companies and researchers to- ward the use of women in clinical trials. In general, researchers have tested drugs on young white males without regard for gender differences, often assuming that data extrapolated from studies on males are readily applicable to females. Even medical treatments designed exclusively for women are developed and tested based on a male …

The Oregon Basic Health Services Act: A Model For State Reform?, Eric L. Robinson

Vanderbilt Law Review

Americans currently spend $733 billion, or 12.3 percent of the Gross National Product (GNP), per year on health care. This is nearly twice what Americans spent on health care just seven years ago. Health care is also one of the fastest growing major items in the federal and state budgets. Not surprisingly, governments, businesses, and individuals all are having difficulty finding resources to meet the increasing costs of health care. As a result, the health care delivery system has cut costs by denying some people access to adequate health, care services. Currently, an estimated thirty-seven million Americans are uninsured. In …

The Pariah Patient: The Lack Of Funding For Mental Health Care, Wayne E. Ramage

Vanderbilt Law Review

In all the furor over the provision of health care in the United States-especially over who will pay for the skyrocketing costs of medical treatment-one class of patient appears to have been overlooked: the mentally ill. This oversight is not new; Anglo-American society historically has viewed the mentally ill as outsiders. In England, for example, inmates at the infamous "Bedlam" hospital for the insane often were displayed for the amusement of the paying public.' Society's disdain of the mentally ill still exists and has led to public neglect of these unfortunates, especially in the provision of mental health care.

Since …

Medicaid, State Cost-Containment Measures, And Section 1983 Provider Actions Under "Wilder V. Virginia Hospital Association", Michael D. Daneker

Vanderbilt Law Review

After the Civil War, Congress enacted a statutory private right of action to ensure the protection of an individual's federal civil rights." This right of action, now codified at Title 42, Section 1983 of the United States Code, creates liability for anyone who, acting under a state law, program, or policy, infringes on an individual's federal rights. Although the authors of Section 1983 intended the statute to serve primarily as a mechanism for the protection of federal constitutional rights, the United States Supreme Court has recognized that Section 1983 is a valid tool for enforcing a wide variety of statutorily …

The Constitutionality Of Pregnancy Clauses In Living Will Statutes, Elizabeth C. Benton

Vanderbilt Law Review

In 1976 the New Jersey Supreme Court allowed parents to remove a life support system from the body of their daughter after doctors deemed her vegetative state irreversible." The case, In re Quinlan, received extensive national media attention and pitted concerns about the quality of life and personal autonomy against respect for the sanctity of life. This conflict has intensified as medical technology has progressed so that patients who otherwise would die faster, natural deaths now are sustained indefinitely. Some patients and families see this life support as medical heroism, while others view it as painful,futile prolongation of death. One …

Aids, Rape, And The Fourth Amendment: Schemes For Mandatory Aids Testing Of Sex Offenders, Paul H. Macdonald

Vanderbilt Law Review

Few subjects are as emotionally troubling as AIDS' and rape. The latter, of course, has plagued society throughout human history, but AIDS only recently has imposed itself upon our social and medical consciousness. Ever since AIDS became a familiar sight in the headlines nearly ten years ago, society has reacted to it with a mixture of anxiety, confusion, and despair. One consequence of the new societal awareness is the increased hesitancy with which individuals approach intimate contact. When intimate contact is involuntary as in the case of rape, fear of exposure to the disease is especially pronounced. Society,however, seems ill-prepared …

Walking In Their Shoes: Paying Respect To Incompetent Patients, D. Don Welch

Vanderbilt Law Review

One of the great games that judges play is to act as if their decisions are based on objective standards. For understandable reasons,judges prefer that their decrees be seen as resting on accepted principles of law rather than on a judicial choice between two competing,plausible opinions. One such accepted principle has been that decisions giving consent for medical treatment of incompetent patients should be made to serve the "best interests" of the patients.' In recent years,courts increasingly have used a new, seemingly less objective standard called "substituted judgment" to replace the best interests standard in certain situations. Under this new …

Cocaine, Demand, And Addiction: A Study Of The Possible Convergence Of Rational Theory And National Policy, A. Morgan Cloud, Iii

Vanderbilt Law Review

As the "war against drugs" meanders through the century,' policy-makers continue to search for effective strategies for combating the illegal drug industry. For seventy-five years the dominant federal strategy has been to curtail supplies of prohibited substances.' In its many permutations, this supply-side approach has included attempts to eradicate crops, to intercept drugs at the Nation's borders, and to arrest, prosecute, and punish commercial participants at every level of the production and distribution system.

