Alabama's high court says doctors must report HIV cases

The Alabama Supreme Court ruled that physicians must comply with State HIV reporting requirements regardless of privacy considerations. Dr. Mark Middlebrooks provided the State with statistical data about his HIV-positive patients, but refused to release their names, arguing that the State regulations were in violation of the 14th Amendment's equal protection clause. The court ruled that preventing the spread of HIV was a legitimate governmental interest, and found no basis for Middlebrook's assertions that the reporting requirement constituted an impermissible invasion of privacy.     

Two courts say ADA doesn't apply in parental rights cases

State courts in Connecticut and Ohio have ruled that the Americans with Disabilities Act (ADA) cannot be used as a defense against efforts by State child welfare agencies to gain custody of neglected or abused children. The ADA prohibits an individual from being denied access to services, programs, or activities of a public entity, but the courts ruled that the ADA did not apply to parental termination cases. The Connecticut and Ohio rulings both held that parents cannot use the ADA to prevent their children from being removed after they have been abused. The cases involved the States' obligations to preserve the family, but the courts ruled the question of whether welfare officials did their best to accommodate parents was irrelevant. A chart displays how the ADA applies to termination hearings in 12 States.     

Governor vetoes bill extending hemophiliacs' right to sue

New Jersey Governor Christine Whitman has vetoed portions of a bill that would have permitted hemophiliacs with AIDS to file injury lawsuits beyond the statute of limitations. Under the bill, passed by the New Jersey Legislature and vetoed by Whitman, hemophiliacs or their survivors would be allowed one year to sue manufacturers of HIV-contaminated blood-clotting products, even if the infection occurred over a decade ago. Whitman suggested guidelines to the courts for case-by-case analyses of plaintiffs' claims under a discovery rule model. The bill's sponsor, State Senator John Lynch, states that Whitman's changes to the bill render it worthless.     

Recent rulings by other courts in AIDS phobia claims

Local, State, and Federal courts have not responded uniformly to fear-of-AIDS claims. The majority of the Supreme and Appeals courts have limited recovery of emotional distress to situations in which the plaintiff was exposed to HIV and faced a realistic prospect of contracting the virus. In California, a shopper who tried on a jacket that had a needle in the pocket was denied damages because there was no evidence that the needle was contaminated. A Connecticut hospital patient who sat on a blood-soaked stretcher could not recover emotional distress damages because he was not actually exposed to blood in such a way as to make HIV transmission possible. Fear-of-AIDS court rulings from across the United States are summarized.     

Economic conditions and suicide rates in New York City

Extant analyses of the relation between economic conditions and population health were often based on annualized data and were susceptible to confounding by nonlinear time trends. In the present study, the authors used generalized additive models with nonparametric smoothing splines to examine the association between economic conditions, including levels of economic activity in New York State and the degree of volatility in the New York Stock Exchange, and monthly rates of death by suicide in New York City. The rate of suicide declined linearly from 8.1 per 100,000 people in 1990 to 4.8 per 100,000 people in 1999 and then remained stable from 1999 to 2006. In a generalized additive model in which the authors accounted for long-term and seasonal time trends, there was a negative association between monthly levels of economic activity and rates of suicide; the predicted rate of suicide was 0.12 per 100,000 persons lower when economic activity was at its peak compared with when it was at its nadir. The relation between economic activity and suicide differed by race/ethnicity and sex. Stock market volatility was not associated with suicide rates. Further work is needed to elucidate pathways that link economic conditions and suicide.     

Inequality of water fluoridation in Southern Brazil--the inverse equity hypothesis revisited

The purpose of this ecological study was to investigate the association between social and economic indicators at the municipal level and the presence of water fluoridation and time when water fluoridation was implemented in the 293 municipalities of Santa Catarina State in Southern Brazil. Several social and economic indicators were obtained from official Brazilian agencies as well as from UNICEF. Questionnaires were sent to local authorities and to the local government water supply Company to obtain information about the presence or not of a fluoridated water supply and the year when fluoridation was implemented. Differences in social and economic indicators between municipalities with and without fluoridated water and between those that have had this service for different lengths of time were compared by the Mann-Whitney U test. In addition, multiple logistic regression analyses was performed to identify associations between social and economic indicators at the municipal level and presence and time of implementation of water fluoridation. Results indicated that larger populations are associated with municipalities with fluoridated water. Larger populations, higher child development indexes and low illiteracy rates are associated with a longer time since the implementation of water fluoridation. The finding that less developed municipalities delayed the provision of water fluoridation corroborates the inverse equity hypothesis.     

