Health Law and Policy Commons^™

The Health Insurance Debate In Canada: Lessons For The United States?, Mary Anne Bobinski

Faculty Articles

This Essay begins with an intentionally ambiguous title. Are comparisons to Canada relevant and useful for policy-makers in the United States and, if so, what lessons can we learn? Part II of this Essay highlights some of the risks and benefits of cross-border comparisons between the United States and Canada. In Part III, I analyze some of the key data points often cited in comparing the two health care systems. Part IV explores the current Canadian debate about private health insurance. Finally, in Part V, I focus on the lessons from Canada for the health insurance debate in the United …

Functional Neuroimaging And The Law: Trends And Directions For Future Scholarship, Stacey A. Tovino

Faculty Articles

Under the umbrella of the burgeoning neurotransdisciplines, scholars are using the principles and research methodologies of their primary and secondary fields to examine developments in neuroimaging, neuromodulation, and psychopharmacology. The path for advanced scholarship at the intersection of law and neuroscience may clear if work across the disciplines is collected and reviewed and outstanding and debated issues are identified and clarified. In this article, I organize, examine and refine a narrow class of burgeoning neurotransdiscipline scholarship; that is, scholarship at the interface of law and functional magnetic resonance imaging.

Imaging Body Structure And Mapping Brain Function: A Historical Approach, Stacey A. Tovino

Faculty Articles

Now in its second decade, functional magnetic resonance imaging (fMRI) localizes changes in blood oxygenation that occur in the brain when an individual performs a mental task. Physicians and scientists use fMRI not only to map sensory, motor, and cognitive functions, but also to study the neural correlates of a range of sensitive and potentially stigmatizing conditions, behaviors, and characteristics. Poised to move outside the traditional clinical and research contexts, fMRI raises a number of ethical, legal, and social issues that are being explored within a burgeoning neuroethics literature. In this Article, I place these issues in their proper historical …

Psychiatric Restraint And Seclusion: Resisting Legislative Solution, Stacey A. Tovino

Faculty Articles

The use of restraint and seclusion in the American psychiatric setting has a rich history - rich in medical, ethical, legal, and social controversy. For centuries, mental health care providers used movement restrictions and solitary confinement to manage psychiatric patients. Superintendents of eighteenth and early nineteenth century insane asylums and other institutions of confinement believed that strait-waistcoats, "tranquilizer chairs," "maniac beds," chains, shackles, and "quiet rooms" deescalated agitation and promoted self-control. Reforms beginning in the nineteenth century helped make some psychiatric institutions more humane, in part because staff members were trained to find ways to calm potentially violent patients without …

Functional Neuroimaging Information: A Case For Neuro Exceptionalism, Stacey A. Tovino

Faculty Articles

Functional magnetic resonance imaging (fMRI) has built on a number of technologies, including electroencephalography, magnetoencephalography, positron emission tomography, and single-photon emission computed tomography, to become one of the decade's most powerful tools for mapping sensory, motor, and cognitive function. Scientists also are using fMRI to study the neural correlates of a range of conditions, characteristics, and social behaviors, including schizophrenia, addiction, racial evaluation, deception, cooperation, and sexual preferences. Now poised to move outside the research context, functional neuroimaging raises a number of confidentiality, privacy, and identity issues. In this Article, I examine whether special, or heightened, confidentiality, privacy, and informed …

A Primer On The Law And Ethics Of Treatment, Research, And Public Policy In The Context Of Severe Traumatic Brain Injury, Stacey A. Tovino

Faculty Articles

No abstract provided.

Hospital Chaplaincy Under The Hipaa Privacy Rule: Health Care Or Just Visiting The Sick, Stacey A. Tovino

Faculty Articles

No abstract provided.

American Midwifery Litigation And State Legislative Preferences For Physician-Controlled Childbirth, Stacey A. Tovino

Faculty Articles

No abstract provided.

The Use And Disclosure Of Protected Health Information For Research Under The Hipaa Privacy Rule: Unrealized Patient Autonomy And Burdensome Government Regulation, Stacey A. Tovino

Faculty Articles

No abstract provided.

