Health Law and Policy Commons^™

Thirty Years Of Solicitude: Antitrust Law And Physician Cartels, Thomas L. Greaney

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Over the last thirty years the Federal Trade Commission and the Department of Justice have challenged dozens of physician cartels, networks, and other arrangements that they alleged constituted price fixing or other restraints of trade under the antitrust laws. In addition, the antitrust agencies have issued numerous advisory opinions, published detailed statements of enforcement policy, and made dozens of public statements on the issue of physician collaboration. The puzzle explored in this essay is why the government's deployment of unparalleled enforcement resources has not curtailed physician attempts to engage in collective bargaining and other attempts to restrain price competition. It …

Book Review: Reviewing Susan Starr Sered And Rushike Fernandopulle, Uninsured In America (2007), Elizabeth Pendo

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Book Review of Susan Starr Sered and Rushike Fernandopulle, Uninsured in America (2007).

The Health Care Choice Act: The Individual Insurance Market And The Politics Of 'Choice', Elizabeth Pendo

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Traditionally, employer-sponsored group insurance plans have been the backbone of health insurance coverage in the United States. While it is still true that most Americans get their health insurance through their employment, the erosion of employer-sponsored health insurance has increased the ranks of the uninsured and pushed more workers, retirees and their families into the individual insurance market. In 2005, for example, nine percent of the population, or nearly 27 million people, turned to individual policies for health insurance coverage.

The Health Care Choice Act of 2005 (the "Act") currently before Congress aims to reform perceived problems in the individual …

A Right To No Meaningful Review Under The Due Process Clause: The Aftermath Of Judicial Deference To The Federal Administrative Agencies, Ruqaiijah A. Yearby

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No one ever looks forward to entering a nursing home because it means leaving the things most dear to them: family, home, and independence. Nevertheless, without the current nursing home system, many elderly and disabled persons, who require comprehensive treatment, would not have access to necessary care. In 2000, nursing homes provided care to 1.6 million elderly and disabled persons, and *724 by 2050, nursing homes are projected to provide care to 6.6 million elderly and disabled persons. Thus, we can ill afford to cripple the nursing home industry. But, this is exactly what has occurred. The Constitution, the Administrative …

Antitrust & Hospital Mergers: Does The Nonprofit Form Affect Competitive Substance?, Thomas L. Greaney

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Following a string of government losses in cases challenging hospital mergers in federal court, the Federal Trade Commission and the Department of Justice issued their report on competition in health care seeking to set the record straight on a number of issues that underlie the judiciary's resolution of these cases. One such issue is the import of nonprofit status for applying antitrust law. This essay describes antitrust's role in addressing the consolidation in the hospital sector and the subtle influence that the social function of the nonprofit hospital has had in merger litigation. Noting that the political and social context …

The Mysterious Survival Of The Policy Against Informed Consent Liability For Hospitals, Robert Gatter

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The role of hospitals in managing the informed consent process for hospital-based treatments has expanded substantially over the last several decades. Most recently, many hospitals have installed multi-media platforms designed to provide a patient with basic information about a recommended procedure, including its associated risks, and to record the patient’s consent to or rejection of the procedure. Yet, despite the substantial control that hospitals exercise over the informed consent process, state courts routinely dismiss informed consent claims brought against hospitals, holding that only physicians have the training and expertise to satisfy informed consent obligations and therefore that only physicians may …

Conflicts Of Interest In International Human Drug Research And The Insufficiency Of International Protections, Robert Gatter

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The problem of financial conflicts of interest in human subjects research is international in scope as drug manufacturers conduct trials in countries outside of the U.S., Japan, and the European Union, thereby side-stepping domestic regulation of conflicts of interest. Because such out-sourcing of human drug trials results in exporting risks associated with financial conflicts of interest, this essay examines the primary international sources for regulating those conflicts. These sources include the World Health Organization’s Guidelines for Good Clinical Practice for Trials on Pharmaceutical Products, the Guidelines for Good Clinical Practice adopted by the International Conference on Harmonisation of Technical Requirements …

Equity Measures And Systems Reform As Tools For Reducing Racial And Ethnic Disparities In Health Care, Sidney D. Watson