Assisted suicide

The U.S. Supreme Court has agreed to hear cases from Washington State and New York regarding the rights of people with terminal illnesses to have their doctor assist them in hastening death. In both the Washington and New York cases, the plaintiffs included people with AIDS or their caregivers. Arguments in the two cases are scheduled in January and decisions are expected in May or June 1997. In both cases, appeals courts struck down State laws.     

Euthanasia, assistance to suicide and the law: developments in The Netherlands.

In this article the developments in euthanasia in The Netherlands are discussed. To a large extent unanimity has been reached about the definition of euthanasia. Since 1973 the courts have become involved in euthanasia cases. The lower courts and the Supreme Court allowed for euthanasia on request under certain conditions. In 1982 a State Committee on Euthanasia was established. This Committee made a proposal of a law on euthanasia and assistance to suicide on request. The Committee delineated requirements to be followed for euthanasia not to be punishable. Although a majority of the Dutch population is in favour of a liberalizing legislation, the political situation delays its adoption.     

Contaminated fish consumption in California’s Central Valley Delta

Extensive mercury contamination and angler selection of the most contaminated fish species coincide in California’s Central Valley. This has led to a policy conundrum: how to balance the economic and cultural impact of advising subsistence anglers to eat less fish with the economic cost of reducing the mercury concentrations in fish? State agencies with regulatory and other jurisdictional authority lack sufficient data and have no consistent approach to this problem. The present study focused on a critical and contentious region in California’s Central Valley (the Sacramento-San Joaquin Rivers Delta) where mercury concentrations in fish and subsistence fishing rates are both high. Anglers and community members were surveyed for their fish preferences, rates of consumption, the ways that they receive health information, and basic demographic information. The rates of fish consumption for certain ethnicities were higher than the rates used by state agencies for planning pollution remediation. A broad range of ethnic groups were involved in catching and eating fish. The majority of anglers reported catching fish in order to feed to their families, including children and women of child-bearing age. There were varied preferences for receiving health information and no correlation between knowledge of fish contamination and rates of consumption. Calculated rates of mercury intake by subsistence anglers were well above the EPA reference dose. The findings here support a comprehensive policy strategy of involvement of the diverse communities in decision-making about education and clean-up and an official recognition of subsistence fishers in the region.     

Changes in Medicare reimbursement in Colorado: impact on physicians' economic behavior.

In 1976 there was a change in Medicare reimbursement policy in the State of Colorado. This study analyzes the impact of that change on physicians' economic behavior. Through 1976, prevailing charges (one of the determinants of the level of physician reimbursement under Medicare) were computed separately within each of 10 regions of Colorado. Since then, they have been computed for the State as a whole, and thus, physicians in like specialties have had equal prevailing charges throughout the State. This change in reimbursement policy led to a relative increase in prevailing charges for physicians in small urban and nonurban areas of the State, and a relative decrease for physicians in the major urban areas. In this paper we analyze the impact of this change on several aspects of physician behavior. We found that physicians whose reimbursement rates declined as a result of the change--primarily those in the Denver/Boulder area--provided more-intensive medical services, had lower assignment rates, and charged lower prices than they would have in the absence of the change.     

Resource allocation decisions in Canada's health care system: can these decisions be challenged in a court of law

This paper explores how the Canadian courts have responded to resource allocation decisions that have impacted on patients. While there have been few Canadian cases, those that exist fall into two categories. In the first part of the paper, we discuss recent cases that fall into the category of traditional negligence cases where a patient has been harmed and is seeking redress from the providers of care. What is emerging is that individual defendants, either physicians or institutions, are raising economic factors in their defence. The issue, we examine in this context is whether economic arguments can be successful in justifying the level of care that was provided and we conclude that, to date, courts have not been receptive to these arguments. The second part of the paper discusses those cases where patients have used legal arguments to try and change a governmental/policy decision, or to seek redress from harm caused by such a decision that has affected their access to care. In this context, patients have used principles of administrative law, constitutional law and tort law with varied degrees of success. We provide an analysis of these cases and conclude that it is difficult for patients to succeed when challenging allocation decisions at the policy level.     

Balancing economic freedom against social policy principles: EC competition law and national health systems

EU Health policy exemplifies the philosophical tension between EC economic freedoms and social policy. EC competition law, like other internal market rules, could restrict national health policy options despite the subsidiarity principle. In particular, European health system reforms that incorporate elements of market competition may trigger the application of competition rules if non-economic gains in consumer welfare are not adequately accounted for. This article defines the policy and legal parameters of the debate between competition law and health policy. Using a sample of cases it analyses how the ECJ, national courts, and National Competition Authorities have applied competition laws to the health services sector in different circumstances and in different ways. It concludes by considering the implications of the convergence of recent trends in competition law enforcement and health system market reforms.     

