Health Law and Policy Commons^™

Birthdate Phaseout To A Nicotine Free Generation, Katharine Silbaugh

University of Richmond Law Review

This Article explores the Nicotine Free Generation (“NFG”) policy, an emerging endgame strategy for tobacco products that employs a completely novel legal design. Tobacco remains the leading cause of preventable death, killing almost half of its users and imposing $600 billion in social costs each year. We see two basic choices for regulating sales: prohibition or a legal age-gate, such as twenty-one, for retail sales. NFG charts a third way. Recognizing the dire harm of tobacco and the serious consequences of abrupt prohibition, NFG lays the groundwork for a gradual transition to a sales sunset. In place of the twenty-one …

A Small Price To Pay For Better Mental Health Crisis Care: Why States Should Be Funding The New 988 Hotline Through Phone Fees, Katherine G. Menello

University of Richmond Law Review

Mental health care in the United States is uncoordinated, underresourced, and overall insufficient. Mental health crisis care is much the same, but with much higher stakes. The lack of a comprehensive mental health crisis care system across the country has led to law enforcement involvement becoming the default system in most communities. Yet, an overwhelming majority of Americans want a better way; in a survey conducted in summer 2023, “85% of people sa[id] they want a mental health response to some- one experiencing a mental health, drug or suicide crisis, not a police response.” The federal government agrees with the …

The Gender And Political Economy Of Home Care, Yiran Zhang

University of Richmond Law Review

On October 25, 2024, The University of Richmond Law Review hosted a Symposium entitled Economies of Extraction: Labor, Care, and the Carceral State. Professor Yiran Zhang delivered the presentation transcribed below, which has been edited for clarity and cohesion. The University of Richmond Law Review was honored to host her and is thrilled to publish this transcript of her thoughtful discussion.

Access, Welfare, And Lawsuits: Restoring Reproductive And Economic Autonomy Post-Dobbs, Jill C. Engle

University of Richmond Law Review

Access to abortion and increased poverty for women and children are inversely correlated: as access to abortion decreases, feminine and child poverty increase. Women who try to access abortions are more likely to already be mothers, and more likely to be living below the poverty line. In post-Dobbs America, abortion is illegal or severely restricted in approximately half of the states. In states where abortion access is most restricted, women and children experience poverty at the highest rates in the nation. The Supreme Court majority that decided Dobbs chose to ignore the connection between abortion and poverty. In doing so, …

A Small Price To Pay For Better Mental Health Crisis Care: Why States Should Be Funding The New 988 Hotline Through Phone Fees, Katherine Menello

Law Student Publications

Mental health care in the United States is uncoordinated, underresourced, and overall insufficient. Mental health crisis care is much the same, but with much higher stakes. The lack of a comprehensive mental health crisis care system across the country has led to law enforcement involvement becoming the default system in most communities. Yet, an overwhelming majority of Americans want a better way; in a survey conducted in summer 2023, “85% of people sa[id] they want a mental health response to someone experiencing a mental health, drug or suicide crisis, not a police response.”...

The Case For Specialty Dockets: The Intersection Of Judicial Intervention, Psychiatric Hospitalization And Involuntary Commitments, Community-Based Services, And Public Safety, The Honorable Jacqueline S. Mcclenney

University of Richmond Law Review

Defendant Doe was diagnosed with a significant mental illness in 2015. His adult diagnosis of paranoid schizophrenia came after having been an adjudicated delinquent following multiple status offenses as a juvenile. Defendant Doe was placed into foster care as a result of his biological father’s incarceration and his mother’s unwillingness to seek treatment for her substance use disorder. Mother, father, and now adult Defendant Doe were all eligible for services and attempted to receive them through the local community services board (“CSB”).

