Saturday, September 10, 2005
According to the Boston Globe, activists, including the United Nations AIDS representative and two prominent AIDS activists in Africa, are partly blaming US policies for the shortage of condoms in Uganda and other developing nations fighting the AIDS epidemic. Despite increases in US shipments of condoms, 612 million condoms this year, more than 60 countries are reporting condom shortages, according to the United Nations. The prevention policy of the Joint United Nations Program on HIV/AIDS states that the "male latex condom is the single, most efficient available technology to reduce the sexual transmission of HIV and other sexually transmitted infection." The United States is moving away from condom advocacy in all its overseas AIDS programs, as evidenced by the taking down of billboards promoting condom use in Uganda . More than half of Washington's funds for preventing sexual transmission of AIDS now go to groups promoting abstinence only. Among these groups are those that argue that the AIDS virus can pass right through a condom. In addition, the distribution of US purchased condoms is more tightly aimed at "high-risk activity" areas as bars, border crossings, brothels, and military bases. Mark Dybul, US deputy global AIDS coordinator, says that promoting condom use to all segments of society would send the wrong message to people who are trying to abstain from sex or stay faithful to one partner. He says:
In a generalized epidemic, what's lost is the true public health message. It is our duty to tell people how they can best protect themselves from the risk of infection. The best way to protect yourself from HIV infection is to abstain, or to be faithful to one partner. If yo can't do either of those, then condoms are the next-best thing.
In Uganda, free condoms are no longer widely available at clinics and the condoms in stores have tripled in price since last year. US policy currently promotes abstinence and faithfulness as the key components in fighting AIDS. One of the highest-risk groups is young married women infected by straying husbands; these women's primary line of protection is the use of a condom. In the editorial "Missing Condoms" the N.Y. Times argues that the abstinence-only teaching does not work in the United States, and there is no reason to think it will work in Uganda.
The policy shift in Uganda threatens to undermine the country's success in bringing AIDS into the open. Ugandans felt relatively free to talk about the risks of catching the AIDS virus and to be open about living with AIDS. If condom users are branded as immoral, it will drive the epidemic back underground. No one knows better than the Ugandans that lives are saved when AIDS is treated as a public health challenge, not a moral crusade.
Thanks to Lindley Bain for her help. [tm]
The White House has announced that Dr. Leon Kass is out as chair of the PCOB and the new chair will be Dr. Edmund Pellegrino. Our friends over at Bioethics.net's blog met the announcement with unrestrained glee, viz.:
Pellegrino is one of the most respected, best published, and most accomplished scholars who has ever worked in bioethics.
It is possible to gush about the White House's decision - a rare opportunity these days - in part because Pellegrino is a good, honest and kind person, but also because Pellegrino is not afraid to engage his academic peers and will not operate like a cheerleader for the administration, nor will he treat the Council like an oversized ethics seminar for neoconservatives. So, for example, I do not expect to hear that the American Enterprise Institute is going to be selling the products of the deliberations by the Council in the future. The sun will never rise on a day where Edmund Pellegrino lobbies Congress as a "private Citizen" for a "second term bioethics agenda," or writes Op Eds defending Presidential stem cell policy while sitting as Chair during a Presidential election year.
Pellegrino's views on a number of issues are well known, since this chair of the PCB has published more than 500 articles in the field and participated in more than 20 books, and while many of them are not my own views, I for one am happy to have those views expressed as the honest result of a well thought-out argument based on his years of peer-reviewed scholarship on clinical ethics. Pellegrino's affiliations with groups of conservatives are of no concern to me because he is, again, no one's stooge. . . .
A conservative choice, yes, but a solid scholar of bioethics whose entire career has revolved around the virtues and character of physicians.
Friday, September 9, 2005
National Pubic Radio has a report from Dr. Hemant Vankawala who was one of the first physicians on the scene for some of the horrors of Katrina's and its aftermath. His story is a difficult one to read but does provide an insider's view about what happened and how terrible it actually was.
