Health Care Law Research Articles

Fears of disclosure and misconceptions regarding domestic violence reporting amongst patients in two US emergency departments.

Patients often do not disclose domestic violence (DV) to healthcare providers in emergency departments and other healthcare settings. Barriers to disclosure may include fears and misconceptions about whether, and under what circumstances, healthcare providers report DV to law enforcement and immigration authorities. We sought to assess undocumented Latino immigrants (UDLI), Latino legal residents/citizens (LLRC) and non-Latino legal residents/citizens (NLRC) beliefs about disclosure of DV victimization to healthcare providers and healthcare provider reporting of DV to law enforcement and immigration authorities. From 10/2018-2/2020, we conducted this survey study at two urban emergency departments (EDs) in California. Participants, enrolled by convenience sampling, responded to survey questions adapted from a previously published survey instrument that was developed to assess undocumented immigrant fears of accessing ED care. Our primary outcomes were the proportions of UDLI, LLRC and NLRC who knew of someone who had experienced DV in the past year, whether these DV victims were afraid to access ED care, reasons DV victims were afraid to access ED care, and rates of misconceptions (defined according to current California law) about the consequences of disclosing DV to healthcare providers. Of 667 patients approached, 531 (80%) agreed to participate: 32% UDLI, 33% LLRC, and 35% NLRC. Of the 27.5% of respondents who knew someone who experienced DV in the past year, 46% stated that the DV victim was afraid to seek ED care; there was no significant difference in this rate between groups. The most common fears reported as barriers to disclosure were fear the doctor would report DV to police (31%) and fear that the person perpetrating DV would find out about the disclosure (30.3%). Contrary to our hypothesis, UDLI had lower rates of misconceptions about healthcare provider and law enforcement responses to DV disclosure than LLRC and NLRC. Fear of disclosing DV and misconceptions about the consequences of disclosure of DV to healthcare providers were common, indicating a need for provider, patient, and community education and changes that lower barriers to help-seeking.

The Pap Smear Test Experience of Iranian Women: A Qualitative Study

Aims: The Pap smear test as the primary screening test for cervical cancer has a low application rate among Iranian women. This study aimed to explore Iranian women’s Pap smear test experiences at healthcare centers. Participants & Methods: This qualitative study was carried out in Varamin City, in 2018. To this end, 15 women admitted to healthcare centers were selected using purposive sampling. Inclusion criteria consisted of married women aged 20-50 years with a history of Pap smear, willingness to participate in the study, Iranian nationality, and ability to speak. To explore the women’s views and experiences, semi-structured interviews were conducted, recorded, transcribed, and analyzed using content analysis. Four criteria, namely credibility, confirmability, dependability, and transferability were used to verify the accuracy and consistency of the data. Findings: The data analysis yielded five main categories, including "intention to perform the test","policies and the administrative system", "social factors helping to perform the test", "barriers to perform the test", and "motivational factors to perform the test". From the participants’ perspective, risk concepts, and supportive policies were critical in enhancing test performance. Conclusions: The results showed that the women’s Pap smear test performance depended on some factors including convenient and friendly interactions with healthcare providers, family support, encouraging policies and laws, and awareness. The cooperation of other organizations to perform a Pap smear test is also emphasized.

When a Diagnosis Has No Name: Uncertainty and Opportunity

Diagnostic uncertainty, commonly encountered in rheumatology and other fields of medicine, is an opportunity: Stakeholders who understand uncertainty's causes and quantitate its effects can reduce uncertainty and can use uncertainty to improve medical practice, science, and administration. To articulate, bring attention to, and offer recommendations for diagnostic uncertainty, the Barbara Volcker Center at the Hospital for Special Surgery sponsored, in April 2021, a virtual international workshop, “When a Diagnosis Has No Name.” This paper summarizes the opinions of 72 stakeholders from the fields of medical research, industry, federal regulatory agencies, insurers, hospital management, medical philosophy, public media, health care law, clinical rheumatology, other specialty areas of medicine, and patients. Speakers addressed the effects of diagnostic uncertainty in their fields. The workshop addressed the following six questions: What is a diagnosis? What are the purposes of diagnoses? How do doctors assign diagnoses? What is uncertainty? What are its causes? How does understanding uncertainty offer opportunities to improve all fields of medicine? The workshop's conveners systematically reviewed video recordings of formal presentations, video recordings of open discussion periods, manuscripts, and slide files submitted by the speakers to develop consensus take‐home messages, which were as follows: Diagnostic uncertainty causes harm when patients lack access to laboratory test and treatments, do not participate in research studies, are not counted in administrative and public health documents, and suffer humiliation in their interactions with others. Uncertainty offers opportunities, such as quantifying uncertainty, using statistical technologies and automated intelligence to stratify patient groups by level of uncertainty, using a common vocabulary, and considering the effects of time.