Defendant Doe received psychiatric and supportive services through the CSB. Defendant Doe again entered the criminal justice system …

Hitting Snooze Amidst Virginia's Mental Health Crisis: The Shortcomings Of The Bed Of Last Resort And The Need For A Continuum Of Crisis Care, Mary C. Fritz

University of Richmond Law Review

In the early morning hours of February 21, 2022, a temporary detention order (“TDO”) was issued for a young girl from Giles County, Virginia, to admit her for psychiatric treatment during a mental health emergency. The minor, identified by the initials S.E., was staying at a residential treatment facility when Chester- field County police officers drove her to Chippenham Hospital for an evaluation. S.E. was to be transported to the Commonwealth Center for Children and Adolescents in Staunton, Virginia, for treatment, but the center “asserted that it had no beds available and refused to accept S.E. as a patient.” Instead, …

Cost Cushion Or Cash Cow? A Federal Drug-Pricing Program Called Into Question, Caleb C. Briggs

University of Richmond Law Review

“Bon Secours turned the hospital’s poverty into an asset,” read a recent story about Richmond Community Hospital published in The New York Times. Richmond Community Hospital has been part of the Bon Secours network since 1995. Since then, the hospital has become one of the most profitable in the Bon Secours network. Yet, over time, Richmond Community Hospital has been stripped of its resources, lost medical staff, and generally seen a decrease in its ability to provide patients quality health care services. The hospital is located in Richmond’s East End, which is a predominantly low-income neighborhood, and a large portion …

Extractive Welfare: Medicaid Statutory Recovery Formulas After Gallardo V. Marstiller, Elenore Wade

University of Richmond Law Review

In 2022, the Supreme Court of the United States held states may seize injured Medicaid recipients’ tort recoveries beyond the portion of those recoveries allocated for past medical expenses actually covered by Medicaid. However, the Court’s decision went beyond that distinction by validating the practice of states using one-size-fits-all “statutory recovery formulas” to seize the tort recoveries of injured Medicaid recipients. Although the Court painted the dispute as one of bland statutory interpretation, the holding enshrines the subordinated social and legal position of recipients of poor people’s programs in the United States. Although others have examined Medicaid, and other poor …

Ain't No Sunshine: Bringing Physician Conflicts Out Of The Dark, Jacob T. Ellberg

University of Richmond Law Review

Many mechanisms have been tried to protect patients from the effects of undisclosed payments to physicians so that patients can make informed decisions about whether their physician’s recommendations are tainted because of the physician’s conflict of inter- est. Over the past decade, those efforts have been dominated by the Physician Payments Sunshine Act (“Sunshine Act”). A decade ago, the Sunshine Act took effect with the aim of increasing transparency of financial relationships between health care providers and manufacturers of pharmaceuticals and medical devices. Yet a decade and more than a billion dollars in effort later, the highly touted Act is …

Cost Cushion Or Cash Cow? A Federal Drug-Pricing Program Called Into Question, Caleb C. Briggs

Law Student Publications

“Bon Secours turned the hospital’s poverty into an asset,” read a recent story about Richmond Community Hospital published in The New York Times. Richmond Community Hospital has been part of the Bon Secours network since 1995. Since then, the hospital has become one of the most profitable in the Bon Secours network. Yet, over time, Richmond Community Hospital has been stripped of its resources, lost medical staff, and generally seen a decrease in its ability to provide patients quality health care services. The hospital is located in Richmond’s East End, which is a predominantly low-income neighborhood, and a large …

Hitting Snooze Amidst Virginia's Mental Health Crisis: The Shortcomings Of The Bed Of Last Resort And The Need For A Continuum Of Crisis Care, Mary C. Fritz

Law Student Publications

In the early morning hours of February 21, 2022, a temporary detention order (“TDO”) was issued for a young girl from Giles County, Virginia, to admit her for psychiatric treatment during a mental health emergency. The minor, identified by the initials S.E., was staying at a residential treatment facility when Chesterfield County police officers drove her to Chippenham Hospital for an evaluation. S.E. was to be transported to the Commonwealth Center for Children and Adolescents in Staunton, Virginia, for treatment, but the center “asserted that it had no beds available and refused to accept S.E. as a patient.” Instead, S.E. …