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Many health care quality regulators, including officials of the Centers for Medicare and Medicaid Services and other agencies, have embraced systems reform—largely through mandates that require health care providers to implement Quality Assessment and Performance Improvement (QAPI) initiatives. Currently, however, no QAPI requirements stipulate that individual plans or providers measure racial and ethnic disparities. Performance measurements that do not track data by race and ethnicity, the author says, not only miss inequities but are likely to overlook promising techniques for reaching patients of particular racial and ethnic backgrounds. Incorporating equity measures into existing QAPI requirements, the report finds, would not …

The Game Of Pleasant Diversion: Can We Level The Playing Field For The Disabled Athlete And Maintain The National Pastime, In The Aftermath Of Pga Tour, Inc. V. Martin: An Empirical Study Of The Disabled Athlete, Donald H. Stone

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Kenny Walker, a deaf football player; Jim Abbott, a one-handed professional baseball player; Tom Dempsey, a physically disabled professional football kicker; Brad Doty, a paralyzed auto racer; and Nick Ackerman, a wrestler with amputated legs, have all competed at the highest level of sports. Persons with mental illness, individuals who are blind, and students with hearing impairments are seeking an opportunity to compete in fair competition with their non-disabled competitors. Can this occur in a fair, open, and just manner between competing athletes?

Does the Americans with Disabilities Act of 1990 ("ADA"), the landmark civil rights act protecting an individual …

What Do Exit Polls And Flu Vaccine Shortages Have In Common?, Albert A. Foer, Robert H. Lande, F.M. Scherer

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What do exit polls and flu vaccine shortages have in common? Both involve situations where society has come to rely excessively on too few entities. When even one company makes a mistake society can suffer significantly. This short piece advocates that we abandon our almost laissez faire tolerence towards high concentration, and rely upon competition, rather than on monopoly or a small number of producers.

Studying Medical Error In Situ: Implications For Malpractice Law And Policy, Lori B. Andrews

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No abstract provided.

Is It Too Late For Title Vi Enforcement? - Seeking Redemption Of The Unequal United States' Long Term Care System Through International Means, Ruqaiijah A. Yearby

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Permeating every facet of life including health care, racial segregation has been a part of the history of the United States since its creation. In fact, the history of African-Americans has been one of tragedy, laced with the hope of equality. This tragedy is a result of three hundred years of slavery, one hundred years of the limited freedom of segregation, three years of the promise of equality granted from the civil rights struggle, and thirty-seven years of resegregation through white flight and institutional racism. Hence, African-Americans have been fighting for the right to freedom, equality, and human dignity for …

Make Room For Dying: End Of Life Care In Nursing Homes, Sandra H. Johnson

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The cornerstone of contemporary nursing home care is a commitment to patient rehabilitation. Improved care is an important and worthwhile goal, but it is a goal that has yet to make room for the dying. A significant proportion of older people will spend their final days in a nursing home. This article calls for a culture shift in nursing home care to promote improved care for not only those who can be rehabilitated but also those who are dying.

This article begins by addressing challenges to achieving this culture that are particular to the nursing home context. It then explains …

The Social, Professional, And Legal Framework For The Problem Of Pain Management In Emergency Medicine, Sandra H. Johnson

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Although supported by both ethical and pragmatic imperatives, pain treatment faces significant barriers, particularly in the setting of emergency medicine. This article argues that pain management is integral to good patient care and specifically, good emergency care. In order to achieve effective emergency pain management, it is crucial to understand the "root causes" of pain neglect in emergency medicine - i.e. to understand why emergency physicians behave as they do in pain treatment.