Why Canada Is in Court to Protect Healthcare for All: Global Implications for Universal Health Coverage.

Countries worldwide are currently endeavoring to safeguard the long-term health of their populations through implementing Universal Health Coverage (UHC), in line with the United Nation's 2015-30 Sustainable Development Goals (SDGs). Canada has some of the world's strongest legislation supporting equitable access to care for medically necessary hospital and physician services based on need, not ability to pay. A constitutional challenge to this legislation is underway in British Columbia (BC), led by a corporate plaintiff, Cambie Surgeries Corporation (CSC). This constitutional challenge threatens to undermine the high bar for UHC protection that Canada has set for the world, with potential adverse implications for equitable international development. CSC claims that BC's healthcare law-the Medicare Protection Act (MPA)-infringes patients' rights under Canada's constitution, by essentially preventing physicians who are enrolled in BC's publicly-funded Medicare plan from providing expedited care to patients for a private fee. In September 2020, after a trial that ran for 3.5 years and included testimony by more than 100 witnesses from around the world, the court dismissed the plaintiffs' claim. Having lost their case in the Supreme Court of BC, the plaintiffs' appealed in June 2021. The appellate court's ruling and reasons for judgment are expected sometime in 2021. We consider the evidence before the court from the perspective of social epidemiology and health inequalities, demonstrating that structural features of a modern society that exacerbate inequalities, including inequitable access to healthcare, can be expected to lead to worse overall societal outcomes.

Human Trafficking: First Responders in Health Care

This article addresses the problems first responders encounter when attempting to identify and rescue survivors of human trafficking. Research indicates that 87.8% of women who escape captivity report they saw a health care provider at least once during captivity. This makes health care providers a critical first responder partner. First responders include law enforcement officers, health care providers, school nurses, and faith-based organizations. Health care workers are most likely to encounter survivors while in captivity. Multi-disciplinary collaborations between health care workers and law enforcement provide increased opportunities to share knowledge and recognize signs of human trafficking in patients. Theoretical paradigms have been used to analyze and anticipate changes in criminal activity and identify victims. Multi-disciplinary teams have developed a check-list of behaviors typical of captives and a questionnaire that illuminates captivity. The article further comments on the reported impact of COVID 19 on the health care’s system ability to recognize victims. It presents the many contributions of school nurses and the faith community to the first responder movement.

Factors affecting retention in the Philippine National Rural Physician Deployment Program from 2012 to 2019: a mixed methods study

BackgroundTo address the maldistribution of healthcare providers and the shortage of physicians in geographically isolated and disadvantaged areas of the Philippines, the Philippine National Rural Physician Deployment Program, or more commonly known as the Doctors to the Barrios (DTTB) program was established in 1993. However, as of 2011, only 18% of the DTTBs chose to stay in their assigned municipalities after their two-year deployment, termed retention. This study aims to identify the individual, local, work, national, and international factors affecting the retention of DTTBs in their assigned communities after their two-year deployment.MethodsA descriptive, mixed-methods, explanatory design was used. For the quantitative part, the modified and updated Stayers Questionnaire was given to all current DTTBs present in a Continuing Medical Education session in the Development Academy of the Philippines. Descriptive statistics were then presented. For the qualitative part, individual, semi-structured key informant interviews were conducted in-person or via phone with current and alumni DTTBs from 2012 to 2019. Proceedings of the interviews were transcribed, translated, and analyzed thematically.Results102 current DTTBs participated in the quantitative part of our study, while 10 current and former DTTBs participated in the interviews. Demographic factors and location, personal beliefs, well-being, friends and family dynamics, and perceptions about work were the individual factors identified to affect retention. Social working conditions, career development, and infrastructure, medical equipment, and supplies were among the work factors identified to affect retention. Geography, living conditions, local social needs, and technology were among the local factors identified to affect retention. Compensation, the recently signed Universal Healthcare Law, and Safety and Security were identified as national factors that could affect retention. International factors did not seem to discourage DTTBs from staying in their communities.ConclusionsA host of individual, work-related, local, national, and international factors influence the DTTB’s decision to be retained in different, complex, interconnected, and dynamic ways. We also identified implementation issues in the DTTB program and suggested interventions to encourage retention.

