Tort Trial and Insurance Practice Section

MEDICINE AND LAW COMMITTEE
Medicine and Law Links

The MEDICINE AND LAW COMMITTEE focuses on all aspects of law that relate to the delivery of health care. This web site was created to provide up-to-date judicial, legislative, and regulatory information to MEDICINE AND LAW COMMITTEE membership as well as site visitors. We invite you to explore the below-listed links. Please let us know what you like or dislike. Send suggestions for additions or improvements to our webmaster.

LINKS BY SUBJECT:

 

ABORTION

  • On March 22, 1999, the United States Supreme Court justices declined to review a New Mexico Supreme Court decision finding that state Medicaid recipients’ abortions will remain funded by the state. New Mexico Right to Choose/NARAL v. Johnson, -- P.2d --, 1998 WL 959993 (N.M. Nov. 25, 1998) (No. 23,239), cert. denied, Klecan v. New Mexico Right to Choose/NARAL, -- S. Ct. -- (mem), 1999 WL 59835, 67 USLW 3504 (U.S. Mar. 22, 1999) (No. 98-1248), <http://supct.law.cornell.edu/supct/html/032299.ZOR.html> (check "certiorari denied" section).
  • On February 22, 1999, the U.S. Supreme Court left untouched a Fourth Circuit decision upholding Virginia’s parental notification statute requiring minors to notify one parent before obtaining an abortion. Planned Parenthood of Blue Ridge v. Camblos, No. 98-834, cert. denied (U.S. Feb. 22, 1999).

ALTERNATIVE MEDICAL SERVICES

  • On February 22, 1999, the U.S. Supreme Court declined to consider a Ninth Circuit decision upholding a Washington State law requiring health maintenance organizations and health care service providers to provide access to "alternative" medical services in health plans. Washington Physicians Service Association v. Gregoire, No. 98-889, cert. denied (U.S. Feb. 22, 1999), <http://supct.law.cornell.edu/supct/html/022299.ZOR.html> (check "certiorari denied" section).
  • The American Society of Health-System Pharmacists Med Master,
    http://www.SafeMedication.com/, helps the attorney and health care
    professional locate important information on alternative medicine.

AMBULANCE SERVICES

  • DHHS OIG Advisory Opinion No. 99-2 found that certain arrangements for discounted ambulance services provided to residents of Medicare skilled nursing facilities may constitute prohibited remuneration under the anti-kickback statute if the requisite intent to induce referrals of federal healthcare program business were present. See <http://www.hhs.gov/progorg/oig/advopn/1999/ao99_2.htm> (issued Feb. 24,1999 and posted March 4, 1999).
  • A December 1998 Office of Evaluation and Inspections (OEI) report, Medical Necessity of Medicare Ambulance Services (OEI-09-95-00412), assessed the medical necessity of a sample of Medicare ambulance services that did not result in hospital or nursing home admissions or emergency room care. The report found that that two-thirds of the 30 sampled cases were not medically necessary because alternative transportation would not have endangered the patient’s health. Medicare allows approximately $104M each year for these medically unnecessary ambulance services. The study recommended that the Health Care Financing Administration develop a prepayment edit to verify the medical necessity of ambulance claims that are not associated with hospital or nursing home admissions or emergency room care. View the report at <http://www.dhhs.gov/progorg/oei/whatsnew.html>.

AMBULATORY SURGICAL TREATMENT CENTERS

ANTITRUST

  • On March 22, 1999, the U.S. Supreme Court left intact an Eleventh Circuit decision that a cooperative buying plan by hospitals to procure temporary nurses from preferred agencies survives antitrust scrutiny. All Care Nursing Serv. Inc. v. High Tech Staffing Servs. Inc., 135 F.3d 740 (11th Cir. 1998), cert. denied, Quality Prof’l Nursing Inc. v. Bethesda Mem’l Hosp. Inc., -- S. Ct. -- (mem), 1999 WL 149901, 67 USLW 3409, 67 USLW 3438 (U.S. Mar. 22, 1999) (No. 98-989), <http://supct.law.cornell.edu/supct/html/032299.ZOR.html> (check "certiorari denied" section).

BALANCED BUDGET ACT OF 1997

BREAST IMPLANTS

CLINICAL TRIALS

  • DHHS INITIATIVES TO STRENGTHEN PROTECTION OF HUMAN RESEARCH SUBJECTS
    On May 23, 2000, a Department of Health and Human Services (DHHS)
    press release, <http://www.hhs.gov/news/press/2000pres/20000523.html>,
    announced new initiatives to strengthen the protection of human research
    subjects in clinical trials, including those involving gene transfer.
    The initiative focuses on education and training, the informed consent
    process, and the monitoring and oversight of clinical trials. Review a
    DHHS fact sheet on the subject at
    <http://www.hhs.gov/news/press/2000pres/20000523a.html>.

    In addition, DHHS plans to pursue legislation to enable the Food &
    Drug Administration to levy civil monetary penalties for violation of
    informed consent and other important research practices – up to $250,000
    per clinical investigator and up to $1M per research institution.
    The DHHS Office of Inspector General (OIG) released three reports
    involving protection for human subjects in clinical trials. Access the
    reports at <http://www.dhhs.gov/progorg/oei>.