The Current State Of Abortion Law In Virginia Leaves Victims Of Domestic And Sexual Violence Vulnerable To Abuse: Why Virginia Should Codify The Right To Abortion In The State Constitution†, Courtenay Schwartz

University of Richmond Law Review

All people must have access to safe and legal reproductive health care—especially victims of sexual and domestic violence who can and do become pregnant because of the violence they experience. This year, the United States Supreme Court overturned Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey in Dobbs v. Jackson Women’s Health Organization. In doing so, the Supreme Court held that the Constitution does not protect the right to an abortion. Though abortion access is currently protected in Virginia, this could change with each new General Assembly session. To guard against the danger that this poses to …

Erisa’S Fiduciary Fantasy And The Problem Of Mass Health Claim Denials, Katherine T. Vukadin

University of Richmond Law Review

Over 100 million Americans face healthcare debt. Most of those in debt have health insurance, with the debt often springing from services people thought were covered. Before and even after receiving care, those seeking coverage must run a gauntlet of obstacles such as excessive pre-authorization requests, burdensome concurrent review of care, and retrospective review, which claws back payment after a treatment is pre-authorized and payment made. Increasingly, this procedural tangle leaves people with unwarranted and unexpected medical bills, quickly spiraling them into debt.

Who polices health insurers’ claims practices? What keeps insurance companies from designing overly burdensome pre-authorization requirements or …

Going The Extra Mile: Expanding The Promoting Affordable Housing Near Transit Act, Emily R. Casey

University of Richmond Law Review

The Promoting Affordable Housing Near Transit Act (“Act”), introduced in Congress in June 2021 and signed into law six months later, proposes a goal of balancing the disproportionately-high costs of housing and transportation felt by lower-income families by combining these resources in one project: transit-oriented housing developments. Middle-income and wealthy suburbanites have ready access to cities by car, but lower-income urbanites lack access to the suburbs without a private vehicle. While the goal of the Act recognizes this disparate outcome, the Act’s failure to include expansion of mass transit into the suburbs will continue to restrict low-income minorities to urban …

With A Wink And A Nod: How Politicians, Regulators, And Corrupt Coal Companies Exploited Appalachia, Patrick C. Mcginley

University of Richmond Law Review

Environmental regulators treated America’s leading coal companies like Wall Street’s mismanaged banks leading to the “Great Recession”—big coal companies that produced millions of tons of coal were simply too big to fail. With a wink and a nod, federal and state regulators ignored a core provision of federal law that was intended to prevent coal companies from continuing their past practices of plundering Appalachia’s mineral wealth while ravaging her environment.

This Article examines how the coal industry successfully evaded compliance with that law. The consequences of this evasion include mass bankruptcies, thousands of acres of mined land laying unclaimed, …

Duped By Dope: The Sackler Family’S Attempt To Escape Opioid Liability And The Need To Close The Non-Debtor Release Loophole, Bryson T. Strachan

University of Richmond Law Review

The opioid epidemic continues to rage on in the United States, ravaging its rural populations. One of its main causes? OxyContin. Purdue Pharma (“Purdue”), the maker of OxyContin, aggressively marketed opioids to the American public while racking up a fortune of over $13 billion dollars for its owners,3 the Sackler family. As a result, roughly 3,000 lawsuits were filed against Purdue and members of the Sackler family. Generally, the lawsuits alleged that Purdue and members of the Sackler family knew OxyContin was highly addictive yet aggressively marketed high dosages of the drug and misrepresented the drug as nonaddictive and without …

Opioid Litigation Panel, Rick Mountcastle, Paul Farrell, Eric Eyre, Patrick C. Mcginley

