Health Law and Policy Commons^™

Retaining Medicaid Covid-19 Changes To Support Community Living, Elizabeth Edwards, David Machledt, Jennifer Lav

Saint Louis University Journal of Health Law & Policy

The impact of COVID-19 on people with disabilities in institutional settings, like nursing facilities, has garnered significant attention. But people receiving comparable services in the community have also been affected significantly. States used several emergency authorities in efforts to facilitate access to and stabilize these Medicaid home and community-based services (HCBS), including behavioral health services. Although states made different policy choices within those authorities, many states expanded the provider pool, increased HCBS provider rates, decreased onerous utilization controls and other barriers to care, expanded telehealth, and added new community-based services. These state policy responses have resulted in new services or …

Lessons Learned From Community-Driven Responsiveness During Covid-19, Amanda Harris, Brittini "Ree Belle" Gray, Ciearra Walker, Melinique Walls Castellanos

Saint Louis University Journal of Health Law & Policy

People of color are suffering and dying from COVID-19 at greater rates than the general population. Additionally, population-level health interventions can worsen health disparities by failing to reach already underserved populations. In response, PrepareSTL, a collaborative, community-led campaign, aims to reach communities of color in St. Louis with accessible information and resources to stop the spread of the coronavirus among the target audiences and help these communities survive the virus’s adverse social and economic impacts. This study (1) analyzes factors contributing to the success of PrepareSTL as a community-led and equity-centered response to COVID-19 and (2) identifies lessons from the …

Covid-19, Doctors, And The “Realities Of Prison Administration” Part I: The Realities Of A Subject Matter Expert, Fred Rottnek

Saint Louis University Journal of Health Law & Policy

COVID-19 is still novel. As scientists continue racing to characterize the virus and its mutations, promote behavioral change, and optimize treatment and vaccination strategies, public policy makers shift their attention from one high priority population to the next. These spotlights have converged on one truism of the pandemic: COVID-19 infection, and all its sequelae, have magnified long-established social and structural inequities in U.S. institutions—including practices in jails, prisons, and detention facilities. While these facilities were recognized as early incubators of the virus, the response of the facility administrators and local leaders were at best uneven and at worst nonexistent. When …

Covid-19, Courts, And The “Realities Of Prison Administration” Part Ii: The Realities Of Litigation, Chad Flanders

Saint Louis University Journal of Health Law & Policy

Lawsuits challenging prisons and jails for not doing enough to stop the spread of COVID-19 among inmates have faced mixed results in the courts: wins at the district court level are almost always followed by losses (in the form of stays of any orders to improve conditions) at the appeals court level or at the Supreme Court. This short Article tries to explain why this is happening and makes three comparisons between how district courts and appeals courts have analyzed these lawsuits. First, district courts and appeals courts tend to emphasize different facts in their decisions. District courts focus more …

The Urban Trauma Drama: The Intersecting Path Of Criminal Justice And Public Health Revealed During The Covid-19 Pandemic, José Felipé Anderson

Saint Louis University Journal of Health Law & Policy

Our society often operates under the delusion that more incarceration in urban areas will make us safer. Crowded cities and the problems for its inhabitants are not new. Those problems often fall more heavily on minority groups. Failed education, healthcare unavailability, and a lack of decent housing have made it difficult for cities to cope with addiction and crime. The COVID-19 pandemic has made the issues in the criminal system harder to ignore. Decline of major manufacturing jobs in cities like the steel and auto industries removed key opportunities for those seeking to overcome poverty and raise families. Debilitating riots …

Skirting The Law: Medicaid Block Grants And Per-Capita Caps In A Pandemic, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

To what extent can an administration abridge Medicaid’s entitlement status by administrative fiat? In the final year of the Trump administration, just before the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) sought to push the outer bounds of this question by announcing the Healthy Adult Opportunity (HAO) initiative. It invited states to submit § 1115 demonstration applications to cover individuals not eligible for Medicaid benefits under the state’s Medicaid plan—meaning, in many cases, the Affordable Care Act’s (ACA’s) Medicaid expansion population. Spending on those populations would be capped, not by purporting to waive federal law regarding matching …

Examining Sociodemographic Data Reporting Requirements In State Disease Surveillance Systems, Samantha Bent Weber, Amanda Moreland, Rachel Hulkower, Tara Ramanathan Holiday