    (1) Recruiting Human Subjects: Pressures in Industry-Sponsored Clinical
    Research (OEI-01-97-00195). To obtain copies of this report, please call
    HCFA's Boston Regional Office at (617) 565-1050 or visit
    <http://www.dhhs.gov/progorg/oei>.

    (2) Recruiting Human Subjects: Sample Guidelines for Practice
    (OEI-01-97-00196). To obtain copies of this report, please call HCFA's
    Boston Regional Office at (617) 565-1050 or visit
    <http://www.dhhs.gov/progorg/oei>.

    (3) FDA Oversight of Clinical Investigators (OEI-05-99-00350). To obtain
    copies of this report, please call HCFA's Chicago Regional Office at
    (312) 353-4124 or visit <http://www.dhhs.gov/progorg/oei>.

COBRA

  • U.S. Supreme Court decides COBRA continuation coverage case. An employer may not deny COBRA continuation coverage under its group health plan to an otherwise eligible beneficiary because he or she is also covered under a spouse’s group health plan at the time he or she elects COBRA coverage under the employer’s plan. Locate the case syllabus and opinion for Geissal v. Moore Medical Corp., No. 97-689 (U.S. Sup., June 8, 1998) at <http://supct.law.cornell.edu/supct/html/97-689.ZS.html>.

CONTRACTOR

  • On January 19, 1999, the U.S. Supreme Court declined to review an appeal by a physician who sued his Medicare contractor alleging its improper actions led to inadequate Medicare compensation for his medical services and exposure to civil and criminal liability for fraud. Pani v. Empire Blue Cross and Blue Shield, No. 98-661, cert. denied (U.S. Jan. 19, 1999), <http://supct.law.cornell.edu/supct/html/011999.ZOR.html> (check "certiorari denied" section).

DENTISTRY

  • On January 19, 1999, the U.S. Supreme Court declined review of an appellate decision upholding state dental board sanctioning of a dentist for hiring an unlicensed dentist to practice in his office. Armstrong v. N.C. Board of Dental Examiners, No. 98-677, cert. denied (U.S. Jan. 19, 1999), <http://supct.law.cornell.edu/supct/html/011999.ZOR.html> (check "certiorari denied" section).

DRUG LABELING

  • FDA REGULATION REQUIRES CLEARER OTC DRUG LABELING. The federal Food and Drug Administration (FDA) issued a final rule standardizing format and content requirements for labeling over-the-counter (OTC) drug products. This rule is intended to assist consumers in reading and understanding OTC drug labeling so consumers may safely and effectively use these products. The rule requires all OTC drug products to carry the new easy-to-read format and the revised content requirements within prescribed implementation periods. 64 Fed. Reg. 13,254 (Mar. 17, 1999); see 1999 WL 139718 (F.R.). Alternatively, view rule at <http://www.access.gpo.gov/su_docs/aces/aces140.html>, a searchable database covering volumes 60, 61, 62, 63 and 64 (1995-1999) of the Federal Register

EMPLOYMENT

  • SEVENTH CIRCUIT RULES NURSING HOME LPNs NOT SUPERVISORS. Licensed practical nurses (LPNs) who work as charge nurses at a Wisconsin nursing home are not supervisors within the meaning of the National Labor Relations Act according to a Seventh Circuit ruling affirming a National Labor Relations Board decision. NLRB v. GranCare Inc., d/b/a/ Audubon Health Care Center, -- F.3d --, No. 97-3431, 1999 WL 107918 (7th Cir. Mar. 3, 1999) (en banc); <http://www.kentlaw.edu/7circuit/1999/mar/97-3431A.html>. The Seventh Circuit holding is in accord with that of the Eighth, Ninth, and District of Columbia Circuits and contrary to that of the Third and Fourth Circuits.
  • SEVENTH CIRCUIT FINDS ON-CALL TIME OF HOSPITAL EMTs NOT WORK TIME. On-call hours of two emergency medical technicians at a Wisconsin hospital were not work time under 29 U.S.C. §207 of the Fair Labor Standards Act (FLSA). The hours were not "so restricted that the employees could not use their time effectively for personal pursuits" and, thus, did not qualify as work time under the FLSA. Dinges v. Sacred Heart St. Mary’s Hospitals, Inc., No. 98-1639 (7th Cir. Jan. 7, 1999). View case summary and link to opinion at <http://www.isba.org/CourtsBull/CBseventhcircuit_civil.html> (alphabetically locate the FLSA). View opinion at <http://www.kentlaw.edu/7circuit/1999/jan/98-1639.html>.

EMTLA

  • On March 22, 1999, the U.S. Supreme Court declined review of a Fourth Circuit decision regarding the application of the Emergency Medical Treatment and Active Labor Act (EMTALA) to a patient transfer. Baxter v. Holy Cross Hosp. of Silver Spring Inc., 155 F.3d 557 (4th Cir. 1998), cert. denied, -- S. Ct. -- (mem), 1999 WL 150113, 67 USLW 3484, 67 USLW 3508 (U.S. Mar. 22, 1998) (No. 98-1169), <http://supct.law.cornell.edu/supct/html/032299.ZOR.html> (check "certiorari denied" section).

