Category: Blog

On Monday, October 5^th, just a little over the week before the deadline, Governor Jerry Brown signed into California state law the End of Life Option Act.  The act would allow adults suffering from a qualified terminal illness to be prescribed a life-ending drug.  On September 14^th, the California Legislature passed the act, but it was unclear which way the governor would go.  The Bill passed forty-four to thirty-five in the Assembly, and twenty-three to fourteen in the Senate.  California is now the fourth state with such a provision alongside Oregon, Washington, and Vermont.

The bill is modeled after the Oregon Death with Dignity Act which provides a number of safeguards to make sure that the bill is not abused by patients or doctors.  The Oregon bill requires a written request that is signed by the patient and witnessed by at least two individuals who attest that the patient is capable, acting voluntarily, and not being coerced.  Both the attending physician and a consulting physician must agree on the diagnosis, prognosis, and capacity of the patient to make an informed decision.  If either physician believes the patient is suffering from a mental disorder or depression, the patient is referred to counseling and cannot receive the prescription until it is determined the patient is not suffering from impaired judgement.  The attending physician must also inform the patient of all of the risks of the prescription and feasible alternatives, which is a common component of informed consent.  Finally, in terms of timing, there has to be fifteen days between an oral request and the prescription being written and forty-eight hours between a written request and a prescription being written.  The California bill has all of these elements as well as a sunset clause, which requires the bill to be renewed after ten years.

The other source of inspiration for the bill was the story of Brittany Maynard, a 29 year-old resident of California who suffered from brain cancer.  She had been given a prognosis of less than six months to live, but since California did not have a law allowing for physician-assisted-end-of-life, she had to establish residency in Oregon to use their law.  Her story caught the attention of the nation, and is credited with re-igniting the conversation of physician-assisted end-of-life options in California and across the country.  Maynard actually spoke to Governor Brown three days before her death, urging him to support the cause.

Some of the fiercest opposition had come from religious groups and disability rights advocates.  They believed that the safeguards do not do enough to protect vulnerable populations – like the elderly, disabled people, and low-income individuals – from being pressured to avoid life-saving care.  A study in 2007 by the Journal of Medical Ethics actually found vulnerable populations no more likely to use the end-of-life option in the case of Oregon.  They examined the elderly, the disabled, women, the uninsured, people with low educational status, low-income people, and racial/ethnic minorities. The study actually came to the opposite conclusion – the most frequent users of the option were white, highly educated, wealthy, and under 85 years old.

A number of states should have a keen interest in yet another state passing death-with-dignity legislation.  Over the past year, sixteen states and the District of Columbia have introduced bills to their state legislatures for this right.  One such state – Montana – already allows death with dignity via the 2009 Montana Supreme Court ruling in Baxter v. Montana, where the Montana Supreme Court ruled that while there is no right to death-with-dignity, it is also not against the public interest and therefore not illegal. Despite this ruling, legislation that would codify this right has failed as recently as this past year.  The New Mexico Second Judicial District Court also ruled in 2014 that the state statute which makes physician-assisted-suicide a felony is not compatible with their state constitution, but that decision was overturned by the New Mexico Court of Appeals this past August. That case is set to be taken up by the New Mexico Supreme Court, and like all of the states mulling over their own death-with-dignity legislation – another state allowing it could create more momentum for future decisions.

Health care professionals are constantly developing and brainstorming innovative ways to increase access to healthcare in an affordable way. Is telemedicine the solution to the health care industry’s problems?

The American Telemedicine Association defines telemedicine as the “use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” Although telemedicine is considered a recent trend, telemedicine has been utilized for over 40 years and continues to grow in popularity. Today, telemedicine is predicted by many healthcare professionals and public health analysts to drastically cut annual healthcare spending. One report claims that in the coming years, telemedicine will cut annual healthcare spending by $60 billion; $40 billion in eliminating roughly two-thirds of unneeded emergency room visits and $20 billion in by replacing one-third of physician visits. Analysts have also noted that an expansion in Medicare coverage for telemedicine services will further increase annual savings.

Some health care professionals, however, are not sold on telemedicines projected savings. Dr. Jha stated, “You do the telemedicine; it leads to more tests. It leads to more follow-up visits. And, over time, when you look at the data, it turns out that telemedicine overall is not necessarily a big cost saver.” Despite this, the overwhelming message from health care professionals and communication professionals alike is that telemedicine works and will account for unprecedented savings.