Saint Louis University Journal of Health Law & Policy

Law plays an important role in the collection of data related to disease and injury in a population. A robust system of laws sets out requirements for the collection, analysis, and dissemination of disease reporting data from local, state, territorial, and federal public health institutions. Occurrence of disease, including outbreaks of novel infectious agents like coronaviruses, influenza viruses, and others that have arisen in recent years, often require epidemiologists and others to understand not only the etiology and specific context of diseases and conditions, but also the trajectory of their spread among and across communities. Capturing sociodemographic data is critical …

Rights Not Fundamental: Disability And The Right To Marry, Gabriella Garbero

Saint Louis University Journal of Health Law & Policy

Disabled people have long been systematically excluded from marriage, despite its personal, religious, cultural, and symbolic importance, and despite it being treated as a fundamental right in other contexts. This exclusion has been perpetuated by arcane laws that require Social Security and Medicaid beneficiaries to include their spouse’s income and assets in eligibility calculations. Since eligibility is contingent upon very little income and very few assets, couples who marry and intend to keep benefits are forced to live far below the poverty line in order to meet income and asset criteria, and many people are unable to make such a …

Enforcing The “Safe And Sanitary” Environment Standard Within U.S. Detention Facilities To Save Children’S Lives, Anam A. Khan

Saint Louis University Journal of Health Law & Policy

Overcrowding and unsanitary conditions within Customs and Border Protection (CBP) detention facilities are ideal for the transmission of infectious disease among CBP detainees. This is a dangerous problem. Between 2018 and 2019, at least six children died after acquiring infectious diseases while detained at CBP facilities. Migrant children are particularly vulnerable because their immune systems are not fully developed and due to the negative impact of trauma and stress have on their immune systems. Infectious disease promulgation within CBP facilities also puts the American public at risk because of the potential for transmission beyond CBP facilities. Employees who are regularly …

Table Of Contents

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Masthead

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Foreword, Elizabeth Pendo

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Protecting Patients From Physicians Who Inflict Harm: New Legal Resources For State Medical Boards, Elizabeth Pendo, Tristan Mcintosh, Heidi A. Walsh, Kari Baldwin, James M. Dubois

Saint Louis University Journal of Health Law & Policy

State medical boards (SMBs) protect the public by ensuring that physicians uphold appropriate standards of care and ethical practice. Despite this clear purpose, egregious types of wrongdoing by physicians are alarmingly frequent, harmful, and under-reported. Even when egregious wrongdoing is reported to SMBs, it is unclear why SMBs sometimes fail to promptly remove seriously offending physicians from practice. Legal and policy tools that are targeted, well-informed, and actionable are urgently needed to help SMBs more effectively protect patients from egregious wrongdoing by physicians.

Past reviews of SMB performance have identified features of SMBs associated with higher rates of severe disciplinary …

State Peer Review Laws As A Tool To Incentivize Reporting To Medical Boards, Nadia N. Sawicki

Saint Louis University Journal of Health Law & Policy

State medical boards have been stymied in their ability to take disciplinary action against physicians who engage in serious misconduct, in part because hospitals and other health care organizations rarely report such misconduct. This Article offers a proposal for incentivizing hospital reporting of physician misconduct, inspired by an existing but flawed model in the federal Health Care Quality Improvement Act. This Article proposes that state legislatures link state medical practice act reporting requirements with state laws establishing an evidentiary privilege for peer review activities.

Diversity From The Perspective Of Corporate Boards And Lawyer Disciplinary Boards, Lissa L. Broome, John M. Conley

Saint Louis University Journal of Health Law & Policy

This Article addresses the organizing question of this symposium—whether diversifying state medical boards (SMBs) would improve their effectiveness in disciplining doctors—by drawing on the comparable experiences of corporate boards of directors and lawyer disciplinary boards. Reexamining our own qualitative study of corporate board diversity conducted several years ago, we find that almost of all of the arguments for board diversity raised in the business literature or our own interviews also tend to support diversity on SMBs. Reviewing the legal profession’s experience with the diversity question on lawyer disciplinary boards, we find that many of these arguments have also been recognized, …

Contextualizing And Strengthening State Medical Board Responses To Physician Sexual Misconduct, Patricia A. King, Emily Gerard, Mark Staz, Eric M. Fish