END-OF-LIFE ISSUES

ERISA

  • On March 25, 1999, the New York Court of Appeals in Nealy v. US Healthcare HMO, 99 N.Y. Int. 0035 (NY Mar. 25, 1999), <http://www.law.cornell.edu/ny/ctap/I99_0035.htm>, held that ERISA does not preempt plaintiff’s medical malpractice, breach of contract and breach of fiduciary duty claims against a primary care physician who allegedly delayed in submitting a specialist’s referral form for approval by an HMO governed by ERISA.

EXPERTS

  • WHO IS AN EXPERT? U.S. SUPREME COURT CLARIFIES RULES ON EXPERT WITNESSES. On March 23, 1999, the U.S. Supreme Court clarified rules on witnesses. In Kumho Tire Co., Ltd. V. Carmichael, No. 97-1709 (U.S. Mar. 23, 1999), the high court unanimously held that the Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, factors for reliability of expert testimony may also be applied to non-scientific experts. View the Kumho syllabus and opinion at <http://supct.law.cornell.edu/supct/html/97-1709.ZS.html>.
  • The Chicago Daily Law Bulletin fee-based online service, <http://www.juryverdicts.com>, offers a comprehensive database for experts in the Midwest.
  • Under the University of Wisconsin’s Expert Site Medicine and Health Directory, there are numerous subspecialties listed, including Anesthesiology, Cardiology, Emergency Medicine, HIV/AIDS, Immunology, Neurology, Obstetrics-Gynecology, Oncology, Ophthalmology, Orthopedics, Pediatrics, Pharmacy, Radiology, Rehabilitation, Respiratory and Pulmonary Medicine, Rheumatology, Stress and Depression, Surgery, Toxicology, and Urology. <gopher://gopher.adp.wisc.edu/11/.browse/metanisel>.
  • The American Medical Forensic Society (AMFS) site, <http://www.amfs.com>, concentrates on medical malpractice case review and expert witness testimony.

FALLS

  • A university-based web site devoted to fall prevention, www.utmb.edu/aging/falls.htm, offers a handy checklist of risk factors for falls, and steps that individuals at risk can take to modify their behavior and their environment to minimize the risk. Although intended primarily for people living at home, the checklist applies to all surroundings.

FRAUD

GAO REPORTS

  • "Nursing Homes: Complaint Investigation Processes Often Inadequate to Protect Residents" dated March 22, 1999 (GAO/HEHS-99-80).
  • "Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Quality Standards" dated March 18, 1999 (GAO/HEHS-99-46).
  • "Veterans’ Benefits Claims: Further Improvements Needed in Claims-Processing Accuracy" dated March 1, 1999 (GAO/HEHS-99-35).
  • "Physician Shortage Areas: Medicare Incentive Payments Not an Effective Approach to Improve Access" dated February 26, 1999 (GAO/HEHS-99-36).
  • "Medical Records Privacy: Uses and Oversight of Patient Information in Research" dated February 24, 1999 (GAO/T-HEHS-99-70).
  • "Medical Records Privacy: Access Needed for Health Research, but Oversight of Privacy Protections is Limited" dated February 24, 1999 (GAO/HEHS-99-55).
  • "Medicare Fraud and Abuse: Early Status of DOJ’s Compliance with False Claims Act Guidance" (GAO/HEHS-99-42R).
  • "Medicare Physician Payments: Need to Refine Practice Expenses Values During Transition and Long Term" dated February 24, 1999 (GAO/HEHS-99-30).
  • "Medicare Home Health Agencies: Role of Surety Bonds in Increasing Scrutiny and Reducing Overpayments" dated January 29, 1999 (GAO/HEHS/99-23).
  • "Major Management Challenges and Program Risks: Department of Health and Human Services" dated January 1, 1999 (GAO/OCG-99-7).

