Treating those found incompetent for execution: ethical chaos with only one solution

In early 1988 the population on America's death rows climbed above the 2,000 mark for the first time in history. In 1986 the United States Supreme Court firmly stated that the Constitution will have been violated if any of these prisoners is put to death while mentally incompetent for execution. In this article we discuss the case of Gary Alvord, the only inmate to be formally found incompetent for execution in modern times. Interviews with psychiatrists and mental health professionals at the Florida psychiatric hospital where Alvord was treated between 1984 and 1987 reveal much ambivalence and anger about the case. We conclude that, out of respect for the rights of these mental health professionals and the ethical codes of their professions, any prisoner found incompetent for execution should have his or her death sentence commuted to long-term imprisonment before treatment is requested or given.     

Medicaid program; review and approval process for Section 1115 demonstrations. Final rule

This final rule will implement provisions of section 10201(i) of the Patient Protection and Affordable Care Act of 2010 that set forth transparency and public notice procedures for experimental, pilot, and demonstration projects approved under section 1115 of the Social Security Act relating to Medicaid and the Children's Health Insurance Program (CHIP). This final rule will increase the degree to which information about Medicaid and CHIP demonstration applications and approved demonstration projects is publicly available and promote greater transparency in the review and approval of demonstrations. It will also codify existing statutory requirements pertaining to seeking advice from Indian health care providers and urban Indian organizations for section 1115 demonstration projects, and for the first time impose as regulatory requirements tribal consultation standards that were previously only published as guidance documents.     

Availability of funds to provide health services in the Pacific Basin--HHS. Notice of availability of funds

The Health Resources and Services Administration (HRSA) announces that up to $331,000 is available under section 301 of the Public Health Service (PHS) ACT 42 U.S.C. 241, for funding public and non-profit private entities for projects to build capacity and improve health services and systems, particularly preventive health services, in the Commonwealth of the Northern Mariana Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau and to provide technical assistance relative to such projects. In recognition of the extent of funding available, these funds will be available only to continue activities currently receiving funds under the section 301 Pacific Initiative grant authority. HRSA will entertain applications from current grantees for supplemental grants to modify project activities, and from eligible organizations for competing continuation grant awards to extend project activities.     

Discontinuation of approval of modifications in notes, guaranteed under Title VI or VII of the Public Health Service Act, proposed to permit use of the notes as collateral for tax-exempt financings--PHS. Final rule

The Department of Health and Human Services (HHS) adds a new section to regulations for making and guaranteeing loans for construction and modernization of hospitals and medical facilities and to regulations for guaranteeing loans for the construction of teaching facilities for health professions personnel. Under these regulations HHS will not approve the modification of the terms of an existing loan guaranteed under Title VI or Title VII of the Public Health Service (PHS) Act if the modification would permit use of the guarantee (or guaranteed loan) as collateral for tax-exempt financing.     

Medical liability and health care reform

We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.     

Health financing research and demonstration grants; availability of funds for grants--HCFA. General notice

This notice announces the availability of HCFA funds for certain priority research and demonstration grants for fiscal year 1983. It contains information about the subject areas for grants that will be given priority, project requirements, application procedures, amounts and duration of grants, and waiver of state plan requirements for demonstration projects. HCFA makes funds available for activities that will help to resolve major health financing policy and program issues or to develop innovative methods for the administration of Medicare and Medicaid.     

Health financing research and demonstration grants; availability of funds for grants--HCFA. General notice

This notice announces the availability of HCFA funds for certain priority research and demonstration grants for the Federal fiscal year 1984. It contains information about the subject areas for grants that will be given priority, project requirements, application procedures, amounts and duration of grants, and waiver of State plan requirements for demonstration projects. HCFA makes funds available for activities that will help to resolve major health financing program issues or to develop innovative methods for the administration of Medicare and Medicaid.     

Public Health Service--National Health Service Corps Scholarship Program. Final regulations

These regulations set forth the requirements for the award of scholarships under the National Health Service Corps Scholarship Program to students receiving academic training in medicine, osteopathy, dentistry, and other health professions in order to assure an adequate supply of trained health professionals for the National Health Service Corps.     

The health of health practitioners: remedial programs, regulation and the spectre of the law

The past two decades have seen an emerging awareness by regulators and some of the health professions about the phenomenon of the impaired practitioner. One response, particularly from the medical profession, has been to design various models of health programs principally to cater to psychiatrically unwell and substance dependent practitioners. However, the health conditions of practitioners are more diverse than these categories, particularly in the era of a stressed and ageing health care workforce. The potential exists for practitioners, their treaters and employers to be legally liable for foreseeable risks posed to patients and clients by practitioners whose health is problematic and/or deteriorating. There is much to be said for practitioners, health service administrators, educators and regulators dealing more effectively with all categories of impaired practitioners before the intervention of the civil law which may not be adequately informed or sophisticated and is most unlikely to be collaborative in its approach.     

Psychological Injury and Law: Editorial on Truth and Consequences, Psychologists and Attorneys

Psychology and law are established but evolving professions that need to communicate better with each other. In the interface of psychology and law in civil proceedings, such as in cases of psychological injury in tort, psychology can help in arriving at just and fair legal decisions that are appropriate in context. Professionals in the legal and mental health communities will find that the combination of the journal, Psychological Injury and Law, and its housing association, ASAPIL, function as a bridge between the two communities.     