Does your partnership deed address performance?

Justin Cumberlege from specialist healthcare law firm Hempsons, provides some guidance on how to address under-performing partners, or conduct issues, in a partnership deed

Transparency of machine-learning in healthcare: The GDPR & European health law

Machine-learning (‘ML’) models are powerful tools which can support personalised clinical judgments, as well as patients’ choices about their healthcare. Concern has been raised, however, as to their ‘black box’ nature, in which calculations are so complex they are difficult to understand and independently verify. In considering the use of ML in healthcare, we divide the question of transparency into three different scenarios:1)Solely automated decisions. We suggest these will be unusual in healthcare, as Article 22(4) of the General Data Protection Regulation presents a high bar. However, if solely automatic decisions are made (e.g. for inpatient triage), data subjects will have a right to ‘meaningful information’ about the logic involved.2)Clinical decisions. These are decisions made ultimately by clinicians—such as diagnosis—and the standard of transparency under the GDPR is lower due to this human mediation.3)Patient decisions. Decisions about treatment are ultimately taken by the patient or their representative, albeit in dialogue with clinicians. Here, the patient will require a personalised level of medical information, depending on the severity of the risk, and how much they wish to know.In the final category of decisions made by patients, we suggest European healthcare law sets a more personalised standard of information requirement than the GDPR. Clinical information must be tailored to the individual patient according to their needs and priorities; there is no monolithic ‘explanation’ of risk under healthcare law. When giving advice based (even partly) on a ML model, clinicians must have a sufficient grasp of the medically-relevant factors involved in the model output to offer patients this personalised level of medical information. We use the UK, Ireland, Denmark, Norway and Sweden as examples of European health law jurisdictions which require this personalised transparency to support patients’ rights to make informed choices. This adds to the argument for post-hoc, rationale explanations of ML to support healthcare decisions in all three scenarios.

A Call for a Stroke Referral Network Between Primary Care and Stroke-Ready Hospitals in the Philippines: A Narrative Review.

The increasing stroke burden, inequity in the distribution of local neurologists, and the recent signing of the Universal Health Care Law in the Philippines provide compelling reasons for policy-makers to devise strategies to establish networks between primary care and stroke-ready hospitals. In this review, we explored the current literature and evidence that emphasized the roles of primary care providers (PCPs) and specialists, care transition, and telemedicine/teleneurology in various stages of stroke management. Clear delegation of stroke care responsibilities among PCPs and specialists is needed. Due to the limited number of specialists/neurologists, PCPs may contribute to addressing the insufficiency of community knowledge of acute stroke symptoms/risk factors, coordination with specialists and stroke-ready hospitals during acute stroke, and continuity of care during the poststroke stage. At present, the Philippines has only 49 stroke-ready hospitals; thus, an efficient and functional referral system for the care transition between the PCPs and specialists must be organized in our country. To provide remote access to expert stroke care for underserved areas and to increase thrombolysis utilization, the establishment of an effective telestroke system is indispensable. The empowerment of PCPs in teleneurology may assist in strengthening communication and networking with specialists with the ultimate goal of improving patient outcomes. In the era of Universal Health Care in the Philippines, the roles of PCP and specialists must be delineated. Increased access to stroke care through the establishment of networks among PCPs and stroke-ready hospitals (ie, via effective transition of care/teleneurology) must be prioritized especially in resource-constrained settings.

The Trauma of Disregard

The Trauma of Disregard

The Role of Medical Professionals in Shaping Healthcare Law during Covid-19

This article explores the changing nature of the allocation of healthcare resources during the Covid-19 crisis and how it may have shaped a new role for medical professionals in healthcare law and policymaking. It contrasts the traditional input of medical professionals in systemic healthcare reforms (1946, 1990 and 2012) with their role in the elaboration of ethical emergency guidance published by the British Medical Association and the Royal College of Physicians in March–April 2020, using a discourse analysis methodology and concepts borrowed from political philosophy.
 Keywords: Covid-19; medical professionals; healthcare law and policy; ethics; justice; emergency guidance.

An educational video improves physician knowledge of a public health care law that affects patient care during hospital clinical practice.