Saint Louis University Journal of Health Law & Policy

As the instrument through which states regulate the professional conduct of medical practitioners, state medical boards play a critical role in addressing physician sexual misconduct. Sexual misconduct in the medical profession is particularly troubling given that physicians are often privy to the most intimate aspects of their patients’ lives. Patients place a profound trust in their physician, and the resulting relational dynamic may impact how a patient perceives or reacts to a physician’s conduct. State medical boards are often criticized for failing to respond appropriately to instances of sexual misconduct. However, some of these criticisms fail to consider historical attempts …

Finding The Cluster: Balancing Privacy And Public Health Amid The Covid-19 Pandemic, Jessie L. Bekker

Saint Louis University Journal of Health Law & Policy

More than 800,000 Americans have died and more than fifty-seven million sickened since March 2020 from the COVID-19 virus and its highly contagious variants. Public health officials urged the public to mask up, socially distance, and stay home in order to curb the virus’ spread in the early months of the pandemic before a vaccine was approved. Meanwhile, those same officials blocked access to valuable information pinpointing areas of disease concentration—“hotspots”—which could have alerted members of the public of locations to avoid. Those officials generally—and usually incorrectly—cited the Health Insurance Portability and Accountability Act (HIPAA) as grounds for …

Improving Access To Emerging Lifesaving Drugs: Solving The Disclosure Problem Within The Patent Dance, Michael J. Schellhous

Saint Louis University Journal of Health Law & Policy

Biologics are a growing class of pharmaceutical drugs and are associated with a significant portion of major medical breakthroughs over the past fifty years. However, in comparison with traditional small-molecule drugs, biologics are vastly more complex, more difficult to manufacture, and extremely expensive. Congress passed the Biologics Price Competition and Innovation Act (BPCIA) in an effort to increase the availability of biosimilars—the generic versions of biologic drugs—but the BPCIA has been largely ineffective. This is due, in part, to the lack of a standard regarding initial information disclosures required at the outset of the BPCIA process, leading to a cumbersome …

The Intellectual Property Of Covid-19, Ana Santos Rutschman

All Faculty Scholarship

The response to COVID-19 is indissolubly tied to intellectual property. In an increasingly globalized world in which infectious disease pathogens travel faster and wider than before, the development of vaccines, treatments and other forms of medical technology has become an integral part of public health preparedness and response frameworks. The development of these technologies, and to a certain extent the allocation and distribution of resulting outputs, is informed by intellectual property regimes. These regimes influence the commitment of R&D resources, shape scientific collaborations and, in some cases, may condition the widespread availability of emerging technologies. As seen throughout this chapter, …

Is There A Cure For Vaccine Nationalism?, Ana Santos Rutschman

All Faculty Scholarship

“[V]accine nationalism . . . should serve as a reality check for the status of global health cooperation in the twenty-first century.”

Gaps In Worker Protections That Increase Essential Workers’ Exposure To Covid-19, Ruqaiijah Yearby

All Faculty Scholarship

States and localities designated more than 55 million Americans as essential workers. Essential workers not only comprise those employed by the health care and food and agriculture industry, but also include teachers, grocery store workers, transit and airline workers, mail and delivery workers, energy sector and utility workers, and domestic workers (Petition for Emergency, 2020). Racial and ethnic minorities are disproportionately employed as essential workers, with Black Americans the most likely to be essential workers (Petition for Emergency, 2020). Essential workers have been left vulnerable to workplace COVID-19 infections and deaths in large part due to the federal and state …

Lessons Learned: Strengthening Medicaid To Address Health And Economic Emergencies, Nicole Huberfeld, Sidney Watson

All Faculty Scholarship

COVID-19 has disproportionately harmed low-income people, especially Black and Latino populations, seniors, and people with disabilities. Medicaid plays an essential role in providing coverage and access to care for these populations. As COVID-19 disrupted employment, earnings, and insurance coverage, Medicaid enrollment increased, in part because Congress offered states increased Medicaid funding in return for maintaining eligibility and enrollment for the duration of the public health emergency (PHE). At the same time, many states expanded eligibility and streamlined enrollment to assure that people could secure and keep coverage. Such policies resulted in more than 5.3 million more Americans having Medicaid coverage …

Covid-19, Courts, And The 'Realities Of Prison Administration.' Part Ii: The Realities Of Litigation, Chad Flanders