Re: "Acute Nonlymphocytic Leukemia and Residential Exposure to Power-Frequency Magnetic Fields"

The analyses presented here are available in greater detail elsewhere. They are not the analyses used to present the data in the original report, but we believe that they are reasonable analyses, suggested by the study's own measurement data, earlier published findings, and consideration of the likely sources of chronic residential magnetic field exposure among adults in the Washington State locale. If the association of magnetic field exposure with acute nonlymphocytic leukemia indicated by the analyses in table 1 is causal (and that is an important "if"), then the data suggest that some 25 per cent or more of these cases in the Washington State locale could be attributable to chronic magnetic field exposure--and that would obviously be a very important consequence. The risk, if real, is not trivial. And since protection from some important sources of exposure (such as electric bed heaters) is easily obtained, it seems hard to find any justification for not pursuing further studies of this subject immediately and vigorously.     

Contributory negligence

The doctrine of contributory negligence evolved from 19th century economic legal policy seeking to protect America's fledgling industries from liability for injuries resulting from their activities. These policies resulted in an anti-claimant environment that made it difficult for any plaintiff, including malpractice plaintiffs, to recover for their injuries. Since the onset of the 20th century, courts, spurred by state and federal legislative acts, have become more even-handed, and contributory negligence has become a limited defense in malpractice cases. This article defines some of the situations where courts have found that patient's actions have barred plaintiff recovery because of contributory negligence and offers the limited prediction that contributory negligence may be on the verge of once again becoming a major malpractice defense.     

The rising long-term trend in occupational injury rates.

Establishment survey data for the United States as a whole and workers' compensation data for the State of California were used to document long-term trends in occupational injury and acute illness rates. After declining throughout the first half of the century, national rates of disabling injuries in manufacturing, construction, and the trade sector have risen sharply in recent decades. Injury rates in mining show no strong trend either up or down since 1960. Increases over recent years have been especially pronounced for strains and sprains, cuts, lacerations and punctures, bone fractures, and acute illnesses. Injury rates in the manufacturing sector are strongly influenced by general economic conditions--rising sharply with business upsurges and declining during recessions. Increases in the rate of unemployment, which decrease worker and labor union bargaining power, are associated with increases in injury rates within manufacturing.     

Two major prison cases poised for court review

The courts are divided on whether the Americans with Disabilities Act (ADA) and the Rehabilitation Act apply to State prisoners. The debate of whether disabled inmates are entitled to the same programs and services as nondisabled inmates will be addressed in court cases in Alabama and Pennsylvania. The U.S. Supreme Court will hear Pennsylvania Department of Corrections v. Yeskey to determine whether Federal disability-rights laws apply to State prisons. In the case, the inmate was denied access to a boot camp program because of his hypertension. The 11th U.S. Circuit Court of Appeals will hear Onishea v. Hopper, an Alabama case involving the question of whether mandatory HIV testing and segregation are permissible if it serves a prison's interests in protecting uninfected prisoners. Both cases have major implications for HIV-positive inmates.     

Review exclusive contracts in light of recent challenges.

Many hospitals hold exclusive physician contracts, primarily with hospital-based specialists such as pathologists, radiologists, emergency physicians and anesthesiologists. But some physicians are beginning to view exclusive contracting as a form of economic credentialing, and have begun challenging such contracts in the courts in a number of states.     

USMLE (United States medical licensing examination) step 1 examination. Legal vulnerability

Since the passage of the Civil Rights Act of 1964, the courts have ruled that sponsors of job entry assessment procedures must demonstrate the absence of discrimination against minorities. If an assessment discriminates, the courts may prohibit the use of the assessment unless the assessment is linked to a job analysis and exhibits validity. In 1994, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) instituted a three-step USMLE examination program as a single pathway for medical licensure. The Step 1 examination is not linked to a physician job analysis, exhibits lower scores for minority groups, and lacks construct validity. To avoid the chaos and expense of a protracted legal challenge, the FSMB and the NBME may need to revise the Step 1 examination, or discontinue it as a requirement of medical licensure.     

Association between types of need, human development index, and infant mortality in Mexico, 2008

The aim of this study was to assess the association between different types of economic and social deprivation and infant mortality rates reported in 2008 in Mexico. We conducted an ecological study analyzing the correlation and relative risk between the human development index and levels of social and economic differences in State and national infant mortality rates. There was a strong correlation between higher human development and lower infant mortality. Low schooling and poor housing and crowding were associated with higher infant mortality. Although infant mortality has declined dramatically in Mexico over the last 28 years, the decrease has not been homogeneous, and there are persistent inequalities that determine mortality rates in relation to different poverty levels. Programs with a multidisciplinary approach are needed to decrease infant mortality rates through comprehensive individual and family development.