GOVERNMENT SITES

  • U.S. Federal Government Agencies Directory offers a list of federal agencies on the Internet. Last updated on January 10, 1999, it allows keyword searches of federal agencies. <http://www.lib./su.edu/gov/fedgov.html>
  • Centers for Disease Control and Prevention (CDC), <http://www.cdc.gov/>. The "Health Information" section of this site leads to various libraries of information on diseases, injuries and disabilities, health risks, specific populations and prevention. Many of these libraries are maintained by component agencies of the CDC, such as the National Center for Environmental Health and the National Institute for Occupational Safety and Health. A "data and Statistics" section leads to collections of scientific data and health statistics, including the HazDat database of hazardous substances releases and health effects.
  • Food and Drug Administration, <http://www.fda.gov>, site covers drugs, toxicology, cosmetics, foods, medical devices, medical products, and more. In addition, the site makes available hundreds of full-text articles and reports.
  • National Cancer Institute, <http://wwwicic.nci.nih.gov>, sponsors CancerNet, a searchable database of clinical and research information. The material is organized into three indexes, one for health professionals, another for researchers, and one for patients.
  • National Center for Health Statistics, <http://www.cdc.gov/nchswww/nchshome.htm>, allows visitors to explore statistics on behavioral risk factors, diseases, infant and child health, vital events, and other topics.
  • National Institutes of Health (NIH), <http://www.nih.gov>. Find NIH clinical alerts; the HSTAT electronic resources (provides full text of clinical practice guidelines and quick reference guides for clinicians); information on current NIH research; the Combined Health Information Database (providing abstracts of more than 70,000 health information resources); and more.
  • National Library of Medicine (NLM), <http://www.nlm.nih.gov>, offers free access to two MEDLINE (a database of over eight million references to articles published in over 3,500 biomedical journals) services, PubMed and Internet Grateful Med. The two differ in their search features and links to sources of information outside MEDLINE. For example, Grateful Med includes other databases with several focusing on AIDS-related information. PubMed provides direct links between MEDLINE abstracts and the publishers of full-text articles. Attorneys who use demonstrative evidence should check out NLM’s Visible Human Project. The project relies on cat scan images to create anatomically detailed, three-dimensional representations of the male and female human bodies. Also available is a library of medical images to view online. Reproductions of these high-resolution images can be ordered. The NLM site also features special libraries covering such topics as toxicology.
  • U.S. Department of Health and Human Services, <http://www.os.dhhs.gov>, links to other health-related agencies including, among others: the Centers for Disease Control and Prevention, the National Institutes of Health, the Agency for Toxic Substances and Disease Registry, the Substance Abuse and Mental Health Services Administration.
  • General Accounting Office (GAO) reports are available on the web at: www.gao.gov.
  • HCFA Health Watch Newsletter, <http://www.hcfa.gov/news/newsltr.htm>, contains the latest HCFA news, regulations, upcoming events, among other items provided in HTML as well as Adobe Acrobat’s PDF format.
  • National Committee for Quality Assurance’s (NCQA)

HCFA

  • HCFA Rulings, <http://www.hcfa.gov/regs/rulings.htm>, clarify and interpret complex or ambiguous provisions of the law or regulations relating to Medicare, Medicaid, Utilization and Quality Control Peer Review, and related matters.

HEALTH REFORM

HEART ATTACKS AND DEFIBRILLATORS

An automated external defibrillator (AED) is a portable lifesaving device that relies on audible or visual prompts to guide trained non-medical users. Legislators in 21 states plan to introduce AED legislation in 1999. For more information, <http://www.nesl.org/programs/health/list.htm>.

HIV/AIDS

  • "Without proof of actual exposure to HIV, a claim for fear of contracting AIDS is too speculative to be legally cognizable." Plaintiffs’ claims for fear of contracting AIDS fail in consolidated cases from Cook County, Illinois. The Illinois Supreme Court held that the plaintiffs failed to establish actual exposure to HIV – the standard by which such claims should be judged. The court believes, however, "that an individual need not demonstrate a likelihood of developing AIDS in the future in order to state a claim for fear of contracting AIDS." Majca v. Beekil et al., Nos. 83677. 83886. 1998 WL 671770 (Ill. Oct. 1, 1998). Full text available at: <http://www.state.il.us/court/supremes/83677.txt>.

HOME HEALTH CARE

ICD-9-CM

  • Summary Report – ICD-9-CM Coordination and Maintenance Committee (Nov. 2, 1998), <http://www.hcfa.gov/events/ic1198mn.htm.>. Additional information on Administrative Simplification requirements of the Health Insurance Portability and Accountability Act (HIPAA) requiring establishment of national standards for code sets can be found at <http://aspe.os.dhhs.gov/admnsimp/.>

INDIVIDUALS WITH DISABILITIES EDUCATION ACT

  • The Individuals with Disabilities Education Act (IDEA), 84 STAT. 175, assures that children with disabilities have a free appropriate public education available to them. Consistent with this purpose, the IDEA authorizes federal financial assistance to states that agree to provide such children with special education and related services. On March 3, 1999, in Cedar Rapids Community School District, the U.S. Supreme Court held that a public school district in a participating state (Iowa) must provide continuous one-on-one nursing care to a wheelchair-bound and ventilator dependent student during school hours. Cedar Rapids Community School Dist. v. Garret F., 119 S. Ct. 992, 67 USLW 4165 (U.S. Mar. 3, 1999) (No. 96-1793). The decision is online at <http://supct.law.cornell.edu/supct/html/96-1793.ZS.html>. For U.S. Supreme Court briefs see 1998 WL 375420 (Pet. Brief), 1998 WL541985 (Resp. Brief) and 1998 WL 664982 (Reply Brief). For a transcript of the oral argument see 1998 WL 781831 (U.S. Oral Arg).

