school of law, university of maryland baltimore law

Published by the Law & Health Care Program (Lk HCP)

School of Law, University of Maryland Baltimore

lAW & HEALTH CAREN

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RVolume Vll

Number 2

Spnog/Summer 21)1111

SPRING CONFERENCE

Guns As A ConsumerProduct

Maryland Governor Parris N.Glendening and AttorneyGeneral J. Joseph Curran, Jr.

were keynote speakers at the L&HCP'sSpring conference, "Guns As A Con-sumer Product: New Public Health andLegal Strategies to Reduce Gun Vio-lence," held on March 9, 2000.

The conference was a response to themounting evidence that firearm injuryand related death has become anepidemic. In fact, there is a growing listof literature that connects not onlyhomicides but also suicides and uninten-tional deaths to gun ownership and anequally fast-growing list of proposals toreduce gun violence. These proposals,in part, reflect a move to regulate gunsin the same manner that cars, toys, andother consumer products are regulated.At the same time, there have been anumber of products liability lawsuitsagainst gun manufacturers for failure tochildproof or design safe guns. One ofthe first suits to allege failure of amanufacturer to design and market achildproof gun is pending in Maryland.These initiatives challenge the limits ofconsumer products safety and liabilitylaws and could have far-reachingeffects on the sale of guns in thiscountry.

The conference, held while theMaryland legislature debated the meritsof "smart gun" legislation, explored thepublic health, policy, and legal ramifica-tions of gun violence and the proposed

Law & Health Care Newsletter 1

Learn more online!Visit our website:

www.law umaryland.edu/maryhealth/inclex.htm

J

Faculty Notes 7

Is There a Pink Slip in My Genes? 8

JHCL&P Elects 2000-2001 Board 9

Focus On:The Student Health Law Organization 10

In this issue:Spring Conference: Guns As aConsumer Product 1

Karen Rothenberg Named Dean 2

Faculty News:UN Symposium on InternationalDisability Rights 4

L&HCP Places in Top Five in U.S. Newsand World Report Survey 12

In the Health Law Clinic 13

Concentration in Health Law Awards 14

Spotlight on Practicums 15

Hellman Explores Moral Choices inthe Design of Clinical Trials 6

Hoffmann Elected Chair of Maryland HealthCare Ethics Committee Network 7

changes to the law in Maryland andaround the country.

As the first presenter, GovernorGlendening spoke passionately aboutthe bill, sponsored by this administra-tion, that would require all guns sold in

Cont. on page 3

From the Director

This has been a year of transitions for

the Law & Health Care Program.

Karen Rothenberg, the founder and

Director of the Program, served as Interim

Dean of the Law School this past year and

was recently appointed Dean (see story ; p.

2). In addition, the Law School moved to

temporary quarters while our new building

is under construction.

In spite of these significant changes, the

L&HCP has continued to thrive. Our faculty

continues to be extremely productive (see

Faculty News and Faculty Notes), our

Journal of Health Care Law & Policy

continues to put forth issues on significant

and timely societal questions, most recently

on "Defining a Disability Under the

Americans with Disabilities Act," (see story

p. 8) and our students continue to be more

energetic than ever (see our story on the

Student Health Law Organization, p. 10).

We look forward to even more new

developments in the Program over the next

year and look forward to sharing them with

you!Diane HoffmannInterim Director

©2000, University of Maryland School of Law

Karen RothenbergNamed Dean

n April 6, 2000, University ofMaryland President David J.Ramsay named L&HCP

Director Karen Rothenberg Dean ofthe University of Maryland School ofLaw. She has served as Interim Deansince August, 1999 after former DeanDonald Gifford resigned. An exten-sive candidate search was conductedprior to Rothenberg's appointment.

The appointment makes Rothenbergthe first woman to lead the law schoolin its 184-year history and one ofabout 20 women law school deansacross the country.

Rothenberg started her legal careerat the firm of Covington and Burlingin Washington, D.C. handling healthlaw issues. As the industry was beingrevolutionized by changes such as theadvent of managed care, the healthlaw field grew increasingly morecomplex.