Blog.bioethics.net also has a story about the bioethical issues posed by Katrina. [bm]
The Daily Telegraph contains an article about a fantastic sounding new diet. It reports,
Scientists in Australia and The Netherlands have come up with a diet they claim will cut a person's risk of heart disease by 78 per cent. And the good news is, you'll want to be on it.
The diet focuses on seven foods that have been proven to reduce cholesterol and blood pressure. It involves daily consumption of 150ml of red wine, which has been found to cut heart disease risk by 32 per cent. Chocaholics line up, because you have to consume 100g of dark chocolate per day, an amount the scientists calculate will reduce blood pressure. You have to eat four meals of fish each week (each 114g), which is said to reduce your heart disease risk by 14 per cent. The diet also includes a daily total of 400g of fruit and vegetables, also proven to cut blood pressure, and 68g of almonds to cut cholesterol. You also have to consume 2.7g of garlic per day to reduce your cholesterol levels.
In a paper published in the British Medical Journal, scientists claim that if all these foods are combined in a diet they will lower the risk of heart disease by 78 per cent.
The research shows men who stuck to this diet would gain an extra six years of life and have an extra nine years free from heart disease. Women would gain an extra 4.8 years of life and have an extra eight years without heart disease.
Thursday, September 8, 2005
- Waiver by Secretary Leavitt
- CMS Action
- Pharmaceutical Needs
- Managed Care
- Patient Consent, Physician Licensure, and other Risk Management Issues (including Liability of Volunteers)
- Academic Medicine/Medical Education
Douglas Mossman provides us with an excellent overview of the recent Journal of the American Association's issue on medical education:
The September 7 issue of JAMA is devoted to medical education, and contains several articles and editorials with findings that are (depending on your point of view) surprising, troubling, concerning, just what you’d expect, or (in a grim way) humorous.
From which doctor would you rather get treatment: a resident who is moderately intoxicated, or a resident who is sleep-deprived? If you ever have to make this choice, an article by Dr. J. Todd Arnedt (of the University of Michigan) and colleagues provides important data to help you. To assess possible effects of sleep deprivation on doctors in training, these researchers compared cognitive performance and driving skills in 34 Brown (Rhode Island) pediatrics residents following:
heavy call — working 80-90 hours a week, and being awake and on duty every fourth night
light call — 45 hours a week, with only occasional night duty
light call with moderate alcohol intoxication, i.e., blood alcohol concentration (BAC) = 0.04-0.06 gm%. Please note: in the study, the doctors weren’t drinking on duty; they were given alcohol only in laboratory conditions.
Arnedt and colleagues found that by the end of a heavy call rotation, the residents’ performance on days after being up most of the night was "equivalent to or worse than the impairment observed at 0.04 to 0.05 g% BAC on tests of sustained attention, vigilance, and simulated driving." Many residents had only limited awareness of their degree of impairment. The authors conclude:
These findings have important clinical implications. Residents must be made aware of post-call performance impairment and the potential risk to personal and patient safety. There should be sleep loss, fatigue, and countermeasure education in residency programs. Because sleepy residents may have limited ability to recognize the degree to which they are impaired, residency programs should consider these risks when designing work schedules and develop risk management strategies for residents, such as considering alternative call schedules or providing post-call napping quarters."
Attorneys may wish to take note of views expressed in an accompanying editorial by Drs. Dawson and Zee (of Australia), who comment that tests of performance done in a research laboratory may not directly equate to how doctors perform in real clinical situations. Yet, say these commentators, the study by Arnedt et al. certainly suggests
"that residents working 80- to 90-hour weeks are at an equivalent or greater risk compared with an intoxicated physician. This is, without doubt, a notable finding and one that should concern those responsible for patient safety and medical training. ...
... It is difficult and perhaps premature to predict how the seeming equivalence for selected neurobehavioral effects of fatigue and alcohol extend to clinical decision making across diverse working conditions. Nevertheless, studies such as this should motivate clinicians and managers to reflect on the legal and scientific defensibility of current work practices.