By any rational measure, the supply-side "war against drugs" has failed. Only ten to fifteen percent of the illicit drugs entering the country are intercepted and …

The Corporate Practice Of Medicine Doctrine: An Anachronism In The Modern Health Care Industry, Jeffrey F. Chase-Lubitz

Vanderbilt Law Review

Corporations, in the form of small, doctor-owned, proprietary hospitals and community or charity nonprofit hospitals, have pervaded the provision of health care services for many years. Recently, however, private, for-profit corporations increasingly have entered the health care field. One industry expert predicts that by the mid-1990s, ten national firms will provide fifty percent of the nation's medical care. Nationwide hospital chains, nonexistent twenty years ago, now own or manage twelve percent of the nation's hospitals. The proliferation of health maintenance organizations, freestanding emergency centers,' and other proprietary health care delivery systems exemplify the increased commercialization of medicine. Indeed, many young …

Legal Rights And Issues Surrounding Conception, Pregnancy, And Birth, Hutton Brown, Miriam Dent, L. Mark Dyer, Cherie Fuzzell, Anita Gifford, Sam Griffin, A. G. Kasselberg M.D., Jayne Workman, Melinda Cooper

Vanderbilt Law Review

Advances in medicine are reported almost daily in the media. Medical researchers have developed and are continuing to develop new methods of creating, saving, and prolonging life. This Special Project examines the impact that rapidly advancing medical technology has on the law governing conception, pregnancy, and birth.

Although medical techniques have advanced rapidly during the past decades, state and federal legislatures have responded in-adequately to the legal consequences of these new birth technologies. The resulting lag between technology and the law has forced courts to confront new situations that do not fit neatly into the statutory framework created to deal …

Alas! Poor Yorick," I Knew Him Ex Utero: The Regulation Of Embryo And Fetal Experimentation And Disposal In England And The United States, Nicolas P. Terry

Vanderbilt Law Review

Replete with analogies drawn to war crimes and expressed fears that the progress of medical science would be halted, the debate over the ethics of human experimentation is nothing if not complex. Nevertheless, in 1978 The Belmont Report was at least able to identify certain generalized ethical principles to guide researchers: "respect for persons," "beneficence," and "justice."' These ethical principles, however, are based ultimately on our perceptions of humanity and personality. Applying these principles to research on fetuses or embryos is fraught with difficulty. Neither of our pluralistic societies has resolved the "separate" debate regarding the appropriate status afforded pre-viable …

Barriers To Providing Effective Treatment: A Critique Of Revisions In Procedural,Substantive, And Dispositional Criteria In Involuntary Civil Commitment, Donald H. J. Hermann

Vanderbilt Law Review

Anyone spending time in a major urban center in the United States must be shocked by the significant number of mentally ill persons living on the streets--the "bag people" who sleep in door-ways, on steam grates, on subway stairs. These people represent a new lifestyle made possible in part by a policy of deinstitutionalization of the mentally ill, which has been motivated largely by economic considerations and rationalized as a matter of mental health law reform. Another major factor contributing to the increasing denial of treatment to the mentally ill has been a revision of the mental health statutes. A …

Reducing Diet-Induced Cancer Through Federal Regulation: Opportunities And Obstacles, Richard A. Merrill

Vanderbilt Law Review

For more than a decade, federal health regulatory agencies have devoted major attention to controlling human exposure to substances believed capable of causing cancer. These efforts have evoked a broad spectrum of criticism; government has been accused of both indolence in the face of an incipient epidemic' and reckless distortion of science to support restrictions on substances that present only trivial risks. A central object of regulatory concern has been the safety of the food supply. At least since the 1958 Food Additives Amendment to the Federal Food, Drug, and Cosmetic Act (FD&C Act),'with its famous Delaney Clause, the Food …

Automatic And Indefinite Commitment Of Insanity Acquittees: A Procedural Straitjacket, John B. Scherling

Vanderbilt Law Review

This Recent Development suggests that the Court erroneously decided Jones. Part II examines the Supreme Court's constitutional analysis of commitment procedures and discusses postacquittal commitment in state and lower federal courts. Part III analyzes the Jones decision and the exception that it allows for the commitment of insanity acquittees. Part IV contends that prior to involuntary and indefinite commitment an insanity acquittee deserves the same standard of proof as a civil commitment candidate-proof of mental illness and dangerousness by clear and convincing evidence. Part IV also argues that absent proof by clear and convincing evidence of the acquittee's need for …

