Law Commons^™

Unwarranted Variations In The Quality Of Health Care: Can The Law Help Medicine Provide A Remedy/Remedies?, Philip G. Peters Jr., John E. Wennberg M.D.

Faculty Publications

This article reviews the essential findings of studies of variations in quality of care according to three categories of care: effective care, preference-sensitive care, and supply-sensitive care. It argues that malpractice liability and informed consent laws should be based on standards of practice that are appropriate to each category of care. In the case of effective care, the legal standard should be that virtually all of those in need should receive the treatment, whether or not it is currently customary to provide it. In the case of preference-sensitive care, the law should recognize the failure of the doctrine of informed …

Income Tax Planning For Long-Term Care, David M. English

Faculty Publications

Planning for long-term involves more than the preparation of powers of attorney and counseling on possible asset transfers to qualify for Medicaid reimbursement. Steps should also be taken to make certain that the person receiving care continues to file an income tax return and does so at a minimum possible income tax cost. Practitioners should be familiar with the procedure for filing a return on behalf of an incapacitated individual. The medical expense deduction, while of little importance for most taxpayers, is critical for many elderly, particularly for those receiving long-term care. Long-term care insurance and life insurance may be …

The Role Of Jury In Modern Malpractice Law, Philip G. Peters Jr.

Faculty Publications

This article explores the policy issues raised by the choice between a custom-based standard of care and a jury-determined reasonability standard. The author examines not only traditional legal arguments but also the recent findings of cognitive psychology, jury performance studies, and health industry research. Not surprisingly, this analysis reveals that both options are imperfect. However, the author cautiously recommends the reasonable physician standard. The revolutionary transformation of the health care industry in last quarter of a century has transferred considerable power from physicians to the health insurance industry, an industry that has not yet earned the privilege of self-regulation. Unlike …

Aids Caps, Contraceptive Coverage, And The Law: An Analysis Of The Federal Anti-Discrimination Statutes’ Applicability To Health Insurance, Sharona Hoffman

Faculty Publications

Traditionally, health insurers have enjoyed the freedom to determine their own terms of coverage, to decide to what extent, if any, patients should be reimbursed for different kinds of treatment, and to establish premium prices. Health insurers typically deny coverage for speech therapy, eye glasses, hearing aids, most foot care, and treatment for infertility. Many insurance providers also exclude or severely limit coverage for mental health, dental care, AIDS, diabetes mellitus, morbid obesity, epilepsy, and alcoholism or drug abuse. Therefore, while some Americans enjoy full coverage for all their health needs, others who have insurance and suffer from serious or …

Disease Management And Liability In The Human Genome Era, Larry I. Palmer

Faculty Publications

No abstract provided.

The Uniform Health-Care Decisions Act And Its Progress In The States, David M. English

Faculty Publications

Over the past decade, planning for health care decision making through the making of an advance directive has become a routine part of personal counseling. Public interest in the subject has been fueled by well-publicized cases such as Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990). In response to this interest, most states authorize their citizens to make at least one form of advance directive: all states statutorily authorize powers of attorney for health care, and all but Massachusetts, Michigan and New York authorize living wills. State legislation has been a mixed blessing. Although intended to facilitate …

The Use Of Placebos In Clinical Trials: Responsible Research Or Unethical Practice?, Sharona Hoffman

Faculty Publications

Developments in medical research have been occurring at a rapidly increasing rate during the past two decades. Expanding budgets, augmented computer capabilities, and new research tools have all dramatically enhanced research technology. Accompanying the proliferation of medical research are increasing concerns about research risks. This article focuses on placebo-controlled clinical trials. The use of placebos enables clinical investigators to compare results from subjects taking an experimental intervention to results from a group that is receiving an inactive substance, such as a sugar pill, in order to determine the efficacy of the new medication. In recent years, some surgeons have also …

The Integrity Of Death: Resolving Dilemmas In Medicine, Larry I. Palmer

Faculty Publications

No abstract provided.

Nursing Home Residents And The New California Health Care Decisions Law, David M. English, Rebecca C. Morgan

Faculty Publications

This article explores issues involving advance directives made by nursing home residents, both prior to and during their stay in a facility, including the frequency of making directives, the reasons why residents fail to make directives, and the reasons why facilities often fail to honor them. Specifically, this article examines these issues in light of the 1999 California Health Care Decisions Law, effective July 1, 2000, and focuses on how this new statute can be used to empower nursing home residents, and adults more generally, to take control of decisions regarding their own health care.