When public health laws are passed that affect clinical practice within hospitals, it is important to educate physicians about best practices in implementing these laws into routine patient care in hospitals. An educational video was developed to inform physicians about a new state public health care law. This study sought to determine whether an educational video about a new state public health care law improves physicians’ knowledge of the law and how to implement the law during clinical practice. A total of n=33 internal medicine physicians participated in this study. This study found that an educational video was successful in increasing physician knowledge about a new public health care law that affects clinical practice. The utilization of validated educational videos may provide a useful resource when attempting to provide education about new public health laws that effect the provision of medical care. Significance for public health As the world of medicine and public health expand their online footprints, new ways are needed to provide knowledge of new public health laws. To our knowledge, this is the first study which sought to validate an educational video about a health care law that affects the provision of medical care. Although further studies are needed, this study is important because it shows educational videos may provide a useful resource as a way to improve understanding about how to interpret and apply new public health laws

Analysis of antenatal care, intranatal care and postnatal care utilization: Findings from the 2017 Indonesian Demographic and Health Survey.

Background and objectiveMaternal healthcare utilization by young women and adolescent girls is associated with maternal health outcomes and plays a critical role in reducing maternal mortality rates in low- and middle-income countries. This study sought to analyze current data on antenatal care (ANC), intranatal care (INC), and postnatal care (PNC) utilization with a focus on mothers aged 15–24 years in Indonesia.MethodsThis study was a secondary analysis of data from the 2017 Indonesian Demographic and Health Survey. The unit data analyzed 2,584 mothers aged 15–24 years who had delivered babies within the five-year period preceding the survey. Bivariate analysis and multiple logistic regression utilizing descriptive statistics were used to explore correlations between the independent variables and ANC, INC, and PNC visits.ResultsAmong the mothers included in the study, the prevalence of service utilization was 90.9% for ANC, 79.4% for INC, and 68.9% for PNC. Women’s age, education level, number and birth order of children, difference in age between the mother and her husband, her husband’s occupation, wealth index, access to the health service, and regional factors were significantly associated with the utilization of ANC, INC, and PNC services.ConclusionThis study provides insights for policymakers on how to strengthen healthcare policies and laws with the aim to improve maternal healthcare services for mothers aged 15–24 years. To improve maternal healthcare utilization among young mothers, national policy should focus on service equality, accessibility, and reliable implementation.

Организация охраны медицинских учреждений

Медицинские учреждения часто становятся объектами совершения противоправных действий из-за наличия наркотических, спиртосодержащих и дорогих медицинских препаратов, а также ценного диагностического оборудования и оргтехники. Ситуация осложняется тем, что медицинский и вспомогательный персонал, пациенты и посетители в случае нападения не могут в полной мере противостоять преступным элементам. Руководство учреждений здравоохранения в первую очередь должно обеспечить безопасность, то есть охрану учреждений, персонала, пациентов и посетителей, а потому должно выполнить необходимое планирование, тщательную разработку и внедрение охранных систем вместе с комплексом мероприятий административного характера. Целью работы является определение особенностей охранной деятельности в сфере защиты учреждений здравоохранения, проведение анализа законодательного и нормативно-правового обеспечения деятельности лицензированных охранных структур, а также их деятельности в сфере здравоохранения, определение потребности в организации таких служб и обоснование концептуальных основ построения интегрированных систем безопасности учреждений здравоохранения. Проведен общий и целенаправленный анализ и оценка законодательной и нормативно-правовой базы охранной деятельности в Украине с целью возможности ее использования для создания служб охраны и обеспечения предупреждения совершения преступлений в учреждениях здравоохранения. Проведено аналитическое исследование по обработке большого количества информационных источников (более 110) относительно создания и деятельности служб охраны в Украине и иностранных государствах с использованием методов Content analysis и Open Source Intelligence (OSINT). Исследована профессиональная отечественная и иностранная специальная литература, а также информация из Интернета об организации, деятельности, управлении и техническом оснащении служб охраны в различных учреждениях, в том числе и в учреждениях здравоохранения. В результате исследования, проведенного с привлечением профессиональных экспертов службы охраны труда, службы безопасности, пожарной охраны, Государственной службы охраны при Министерстве внутренних дел Украины, относительно организации и урегулирования оптимального функционирования служб охраны в учреждениях здравоохранения выявена насущная необходимость в их создании для обеспечения безопасности, защиты персонала и пациентов, что будет способствовать предупреждению совершения противоправных действий. Рассмотренная проблематика функционирования служб охраны в учреждениях здравоохранения актуальна, требует дальнейшей разработки и обсуждения на страницах журнала с привлечением руководителей отрасли и учреждений здравоохранения, специалистов охранных служб и правоохранительных органов.