Public Health Service--Grants for allied health projects. Final rule

These regulations set forth requirements for grants to: (a) Establish regional or State systems to assure that allied health and nursing personnel needs in the area are met by coordinating and managing allied health professions and nursing education and training within and among educational institutions and their clinical affiliates; (b) Establish or improve recruitment, training, and retraining programs for allied health personnel; and (c) Establish career ladders and advancement programs for practicing allied health personnel. These regulations implement section 796 of the Public Health Service Act.     

Forwards or backwards? New directions in Danish patients' rights legislation

The Danish Patients' Rights Act from 1998 was the first comprehensive piece of legislation addressing the basic legal values and principles governing the relation between patient and the health care services. Since the adoption of the Act there has been continuous legislative activity in the field, and the objective of the article is to discuss how recent developments in Danish patients' rights legislation shall be interpreted in terms of balancing interests of patients towards interests of society and the health care professions.     

Privacy Act of 1974; new system of records--Department of Health and Human Services; Public Health Service. Notification of a new system of records: 09-25-0143

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new system of records, 09-25-0143, Biomedical Research: Records of Subjects in Clinical, Epidemiologic and Biometric Studies of the National Institute of Allergy and Infectious Diseases, HHS/NIH/NIAID. We are also proposing routine uses for this system. This system will be used to support (1) epidemiologic, clinical and biometric investigations into the causes, nature (morbidity and mortality), outcome, therapy and cost of infectious, immunologic and related diseases; (2) review and evaluation of the progress of these research projects, and identification and planning for improvements or for additional research. The population and statistical studies supported by this system may be conducted or managed by Institute staff as well as others outside the Institute. This system comprises records maintained in a number of distinct research projects. The number and specific nature of projects will change over time as new ones are started and as work on existing projects is completed.     

Liability of manufacturers and providers of health related goods and services: confronting the dilemma.

In this Article, Theodore Cooper, M.D., Assistant Secretary for Health at HEW, contends that the crush of lawsuits brought by aggrieved health care consumers against medical professionals and institutions, and drug and medical equipment manufacturers, may be the result, in large part, of a widely held impression--often encouraged by members of the health professions and industries themselves--that medicine has unlimited powers to heal. Dr. Cooper suggests that those involved in providing health care services and products--and members of the legal profession-have a responsibility to inform the public that this expectation is unrealistic and that everyone suffers when the number of such lawsuits and the size of damage awards are excessive.     

State Medicaid reform under Section 1115 demonstration authority

Given the complexity of federal Medicaid law and the limitations it imposes on state flexibility, it is likely that states will continue to ask the Secretary to grant waivers under Section 1115 to allow them to pursue new approaches to health care reform. The results of currently operational Section 1115 projects involving statewide managed care systems will be useful in evaluating the Medicaid reform measures currently under discussion in other states and at the federal level. In particular, the ability of the states to control Medicaid and indigent care costs and to utilize federal dollars more efficiently should prove important in evaluating a block grant approach to federal Medicaid funding. Moreover, Section 1115 project results that bear on the sufficiency of various Medicaid capitation rate methodologies will also be of value as more states expand the use of managed care arrangements for their Medicaid populations.     

Lessons from Tuskegee: What Law Enforcement Can Learn from the History of Bioethics

Though Black lives continue to be lost during encounters with law enforcement, we remain far from a policy solution. While leading presidential candidates fail to offer concrete proposals, the recommendations of Campaign Zero appear to have found little traction. Furthermore, we are far from understanding the causes of the disproportionate use of violence against minorities. Faced with a growing crisis, law enforcement would do well to consider professions that have taken successful steps to outgrown their history of racial violence. The medical community’s response to the Tuskegee syphilis experiment is particularly instructive. Much as the medical community responded to a crisis of racial violence by fundamentally reconceptualizing the role of the physician, the time has come for a new ethics of policing that will reshape our understanding of the role of law enforcement.     

Psychological Injury from Licensing Complaints Against Mental Health Practitioners

Today's mental health practitioners are subject to governmental (e.g., licensing boards) and legal (e.g., professional liability or malpractice) monitoring and regulation. Regrettably, the governmental and legal oversight of health care has proven to be tilted in favor of the service user, with frequent unfair processing and unjustifiably harsh penalties imposed on mental health practitioners—which often result in psychological injury. Stress and anxiety caused by a licensing complaint is common; and in this article, the psychological effects are set forth. It is concluded that there is no reason to expect relief from the risks of practice in the future, that is, typical licensing complaints plus added ethical issues are likely as the mental health professions evolve. This means that, whenever there is an indication of a possible complaint from a service user, today's mental health practitioner must, as part of the support services essential for practice, be prepared to rely on legal counsel.     

Legal Aid in the Eye of a Storm: Rationing, Contracting, and a New Institutionalism

This article discusses possible rationales underlying a legal aid system through an articulation of theories of distribution in the legal services market, considers the idea of prioritization and planning or, in the political vernacular, rationing of public funding, and addresses the impact of economic and social theories of the professions on legal aid structures. Finally, the emerging concepts of 'new-institutionalism' and 'new public management' are introduced to indicate the organizational and sociological complexity of reforming the legal services market. Each of these threads illustrate competing values and institutional influence on publicly funded legal services. Bureaucratic rules mix with professional and economic incentives to articulate entitlement to public money in a predominantly private forum. Drawing on research in the field of rationing health care, sociological and economic work on legal services, and organizational theories, it will be demonstrated that conceptual, policy, and research tools need to play closer attention to this competition of values.