Mental Health Advance Directives: Having One's Say?, Justine A. Dunlap

Faculty Publications

First, this Article traces the extension of the right to refuse treatment to the psychiatric realm. Next, the Article addresses advance directives for health care and their utility for mental health issues. Then, the Article examines state statutory and judicial responses to mental health advance directives. Finally, the Article analyzes why the right to control future psychiatric treatment, including the right to refuse treatment, has been slow to gain acceptance. Although mental health advance directives present real challenges, legally and otherwise, this Article concludes that they are firmly rooted in the law and their rejection is, more often than not, …

The Quiet Demise Of Deference To Custom: Malpractice Law At The Millenium, Philip G. Peters Jr.

Faculty Publications

According to conventional wisdom, tort law allows physicians to set their own standard of care. While defendants in ordinary tort actions are expected to exercise reasonable care under the circumstances, physicians traditionally have needed only to conform to the customs of their peers. However, judicial deference to physician customs is eroding. Gradually, quietly and relentlessly, state courts are withdrawing this legal privilege. Already, a dozen states have expressly rejected deference to medical customs and another nine, although not directly addressing the role of custom, have rephrased their standard of care in terms of the reasonable physician, rather than compliance with …

Beneficial And Unusual Punishment: An Argument In Support Of Prisoner Participation In Clinical Trials, Sharona Hoffman

Faculty Publications

Currently, approximately 1.8 million people are incarcerated in the United States at any given time. A disproportionately large percentage of the prisoner population has serious illnesses, such as AIDS and tuberculosis. Prisoners most often, however, are barred from participation in clinical trials, even when conventional therapy has failed, and experimental treatment might provide them with their only hope of survival.

Much of the reluctance to include prisoners in biomedical research is based on history. In the past, prisoners have been severely abused and even tortured in medical studies conducted in the Nazi death camps, Japanese prisoner camps, and correctional facilities …

More Sorry Than Safe: Assessing The Precautionary Principle And The Proposed International Biosafety Protocol, Jonathan H. Adler

Faculty Publications

Part I of this paper provides a brief overview of the development of biotechnology, its regulation and its use, with a particular emphasis on agricultural biotechnology. Part II outlines the United Nations Convention on Biological Diversity, which provides an international legal framework for a biosafety protocol and summarizes the results of recent protocol negotiations, such as those conducted in Cartagena, Colombia in February 1999, which continued in Montreal in January 2000. Part III explains why the proposed protocol embodies a variant of the precautionary principle and why such policies may do more harm than good. This paper concludes with some …

Informed Consent For Neonatal Circumcision: An Ethical And Legal Conundrum, J. Steven Svoboda, Robert S. Van Howe, James G. Dwyer

Faculty Publications

No abstract provided.

Harming Future Persons: Obligations To The Children Of Reproductive Technology, Philip G. Peters Jr.

Faculty Publications

Two paradigms dominate contemporary ethical and legal debate about the risks posed to children who owe their lives to reproductive technology. One asks whether the children have lives so tragic that life itself is harmful. The other approach asks whether children so conceived are likely to enjoy a minimally decent existence. Although the two approaches have quite different analytic foundations, they share one crucial trait. Each concludes that children who owe their lives to reproductive technology are harmed only when that technology causes genuinely catastrophic injuries.Because these conventional paradigms define harmful conduct exclusively by reference to the magnitude of the …

A Proposal For Federal Legislation To Address Health Insurance Coverage For Experimental And Investigational Treatments, Sharona Hoffman

Faculty Publications

Health insurance coverage for experimental treatments has generated significant debate and frequent litigation in recent years. In many cases, denials of coverage for investigational therapies constitute economically and ethically sound policy. This article argues, however, that health insurance providers should be required to cover experimental treatments in limited circumstances, namely, when they are administered in phase III clinical trials to patients with terminal illnesses who are likely to die within two years. This coverage mandate would help the sickest patients, who have no other treatment options, and would benefit medical researchers, who often face a dearth of patients willing to …

Patient Safety, Risk Reduction, And The Law, Larry I. Palmer

Faculty Publications

No abstract provided.