Among the things that struck me — a physician who got his M.D. in 1981 — is how the perception of "heavy" call has changed (fortunately) from "the bad old days" when I trained. During parts of my psychiatric internship, I worked about 80 hours a week, but I had it easy: my friends in pediatrics and internal medicine typically worked 100-110 hours a week, and my friends who became surgeons frequently worked 120 hours a week. To us, a 45-hour work week felt like vacation!
It may seem obvious that long hours, over-work, and sleep-deprivation would adversely affect medical resident’s education, clinical competence, and emotional outlook. But that view is not universally held, and available research about the topic is ambiguous. Dr. Kathlyn Fletcher and colleagues (from Milwaukee, Chicago, and Ann Arbor) review research on how reductions in work hours affect residents. They found that "[i]nterventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents’ quality of life." However, interpretating the outcomes of available studies was hampered by less-than-ideal research design and lack of validated tools for assessing results or effects of more sleep. Therefore, "[t]he long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents’ quality of life and quality of patient care."
A third article in JAMA suggests, however, that one should not be optimistic about having many good studies take place, because research on medical education tends to lack ample sources of funding. Dr. Darcy Reed (Mayo Clinic, Rochester MN) and colleagues at Johns Hopkins researched funding for medical education, as reported in 243 published articles in 2002-03. The median calculated cost of conducting these studies was $24,500, which (if it sounds like a lot) is a small fraction of what often gets spent on studies to research new medications or technology. The authors conclude, "The majority of published medical education research is not formally funded, and the studies that do receive support are substantially underfunded."
A fourth JAMA article points to one informal but salient source of medical student "education": contacts with pharmaceutical company representatives. Dr. Frederick Sierles and colleagues from several medical schools surveyed third-year medical students about their exposure to and interactions with drug companies. At least 89% of the student-respondents had gotten a drug-company provided lunch, a small gift (e.g., pen or coffee mug), a journal reprint, or a snack (e.g., donut, candy) from a pharmaceutical representative; six-sevenths had attended formal educational events ("Grand Rounds") that were "sponsored" (paid for) by drug-companies. Also, "93% of the students had been asked or required by a faculty member to attend a sponsored lunch." Fewer than one in ten medical students thought it was inappropriate to get textbooks or meals from drug companies, but three-fourths disapproved of having drug companies pay for vacations. Few medical schools have policies about interactions between drug companies and students, and "very few" of the respondents in this study knew whether their own schools had such policies. Concerning the impact of such policies and formal training about how to react to drug company promotional efforts, the authors comment:
Given evidence of an accepting attitude toward these relationships early in the medical socialization process, before residency begins, interventions would best be directed to medical students. There is some evidence that classroom educational activities change attitudes or behavior but we did not find any important differences in students whose schools provided formal teaching. However, these activities were limited in duration, and by appearing only once during medical school did not have an opportunity for reinforcement. Moreover, voluntary attendance may signal to students that the school does not attach much importance to the material.
If you’re interested in reading more about these and other medical education topics, here’s the link to this week’s issue of JAMA:
According to this recent article in The Guardian Unlimited (UK), scientists are attempting to bring back the Tasmanian Tiger. The Guardian reports,
Exactly 69 years after the last Tasmanian tiger died in an Australian zoo, scientists are planning to use Jurassic Park-style technology to bring the carnivore back to life.
The thylacine, a wolf-like creature with a backwards-facing pouch and jaws the size of a shelf bracket, was the biggest meat-eating marsupial.
Since the last living specimen, named Benjamin, died in Hobart zoo on the night of September 6 1936, it has become a conservation icon.
Scientists at the Australian Museum, in Sydney, first proposed bringing the thylacine back to life in 1999, but the plans were abandoned earlier this year when researchers said the DNA they had recovered was too poor in quality.
