Health Law and Policy Commons^™

Addressing The Challenges Of Cognitive Decline In The Physician Workforce, Sharona Hoffman

Faculty Publications

This book chapter examines the growing challenge of cognitive decline among aging physicians and analyzes various approaches to addressing it. In 2024, twenty percent of working physicians were sixty-five or older, and evidence suggests that 12-14% of older clinicians have cognitive deficits that may affect job performance. The chapter evaluates two primary approaches to cognitive assessment: employer-initiated programs and programs operated by state medical boards. Employer "late career practitioner policies" (LCPP) that require older physicians to undergo testing are becoming increasingly popular among health care organizations. But they are vulnerable to challenge under disability and age discrimination laws, as evidenced …

Frontmatter, Case Western Reserve University School Of Law

Health Matrix: The Journal of Law-Medicine

No abstract provided.

Incentivizing Bidirectional Ev Charging Stations, Luke Warkall

Health Matrix: The Journal of Law-Medicine

California recently enacted a law that gives the California Energy Commission authority to require that Electric Vehicles (“EVs”) sold in California be capable of bidirectional charging. A bidirectional EV is capable of sending energy stored in the EV battery to a person’s home and to the grid. Bidirectional EVs are a novel step in the right direction in the global fight against climate change. They offer a substantial and mobile power source to communities recovering from natural disasters and can offset the demand for nonrenewable energy consumption by storing solar, wind and other renewable energy, then sending that energy back …

Right To Life, Right To Arms: Conservative States' Antithetical Approaches To Abortion And Gun Laws, Kristen Mehalko

Health Matrix: The Journal of Law-Medicine

Following Dobbs v. Jackson Women’s Health Organization and New York State Rifle & Pistol Association v. Bruen, twelve states enacted total abortion bans while simultaneously maintaining among the weakest gun safety laws in the nation. This Note explores the policy contradiction inherent in this approach: states invoking fetal life protection experience gun death rates substantially exceeding national averages, with firearms becoming the leading cause of death for children in these jurisdictions. The Note reveals how these states employ divergent strategies across two policy domains. Abortion restrictions receive vigorous enforcement through criminal statutes and private liability mechanisms, whereas gun regulations face …

Volume 36 Cover, Case Western Reserve University School Of Law

Health Matrix: The Journal of Law-Medicine

No abstract provided.

Waking Up From The Resident Duty-Hour Nightmare, Olivia Jack

Health Matrix: The Journal of Law-Medicine

Lengthy, grueling hours have long been the tradition for physicians-in-training, but resident exhaustion is a threat to patient and resident safety in the United States. This Note outlines the historical development of resident duty-hour regulation and examines the political and professional forces that continue to shape the current system. It argues that the current accreditation-based approach, that nearly all states rely on, inadequately protects residents and patients. This Note proposes several legislative and regulatory solutions, but suggests that in this moment of history, states are uniquely positioned to fill the regulatory gap. Such solutions include mandatory automated duty-hour tracking, regular …

Trapped: How Asset Restrictions Impact Supplemental Security Income Eligibility And Impoverish Individuals With Disabilities, Jaclyne Berger

Health Matrix: The Journal of Law-Medicine

For almost forty years, Congress and the SSA have failed to update the asset limit for SSI eligibility despite the punitive nature of it toward individuals with disabilities who wish to attain financial security. This Note argues that this failure forces individuals with disabilities to choose between financial stability and the Medicaid coverage that they need, contributing to a vicious cycle of poverty. By exploring current eligibility requirements, legislative gaps, and inadequacies of current savings options for individuals with disabilities, this Note makes the case for updating the current requirements and increasing access and accountability of ABLE accounts. These changes …

It's Magic?: Ozempic, Addiction Treatment, And The Law, Amandeep S. Grewal

Health Matrix: The Journal of Law-Medicine

The world may finally have a cure for drug addiction: Ozempic. That drug, popularly used for weight loss treatment, has spawned miracles for many patients. Their cravings for alcohol, opioids, nicotine and other addictive substances have disappeared along with their waistlines. But the legal system might not be ready to handle Ozempic. Some laws and policies discourage medication-assisted addiction treatment, especially in drug court systems. Drug court participants often face pressure to achieve sobriety through Alcoholics Anonymous and other twelve-step programs, rather than with medical assistance. Legal scholars and harm reduction advocates probably go too far in the other direction. …

Abortion Bites Back: An Analysis Of Direct Democracy Efforts In A Post Dobbs-Era, Kathleen Darcy, Pamela Aronson, Lisa Martin, Sarah Chaban