She made the change from privatepractice to academia seventeen yearsago, and when she joined the lawschool faculty. Rothenberg madeseveral commitments. One of the firstto be realized was the formation ofthe Law & Health Care Program,which has flourished under herdirection and is consistently ranked inthe top five such programs nationwideby U.S. News & World Report.

A second commitment was to fosterinterdisciplinary programs on theUniversity of Maryland Baltimorecampus. In addition to the lawschool, the Schools of Dentistry,Medicine, Nursing, Pharmacy andSocial Work are located on thecampus, as well as the University ofMaryland Medical System. Today, apervasive spirit of interdisciplinarycooperation is evident in the curricu-lum, clinical education, facultyresearch, conferences, symposia-nearly every aspect of campus life hasbeen positively affected by the trend.

Dean Karen Rothenberg

Rothenberg has also been nationallyrecognized for her scholarship in healthlaw. Her research has impacted manycutting-edge issues in the field, includingregulation of the use of genetic informa-tion by insurers and employers, regula-tion of clinical research and reproductivetechnologies, and women's health andHIV-AIDS issues.

In appointing Rothenberg, Ramsaysaid, "In her seventeen year career as afaculty member at Maryland, ProfessorRothenberg has earned a reputation forexcellence not only on campus but in thenational and international legal andhealth care communities. I am sure thatunder her leadership the School of Lawwill continue to grow in stature."

Professor Diane Hoffmann, formerAssociate Director of the L&HCP, iscurrently Interim Director and ProfessorJoan O'Sullivan has been appointedActing Associate Director.

Law & Health CareNewsletter

is published by the

Law & Health Care Program

at the

School of Law

Unix ersity of Maryland

Baltimore

515 West Lombard Street

Baltimore. M D 21210

L&HCP Faculty:

Diane E. Hoffmann, JD, MS

Interim Director, L&HCP and Associate Dean,

Uiiversirs of Maryland School of Law

Joan O ' Sullivan, JD

Acting Associate Director. L&HCP

There are a number of law school

'acuity who contribute to the diversity of the

Law & Health Care Program through their

teaching and scholarship. -We share some of

these facult''s selected publications, presenta-

tions, and appointments in Faculty .Votes:

Taunya Lovell Banks. JI)

Richard Boldt, Jl)

Karen C:zapanskiv,JD)

Deborah S. Hellman, 1D, MA

Susan J. Hankie, JD, MPH

Stanley S. Herr, JD. DPhil

David A. Hyman, MD. JD

Susan Leviton. JD

Karen Rothenberg, JD, M PA

Rena I. Steinzor. Il)

Deborah J. Weimer. JD, LI-M

Roger C. Wolf. ID

Adjunct Faculty (2000-2001)

Ellen Callegary. JD. Callegary & Steelman

John R. Catizone, JD. The St. Paul Company

James Doherty, Jr.. IL). Pecore & Doherty, LLC

W. Lawrence Fitch. JD. Community

Forensic Serv ices

Douglas MacLean, PhD,

University ofMaryland. Baltimore Count

Kevin Si Ananev. JD. Office of Health and

Human Services

Lewis Noonberg. JD, Piper and .Marburv

Frank Palumbo. PhD. JD. University of

Maryland School of Pharnucy

Robert T. NI. Phillips, MD, PhD

Forensic Consultation Association. Inc.

Sanford V. Te:plitzky. JD, Ober, Kaler,

Grimes & Shriver

Program Coordinator/Editor:Narscv Zibri , n, AIA

Administrative Assistant:victoria Ndiave

Continents and letters should heforwarded to the above address.

2 Law & Health Care Newsletter - www.law.umaryland.edu/maryhealth/index.htm

Guns As a Consumer ProductCont. from page 1

Maryland to have built-in trigger locksas of 2002 as well as the possibleapplication of "personalized handgun"technology (e.g., guns that couldrecognize owners and other authorizedusers) by as early as 2003. (See box,this page.)

