Journal of health law最新文献

Within the last 20 years, the fragile symbiotic relationship between physicians and hospitals has become increasingly strained. Physicians have created new healthcare delivery systems, including a host of for-profit, physician-owned specialty hospitals. Proponents of specialty hospitals argue that they provide high quality facilities and allow for innovative treatments. Opponents, however, contend that such hospitals "cherry pick" patients who otherwise would help to subsidize general hospitals, and point to the various fraud and abuse issues raised by physician-owned specialty hospitals. This Article examines the specialty hospital phenomenon and the arguments for and against such entities. It also analyzes whether an extension of the present federal moratorium on the construction of new physician-owned specialty hospitals is in the best interests of the country's healthcare system. The author concludes that the data are unclear as the overall impact of such hospitals and that they should not be further constrained until when and if the facts are clear.

The process of choosing and prescribing prescription drugs is complex. While the choice about which drug to prescribe is made by the physician, the physician may be influenced by patient demand, which, in turn, may be influenced by consumer advertisements. As a result, consumer advertisements for prescription drugs need to provide information that gives consumers an understanding, not only of drug risks and efficacy but also of the notable limits on benefits claimed. This Article examines the drug-specific focus of consumer advertising for prescription drugs from two perspectives: the need to prevent confusion that could affect medical decisions about alternative treatments and the need to prevent misimpressions about the value of a drug that can create consumer demand on physicians and insurers for more expensive drugs than needed.

Following the attacks of September 11, 2001(9/11), there have been increasingly divisive proposals for Americans to sacrifice liberty for safety. "Health and human rights" provides a much more constructive and effective framework than fear on which to base both routine public health actions and responses to public health emergencies. This can be illustrated by the failure of bioterrorism-based government initiatives at both the state and federal levels since 9/11, as well as the worldwide response to the post-9/11 SARS epidemic. Effective public health work can only occur with a population that trusts its public health officials. 9/11 can serve as a catalyst to reform public health by adopting the health and human rights framework that can move it from a fragmented state and local activity to one that is federal and coordinated, and ultimately one that is global and based on transparency, trust, science, and respect for human rights.

In March of 2004, the Centers for Medicare & Medicaid Services released new regulations that interpreted the Federal Physician Self Referral Act, otherwise known as Stark II. The new regulations, commonly referred to as the Phase II regulations, must be carefully considered when structuring physician compensation models. Stark II generally holds that physicians may not make a referral for designated health services to an entity with which they have a direct or indirect financial relationship. This Article outlines the provisions of Stark II that are applicable to physician compensation methodologies. In addition, the authors evaluate hypothetical transactions involving physician groups seeking viable compensation schemes and explore the validity and risks of each.

The tragic circumstances surrounding the death of Theresa Marie Schiavo have reignited discussion regarding end-of-life decisionmaking. In this Article, the author examines the current legal and ethical environment surrounding the decision to end life-sustaining treatment. Starting with the New Jersey Supreme Court's decision in In re Quinlan, the author discusses how such important issues as who should be the surrogate decisionmaker, attitudes towards artificial nutrition and dehydration, and difficulties in defining medical futility. Looking through a post-Schiavo lens, the Article examines state law addressing these issues and how these choices may be reexamined in the coming years.

Hospitals often engage in physician recruitment in an effort to fulfill a community need for a particular medical specialty. In doing so, the hospital must comply with the regulatory requirements of the physician recruitment exception of the Stark law, which over the years has generated a great deal of discussion and perhaps confusion. The publication of the Stark II, Phase II regulations in March 2004 was supposed to provide guidance and clarity, but the new regulations have raised a number of new issues and concerns, particularly regarding the requirements imposed on recruiting arrangements involving group practices. This Article reviews the regulatory requirements of the new physician recruitment exception and addresses several of the concerns that have been raised. Specifically, it examines the new regulatory definition of the "geographic area served by the hospital," the restrictions on income guarantees when the recruited physician joins a group practice, and the prohibition on additional practice restrictions. The author concludes that, while some of these concerns are legitimate, others will have little practical implication and should not hinder the ability of hospitals to engage in reasonable, beneficial recruitment activities.

Physician-owned specialty hospitals have flourished in today's healthcare arena, but also have been the subject of a great deal of controversy. The author argues that the rise of specialty hospitals has been the result of a confluence of two healthcare policies: (1) skewed DRG payment methodologies and (2) the misapplication of exemptions to the Stark Law's ban on physician self-referral. This Article examines the aspects of these healthcare policies that have allowed for the explosion of specialty hospitals, as well as the arguments for and against the creation and need for specialty hospitals. The Article also analyzes the reform proposals to correct the Stark and DRG methodologies and how those proposals will affect both specialty and general hospitals.

Rarely have all the branches of federal and state government converged upon a single issue, a single person as they did in the tragic and acrimonious case of Theresa Maria Schiavo. In late 2003, the Florida Legislature passed what become known as "Terri's Law" and in Spring of 2005, Congress and the President of the United States sought to directly intervene in the care of the severely brain damaged woman. During that period, the state and federal court systems, through the highest courts in both venues, ruled on Ms. Schiavo's life, resulting in the removal of an artificial feeding tube and her death during Easter week. The legal and medical issues in this complex, politically and emotionally charged case continue to raise important questions for health attorneys. In this Article, Professor Wolfson, who served as the legislatively mandated, court appointed special guardian ad litem for Theresa Schiavo in late 2003, provides a distinctive first-person overview of the Schiavo case.