However, the museum's former director told Guardian Unlimited that a team of Australian and US researchers were restarting the project and hoped to use new techniques that could lead to the sequencing of the entire thylacine genome.
Just in case you had true concern about this project, the article continues,
However, there are still enormous hurdles to be overcome and many geneticists doubt whether the project is feasible.
Wednesday, September 7, 2005
There are a ton of issues that arise for health care professionals who travel to the Gulf States to help out and for the HCPs and institutions in the other states who are dealing with an influx of evacuees, displaced health care workers from the states hurt by the hurricane, and by out-of-staters coming in to help. Fortunately, there are some sites that have been working overtime to collect questions and answers that range across the spectrum of health law issues from consents to licensing to HIPAA to EMTALA to insurance coverage to reimbursement to . . . .
- American Health Lawyers Association (also: Katrina listserv signup)
- American Bar Association
- State Bar of Texas Health Law Section
- Center for Law & the Public's Health at Georgetown University
- CMS' Katrina Website
- CDC's Public Health Law News (Sept. 7 issue)
- CDC's Katrina Health Information page (also: health professionals' page)
- FirstGov's Katrina Recovery page
The New York Times reported recently that a number of judges are refusing to hear young women's cases for judicial bypass of parental notification laws. According to the Times,
A pregnant teenager went to the grand and imposing county courthouse here early in the summer, saying she wanted an abortion. The circuit court judge refused to hear the case, and he announced that he would recuse himself from any others like it.
"Taking the life of an innocent human being is contrary to the moral order," the judge, John R. McCarroll of Shelby County Circuit Court, wrote in June. "I could not in good conscience make a finding that would allow the minor to proceed with the abortion."
The teenager was in court because Tennessee, like 18 other states, requires minors to obtain a parent's permission before they can have an abortion.
But the state also allows another option. The teenagers can ask a judge for permission to decide for themselves.
Judges, however, are starting to opt out. Other judges of the Shelby Circuit Court have recused themselves like Judge McCarroll, and now, according to one judge, only four of the nine judges on the court hear such abortion applications.
This seems to be a bad precedent. Isn't this part of their job? [bm]
Adam A. Milani Disability Law Writing Competition
Adam A. Milani Disability Law Writing Competition
Sponsored by the Mercer University School of Law; sponsorship by the American Bar Association Commission on Mental and Physical Disability Law is pending
Sponsored by the Mercer University School of Law; sponsorship by the American Bar Association Commission on Mental and Physical Disability Law is pending.
Adam A. Milani
Adam A. Milani – a passionate disability rights activist and accomplished scholar – was well known for his publication of numerous practical books and articles in the field of disability discrimination. He taught legal writing as well as the law of disability discrimination and always encouraged his students to become prolific and outstanding writers.
Purposes of the Adam A. Milani Disability Law Writing Competition
The purposes of the competition are to promote greater interest in and understanding of the field of disability law and to encourage excellent legal writing skills in students enrolled in ABA accredited law schools.
The submission may address any aspect of disability law, theory or practice the contestant chooses.
Categories and Requirements
The competition invites submissions in two categories, the Essay category and the Law Practice category.
Essay Category:Submissions in the essay category should be essays or law review-type articles on a disability law topic. Essay submissions are limited to 20 typewritten pages, including footnotes or endnotes. The text of the submission must be double-spaced, with twelve-point font and one-inch margins.
Law Practice Category: Submissions in the law practice category should be briefs or office memoranda on a disability law topic. The text of a submission must be double-spaced, with twelve-point font and one-inch margins. Office memoranda submissions are limited to 20 typewritten pages. For briefs, the Question(s) Presented section, Statement of the Facts / Statement of the Case section, the Argument section, and the Conclusion are limited to 20 pages. Briefs may include any other customary component of a similar court document, but those components will not be evaluated.
If the submission covers both a disability law issue and a non-disability law issue, only the disability law issue will be evaluated. For papers written originally for a legal writing class, only two papers per legal writing professor per year will be considered. If more than one student of a particular professor desires to submit his or her paper, the professor shall choose which paper will be submitted.