University of Richmond Law Review

On February 17, 2023, the University of Richmond Law Review hosted a symposium entitled Overlooked America: Addressing Legal Issues in Rural America. A portion of the event focused on the ongoing opioid epidemic in the United States, including the causes and effects of certain actions taken by players in the pharmaceutical industry. The Opioid Litigation Panel, transcribed below, brought together four of the most prominent leaders in the fight for justice in the opioid epidemic: Mr. Rick Mountcastle, Mr. Paul Farrell, Mr. Eric Eyre, and Professor Patrick McGinley. The University of Richmond Law Review was so honored to have …

Duped By Dope: The Sackler Family’S Attempt To Escape Opioid Liability And The Need To Close The Non-Debtor Release Loophole, Bryson T. Strachan

Law Student Publications

The opioid epidemic continues to rage on in the United States, ravaging its rural populations. One of its main causes? OxyContin. Purdue Pharma (“Purdue”), the maker of OxyContin, aggressively marketed opioids to the American public while racking up a fortune of over $13 billion dollars for its owners,3 the Sackler family. As a result, roughly 3,000 lawsuits were filed against Purdue and members of the Sackler family. Generally, the lawsuits alleged that Purdue and members of the Sackler family knew OxyContin was highly addictive yet aggressively marketed high dosages of the drug and misrepresented the drug as nonaddictive and without …

Parens Patriae After The Pandemic, Meredith Johnson Harbach

Law Faculty Publications

The COVID-19 pandemic prompted extraordinary state action to protect American children. Acting in its longstanding role as parens patriae, the state stepped in to protect children and their families from the ravages of the pandemic as well as from the dramatic upheaval it precipitated. This Article will evaluate the state’s pandemic response vis-à-vis children and their families, mining the experience for lessons learned and possible ways forward. Specifically, this project will argue that the state’s pandemic response represented a departure from the state’s conventional approach to parens patriae. Conventional practice prior to the pandemic was characterized by a state model …

Public Charge Grounds For Inadmissibility: Impact On Noncitizen Health Insurance Coverage, Madeline M. Culbreth

Richmond Public Interest Law Review

The public charge rule is an ongoing barrier to health insurance for lawfully

present immigrants and ought to be removed. Healthcare coverage for

immigrants is a critical aspect of the country’s health care scheme. Recent

changes to the United States’ immigration policy are contributing to growing

fears among immigrant families about participating in Medicaid and CHIP.

The most effective solution is to permanently alter the Immigration and Nationality

Act. Congress should expressly exclude health insurance from being

considered in the public charge grounds for inadmissibility.

This Is Not New: Addressing America's Maternal Mortality Crisis, Emily Siron

Richmond Public Interest Law Review

This article utilizes an intersectional approach to examine the causes and

realities of the dismal state of pregnancy-related healthcare in the United

States, highlighting the disparate impact on Black pregnant people. The

enslavementand brutalization of Black women in the U.S. demonstrates how

American society systematically devalues Black health, especially reproductive

health. The impacts of this horrific history persist today, resulting in the

American healthcare system utterly failing Black mothers and pregnant people

of all gender identities. This article surveys this history and presents policy

solutions to improve maternal health outcomes for all, but especially

Black individuals, including proposed pieces …

Access Is Everything - Post Rhpa Virginia - What's Next? The Case For Rhea And Other Matters, Galina Varchena, Margie Del Castillo

Richmond Public Interest Law Review

Virginia has taken positive forward steps to liberalize its abortion legislation,

bringing it closer in line with medical science and common sense. However,

accessing abortion care remains difficult for many, and additional legislative

measures are necessary to make the full range of reproductive

healthcare accessible for all, regardless of immigration status, race, gender,

income, or geography. The Reproductive Equity Healthcare Act, a bill modeled

in part on its Oregon namesake, is the next logical step forward towards

making reproductive justice a reality for all Virginians. While the details of

the final bill may vary, there are fundamental pillars that reproductive …

Imagining A Better Public Health (Law) Response To Covid-19, Evan Anderson, Scott Burris

University of Richmond Law Review

This Article is not a thorough-going history of the pandemic response. By way of critique and suggesting a way forward for public health, we are going to imagine how public health—both the official agencies and the interconnected nodes in academia and health systems—might have approached COVID-19 differently. This is a story that focuses on good judgment as the lynchpin of optimal pandemic response and allows us to think about where good judgment seems to have been lacking, and how public health culture and institutions might change to improve the chances of better judgment next time.