Letters To The Editors Of Health Matrix, Ken Wing

Faculty Articles

Professor Wing presents this letter to the editor concerning the health law in the U.S. He argues that there is no severable body of principles, or even a set of issues, defined by either circumstances or type of controversy in the teaching of health law. Would health law involve the legal issues that arise in the delivery of patient care? Well, that begins to define the subject, but that is only part of what's called health law. Legal issues related to health care? To health? Those definitions may work, but what is the point of such a broad and meaningless …

Legal Movements In Intellectual Property: Trips, Unilateral Action, Bilateral Agreements, And Hiv/Aids, Margo A. Bagley

Faculty Articles

This Article begins with an overview of the relationship between the Agreement on Trade-Related Aspects of Intellectual Property Rights (the "TRIPS Agreement") and the HIV/AIDS pandemic which created the need for the Doha Declaration. It then discusses two trade-related movements, unilateral action and TRIPS-plus bilateral agreements, that call into question the long-term effectiveness of the TRIPS Agreement process, generally, and the benefits of the Doha Declaration, in particular, in addressing multiple facets of the access to essential medicines problem. This Article concludes that a consideration of these issues should be included in the development of any further TRIPS-related solutions to …

Policy Choices And Model Acts: Preparing For The Next Public Health Emergency, Ken Wing

Faculty Articles

This article explores policy choices and model acts related to public health administration in the U.S. This article provides information of the general public or state policymakers concerning important policy choices, variation of the pre-existing legal structure in each state, and the principles of separation of powers in limiting legislature's ability to delegate legislative-type decisions.

Women, Poverty, Access To Health Care, And The Perils Of Symbolic Reform, Mary Anne Bobinski, Phyllis Griffin Epps

Faculty Articles

This article looks at health care through gendered eyes. We sift though available data on access to health care, health status, and health treatments to determine whether men and women experience health care differently in the United States. While we do not doubt that overt gender-based discrimination occasionally occurs in health care, this article focuses on the importance of unintended consequences and unconscious bias. We also explore the impact of symbolism about women's roles on the process of health care reform. The results have important implications for policy makers, advocates, and health care providers.

The United States has a large …

Health Care Reform In The Year 2000: The View From The Front Of The Classroom, Ken Wing

Faculty Articles

This article looks at the implications of the evolution of health care reform from the perspectives of teaching health law in the United States. U.S. on Congress' adoption of important limits on federal welfare programs, the direct role of government in financing health care, and the practical and theoretical problems in attempting to move forward to a more government controlled health care systems.

Bajakajian: New Hope For Escaping Excessive Fines Under The Civil False Claims Act, Melissa Ballengee Alexander

Faculty Articles

No abstract provided.

Autonomy And Death, Annette E. Clark

Faculty Articles

In this article, Professor Clark explores the contours of the current debate over physician-assisted death. She begins by focusing on the legal issues raised by statutory attempts to either legalize or criminalize physician-assisted death, with particular emphasis on the constitutional questions that are currently before the United States Supreme Court. She then examines physician-assisted death from both medical and societal perspectives. Professor Clark uses a thought experiment in which assisted death is facilitated by persons other than physicians, and in doing so, questions whether physicians are the proper persons in whom to wrest power over assisted death. She points out …

Criminalization Of An Epidemic: Hiv-Aids And Criminal Exposure Laws, Michael L. Closen, Mary Anne Bobinski, Donald H.J. Herman, John F. Hernandez, Gene P. Schultz, J. Kelly Strader

Faculty Articles

Unfortunately, the HIV-AIDS epidemic is still out of control. According to federal esti­mates, another American becomes infected with HIV every thirteen minutes; consequently, eight people in the United States will contract HIV during the course of this program. Many individuals have been prosecuted and convicted for exposing others to HIV and in rare circum­stances for actually transmitting HIV to others. These cases have involved activities such as bit­ing, spitting, throwing bodily substances, and sexual conduct.

Serious questions have been raised about some of the prosecutions as well as the HIV-specific criminal statutes which have been adopted. This discussion will address …

The Right To Health Care In The United States, Ken Wing

Faculty Articles

This article provides an analysis of the history of constitutional interpretation in the United States, and reveals that any right Americans have to health care is a political rather than constitutional right.

Risk And Rationality: The Centers For Disease Control And The Regulation Of Hiv-Infected Health Care Workers, Mary Anne Bobinski

Faculty Articles

The publicity surrounding the Bergalis case has created a new and powerful fear for some-the fear of contracting a fatal disease while obtaining medical or dental care. Following Bergalis' congressional testimony, Congress passed a bill requiring states to regulate HIV-infected health care workers (HCWs). Responding to constituents' fears, state legislatures had already been debating a wide range of bills designed to confront the risk of HIV transmission in health care settings. Private actors, such as hospitals and insurers, feared litigation or loss of business if the public perceived them to be ignoring the problem of HIV infection among HCWs. As …

Introduction (Special Health Law Issue), Ken Wing

Faculty Articles

This article outlines the topic of affordable health care in the United States. It advocates for citizens who, according to the article, do not receive adequate health care attention. Ultimately, the article demonstrates that the United States has the resources to solve the health care crisis.