Some Order Out Of Chaos In Wrongful Death Law, T. A. Smedley

Vanderbilt Law Review

In this Article, the author endeavors to outline a fair and manageable uniform law on wrongful death. Part II of this Article summarizes the historical development and inadequacies of the diverse types of wrongful death and survival laws in the United States.Part III explores the damages recoverable under the existing statutes. Part IV examines two significant proposals for reforming this area of the law. Finally, parts V and VI contain the author's suggestions for a fair yet manageable wrongful death statute that may serve all jurisdictions.

Redefining Government's Role In Health Care: Is A Dose Of Competition What The Doctor Should Order?, James F. Blumstein, Frank A. Sloan

Vanderbilt Law Review

Throughout the 1970s, the two major political parties espoused some form of national health insurance. Faced with a fiscal squeeze, however, the Carter Administration gave national health insurance a relatively low priority.The political movement for comprehensive national health insurance rests on an ideological commitment that the federal government should underwrite the cost of providing universal access to medical services. The objective is essentially redistributive in nature: equitable concerns for the disadvantaged loom as the major focus. The selective expansion of coverage to encompass those identified as needy and worthy, but only those so identified, is anathema to those who traditionally …

Health Professionals' Access To Hospitals: A Retrospective And Prospective Analysis, Jane L. Davis

Vanderbilt Law Review

The professional interdependence of the hospital institution and practicing physicians is a phenomenon of post-World War II society. This Note first examines the historical development of that interdependence and explores its erosion into a hospital-dominant mode. Next it examines the most important forces that influence and complicate the question of hospital privileges for the physician within the modern hospital: the interrelated pressures of intraprofessional restraints, pertinent government regulation, and medical technology. Then it sketches the internal procedures that have engendered and defined the relationship between physician and hospital, with special attention to the weaknesses within the procedures that have led …

Medical Care And Procompetitive Reform, T. R. Marmor, Richard Boyer, Julie Greenberg

Vanderbilt Law Review

It is not the purpose of this Article to reject all features of procompetitive proposals. Competitive health plans, multiple health plan choice, provider and consumer cost consciousness, and antitrust activity all may have some place in a larger strategy to rationalize the medical care system. Each of the proposals has some advantages in terms of increasing consumer choice and altering the balance of power between existing actors. As an approach to universal medical care system reform, however, competition alone is inadequate. In fact, one could argue that the most technically feasible way to both rationalize the medical care system and …

Competition Versus Regulation In Medical Care: An Overdrawn Dichotomy, Randall R. Bovbjerg

Vanderbilt Law Review

This Article discusses these issues in considering the "competitive" approach to reforming medical care financing and delivery.Although the approach is an extremely promising one, strongly held individual and social values underlie the current system, and powerful private interests have a stake in the status quo. Reforms,therefore, may never be fully implemented or realize their theoretical potential in practice. In any case they will take some time to work; no approach can be an immediate panacea. If government is to embark upon a "procompetitive" course, it needs to proceed carefully. Especially during the transition to a more competitive system, we need …

Competition In Health Services:Overview, Issues And Answers, Clark C. Havighurst

Vanderbilt Law Review

This Article is intended to put in context the many issues raised by this new interest in competition as a disciplinary force in the health services industry. After presenting a statement of the general theory supporting increased reliance on market forces, the Article turns to the key arguments advanced against that theory. The issues are many and complex, and the Article makes no attempt to treat them exhaustively. Rather, the aim is to highlight the weak as well as the strong points for and against competition in a manner that focuses the controversy and clarifies the issues. Until very recently, …

The Public Interest And Governing Boards Of Nonprofit Health Care Institutions, Robin Dimieri, Stephen Weiner

Vanderbilt Law Review

This Article specifically considers whether the existing legal system permits corporate governance mechanisms to function in a manner that promotes the public interest, particularly the public's interest in disclosure and participation in institutional policy development. The Article focuses on the viability of corporate governance structures in the health care industry, with special emphasis on the nonprofit hospital corporation. The Article begins with an overview of the issue of role reversal between management and directors of nonprofit corporations.The manifestations of role reversal are seen in the trend in non-profit corporations toward excessive delegation of board powers to executive committees, the elimination …