Trustworthy Digital Contact Tracing, Emily Berman, Leah R. Fowler, Jessica L. Roberts

University of Richmond Law Review

This Article takes a closer look at digital contact tracing in the United States during the coronavirus pandemic and why it failed. It begins by explaining the shortcomings of traditional analog methods and the resulting need for digital contact tracing. It then turns to the norms regarding consent, the scope of the data collected, and the limits on subsequent use necessary for cooperative surveillance. We argue that any successful digital contact-tracing program must incorporate these elements. Yet while necessary, those strategies alone may not be sufficient. People justifiably lack trust in public health authorities, in new technologies, and in the …

The Future Of Wastewater Monitoring For The Public Health, Natalie Ram, Lance Gable, Jeffrey L. Ram

University of Richmond Law Review

This Article thus expands the extant literature by considering the legal and ethical dimensions of wastewater surveillance more thoroughly and more broadly. It arrives at an auspicious time, as the United States moves into a vaccine-mediated phase in which COVID-19 is less likely to give rise to broad stay-at-home orders and more likely to trigger narrower, more targeted interventions. It seeks to offer guidance for the legal and ethical use of wastewater surveillance along two dimensions. The first dimension considers the circumstances under which wastewater monitoring should be deployed for detecting and responding to COVID-19 specifically. The second dimension zooms …

Expanding Medicaid In The Postpartum Period, Madison P. Harrell

University of Richmond Law Review

This Comment will discuss how the current Medicaid law is insufficient to address the issue of disappointing maternal health outcomes in the United States and how the federal government should begin to remedy the problem. First, I will shed light on the maternal health crisis in the United States, before discussing the history of pregnancy and postpartum Medicaid coverage. Then, I will outline the enactment of the Affordable Care Act, the subsequent court battle over its constitutionality, and the effects of that decision on the current landscape of pregnancy and postpartum Medicaid coverage. Finally, I will detail my proposal for …

Unmet Legal Needs As Health Injustice, Yael Cannon

University of Richmond Law Review

In Part I, this Article examines the health justice framework through which laws are understood as determinants of health equity. In Part II, this Article argues that when unaddressed for low-income individuals, legal needs serve as social determinants of health. Applying the health justice framework, the Article examines the major domains of social determinants of health (“SDOH”) and identifies areas of law for which unmet legal needs contribute to poor health and health inequity. Specifically, it analyzes how the five major domains of SDOH of the Healthy People 2030 paradigm of the U.S. Department of Health and Human Services (“HHS”) …

Reforming Age Cutoffs, Govind Persad

University of Richmond Law Review

This Article examines the use of minimum age cutoffs to define eligibility for social insurance, public benefits, and other governmental programs. These cutoffs are frequently used but rarely examined in detail. In Part I, I examine and catalogue policies that employ minimum age cutoffs. These include not only Medicare and Social Security but also other policies such as access to pensions and retirement benefits, eligibility for favorable tax treatment, and eligibility for discounts on governmentally provided goods and services. In Part II, I examine different rationales underlying eligibility and discuss the imperfect fit between these rationales and the use of …

Expanding Medicaid In The Postpartum Period, Madison P. Harrell

Law Student Publications

This Comment will discuss how the current Medicaid law is insufficient to address the issue of disappointing maternal health outcomes in the United States and how the federal government should begin to remedy the problem. First, I will shed light on the maternal health crisis in the United States, before discussing the history of pregnancy and postpartum Medicaid coverage. Then, I will outline the enactment of the Affordable Care Act, the subsequent court battle over its constitutionality, and the effects of that decision on the current landscape of pregnancy and postpartum Medicaid coverage. Finally, I will detail my proposal for …