Currently, Medicare only covers telemedicine services for rural and medically underserved areas when video conferencing is used. As telemedicine continues to develop public health professionals will keep a watchful eye on the Centers for Medicare and Medicaid Services to see if reimbursement for telemedicine services expands.

Telemedicine seems to be the golden child in healthcare; it cuts costs, increases access to care, and spurs innovation. Despite this, advancements in telemedicine possess major privacy concerns. As telemedicine continues to evolve from its video conference/consultation base to more services are being offered via mobile apps and text messages, how is a patient’s information being managed and protected?

Telemedicine requires developers, consumers, and physicians alike to consider if information from a video consultations will be recorded, or how data collected from a mobile health app will be stored, and whether federal or state privacy law is violated with such practices. The Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC), recognizing the need for guidance in the telehealth arena, provide resources for providers, implementers and consumers to address the many privacy issues related to health and mobile devices. ONC harps on the importance of encryption and being an informed consumer to help decrease privacy violations. Even still, federal, state, and local governments will continue to develop laws and regulations that address the ever-changing privacy landscape in light of continued telehealth innovation.

In the United States District Court of Los Angeles a case is being brought against the Compton Unified School District for failure to not adequately provide appropriate education and assistance for those students who have suffered from a “complex trauma.” The Plaintiffs assert that too often the school district turns to punishment for students who are attempting to cope with the struggles they face in their lives.

To better understand the type of trauma these students are experiencing it is important to understand the environment these children have grown up in throughout their lives. Compton is a city located south of Los Angeles and has an extremely violent reputation; last year alone the murder rate in Compton was five times the national average. These students face problems of addicted parents, homelessness, and a constant fear of violence in their everyday lives. One of the Plaintiffs said that he witnessed his first murder at the young age of eight, took a bullet to the knee, and in 2014 alone witnessed twenty shootings; another Plaintiff was mistakenly arrested at gunpoint by police at school. One plaintiff was sexually assaulted on the bus, on her way home from school. Gangs are a normal part of life and fear is something that students have to accept as a part of their lives. According to Susan Ko of the National Center for Child Traumatic Stress, exposure to violence can have a profound impact on one’s ability to learn.

The suit being brought argues that “complex trauma” should be considered a disability under the Rehabilitation Act and Americans with Disability Act. The complaint states that individuals who experience chronic or repeat trauma demonstrate physiological impairment in performing normal daily activities such as thinking, learning, reading, and concentrating. Something as simple as social interaction can cause bodily distress due to former trauma. Memories of fear can be created on multiple levels in the brain’s system because trauma triggers multiple functions of the brain. Research by Victor Carrion and Shane S. Wong of Stanford University shows that the hippocampus plays an important role in learning new information. Those who have experienced “complex trauma” have a smaller hippocampus, which makes learning more difficult. By classifying “complex trauma” as a disability the complaint asserts that these children will be able to receive the help they need to process their trauma and move forward.

A recent article said that a program implemented in the Los Angeles School District of 10 counseling sessions was effective in helping the students recover and improve their performance in school. By providing programs such as this one in low income areas teachers will receive the training necessary to: recognize trauma and seek mental health support to assist the students in coping with their trauma. These programs will allow school’s from a punishment structured system of handling student outbursts as a result of their trauma to promoting reconciliation and mediation before jumping to a suspension or expulsion.

The school district is extremely sympathetic to these children, but has to acknowledge the large costs that would have to be allocated to these programs and that there are other school districts with these same issues that do not have lawsuits pending.

While the cost may be high,is it possible that now is the time to spend more in cities and neighborhoods such as Compton to promote students getting the help they need for the trauma they have experienced throughout their lives? As a nation we should prioritize investing in children’s futures. It is important to recognize that every child deserves a chance to have a positive learning experience and feel safe in the school environment. While this occurs in places outside of Compton, maybe it is time for all states to take a look at their lower-income neighborhoods to see what they can do to help kids who are suffering from “complex trauma.” These kids deserve a chance to learn and create better lives for themselves and future generations. This transition may not be an overnight transformation, but by classifying “complex trauma” as a disability more students will be able to get the help they need.