Legal and Ethical Considerations in the Conservation of Artwork Produced During Art Therapy

ABSTRACT Works of art created by children under the care of art therapy pioneer Edith Kramer at the Wiltwyck School for Boys in the 1950s are presented as a case study to examine the practical, legal, and ethical challenges of conserving art produced in the course of therapy. The artworks, deposited in the New York University Libraries Special Collections in 2011, are five drawings and forty-two paintings on paper. Multidisciplinary research into the fields of art therapy, archival management, health care law, and the history of Wiltwyck revealed a broad spectrum of value categories associated with the artworks. A values-based decision-making process, together with information garnered through materials testing and analysis, informed conservation actions, including the retention of post-custodial interventions and redaction of private health information.

Best Interests Decisions in Clinical Practice: Reviewing the Current Evidence

"‘Best interests’ decisions are often needed when patients lack capacity to make their own healthcare decisions. Despite the ubiquity of ‘best interests’, there remains considerable ambiguity about what best interests are and how the standard should be applied, alongside a lack of understanding about how best interests decisions are actually made in clinical practice. Balancing Best Interests in Healthcare Ethics and Law (BABEL) is an interdisciplinary project, funded by a Wellcome Trust Collaborative Award, which aims to explore best interests decision-making in healthcare, both empirically and normatively. In this paper, we outline initial findings from a narrative review that asked, ‘what evidence do we have about how best interests decisions are made in clinical practice in England and Wales?’. Data were extracted from included papers using a standardised form, and then subjected to thematic analysis, focussing on what the papers told us about the process of decision-making, the stakeholders involved, the barriers and facilitators. Early results suggest we have some limited evidence about how best interests decisions are made in clinical settings, and the majority of this evidence concerns mental health and end-of-life care. Common factors taken into account in these decisions include: the patient’s clinical circumstances; risk assessment; the patient’s wishes; cost-effectiveness; avoiding harm; the patient’s well-being; autonomy; capacity assessment; and family’s wishes. "

Taking on a new GP partner

Justin Cumberlege, a partner in the healthcare law firm Hempsons, highlights some considerations when a new partner joins you

Individual and 'national' healthcare rights: Analysing the potential conflicts.

Individual rights to healthcare (RTHCs) are increasingly common in law. Yet even plausible theoretical defences thereof raise a classic problem in the philosophy of rights: How do individual rights relate to 'collective' rights within the same domain? Collective rights are common in international law and in the domestic laws of states that recognize RTHCs. These collective rights often include health-related components. There are at least prima facie plausible reasons to think that such collective 'health rights' should exist. A complete account of health rights should thus explain how individual and collective health rights claims relate to one another and what one should do in cases where the claims conflict. This work contributes to our understanding of health rights by analysing the relationship between individual RTHCs and a plausible candidate collective health right, namely a sub-state national right to control healthcare law and policy. It argues that concerns about rights conflicts in this context make sense, but genuine conflicts between individual health rights and national control over healthcare are rare. The strongest cases for sub-state national 'self-determination' rights do not implicate healthcare, or tend not to provide reasons to override any individual RTHCs. Conflicts are possible in rare cases and may even favour fulfilling the collective rights claims. Yet individual RTHCs remain important even in those cases. Individual rights remain useful measures for evaluating the exercise of collective rights: exercises that violate (or even fail to fulfil) individual health rights are worse for so doing.

Sabrina Germain, Justice and Profit in Health Care Law: A Comparative Analysis of the United States and the United Kingdom

Sabrina Germain, <i>Justice and Profit in Health Care Law: A Comparative Analysis of the United States and the United Kingdom</i>

COVID‐19 critical success factors in Indian healthcare industry—A DEMATEL approach

The prosed study aims to provide COVID‐19 critical success factors (CSF) associated with pandemic circumstances in the Indian healthcare industry (HCI). The CSF was identified via expert team inputs and a detailed literature review. The Decision‐Making Trial and Evaluation Laboratory (DEMATEL) method is used to determine the causal relationship between identified CSF. The methodology was supported by the case study of the Indian HCI. A total of 15 CSF in the Indian HCI during COVID‐19 are identified and prioritized using the DEMATEL method. The findings indicate that the high‐quality personal protective equipment (PPEs; LC8) and testing laboratories/facilities, centres, and kits (LC15) are the significant cause, and appropriate healthcare laws (LC13) are the least effect group. The study shows that policy and decision‐makers need to emphasize on LC8 and LC15 CSF in the Indian HCI and act accordingly to win the battle against post‐COVID‐19 circumstance. The policy/decision‐makers and healthcare administrations can identify the CSF and focus on that particular CSF. The identified CSF will help policy and decision‐makers swiftly build up the HCI to cope with the future pandemic.