INSURANCE/REINSURANCE

Working on a brief, writing an opinion letter, or preparing an internal memo and require a good explanation for an insurance or reinsurance term? There are a variety of sources available on the web that provide insurance and reinsurance definitions. Sites highlighted by Larry P. Schiffer, lpschiffer@mcimail.com, in the TIPS Excess, Surplus Lines and Reinsurance Committee Newsletter (Winter 1999) include:

LONG-TERM CARE

  • Senior Sites, http://www.seniorsites.com, from the California Association of Homes and Services for the Aging lists information on non-profit facilities and services.
  • The Elderconnect, www.elderconnect.com, database covers over 33,000 facilities nationwide and is searchable by city, county, and type of service including long term care, home health, retirement homes, hospitals, and other service categories of interest to the aging. It combines information from HCFAs "OSCAR" database with other databases. Unfortunately, the data is not frequently updated. This page does include a disclaimer as to accuracy.
  • Geriatric Video Productions, www.geriatricvideo.com, is a commercial site which has descriptions of, and sells, training videos on a wide range of long term care topics. An interactive page allows visitors to suggest topics for future videos.
  • Best Practices in Long-Term Care. The Health Care Financing Administration’s (HCFAs) Health Standards Quality Bureau Advisory Committee has created a web page to collect "best practices" in long-term care. To learn about the best practices that have been reviewed and recommended by the HCFA Sharing Innovations in Quality (SIQ) Team, and/or to submit suggestions for successful practices to the HCFA SIQ Team, visit, <http://www.hcfa.gov/medicaid/siq/siqhmpg.htm>.

MEDICAID

  • On March 22, 1999, the United States Supreme Court justices declined to review a New Mexico Supreme Court decision finding that state Medicaid recipients’ abortions will remain funded by the state. New Mexico Right to Choose/NARAL v. Johnson, -- P.2d --, 1998 WL 959993 (N.M. Nov. 25, 1998) (No. 23,239), cert. denied, Klecan v. New Mexico Right to Choose/NARAL, -- S. Ct. -- (mem), 1999 WL 59835, 67 USLW 3504 (U.S. Mar. 22, 1999) (No. 98-1248), <http://supct.law.cornell.edu/supct/html/032299.ZOR.html> (check "certiorari denied" section).

MEDICAL MALPRACTICE

MEDICARE

  • On March 30, 1999, the Board of Trustees for Medicare issued their most recent reports to Congress on the financial operations and actuarial status of the Medicare program.
  • On February 23, 1999, the U.S. Supreme Court unanimously ruled that the Provider Reimbursement Review Board (PRRB) lacks jurisdiction to review a Medicare fiscal intermediary’s refusal to re-open a Medicare reimbursement determination, even where, as in this case, "new and material" evidence demonstrated that the provider was entitled to additional Medicare reimbursement. Your Home Visiting Nurse Services Inc. v. Shalala, No. 97-1489 (U.S. Feb. 23, 1999). Locate syllabus and opinion at <http://supct.law.cornell.edu/supct/html/97-1489.ZS.html>. This decision will affect the number of Medicare reimbursement determinations intermediaries will re-open to adjust in the future. See Health Care Daily Report (BNA Feb. 24, 1999). This case means Part A providers should appeal their Notices of Program Reimbursement within 180 days to preserve their appeal rights. Id.
  • On February 11, 1999, the Health Care Financing Administration (HCFA) published an operational policy letter (OPL) detailing model language that providers can use to explain Medicare appeal rights to beneficiaries when they are being discharged from the hospital. Locate the OPL on the agency’s website, <http://www.hcfa.gov/medicare/mgdcar1.htm>, by selecting OPL#82 - Notice of Discharge and Medicare Appeal Rights (NODMAR) Model Language. Alternatively, download in WordPerfect 6.1 or in PDF format viewable in Adobe Acrobat from <http://www.hcfa.gov/medicare/opl082.htm>.
  • Provider Reimbursement Review Board (PRRB), <http://www.hcfa.gov/regs/prrb/htm.>, is an independent panel to which a certified Medicare provider of services may appeal if it is dissatisfied with a final determination of its fiscal intermediary or HCFA.
  • A limited selection of 1998 PRRB decisions is available to download in Adobe’s portable document format (.pdf), <http://www.hcfa.gov/regs/decision.htm.>. Plans exist to expand the website to include all current fiscal year decisions.
  • Medicare Geographic Classification Review Board procedures, including instructions for 1998 appeals (for fiscal year 2000) and application forms are available in Adobe PDF format at <http://www.hcfa.gov/regs/mgcinfo.htm.> Select individual hospitals or hospital groups.
  • DHHS OIG Advisory Opinion 98-17 (issued Nov. 6, 1998), concluding that donations by a company to a §501(c)(3) charitable organization to fund Medicare Part B or Medigap premiums for financially needy Medicare beneficiaries with end-stage renal disease, where some or all of the beneficiaries may be receiving treatment from the donor, would not trigger civil monetary penalties under SSA §1128A(a)(5), posted at the OIGs web site at <http://www.hhs.gov/progorg/oig/advopn/1998/ao98_17.htm>.
  • November 1998 DHHS OIG report, Medicare Reimbursement for Hospital Beds in the Home: Payment Methodology, OEI-07-96-00222, comparing Medicare’s rental reimbursement methodology and utilization patterns for hospital beds in the home to policies utilized by other federal, state, private insurance companies, and managed care organizations, is available in Word 7.0, HTML, and PDF at <http://www.dhhs.gov/progorg/oei/whatsnew.html>.