This article begins by addressing the neglect of pain in emergency medicine and the dearth of empirical research regarding the causes of this neglect. After considering barriers …

Is It Too Late For Title Vi Enforcement?: Seeking Redemption Of The Unequal Long Term Care System In The United States Through International Means, Ruqaiijah Yearby

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Legal and medical experts have noted continued racism in the health care system that prevents the equal distribution of quality care. Initially most racism was intentional and expressed through de jure segregation, as evidenced by federal funding of the construction of racial segregated health care facilities. Now most racism, expressed through de facto segregation, is subtly incorporated into the daily practices of institutions causing an adverse disparate impact on African-Americans. This institutional racism establishes separate and independent barriers through the neutral denial of opportunities and equal rights to individuals and groups that results from the normal operations of the institutions …

Ending The Exploitation Of The Vulnerable: The Promise Of The Intersection Of American Bioethics, Human Rights, And Health Law, Ruqaiijah Yearby

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Traditionally, American bioethics has served as a safety net for the rich and powerful, for they are not forced to act as research subjects to obtain access to general health care for themselves or their children. However, American bioethics has failed to protect the vulnerable, i.e. indigent minorities. The vulnerable are not treated the same as the rich. They do not have access to health care. They are exploited in clinical trials that promise monetary gain or access to health care and their autonomy rights are often ignored. Some of the vulnerable most affected by these disparities are African-Americans. African-Americans …

Telling Stories About Health Insurance: Using New Films In The Classroom, Elizabeth Pendo

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In keeping with the Symposium theme, "The Mass Media's Influence on Health Law and Policy," this essay is designed to share my experience using clips from three recent popular films as a method of enhancing coverage and discussion of legal and policy issues surrounding the private health insurance system, and to provide some practical advice for others interested in doing the same. Specific topics include the erosion of employer-sponsored health insurance, continuation of private coverage under COBRA and HIPAA, public health care programs, physician incentives, the uninsured and access to care and legal remedies for claim denial. This essay builds …

The Politics Of Infertility: Recognizing Coverage Exclusions As Discrimination, Elizabeth Pendo

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Infertility affects approximately ten percent of the reproductive-age population in the United States, and strikes people of every race, ethnicity and socio-economic level. It is recognized by the medical community as a disease, one with devastating physical, psychological, and financial effects.

In 1998, the Supreme Court held in Bragdon v. Abbott that reproduction is a major life activity within the meaning of the ADA. Many lawyers, activists and scholars thought that coverage for infertility treatment would follow soon after. In fact, in 2003 in the first major case applying Bragdon to health benefits, Saks v. Franklin Covey, the Second Circuit …

Mission, Margin, And Trust In The Nonprofit Health Care Enterprise, Thomas L. Greaney, Kathleen Boozang

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The law governing charitable corporations remains neglected and thoroughly muddled. Still unsettled are central issues regarding the accountability of directors and management, legal standards governing organic changes by nonprofit institutions, and mechanisms to ensure fidelity to the organization's charitable mission. For nonprofit corporations in the health care sector, which represent a large proportion of all health services supplied nationwide, particularly charity care, these shortcomings have had serious repercussions. The central issue addressed in this Article is how fidelity to the mission of the charitable health care corporation should be monitored. It advances the normative perspective that the law should maximize …

Good Enough To Use For Research, But Not Good Enough To Benefit From The Results Of That Research: Are The Clinical Hiv Vaccine Trials In Africa Unjust?, Ruqaiijah A. Yearby

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The epidemic of the Human Immunodeficiency Virus (HIV) infection in Sub-Saharan Africa, the region most affected by the HIV pandemic and where HIV is the leading cause of death, is reaching insurmountable proportions. In fact, out of the 36.1 million HIV infections worldwide, 25.3 million, seventy percent, are in Sub-Saharan Africa. Additionally, of the more than 15,000 people who are infected with HIV every day, ninety-five percent of the cases are in populations that live in developing countries such as those located in Sub-Saharan Africa. Due to the significant number of Africans infected with HIV, many researchers and ethicists have …

Disentitlement? The Threats Facing Our Public Health-Care Programs And A Rights Based Response, Sidney D. Watson

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In the battle over the future of American health policy, the lines are drawn. On one side are those who seek to turn health care financing and delivery over to private markets that are individualized—where patients strike their own bargains rather than relying on employers or government insurers—and free from governmental mandates. On the other side are those who support a continuing role for government in assuring access to health insurance and health services and in controlling costs and monitoring the quality of care. The lines are hard, fast, and ideological.