Health Matrix: The Journal of Law-Medicine

The legal landscape surrounding reproductive rights is in flux, and direct democracy is a method by which increasingly informed and connected citizen voters are able to skirt perceived slowmoving or biased legislatures. Myriad factors shape state-level referendums, including social movements that intersect with gender ideology to challenge or defend existing arrangements. Yet, we know little about referendum rhetorical framing as tied to successes or failures in this pivotal post-Dobbs era. We use a content analysis to look at the rhetoric in state-level ballot proposals on reproductive freedom that were put in front of voters after the Dobbs decision (2022–2024). We …

Stop Preventing Prevention: Securing Minors' Access To Hiv Care, Sarah Steadman

Health Matrix: The Journal of Law-Medicine

A troubling state legislative trend is emerging, marked by regressive restrictions on minors’ sexual health care autonomy, which increases their risk of HIV infection. This trend aligns with the current political hostility towards access to reproductive health care, including minors’ access to contraceptives. Access to HIV preventive care may become collateral damage as politicized parental control legislation aims to roll back established norms that recognized the public health imperative of allowing minorsto independently consent to sexual health care, including HIV testing and treatment, thereby encouraging their uptake. This backsliding is occurring as rates of HIV infection among youth are unacceptably …

The Doctor Won't See You Now: Legal Proscriptions For Medical Tourism Control And Regulation, Shenley W. Wish

Case Western Reserve Journal of International Law

The Medical Tourism industry has experienced remarkable growth in the past decade and is tracking to exceed that growth dramatically in the coming decade. With this rapid expansion, however, comes growing pains—predominantly lackluster patient safety. This Note examines the opportunities and challenges that would arise from regulating Medical Tourism through an international treaty, recognizing that an international treaty approach provides the most comprehensive and practically feasible solution for addressing complex cross-border constraints to create a safer global medical industry. (from the author)

Access To Primary Care And Health Care Fragmentation, Sharona Hoffman, Ishani Ganguli

Faculty Publications

This Article examines the growing crisis of long primary care wait times and the health care fragmentation that is associated with them. Patients who feel ill or are worried about new symptoms must often wait weeks or longer for appointments. In the wake of excessive wait times for primary care physician (PCP) appointments, patients increasingly turn to convenience care models such as urgent care centers, retail clinics, direct-to-consumer telemedicine, and at-home testing. While these alternatives offer prompt attention, they sacrifice other core functions of primary care and may exacerbate poor health outcomes and inequities. The Article argues that long wait …

Health Care Fraud And The End Of Chevron, Joan H. Krause

Health Matrix: The Journal of Law-Medicine

What do the Environmental Protection Agency’s “plantwide” definition of a “stationary” pollution source,” a National Marine Fisheries Service determination of who pays for fishing boat observers, and a Department of Health and Human Services rule governing the marketing of prescription drugs have in common? In short, a government agency’s interpretation of a federal statute. All three cases go to the heart of the administrative state: the ability of an agency, staffed by experts in the field, to interpret static statutory language to offer practical guidance to an ever-evolving industry.

The same is true of health care fraud, although it is …

Contrasting Visions Of Age: Manifestations Of Ageism In Law, Art, And Health Care, Janet L. Dolgin

Health Matrix: The Journal of Law-Medicine

Ageism has befuddled the law’s attempts at remediation. Each “ism” (e.g., sexism, racism) differs from the others. Ageism, however, differs fundamentally from other “isms.” That difference explains the law’s failure to limit it. This article describes the difference, and it explains why that difference has rendered ageism resistant to legal remedies. Legal scholars and gerontologists have asked why the law’s efforts to limit the bias, stigma and discrimination that stem from ageism have largely failed. A remarkable framework for responding to that query derive from literary and artistic depictions of old people over time.

This article has identified shifting visions …

Predictive Health Discrimination: Cabining Ai Risk Assessment To Protect Worker Data, Elizabeth A. Brown

Health Matrix: The Journal of Law-Medicine

Predictive health data monitoring is rapidly expanding in workplaces, outpacing legal protections and exposing workers to new risks. Employers may now use analytics powered by artificial intelligence (“AI”) to identify which workers are most likely to develop future disabilities, raising the threat that these workers will face limited opportunities and discrimination before such action is clearly illegal.