 

Health Law & Policy Brief 2015-2016 Applications

The Health Law & Policy Brief (HLPB) is accepting applications for new members! We encourage 1Ls, 2Ls, 3Ls, and LLMs to apply.

The Health Law & Policy Brief covers a broad range of topics including: health care, food & drug, disability law, administrative law, and business law; both domestic and internationally. HLPB is entirely online. We publish long academic articles by students, professors, and practitioners. We plan to have two issues in the coming year – a Fall 2015 issue and a Spring 2016 issue. HLPB also has a blog component, which features short pieces on new and developing topics. The blog​ ​is located at​ ​https://www.healthlawpolicy.org/ ​and​ ​is updated every month.

We are primarily seeking multiple staff members to “spade” (edit) our academic articles. If selected as a staff member, you will receive training and advance notice before getting a spading assignment. You will be supervised by a more experienced Articles Editor. You will not receive more than one spading assignment per semester.​ ​We are also seeking one Marketing Director​.​

To apply, please email the HLPB Editor-in-Chief, Mohammad Mesbahi, at mohammadh.mesbahi@gmail.com with the​ ​​​subject line “LAST NAME – HLPB Application.”​ ​​Please briefly explain your interest in joining the HLPB, and if applicable, any interest or prior experience in health law, food and drug law, or disability law. Please also attach a current resume (GPA not required).
​​
Application deadline: Friday, October 2, 2015 at 11:59am (noon). ​​ We look forward to receiving your application!

​​Applicants who are selected ​to become members of HLPB ​should try to attend the HLPB Spading and Blogging Training on Saturday, October 3, 2015 from 1:00 PM – 4:00 PM in WCL Room 526.​ ​Those who cannot attend would be expected to notify the HLPB Editor-in-Chief and will be allowed to meet at a later time with the HLPB Editor-in-Chief.​ ​ Those attending this meeting should bring a laptop and their Bluebook.

In July 2015, the FDA proposed a rule that would update the Nutrition facts label on most food packages to include more information about how much added sugar is in a food product and what the appropriate consumption levels are. Added sugars are sugars and syrups that are added to food or beverages when they are processed or prepared.  Major sources of added sugar include soft drinks, sugars, candy, cakes, cookies, pies and fruit drinks; dairy desserts and milk products (ice cream, sweetened yogurt and sweetened milk); and other grains.

The proposed rule will require declaration of the “percent daily value” for added sugars. Presently, it is recommended that daily calories from added sugars not exceed 10 percent of a 2000-calorie diet. In a 2000-calorie-a-day diet, that works out to a daily maximum of about 200 calories a day or 12 teaspoons of added sugar. Currently, added sugar is presented in grams on nutrition fact labels. One gram of sugar contains about 4 calories. http://www.npr.org/sections/thesalt/2015/07/24/425908798/no-more-hidden-sugar-fda-proposes-new-label-rule

Food companies throughout the United States add sweeteners to their products, which increases calories but provides no nutritional value. Also, consuming too much added sugar leads to weight gain, obesity, Type 2 diabetes, and reduced heart health, and heart disease. Most Americans consume way more sugar than they realize. Sugar is one of the few major food components that doesn’t have a recommended consumption level on U.S. food labels, primarily because FDA hasn’t issued recommended consumption levels. This action by FDA will promote consumer awareness and allow Americans to make informed decisions relating to their sugar intake.

“For the past decade, consumers have been advised to reduce their intake of added sugars, and the proposed percent daily value for added sugars on the Nutrition Facts label is intended to help consumers follow that advice,” wrote Susan Mayne, director of the FDA’s Center for Food Safety and Applied Nutrition, in an agency news release.

Currently, the FDA is taking comment on the new proposal for 75 days. Many health activists and consumer advocate groups have applauded the FDA’s efforts to inform consumers about how much added sugar they are actually consuming when they consumer processed foods and beverages. The agency will probably also hear from food companies. The Sugar Association has already weighed in, probing whether the move to constrain added sugars to no more than 10 percent of daily calories is backed by sufficient scientific evidence and studies. Moreover, food companies argue that nutrition fact labels do not influence most consumers and it will be expensive for companies to implement into their products.

This proposed rule is a part of a major overhaul by the Obama administration to modernize nutrition fact labels and inform consumers so they may lead healthier lives.

 

Written by Karina Velez–Fellow Health Law and Policy Brief Junior Blogger