The Governor's keynote was followedby a session on the epidemiologicevidence of gun violence and the publichealth response. Speakers includedJames A. Mercy, Ph.D. and StephenTeret, J.D, M.P.H. Mercy, a VisitingProfessor in the Department of Emer-gency Medicine at the Medical Collegeof Wisconsin (MCW), was formerly theAssociate Director for Science of theDivision of Violence Prevention at theCenters for Disease Control in Atlanta.He is currently working with the FirearmInjury Center at MCW and professionalsacross the country to build a NationalFirearm Fatality Reporting System.

Teret is Director of the Johns HopkinsCenter for Gun Policy and Research andis a national expert on firearm injuryprevention. Under Teret's leadership, in1996, the Center developed a model lawthat would require all new handguns tobe personalized, that is, only fired bytheir intended owner. The model law,

revised in 1998, has been used byPennsylvania, New Jersey, New Yorkand other states in their efforts to writeeffective legislation.

Vincent DeMarco, representingMarylanders Against Handgun Abuse,spoke on the politics of gun control andvoter education. He distributedexcerpts from the Maryland HandgunPoll, which showed that 76 percent ofMaryland voters favor legislationrequiring all new handguns sold inMaryland to be personalized and child-proof.

Attorney General Curran, theconference luncheon speaker, discussedhis recently published 63-page report,"A Farewell To Arms: The Solution toGun Violence in America," which callsfor banning firearms, as well as hispersonal reasons for becoming involvedin this highly controversial issue.

Other speakers at the conferenceincluded: Stuart Simms, Secretary ofthe Maryland Department of PublicSafety and Correction who spoke ongun safety issues in Maryland, JonVernick from the Johns Hopkins Centerfor Gun Policy and Research whoprovided information on legislativeproposals regulating gun safety, Dr.Thomas Scalea, physician-in-chief ofthe R Adams Cowley Shock TraumaCenter who provided information on

both the increase over time of theseverity of handgun injuries and theincrease in number of such injuries, andSenator Timothy R. Ferguson, MarylandState Senate who spoke on redesigningguns, questioning whether the technol-ogy was far enough advanced.

The conference ended with a provoca-tive discussion by four panelists, who inlight of recent litigation against gunmanufacturers, debated whether the tortsystem is the best way to force change inthe design of guns. The four panelistswere Andrew D. Freeman, BrownGoldstein and Levy, representing theplaintiff in the current suit in Marylandagainst Sturm Ruger for failure tochildproof their guns; Lawrence S.Greenwald, Gordon, Feinblatt, Rothman,Hoffberger & Hollander, LLC, whorepresents Beretta U.S.A. Corp. inproducts liability litigation; Jonathan E.Lowy, from the Center to PreventHandgun Violence, and Deborah L.Robinson, Robinson WoolsonO'Connell who teaches products liabilitylaw as an adjunct professor at theUniversity of Maryland School of Law.

Papers based on the conferencepresentations will be included in asymposium issue of the Journal ofHealth Care Law & Policy to bepublished later this year. A Journalorder form is included on page 9.

President Clinton Attends Signingof Gun Control Bill

On April 12, 2000, PresidentBill Clinton attended theceremony during which

Governor Parris Glendening's guncontrol bill was signed into law.Dean Karen Rothenberg was alsopresent at the signing.

The main provisions of the lawrequire that all handguns sold inMaryland as of October I, 2000 mustcome with external trigger locks, andas of January I. 2003. all newhandguns must have built-in locks.Police guns will be exempt. "Smartgun" technology was deleted by

amendment, but the law requires astate board to report on the technol-ogy.

Other provisions require:• Some felons, if found with a

firearm after release from jail, to servemandatory minimum sentences of fiveyears without parole;

• Handgun purchasers to completea two-hour gun-safety course;

• Gun manufacturers to send dealersa bullet casing from any handgun soldin Maryland. The dealer must send thecasing to state police for use in trackingguns used in crimes; and

• Juveniles convicted of aviolent crime to be barred fromowning handguns until age 30.

At the bill signing, PresidentClinton praised Maryland for takingthe lead on this controversial issue,"Everything [my administration]has tried to accomplish . . . Mary-land has been out there on theforefront of the change, and is againleading the way. Congress shouldfollow Maryland's lead."

www.law.umarylard.edu/maryhealth/index.htm - Law & Health Care Newsletter 3

Faculty News .. .