First Prize will range between $300 and $500, depending on whether two awards are given. The first prize winner in the essay category may also receive an invitation to publish in the ABA Mental and Physical Disability Law Reporter. The winning submission in each category will be posted online at the Mercer University School of Law website.
Entries for the competition must be submitted by mail to the "Adam A. Milani Disability Law Writing Competition," Mercer University, School of Law, 1021 Georgia Ave., Macon, GA 31207-0001. Submissions must be postmarked by June 15, 2006, by U.S. mail or a recognized commercial express service. Entries submitted by fax will not be accepted. The contestant’s name and other identifying markings such as school name are not to be on any copy of the submitted entry. The staff at Mercer University School of Law will assign a random number to each entry and will record this number on all copies of each submission. Neither the contestant’s identify nor his or her academic institution will be known to any Milani Competition Judge. Two copies of the entry must be submitted along with a disk containing an electronic copy of the submission in Word Perfect or Word format. Clear, legible photocopies without changes are acceptable. Each entrant may submit only one entry. Contestants will receive confirmation of the entry, and winners will be notified by mail of their selection. Entries must be accompanied by the enclosed entry form. The form and these rules also appear on the Mercer University School of Law website, .
The Essay and Law Practice categories are open to all second and third year full-time law students (and second through fourth year part-time students). The Law Practice category is also open to all first year law students who are enrolled in a Legal Writing course. For the first year of the competition (the academic year 2005-2006), students who met these criteria during 2004-2005 are also eligible.
Employees of Mercer University School of Law (except for work-study students) are not eligible to enter the competition. Submissions that have been accepted for publication prior to submission to the Milani Writing Competition are not eligible. If a student’s submission is accepted for publication after submission to the Milani Writing Competition, the student must inform the publisher that the submission may be published by the ABA if selected as a winner.
Each entry shall be the original work of a single individual and constitute an independent subject. Jointly authored submissions are not eligible.
Essay Submissions: For entries in the Essay category, the author must perform all the key tasks of identifying the topic, researching it, analyzing it, formulating positions and arguments, and writing and revising the paper for himself or herself. The author may inform another of the progress he or she has made in performing these tasks and accept a reasonable amount of responsive advice from academicians or practitioners in the field, but the author must avoid collaboration with other students. The final product should reflect the author’s own ideas and work and not those others.
Law Practice Submissions: For entries in the Law Practice category, the author must perform all the key tasks of researching, writing, and revising the paper for himself or herself, but may receive a reasonable amount of advice from academicians or practitioners. The author must avoid collaboration with other students, except for any discussions that occur as part of course activities approved by the student’s professor. Under no circumstances may any of the written product be produced by another.
Criteria and Judging
All entries will be judged anonymously by the Milani Competition Judges, who will select the winning submission(s). The Director of the Milani Writing Competition at Mercer University School of Law will notify the award winner(s). The Judges reserve the right not to award any prizes if it is determined that no entries are of sufficient quality to merit selection that year.
Essay Category: Entries in the Essay category will be judged based on the following criteria: clarity of the theme or thesis presented; significance of the topic to the field of disability law; originality and creativity of topic treatment; quality of analysis; quality of research and authority provided; and technical quality of writing, including organization, grammar, syntax, and form.
Law Practice Category: Entries in the Law Practice category will be judged based on the following criteria: quality of research and authority provided; accuracy and clarity of the analysis; compliance with standard conventions of similar court documents; and technical quality of writing, including organization, grammar, syntax, and form.