American Health Policy In The 1980'S, Ken Wing

Faculty Articles

The author notes that the composition of the 'fundamental problem" of rising health care costs is not easily defined. The varying interests of providers, consumers, and the government's budget diverge and overlap in a weblike maze, creating multifarious and fractured perspectives regarding what actually constitutes the problem. Consequently, no underlying ideological thread in American health care policy has emerged to direct a unified response to the 'fundamental problem." It is in this political context that American health care policy of the 1980's will be shaped. Professor Wing has undertaken an exhaustive review of both health care cost data and the …

The Emergency Room Admission: How Far Does The Open Door Go?, Ken Wing, John R. Campbell

Faculty Articles

In recent years many private and some public hospitals have assumed a new proprietary persona, a business-like posture that clashes with the traditional hospital goals of charity and community service. This conflict may be most acute in the emergency room where the hospital may further its financial interests by quickly transferring or discharging undesirable emergency patients. This article explores the extent of a private hospital’s legal obligation to treat a patient once emergency care has begun. It begins by looking at hospital revolutions, emergency rooms, and the standards of emergency care. It then explores the common law and “no duty” …

North Carolina's Medicaid Program: The Effects Of The Reagan-Era Budget Reductions, Ken Wing

Faculty Articles

This article is principally a description of the current program and the legislative and administrative changes made in response to the recent federal budget cuts, an assessment of the state's current cost containment strategy, and an analysis of the options facing North Carolina in the years to come.

The Impact Of Reagan-Era Politics On The Federal Medicaid Program, Ken Wing

Faculty Articles

The political future may be difficult to predict with specificity, but surely the level of publicly-sponsored medical care for the poor will be severely reduced in the coming years, leaving millions of poor Americans to rely on the charitable capacity of the nation's health care providers-or simply to go without. What follows is an attempt to support this characterization of Medicaid and its political future. Section I of this article is a description of Medicaid, its structure prior to 1981, and the legal and political history of its development and implementation. In addition to providing the basis for understanding the …

The Community Service Obligation Of Hill-Burton Health Facilities, Ken Wing

Faculty Articles

This article focuses squarely on the community service provision and the regulations promulgated thereunder. The analysis traces the statutory and regulatory history of the community service obligation and examines the scope of the discretion that has been delegated to federal and state agencies to define and enforce this obligation. The discussion begins with a brief history of the original Hill-Burton program and the several amendments and modifications of the program over the last several decades. Next, the legislative history of the community service obligation is examined in an effort to determine the scope of authority created by Congress in establishing …

Title Vi And Health Facilities: Forms Without Substance, Ken Wing

Faculty Articles

Title VI of the Civil Rights Act of 1964 prohibits racial discrimination by recipients of federal funds, including institutions that provide health care. This article assesses the current status of the Title VI enforcement program for health facilities and the problem of racial discrimination in these institutions that the Act is trying to resolve. After analyzing the legislative and political history of Title VI as it relates to health facilities, the author concludes that Title VI enforcement has been ineffective and misdirected and he suggests changes that could improve the program's implementation.

National Health Planning And Resources Development Act Of 1974: Implications For The Poor, Ken Wing, A. G. Schneider

Faculty Articles

The National Health Planning and Resources Development Act of 1974, was signed into law on January 4, 1975, following a lengthy legislative struggle. During the past 11 months, the fighting among private and public health interests has continued, although the principal arena has shifted from the Congress to the Department of Health, Education and Welfare, which is charged with primary responsibility for implementing the law. While the final outcome of this political conflict is still difficult to foresee, some informed estimates can already be made concerning the implications of this legislation for the poor. This article will not summarize the …

Representation Of Clients In Matters Relating To Hospital Bills, Ken Wing, S. Axelrad, P. A. Butler

Faculty Articles

This article is designed to acquaint Legal Services attorneys with a range of government health programs for which their clients may be eligible, and a number of legal theories that may impose a duty to provide care on public or private medical care institutions. The primary objective is to provide background material to assist the attorney in getting medical bills paid or defending a collection action. The article also includes a discussion of legal duties to provide care that will be useful in advising clients and consumer groups of their rights and of the programs and services that should be …

Mental Commitment Cases Of 1971 Supreme Court Term, Ken Wing, R. Carman

Faculty Articles

Even in areas where legal representation has become available to the poor through the efforts of Legal Services programs, there is still one group that is almost universally denied representation: those confined under the various forms of civil commitment and patients in mental health institutions. Almost by definition in need of legal counsel and predictably indigent, they are faced with interpersonal and institutional barriers that further reduce their chances to obtain representation. It is the position of the National Health Law Program that Legal Services programs throughout the country should focus some of their attention towards this portion of their …