The most recent skirmish ended November 24, 2003, when …

Five Easy Pieces: Motifs Of Health Law, Sandra H. Johnson

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The film Five Easy Pieces is named for a selection of five piano compositions that the Jack Nicholson character played in a childhood recital. Here, its namesake refers to five motifs of teaching and practicing health law. Like playing the piano pieces, some of these motifs sound difficult to teach but are quite easy, and others sound easy but are quite difficult.

First, whether it is the lawyers shaking their heads about the doctors or the doctors stunned by the ignorance of the lawyers, these two professions have difficulty reaching common understandings. Health law’s defining characteristic is that it attempts …

Chicago's Procrustean Bed: Applying Antitrust Law In Health Care, Thomas L. Greaney

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Antitrust enforcement in health care has undergone considerable buffeting in recent years with government agencies losing a string of important cases in federal court and support for vigorous enforcement waning among some policymakers. Critics of doctrinal development in antitrust law have begun to question whether the underlying economic relationships are accurately reflected in the law of antitrust as applied in health care. This article advances the positive claim that antitrust doctrine often suppresses pertinent features of the health care marketplace and urges courts and enforcers to pause before applying precedent and evidentiary rules of thumb that do not fit the …

Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo

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Several recent films have villainized the health insurance industry as central elements of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical …

Faith, Confidence And Health Care: Fostering Trust In Medicine Through Law, Robert Gatter

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This Article responds to the work of Professor Mark A. Hall, who has written an accompanying essay in reply, published in the same issue of the Wake Forest Law Review.

This Article identifies an emerging medical trust movement and challenges its normative claim that, as a matter of policy, the law should be used to preserve, if not promote, trust in medicine. Key to this challenge is the fact that the emerging movement defines medical trust in emotional terms as a kind of faith that goes beyond rationally based confidence. First, because the movement defines medical trust as faith, it …

Licensing Health Care Professionals: Has The United States Outlived The Need For Medical Licensure?, Gregory Dolin

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With an expanding market for what is now known as "complimentary and alternative" medicine (CAM), states are increasingly facing the issue of who can and who should be allowed to practice medicine. Of necessity, this question also concerns whom patients may see to treat their ailments.

This paper will argue that the struggle to define who is and who is not licensed to practice medicine is rather fruitless and will always leave patients with less choice than they desire. Part II will review the history of licensure in the United States. Parts III and IV will focus on benefits and …

Time To Enter A "Do Not Resuscitate" Order On The National Resident Matching Program's Chart, Gregory Dolin

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This article focuses on the NRMP system and argues that the process is neither efficient nor pro-competitive. This article argues that Congress erred in bestowing an antitrust exemption on the NRMP and the participating institutions.

This article suggests that although the system may have been necessary to check the problem of early recruiting that was pervasive in the 1950s (similar to the one that plagued the federal judiciary until just two years ago), the system has outlived its usefulness. Part II will explain the Match's history and function and will discuss how the system makes participation in the Match inevitable …

Physician Liability And Managed Care: A Philosophical Perspective, Dionne L. Koller

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Despite the emergence of managed health care and the resulting dramatic change in the role of the third-party payer in the physician-patient relationship, the liability standards applied to physicians largely have remained unchanged. This has created a tension between physicians' legal and ethical obligations, and the requirements imposed on the physician by managed health care. Specifically, the issue confronts the physician in the context of malpractice liability. Managed Care Organizations impose a significant amount of control over the way physicians practice medicine, often forcing physicians to ration care. Notwithstanding any beneficial cost savings that might result, this approach subjects the …

Ethical, Legal, And Social Issues In Genetic Testing For Complex Genetic Diseases (With E. Zuiker), Lori B. Andrews

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No abstract provided.

Reforming Civil Rights With Systems Reform: Health Care Disparities, Translation Services, & Safe Harbors, Sidney D. Watson

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Looking gaunt but determined, 59 year-old Robert Tools was introduced on August 21, 2001, as a medical miracle-the first surviving recipient of a fully implantable artificial heart. At a news conference, Tools spoke with emotion about his second chance at life and the quality of his care. His physician looked on with obvious affection, grateful and honored to have extended Tools's life. Mr. Tools has since lost his battle for life, but will be remembered as a hero for undergoing an experimental technology and paving the way for other patients to undergo the procedure. Moreover, the fact that Tools was …