MEDICARE+CHOICE

  • Report to Congress: Proposed Method of Incorporating Health Status Risk Adjusters into Medicare+Choice Payments (dated March 1, 1999; posted March 30. 1999), <http://www.hcfa.gov/pubforms/rtc_mpc.htm>.
  • Medicare+Choice Program Part C Statutory Requirements and Regulatory Implementation, <http://www.hcfa.gov/medicare/mplusc.htm>. This web page provides downloadable files in WP 6.1 for Windows (.WPD extension), ASCII Flat Text files (.TXT extension), HTML (.HTM extension), and PDF (.pdf extension).
  • Letter (Dec. 8, 1998) regarding Implementation of the Subpart D Quality Assurance (QA) Provisions under the Medicare+Choice Regulation and the Quality Improvement System for Managed Care (QISMC), <http://www.hcfa.gov/medicare/extnfinl.htm>
  • Implementation of HCFAs Quality Improvement System for Managed Care (QISMC) Interim Standards and Guidelines (HCFA Operational Policy Letter No. 72, Sept. 30, 1998), <http://www.hcfa.gov/medicare/opl072.htm.>
  • Statement of Michael Hash, HCFA Deputy Administrator on the Medicare+Choice Program before the House Commerce Committee Subcommittee on Health (Oct. 2, 1998), <http://www.hcfa.gov/testmony/choice1.htm.>

NURSING HOMES

  • On March 25, 1999, President Clinton signed H.R. 540, Nursing Home Resident Protection Amendments of 1999, prohibiting transfers or discharges of nursing facility residents as a result of a voluntary withdrawal by their facility from participation in the Medicaid program. View the bill at <http://thomas.loc.gov>.
  • In July 1998, President Clinton called for regulators to crack down on nursing homes that break the law. In October 1998, HCFA unveiled the federal government’s official nursing home guide page, <http://www.medicare.gov/nursing/home.html>. It includes pamphlets on how to choose a nursing home, and, for the first time, the actual results of nursing home inspections ("surveys") for every Medicare and Medicaid certified nursing home in the country. The "tags" and the names of the problems cited ("deficiencies") and the seriousness ("scope and severity") are posted here. However, the actual text of the citations is not available. Also, if an inspection has just taken place at a facility, it will probably be several months before results are posted.
  • Periodically, HCFA makes available electronic versions of Reports to Congress on selected issues, <http://www.hcfa.gov/pubforms/rtc.htm> including A Report to Congress Study of Private Accreditation (Deeming) of Nursing Homes, Regulatory Incentives and Non-Regulatory Initiatives, and Effectiveness of the Survey and Certification System (released to Congress July 1998).
  • Physical and chemical restraint use in nursing homes
  • Untie the Elderly, <http://www.ute.kendal.org>, Read their newsletter, and access the steps toward a successful restraint reduction program prepared by the Pennsylvania Restraint Reduction Training Team.

PATIENT’S BILL OF RIGHTS

PATIENT DUMPING

  • On January 13, 1999, in a per curiam decision, the U.S. Supreme Court held that patients who allege that they were wrongly refused emergency room treatment or "dumped" at another hospital need not show that the hospital "acted with an improper motive" to establish breach of federal patient dumping law. Roberts v. Galen of Virginia, Inc., No. 97-53 (U.S. Jan. 13, 1999), marks the Court’s first interpretation of the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. §1395dd. View opinion at <http://supct.law.cornell.edu/supct/html/97-53.ZPC.html>.

PHYSICIAN INCENTIVES

  • In Herdrich v. Pegram, 154 F.3d 362 (7thCir. 1998), the Seventh Circuit said HMO physician-administrators who limit medical care and pocket the savings can be sued for breaching their fiduciary duty to patients. The defendants have filed a motion for rehearing en banc. The decision is available at <http://laws.findlaw.com/7th/971070.html>.

QUI TAM ACTIONS

  • In U.S. ex rel. Foulds v. Texas Tech. Univ., No. 97-11182 (5th Cir. Mar. 29, 1999; revised Mar. 31, 1999), <http://www.ca5.uscourts.gov/opinions/pub/97/97-11182-CV0.htm.>, the Fifth Circuit held that the Eleventh Amendment "divests the federal courts of jurisdiction" to hear a qui tam action brought by a private citizen against a state or state entity.

REINSURANCE

Reference links that are listed under INSURANCE.

RESEARCH

See also TOPICAL LINKS.