Employers are accelerating predictive biometric surveillance, fueled by financial incentives like reduced health insurance costs and higher productivity, accommodations for older workers, and the ubiquity of predictive analytics in general. Current federal and state laws offer scant protection against discrimination based on predicted …

Mitochondrial Replacement Techniques For Infertility: How Legal Barriers Harm Patients And Children, Kerry Lynn Macintosh

Health Matrix: The Journal of Law-Medicine

Recent studies show that mitochondrial replacement techniques (“MRTs”) can help women with poor egg quality and repeated IVF failures get pregnant and deliver healthy children. Unfortunately, infertile Americans can derive no hope from this promising development.

The U.S. Food and Drug Administration (“FDA”) claims jurisdiction over novel assisted reproductive technologies. Fertility clinics and doctors who want to provide MRTs must submit an investigational new drug (“IND”) application to the FDA and wait for approval before proceeding with clinical trials. However, for the past decade, Congress has enacted an annual appropriations rider that precludes the FDA from acknowledging receipt of applications …

English Only: The Increasing Problem Of National Origin Discrimination In Federally Funded Clinical Research, Sarah Reckess

Health Matrix: The Journal of Law-Medicine

Title VI of the U.S. Civil Rights Act prohibits institutions receiving federal financial assistance from discriminating based on race, color, or national origin. The term “national origin” includes people with limited English proficiency (“LEP”). The number of LEP residents has increased in the United States to over 10% of the residents in the most populous states (Texas, California, New York, Florida, and Nevada). Executive Order 13166, issued in 2000, requires all federal agencies to comply with Title VI by establishing guidelines that remove language barriers to federal programs, services, benefits, and activities. Additionally, it allows federal agencies to withhold funding …

Your Car Is Killing You: Reducing Traffic To Promote Healthy Communities, Andrew D. Levy

Health Matrix: The Journal of Law-Medicine

In the United States, cars contribute to a bevy of health problems, constituting a large cost to U.S. taxpayers who must subsidize the medical treatment that stems from them. This Note explores solutions to this health problem by attempting to minimize the number of cars in urban spaces. In particular, it looks at reworking statutory funding strategies for bicycle lanes, calls for using certain types of bicycle lanes that will lead to wider utilization, and advocates for rezoning urban areas to promote density.

The Harms Of Expanding Physician-Assisted Suicide, Katherine Drabiak

Health Matrix: The Journal of Law-Medicine

Currently, nine states and the District of Columbia have passed laws in the U.S. to legalize and regulate the practice of physicianassisted suicide (“PAS”). Proponents initially garnered public support by portraying PAS as distinct from suicide, framing it as a rare mechanism for patients with terminal illness to achieve a peaceful death, enhance autonomy, and reduce suffering. Original state laws contained numerous eligibility requirements designed as safeguards to provide stringent limits. However, over the past few years proponents of PAS have systematically worked to expand PAS and erase these limits by increasing eligible providers, reducing waiting periods, and eliminating residency …

Medical Necessity And Prior Authorization: The Unregulated Power Of Insurers, Virginia Lefever

Health Matrix: The Journal of Law-Medicine

The absence of a uniform federal definition of “medical necessity” in employer-sponsored health plans has allowed insurers to create their own coverage standards, often resulting in inconsistent and opaque determinations that limit access to essential care. This Note argues that ERISA’s silence on medical necessity grants insurers excessive discretion, enabling restrictive prior authorization policies that disadvantage patients and providers alike. By analyzing judicial interpretations, regulatory gaps, and the disparate standards imposed by insurers, this Note makes the case for a federally mandated definition of medical necessity applicable to all employer-sponsored plans. A standardized definition would promote transparency, reduce litigation, and …

“The Craze For Legal Proceedings”: Another Look At Schloendorff V. New York Hospital, Paul A. Lombardo

Health Matrix: The Journal of Law-Medicine

In 1914, Judge Benjamin Cardozo wrote an appellate decision in the case of Schloendorff v. Society of the New York Hospital containing the assertion, “Every human being of adult years and sound mind has a right to determine what shall be done to his own body.” This quotation later became a touchstone for discussions of the principle of informed consent. Previous scholarship has questioned the use of Schloendorff as a byword of patient self-determination, but more recently discovered records suggest yet another way to understand the famous case. Material from the archive of the New York Hospital—where Mary Schloendorff’s surgery …

Frontmatter, Case Western Reserve University School Of Law

Health Matrix: The Journal of Law-Medicine

No abstract provided.