Entry Form Please type or print clearly. Name of Student: Student’s Current Mailing Address: Student’s Permanent Mailing Address: Student’s E-mail: Student’s Phone: ________________________________ Name and Address of School: Expected Graduation Month and Year: Check one: Essay category Law Practice category Name and phone of Professor or Faculty Advisor: I understand that the selection of the winning entry is the sole responsibility of the Adam A. Milani Disability Law Writing Award Selection Committee, and I acknowledge that I have been provided with a copy of the competition procedures, to which I agree. In the event I am selected as a winner, I agree that the American Bar Association may provide me with an offer to publish the submission in the Mental and Physical Disability Law Reporter. If I attempt to publish my submission elsewhere, I will inform the publisher that if my submission is selected as the winner, it may also be published as submitted to the ABA. Date: Student’s Signature: Employees of Mercer University School of Law (other than work-study students) are ineligible to enter the competition.
Please type or print clearly.
Name of Student:
Student’s Current Mailing Address:
Student’s Permanent Mailing Address:
Student’s Phone: ________________________________
Name and Address of School:
Expected Graduation Month and Year:
Check one: Essay category Law Practice category
Name and phone of Professor or Faculty Advisor:
I understand that the selection of the winning entry is the sole responsibility of the Adam A. Milani Disability Law Writing Award Selection Committee, and I acknowledge that I have been provided with a copy of the competition procedures, to which I agree. In the event I am selected as a winner, I agree that the American Bar Association may provide me with an offer to publish the submission in the Mental and Physical Disability Law Reporter. If I attempt to publish my submission elsewhere, I will inform the publisher that if my submission is selected as the winner, it may also be published as submitted to the ABA.
Date: Student’s Signature:
Employees of Mercer University School of Law (other than work-study students) are ineligible to enter the competition.
Tuesday, September 6, 2005
LexisNexis' Law School Publishing group has implemented a plan to respond to the needs of law school students displaced by Hurricane Katrina. LexisNexis will provide free coursebooks to all displaced students enrolled in a law school class that requires a LexisNexis coursebook. LexisNexis will also provide free copies of relevant titles from our Understanding Series and our Q & A Series to all displaced students enrolled in a law school class that corresponds to a title in our Understanding and Q & A product lines.
To receive this assistance, an appointed school administrator (e.g., the registrar) must make this contact on behalf of the displaced student(s) who have been invited to participate in their Fall 2005 program. Requests must include:
- Students' name
- Mailing address
- Email address (if any)
- Phone number
- Home law school
- Author name & title of adopted LexisNexis coursebook
- Fall 2005 course listing (to determine relevant study aid titles to send to each student).
Please send this information to: Lisa Hughes, LexisNexis Law School Sales Operations Manager, via email at Lisa.A.Hughes@lexisnexis.com, or via fax at 518-641-6090.
Effect Measure posts some of the problems getting doctors and other health professionals to those in need. Getting willing physicians to the sick went less than smoothly. Also, Michelle Pilecki of Huffington Post reports on some of the first disease outbreaks resulting from Katrina. She reports,
Von Roebuck, [Centers for Disease Control and Prevention spokesman], said officials had detected the disease among some storm evacuees and stragglers but had not been able to determine how many cases there were. It does not appear that anyone has died from the disease.
There's no reason to panic. The LAT story explains
Among healthy people, vibrio vulnificus causes vomiting, diarrhea and abdominal pain but is generally not life-threatening. It can be readily cured with antibiotics such as doxycycline or cephalosporins, with no long-term effects.
It is substantially more serious in people with chronic liver disease or people who have compromised immune systems, such as those taking transplant drugs. In those cases, the bacterium escapes into the bloodstream, where it causes fever and chills, septic shock — characterized by sharply decreased blood pressure — and blistering skin lesions. About half of those who contract bloodstream infections die, according to the CDC.
There is no evidence that the bacterium spreads from human to human.
This paper focuses on the development of managed care policy in the United States since 1985. It empirically examines the development of statutes, legislation, regulations, and federal and state court decisions which relate to managed care organizations and managed care policies. The paper begins with an analysis of managed care theory as it relates to the delivery of health care services in the United States. It then goes on to ask the question: is this a good theory? We then look at federal and state policy initiatives in the executive, legislative, and judicial branches of government. The paper argues that government cannot make up its mind whether it wants to support or constrain the implementation of managed care theory and its further development. We document initiatives which serve as facilitators and barriers to the implementation of managed care theory; taken together, these legal and policy initiatives represent the "two faces of managed care". The consequence of the two faces is that it is not clear whether managed care organizations have been successful.