  • PubMed, <http://www.ncbi.nlm.nih.gov/PubMed/>, has free access to MEDLINE, the National Library of Medicine’s database of 9 million medical articles. MEDLINE is a bibliographical index and, therefore, does not provide full article text. Instead, it offers abstracts and the citation required to retrieve articles from medical libraries.
  • The Health Hippo is a collection of policy and regulatory materials related to health care. <http://hippo.findlaw.com>. Topics to select from include, among others: Advance directives; biological products; infection control; labs, diagnostic facilities and telemedicine; medical devices; and vaccines.
  • The American Medical Association (AMA) site, <http://www.ama-assn.org>, features an extensive collection of resources and information regarding medical science and education. The site offers abstracts and selected full text from the Journal of the American Medical Association (JAMA). In addition, it has specialized archives devoted to specific areas of medical practice, such as internal medicine, ophthalmology, and pediatrics. The site also includes a searchable database, Physician Select, with information on most physicians licensed in the United States. Further, it hosts Hospital Select, a database of information on almost every hospital in the United States searchable by name/location, service line or health plan.
  • New England Journal of Medicine, <http://www.nejm.org>, features full and partial text from some articles, editorials, book reviews, correspondence, and opinion pieces. Article abstracts are provided and full article text can be ordered.
  • Priory Lodge Education, <http://www.priory.com>, publishes international, peer-reviewed journals on the following topics, among others: dentistry, psychiatry, chest medicine, general practice, pharmacy, veterinary, anesthesia, family practice, and medicine. Each journal has its own site featuring articles and news.
  • Softkey Body Works is a comprehensive and inexpensive CD ROM that provides a full map of the human body with animations and audio explanation. It is excellent for illustrating medical points to a jury or for depositions. Find it at <http://www.cbclegal.com>.
  • Human Anatomy OnLine, <http://www.innerbody.com>, provides a fun but introductory interactive anatomy lesson complete with illustrations, animation, and links.
  • Martindale’s Virtual Medical Center, <http://www.sci.lib.uci.edu/HSG/Medical.html>, links to over 40,000 multi-media teaching files, 900+ multimedia tutorials, 2,500+ databases, 115,000+ multimedia medical cases, 10,000+ movies, and 700 multimedia course/textbooks.
  • MedExplorer, <http://www.medexplorer.com.>
  • Medical Matrix, <http://www.medmatrix.org>, features encyclopedic collection of links to medical resources with 4,000+ links organized into the following categories: disease and specialty, clinical practice, literature, education, health care professionals, and computers and technology.
  • MedicineNet, <http://medicinenet.com>, alphabetically lists disease and their treatments; a provides a listing of medications, their uses and side effects; and includes a dictionary of medical terms.
  • MedScape, <http://medscape.com>, provides thousands of peer-reviewed articles and MEDLINE access.
  • The Virtual Hospital, <http://indy.radiology.uiowa.edu>, is an electronic health sciences library maintained by the University of Iowa College of Medicine to provide the latest medical information to practicing physicians. Some databases are limited to University of Iowa faculty and students.

RESOURCES

  • The American Society of Health-System Pharmacists Med Master,
    http://www.SafeMedication.com/, helps the attorney and health care
    professional locate important information on safe and effective use of
    medications.

RICO

  • On March 8, 1999, the U.S. Supreme Court decided that it will review a statute of limitations question presented by a Texas man’s claim that a group of doctors and their business entities improperly conspired to admit, treat, and hold him at a psychiatric facility for reasons related to their financial gain in violation of the federal Racketeer Influenced and Corrupt Organizations Act (RICO). Rotella v. Dallas Psychiatric Assocs., 147 F.3d 438 (5th Cir. 1998), cert. granted, 1999 WL 114456, 67 USLW 3376, 67 USLW 3420, 67 USLW 3553 (U.S. Mar. 8, 1999) (No. 98-896). The case promises to resolve a federal circuit split over whether the statute of limitations in RICO civil actions begins upon discovery of the injury in question, or when plaintiffs learn both of the existence of their injuries and obtain knowledge of a pattern of racketeering. See 4 HEALTH CARE DAILY REPORT (BNA Mar. 9, 1999).

SAFETY ADVISORIES

  • SAFETY ADVISORY ON GLASS CAPILLARY TUBES. On March 1, 1999, the Food and Drug Administration (FDA), the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC), and the Occupational Safety and Health Administration (OSHA) issued a joint safety alert advising of the potential risk of injury and/or infection from bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B and hepatitis C viruses, due to accidental breakage of glass capillary tubes, and recommending certain steps to minimize the risk. Copies of this safety advisory and additional relevant information can be found on the following webpages: <http://www.fda.gov/cdrh/safety.html>, <http://cdc.gov/niosh/homepage.html>, <http://www.osha-slc.gov/SLTC/needlestick/index.html>.
  • PUBLIC HEALTH ADVISORY ON EXPLOSIONS AND FIRES IN ALUMINUM OXYGEN REGULATORS. In February 1999, the Food and Drug Administration (FDA) and the National Institute for Occupational Safety and Health (NIOSH) issued a public health advisory to hospital administrators, nursing homes, home health care agencies, risk managers and others noting the hazards with oxygen regulators made of aluminum. The alert recommends safety practices for handling and operating oxygen equipment. Locate the advisory at <http://www.fda.gov/cdrh/safety.html>. Obtain FDA public health advisories, safety alerts, and other FDA postmarket safety notifications by list server subscription via e-mail to fdalists@www.fda.gov. Additional information, guidance and training regarding oxygen and fire safety is available from a number of online sources, including: the Compressed Gas Association - <http://www.cganet.com>, the National Fire Protection Association - <http://www.nfpa.org>, the American Society for Testing and Materials - <http://www.astm.org>, and the Centers for Disease Control and Prevention National Institute for Occupational Safety and Health - <http://www.cdc.gov/niosh/firehome.html>.