Making Super Soldiers: Command Authority And The Implications Of “Getting To Yes”, Christopher J. Lin

Health Matrix: The Journal of Law-Medicine

The capability and will to enhance soldiers’ minds and bodies for warfare have existed throughout the centuries and across nations, from Ancient Greek hoplites partaking in wine before battle to calm nerves, to American servicemembers consuming amphetamines to remain awake during long-range reconnaissance missions in the Vietnam War. With advancements in biomedical technology, certain types of enhancements entail modifications with varying degrees of permanence to enhance battlefield performance. This Article explores the historical context and contemporary developments of biomedical enhancements, with a focus on the longstanding deference to military command authority regarding issues of individual autonomy. By examining the impacts …

At What Cost: Medicare’S Cost- Saving Measures In Skilled Nursing Facilities And Their Impact On Vulnerable Populations, Julia Mcdermott

Health Matrix: The Journal of Law-Medicine

As the highest spender of health care in the world, the United States continues to look for ways to reduce its spending. As the main health insurance provider for the elderly and disabled, Medicare shares this mission. Unfortunately, some of Medicare’s cost-saving initiatives in one of its most critical care settings, Skilled Nursing Facilities, cause disproportionately negative impacts on vulnerable populations. This Note analyzes three of Medicare’s cost-saving measures in Skilled Nursing Facilities, namely value-based purchasing programs, the twenty-day limit on full coverage, and the practical matter provision. This Note highlights how these measures have a disparate negative effect on …

Sacrificing Financial Health For Physical Health: The Implications Of Medical Credit Cards, Emma Kerro

Health Matrix: The Journal of Law-Medicine

Rising healthcare costs have contributed to significant medical debt increases for Americans in recent years. One way patients are paying these charges is with a medical credit card. The increase in popularity of medical credit cards can, in part, be attributed to non-profit hospitals’ insufficient charity care offerings. Some hospitals are— themselves—offering healthcare financing products to patients rather than offering charity care. As a result, low income patients often become trapped in a cycle of medical debt. While patients may need help paying for their care, a predatory lending option should not be their first or only choice. Non-profit hospitals …

Issue 35 Cover, Case Western Reserve University School Of Law

Health Matrix: The Journal of Law-Medicine

No abstract provided.

Patient Autonomy, Public Safety, And Drivers With Cognitive Decline, Sharona Hoffman, Cassandra Burke Robertson

Faculty Publications

With a growing elderly population, cognitive decline in drivers has become a significant public safety concern. Currently, over thirty-two million individuals who are seventy or older have driver’s licenses, and that number is growing quickly. In addition, almost ten percent of U.S. seniors (those sixty-five and older) have dementia, and an additional twenty-two percent have mild cognitive impairment. Between a quarter and a half of individuals with mild to moderate dementia still drive. As cognitive abilities such as memory, attention, and decision-making skills deteriorate, a driver's ability to operate a vehicle safely can be compromised. This not only puts the …

Protecting Older Adults Who Are Incarcerated: Does The 8th Amendment Work?, Jalayne J. Arias

Health Matrix: The Journal of Law-Medicine

Older adults in prison and within other carceral systems (i.e. jails, parole) are uniquely at risk for elder mistreatment. Emerging research has begun to consider the experiences of older adults within carceral settings, including aging in prison, chronic conditions and medical care, compassionate release, and end-of-life care. This research exposes evidence that prisons and other carceral settings lack resources and services for older adults. Given increased vulnerability and a lack of protective resources, older adults experiencing incarceration may experience disproportional rates and consequences of elder mistreatment. A public health approach to develop tools and resources that would prevent, detect, and …

Decision-Making Supports And Cognitive Decline, Rebekah Diller

Health Matrix: The Journal of Law-Medicine

For persons with a range of cognitive disabilities, supported decision-making, rooted in a human rights approach to disability, has emerged as a tool that permits them to make legally binding decisions and avoid guardianship. As supported decision-making policy has evolved in the United States, state statutes have primarily focused on formal agreements through which individuals can designate trusted supporters to assist in obtaining information, processing that information, and communicating a decision. This Article argues that supported decision-making has promise for preserving the autonomy of persons living with dementia, but that the model of a supported decisionmaking agreement embodied in the …

Planning For Cognitive Decline: Combining Formal Supported Decision-Making Agreements And Healthcare Power Of Attorney, Megan S. Wright

Health Matrix: The Journal of Law-Medicine

Patients who have impaired decision-making abilities may not be permitted to make contemporaneous medical decisions. Instead, a substitute decision maker, including a healthcare agent, may be asked to decide on the patient’s behalf even if the patient wants to participate in the medical decision making. Being marginalized in decisions made about their medical care may lead to a decline in wellbeing for these patients. But supported decision making, wherein a person with cognitive impairments receives decision-making assistance, may facilitate such patients making contemporaneous medical decisions. As supported decision-making legislation spreads throughout the United States, there are questions about how this …