UN Symposium onInternational Disability Rights

by Stanley S. Herr

Professor Herr is a professor of law at the University ofMaryland School of Law

and immediate past president of the American Association on Mental Retardation.

He is on sabbatical leave as Visiting Richard Crossman Professor, Haifa

University and Mare Switzer Distinguished Research Fellow, National Institute on

Disability Research and Rehabilitation, U S. Department of Education. In this

article Professor Herr describes his experiences as a delegate to the UN

Symposium on International Norms and Standards Relating to Disability.

How do you advance the rights of the world's 500,000,000 people withdisabilities? How do you help governments and society to see andunderstand the human rights and needs of this huge, but largely invisible

minority? How do you assure that the less assertive and less vocal sectors of thisminority, such as people with intellectual disabilities, receive their due concern anddignity? These in essence, were the challenges posed by the United Nationscosponsored Interregional Seminar and Symposium on International Norms andStandards Relating to Disability, held in Hong Kong from December 13-17, 1999.

Along with its co-organizers, the Equal Opportunities Commission of HongKong and the Faculty of Law of the University of Hong Kong, the UN sought tobring together international experts to consider three main topics. The first was tocritically examine the adequacy of the existing human rights framework for persons

with disabilities and to explore current

with mental, physical, and sensoryand possible strategies for ensuring the

disabilities.equalization of opportunities for people

These were truly roll-up-your-with disabilities. The second was to

sleeves, working sessions with meet-map issues and strategics for building

ings and drafting sessions from morn-national capacity to promote and

ing through night. Add a considerablemonitor the implementation of those

touch of jet lag and the participantshuman rights. The third was to analyze

required the stamina of marathonemerging approaches to the definition

runners. To facilitate open discussion,of disability. These were tough and

the tasks of moderating sessions werecomplex issues to confront, but in

rotated among the experts. I moderatedseveral respects, this meeting at the end

two sessions and worked with aof the millennium may prove a turning

drafting group responsible for develop-point for international disability rights.

ing findings and recommendations onI was privileged to be invited to the

international norms and standards. Thisconference as a delegate experts on

collaborative work with Theresialaw and on disability rights represent-

Degener, a visiting professor froming some 20 countries around the

Boalt Law School and a Germanworld. At Maryland Law School. my

disability rights specialist and activiststudents and T had often worked on law

[who happened to be horn withoutreform projects of national and even

arms]. and Janet Lord, a legal analystinternational dimensions so I welcomed

with the World Bank, was intense andthis chance to extend my work on

very satisfying. By the end of the week,international law relating to people

we had a substantial draft report with

recommendations targeted to the UN,governments, non-governmentalorganizations [NGOs] and even thecorporate sector.

By far, our most dramaticrecommendation was for a UnitedNations treaty on disability rights. In asession that I led with Prof. Degener,after thoughtful contributions from allthe delegates, we concluded that theUN, member States and disabilityrights organizations "should initiate theprocess for the adoption of aninternational treaty dealing specificallywith the human rights of people withdisabilities. " Recognizing that such aprocess will take time and resources,the forum called for a drafting processfor such a treaty that would be openand inclusive, taking into account theinterests of all persons with disabilities,and involving such persons as principalparticipants in that process. Since aregional convention is now open forratification-the Inter-AmericanConvention on the Elimination of AllForms of Discrimination-governments in the Americas wereurged to ratify this document. Weconcluded that other regional effortscould also help to pave the way for aninternational convention. Unlike "softlaw" declarations, regional and UNtreaties are enforceable and "haveteeth. "

In the Seminar's final plenarysession, we adopted dozens ofrecommendations that can spellconcrete progress for internationaldisability rights. These included 15recommendations directed to the UNand its constituent bodies and morethan a dozen recommendations togovernments.

We also produced an impressiveagenda for future research andactivism. Among other items, theforum called for research to identify theuses of international standards ondisability in domestic law contextssuch as litigation, legislation, and otherpublic policy formulations. We agreedto develop a compilation of national


Faculty News .. .

laws on disability discrimination,special education, vocationalrehabilitation, personal support,accessibility to health care services,transport, and other supports andbenefits that can offer models in thedevelopment of national andinternational laws and disabilitypolicies. This material, periodicallyupdated. should be part of a web sitemaintained at the UN.