SOCIAL SECURITY ACT

  • Title XXI – State Children’s Health Insurance Program

STARK

  • HCFA Stark advisory opinion HCFA-AO-98-002 (Nov. 1998), <http://www.hcfa.gov/regs/aop/>, addressing whether the partners and physician employees of a proposed partnership may, under the "in-office ancillary services" exception defined in section 1877(b)(2) of the Social Security Act, refer Medicare and/or Medicaid patients to the partnership for eyeglass prescriptions filled subsequent to cataract surgery with the insertion of an intraocular lens

STATE BAR HEALTH LAW SECTIONS

TELEMEDICINE

  • Periodically, HCFA makes available electronic versions of Reports to Congress on selected issues, <http://www.hcfa.gov/pubforms/rtc.htm>. Choose Telemedicine Report to Congress (released to Congress December 4, 1997).

TOPICAL SITES

  • The National Institute on aging released its progress report on Alzheimer’s Disease, 1998. The report describes recent research focusing on brain changes and genetic factors. It includes advances in potential treatments, identifies risk factors, and discusses diagnosis and prevention. The report is available from the Alzheimer’s Disease Education and Referral (ADEAR) Center website, <http://www.alzheimers.org/pr98.html>.
  • OncoLink, <http://www.oncolink.upenn.edu>, is a fully searchable site offering information about cancer. For example, learn more about cancer causes, screening and prevention; clinical trials; and psychosocial support. Provides links to other cancer resources available online.
  • The Association of Cancer Online Resources sponsors ACOR, <http://www.acor.org>, where visitors can search the archives of cancer-related Internet mailing lists. Topics covered include breast cancer, general cancer, leukemia, colon cancer, esophageal cancers, Hodgkin’s Disease, kidney cancer, sarcoma, lung cancer, melanoma, myeloma, ovarian cancer, testicular cancer, and pediatric cancers.
  • PharmInfoNet, <http://pharminfo.com>, is a comprehensive source for information about drugs. Browse and search a collection of articles and resources arranged by generic and brand drug names. Other features include DrugFAQ, providing answers to questions about specific drugs; DrugPR, providing industry press releases about specific products; peer-reviewed articles on pharmaceutical topics; archival information from the Internet news group sci.med.pharmacy; and selected archives from professional List Serves.
  • The American Psychological Association, <http://www.apa.org/psychnet>, sponsored a fully searchable database of abstracts from more than 1,350 scholarly journals as well as a PsychCrawler, a tool to search other web-based psychology resources.
  • Psychiatry.com, <http://www.psychiatry.com>, provides information about mental retardation and psychiatry, psychiatry and law, and geriatric psychiatry.
  • Internet Mental Health, <http://mentalhealth.com>, has information on 50 common mental disorders and 65 common psychiatric medications, an online magazine, and links to other health sites.
  • Southern California Orthopedic Institute, <http://www.scoi.com>, offers an introduction to orthopedic medicine and injuries.
  • American Academy of Ophthalmology, <http://www.eyenet.org>, provides general information about eye anatomy and diseases. A members-only section features substantive articles.

UTILIZATION REVIEW

  • On March 3, 1999, the Court held that a private insurer’s decision to suspend benefit payment for disputed medical treatment and seek utilization review (UR) of the reasonableness and necessity of said treatment is not attributable to the state (Pennsylvania) so as to subject the insurer to Fourteenth Amendment constraints. American Mfrs. Mut. Ins. Co. v. Sullivan, 119 S. Ct. 977, 67 USLW 4158 (U.S. Mar. 3, 1999) (No. 97-2000). Locate the opinion and syllabus at <http://supct.law.cornell.edu/supct/html/97-2000.ZS.html>. According to Michael W. McConnell, the Chicago attorney who argued the case before the U.S. Supreme Court, the most important application of the decision "will be in the areas of HMO and other health care financing arrangements. The clear message is that procedural requirements for patient protections are going to be a matter of statute and regulation, and not a matter of constitutional due process." See 4 HEALTH CARE DAILY REPORT (BNA Mar. 4, 1999). For U.S. Supreme Court briefs see 1998 WL 789344 (Pet. Brief), 1998 WL 798875 (Resp. Brief), 1998 WL 847509 (Resp. Brief), 1998 WL 906319 (Reply Brief) and 1998 WL 906321 (Reply Brief). For a transcript of the oral argument see 1998 WL 32846 (U.S. Oral Arg).

Y2K

  • Statement by Nancy-Ann DeParle, Administrator, Health Care Financing Administration (Sept. 28, 1998), <http://www.hcfa.gov/news/pr092898.htm., concerning HCFAs progress toward achieving Year 2000 compliance and HCFAs goal of ensuring that Medicare beneficiaries will continue to receive services after January 1, 2000.

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