Shaping Regional Economies To Sustain Quality Work: The Cooperative Health Care Network, Peter R. Pitegoff

Faculty Publications

This chapter chronicles a creative response to social retrenchment, a saga of strategic deployment of accessible resources and a reshaping of regional economic forces for the benefit of targeted labor markets. While charting its own course, CHCB is part of a mutually supportive network of health care employers and trainers, including successful home care companies in Philadelphia and the South Bronx. Together, these three corporations form the core of the Cooperative Health Care Network and employ over 500 home health aides. About 80 percent of the employees were formerly dependent on public assistance. The network [network] experience and their applicability …

Genetic Testing, Genetic Medicine, And Managed Care, Mark A. Rothstein, Sharona Hoffman

Faculty Publications

As modern human genetics moves from the research setting to the clinical setting, it will encounter the managed care system. Issues of cost, access, and quality of care will affect the availability and nature of genetic testing, genetic counseling, and genetic therapies. This articles explores such issues as professional education, coverage of genetic services, privacy and confidentiality, and liability. It concludes with a series of recommendations for the practice of genetic medicine in the age of managed care.

The Evolution Of Health Care Decision Making: The Political Paradigm And Beyond, Elizabeth Price Foley, Elizabeth C. Price

Faculty Publications

The ascendancy of the political paradigm as the primary mode of health care decision-making is a natural evolutionary reaction to the unrestrained market paradigm. Although a certain of political intrusion into the health care marketplace is both necessary and useful, it has the potential to unravel the efficiencies achieved by managed care. Overzealous intervention in the health care market in the name of "reform" may cause the health care decision-making pendulum to swing back to the provider paradigm, with its tendency to escalate health care costs and diminish access. One possible way to achieve decision-making equilibrium and and end the …

Crossing The Line: The Political And Moral Battle Over Late-Term Abortion, Rigel C. Oliveri

Faculty Publications

This paper focuses on the political and moral debate surrounding two pieces of federal legislation which sought to criminalize a particular late term abortion technique scientifically known as "intact dilation and extraction," and popularly known as "partial birth abortion." The Congressional "Partial Birth Abortion" Bans of 1996 and 1997 inflamed the already emotionally charged contest over abortion rights. The intense lobbying and advocacy efforts put pro-choice activists in the uncomfortable position of having to defend one of the most extreme positions on the abortion-rights spectrum. The advocacy was further complicated by the fact that very few women obtain late term …

Institutional Analysis And Physicians' Rights After Vacco V. Quill, Larry I. Palmer

Faculty Publications

No abstract provided.

Beginning The Endgame: The Search For An Injury Compensation System Alternative To Tort Liability For Tobacco-Related Harms, Paul A. Lebel

Faculty Publications

No abstract provided.

Introduction: The Law-Medicine Center 50th Anniversary Symposium: The Field Of Health Law: It’S Past And Future, Maxwell J. Mehlman

Faculty Publications

Introduction to The Law-Medicine Center 50th Anniversary Symposium: The Field of Health Law: Its Past and Future, Cleveland, Ohio 2004.

The Law Of Above Averages: Leveling The New Genetic Enhancement Playing Field, Maxwell J. Mehlman

Faculty Publications

In this article, I will explore some of the legal implications of this emerging technology-the technology of genetic enhancement. Specifically, I will discuss how the law might respond to two related consequences: an increase in social inequality, and the

Introduction - Kyl Amendment Symposium, Maxwell J. Mehlman

Faculty Publications

Introduction to the Symposium: Medicare Private Contracting (The KYL Amendment), Cleveland, Ohio, 2000.

Introduction, Symposium National Health Care Reform: The Legal Issues, Maxwell J. Mehlman

Faculty Publications

Introducation to the Symposium: National Health Care Reform: The Legal Issues, Cleveland, Ohio, 1995.

The Human Genome Project And The Courts: Gene Therapy And Beyond, Maxwell J. Mehlman

Faculty Publications

No abstract provided.

Symposium: Workshop On Inherited Breast Cancer In Jewish Women: Ethical, Legal, And Social Implications, Maxwell J. Mehlman

Faculty Publications

Introducation to Symposium: Workshop on the BRCA1 Breast Cancer Gene in the Jewish Population, Cleveland, Ohio, 1997.

What's Competence Got To Do With It: The Right Not To Be Acquitted By Reason Of Insanity, Justine A. Dunlap

Faculty Publications

An acquittal by reason of insanity is sufficiently adverse and is in many ways more akin to a conviction than to an outright acquittal. Although not technically punishment, it involves substantial infringement of rights. The legal literature has devoted significant space to the issue of a criminal defendant’s competence to stand trial and to the issue of the insanity plea. The problem of a pretrial insanity acquittal of an incompetent defendant, on the other hand, has not been extensively examined. In undertaking that task, this article will, in Part II, review the law and practice of competency determinations. Part III …