Document: Available from the SSRN Electronic Paper Collection:http://papers.ssrn.com/paper.taf?abstract_id=761785
Monday, September 5, 2005
Professor Thomas Hafemeister of the University of Virginia School of Law has a terrific newsletter entitled "Develoments in Mental Health Law" that provides an informative overview of recent legal news in mental health law. You can register to receive an e-mail copy here. This month his newsletter reports on a report by the American Psychological Association on psychologists's ethical duties during national security investigations.
APA Task Force Report Addresses Psychologists’ Ethical Obligations in Investigations Related to National Security
The American Psychological Association has released a task force report that addresses psychologists’ ethical obligations during investigations related to national security. The report follows accounts that psychologists and psychiatrists participated in interrogations of detainees at the Guantanamo Bay naval station. The report states that “it is consistent with the APA Ethics Code for psychologists to serve in consultative roles to interrogation and information-gathering processes for national security-related purposes, as psychologists have a long-standing tradition of doing in other law enforcement contexts.” The report also notes, however that “the Task Force was unambiguous that psychologists do not engage in, direct, support, facilitate, or offer training in torture or other cruel, inhuman, or degrading treatment and that psychologists have an ethical responsibility to be alert to and report any such acts to appropriate authorities.” The report and its recommendations to the American Psychological Association Board of Directors can be found at http://www.apa.org/releases/PENSTaskForceReportFinal.pdf.
There hasn't been much coverage of this development, but it sure seems worth at least brief notice (especially by hospital counsel): On August 18, CMS published revisions to its Interpretive Guidelines for Hospital Conditions of Participation in the Medicare and Medicaid programs (PDF) (COPs are at 42 CFR § 482).
The revisions address the following topics:
- Governing Body (§ 482.12) - Provides clarification regarding which patients admitted by nurse midwives require physician supervision;
- Patients’ Rights (§ 482.13) - Provides clarification of the patient grievance process, revises the definition of grievance, and clarifies requirements for the provision of a written response;
- Laboratory Services (§ 482.27) - Clarifies CMS requirements for the availability of emergency laboratory services; and
- Food and Dietetic Services (§ 482.28) - Clarifies that therapeutic diets must be prescribed (ordered) by the person responsible for the care of the patient.
In particular, the changes to the patient-grievance requirements seem to be quite extensive, up to and including a clarification of the responsibilities of hospitals' governing boards.
The effective date of the new Interpretive Guidelines is Sept. 19. [tm]
Sunday, September 4, 2005
Last night, Chief Justice Rehnquist passed away at his home in Virginia. His legacy on the Supreme Court and his conservative principles are discussed by the New York Times, the Washington Post , the LA Times, the Chicago Tribune, and the Boston Globe, as well as by SCOTUSblog here and here. Linda Greenhouse of the Times provides some thoughts of the future course of nominations,
Although the chief justice was known to be seriously ill with the thyroid cancer, which was diagnosed last October, his death at this moment came as a surprise. Six weeks ago, with rumors swirling that he would soon retire, he issued an unusual statement declaring that he would continue to serve as chief justice "as long as my health permits."
His death on the eve of the confirmation hearings for Judge John G. Roberts Jr., set to begin Tuesday, raised the prospect that President Bush might transfer Judge Roberts's nomination, making him a candidate for chief justice instead. Judge Roberts was a law clerk to Chief Justice Rehnquist, who was then an associate justice, during the court's 1980 term. . . . .
The chief justice's death also raised the question of whether Justice O'Connor, who announced July 1 that her retirement would be effective upon the confirmation of her successor, might agree to remain on the court in the interim. There is essentially no prospect that two Supreme Court vacancies can be filled before the new court term begins on Oct. 3.