All Faculty Scholarship

Lawsuits challenging prisons and jails for not doing enough to stop the spread of COVID-19 among inmates have faced mixed results in the courts: wins at the district court level are almost always followed by losses (in the form of stays of any orders to improve conditions) at the appeals court level or at the Supreme Court. This short article tries to explain why this is happening, and makes three comparisons between how district courts and appeals courts have analyzed these lawsuits. First, district courts and appeals courts tend to emphasize different facts in their decisions. District courts focus more …

Editor, Ethical Challenges In Discharge Planning: Stories From Patients, Elizabeth Pendo

All Faculty Scholarship

This symposium includes twelve personal narratives from patients and their caregivers who have navigated challenges in planning for discharge from the hospital and transition to care at home, a rehabilitation facility, long-term care facility, or hospice. Three commentaries on these narratives are also included, authored by experts and scholars in the fields of medicine, bioethics, and health policy with particular interest in vulnerable populations. The goal of this symposium is to call attention to the experiences of patients during transitions in care and to enrich discussions of ethical issues in discharge planning.

Covid-19 Employee Health Checks, Remote Work, And Disability Law, Elizabeth Pendo

All Faculty Scholarship

The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities, about 61 million individuals in the U.S. The law’s protections in the workplace are especially important during COVID-19, which has worsened pre-existing disparities experienced by people with disabilities. The ADA also applies to new strategies to reduce the risk of COVID-19 infection in the workplace. This Chapter will focus on two strategies that impact individuals with and without disabilities – employee health screening, testing and vaccination policies, and new or expanded remote work programs.

Intellectual Property As A Determinant Of Health, Ana Santos Rutschman

All Faculty Scholarship

Public health literature has long recognized the existence of determinants of health, a set of socio-economic conditions that affect health risks and health outcomes across the world. The World Health Organization defines these determinants as “forces and systems” consisting of “factors combin[ing] together to affect the health of individuals and communities.” Frameworks relying on determinants of health have been widely adopted by countries in the global South and North alike, as well as international institutional players, several of which are direct or indirect players in transnational intellectual property (IP) policymaking. Issues raised by the implementation of IP policies, however, are …

Vaccine Clinical Trials And Data Infrastructure, Ana Santos Rutschman

All Faculty Scholarship

We find ourselves at a momentous turn in the history of vaccines. The COVID-19 pandemic triggered a quasi-global vaccine race that not only compressed vaccine research and development (R&D) timelines, but also paved the way for the administration of a new type of vaccine technology – mRNA vaccines, which work in substantially different ways from the vaccines in use before the pandemic.

While the process of bringing emerging COVID-19 vaccines to market has taken place in an unusually short timeframe, it was largely predicated on the same scientific and regulatory processes that govern the development, approval and deployment of new …

The Functional Operation Of Workers’ Compensation Covid Presumptions, Michael C. Duff

All Faculty Scholarship

During 2020, a number of U.S. states implemented workers' compensation COVID-19 presumptions. This short informal paper defines and explains legal presumptions generally and then discusses the workers' compensation presumptions. The paper contends that at this juncture it is not clear whether states intended to enact "Thayer-Wigmore" or "Morgan" presumptions; but if they operate as Thayer-Wigmore presumptions they will not do workers' compensation claimants much good in the context of non-jury proceedings presided over by administrative law judges.

Ending The War On People With Substance Use Disorders In Health Care, Kelly K. Dineen, Elizabeth Pendo

All Faculty Scholarship

Earp et al. (2021) provide a robust justification for the decriminalization of drugs based on the systemic racism that fuels the “war on drugs” and the ongoing harms of drug policies to individuals. The authors’ call for decriminalization is a necessary but insufficient step in addressing the entrenched structural, institutional, and individual discrimination that leads to the inequitable and unjust treatment of people with substance use disorder (PWSUD). Nothing short of robust enforcement of existing legal protections and sweeping legal reforms in the regulation of addiction treatment, controlled substances, health care finance, and civil rights law will be adequate to …

Property And Intellectual Property In Vaccine Markets, Ana Santos Rutschman

All Faculty Scholarship

As biopharmaceutical forms of technology, vaccines constitute one of the most important tools for the promotion and maintenance of public health. Tolstoy famously wrote that [h]appy families are all alike; every unhappy family is unhappy in its own way.¹ Vaccine markets offer perhaps one of the most extreme embodiments of Tolstoy's principle² in the field of biopharmaceutical innovation.