The experts also grappled with theproblematic search for an internationaldefinition of disability. Since UNresolution 1998/31 already calls for ahuman rights treaty monitoring bodiesand governments to "cover fully thequestion of human rights of personswith disabilities in complying" withtheir reporting obligations underrelevant human rights treaties, such asconventions dealing with children,women, and other protected groups, theissue of an international definition isnot just a theoretical matter.

One of the innovative features of theseminar was an advocacy and humanrights workshop that featuredexperimental approaches to nationalcapacity building that includeddisability-accessible Internettechnologies for distance collaboration.

I also led a session that revealedheartening examples of the increasedparticipation and inclusion of peoplewith disabilities. Promisingdevelopments are occurring in all partsof the globe, in countries as diverse asCambodia, China, Colombia, CostaRica, India, Japan, Pakistan,Philippines, Poland, Tanzania, Uganda,and the United States. Many delegatesat this meeting had been lonelycrusaders for changes in theirrespective countries. A Cambodianman in a wheel chair spoke withunderstated emotion about the threatposed in his land for its 11 millioncitizens who live amidst 10 millionunexploded land mines. An Indianwoman who used a wheel chairreferred to the double jeopardy on hersub-continent that comes from being

female and disabled. For all thedelegates, the chance to work togetherand to plan the next steps for progressin the face of formidable obstacles wasexhilarating. Sometimes the word"empowerment" is just a slogan.Sometimes, as in this Hong Kongmeeting at the dawn of a newmillennium, empowerment has a realpalpable meaning.

As we return to our daily routines,we have much left to do. We take to

heart the message we received from thePresident of the UN General Assemblywho described our meeting as "awelcome, innovative and uniqueundertaking to translate thecommitment of the internationalcommunity into concrete policies,strategies and programs aimed atfurthering equalization of opportunitiesby, for and with persons withdisabilities. " As his Excellency Dr.Theo-Ben Gurirab congratulated us

"for personal dedication to thisimportant initiative" and urged us topromote "awareness and building ofnational capacities to implementinternational norms and practices,focusing on empowerment of peoplewith disabilities, " we carry the burdensand joys of new commitments forged inHong Kong. For example, anotherdelegate and I are exploring puttingtogether a manual on internationaldisability rights to help activists around

the world. And the work on UN and/orregional treaties on disability rightswill surely take many years. But as theancient Chinese proverb says, a journeyof a 1000 miles begins with a singlestep. We have now taken those firstfirm steps.

This article was excerpted from a versionpreviously published in News and Notes, apublication of the American Association onMental Retardation.

Professor Stanley Herr at the Seminar and Symposium on International Norms andStandards Relating to Disability,

www.law.umaryland.edulmaryhealth/index.htm - Law & Health Care Newsletter 5

Faculty News .. .

Hellman Explores Moral Choicesin the Design ofClinicalTrials

G C onsider the case of a patientdying of a disease for which thestandard therapy offers very

little hope. Her doctor tells her that astudy testing a new therapy has beencarried out. But the results of thatstudy are not considered meaningfulbecause the requisite "p" value was notreached (significance level for studydata). He invites the patient to join anew study where she stands a 50percent chance of being assigned to thestandard, not very effectivetherapy. "

What should she do? Should shetry the new treatment when there isa great deal of uncertainty as towhether it is more beneficial thanthe standard treatment? Or shouldshe pick the standard-not veryeffective-therapy about whichdoctors know more?

Law & Health Care ProgramProfessor Deborah Hellman raisedthis question in a lecture she gave aspart of the Medical HumanitiesHour at the University of MarylandMedical System on March 16, 2000.

She discussed the RandomizedClinical Trial (RCT) and the use of .05as the significance level for studyresults--a remedy for chance and therandomized assignment of studysubjects to treatments a remedy forbias in her talk, "The Quest forCertainty: Moral Choices in the Designof Clinical Trials. "

Hellman argues that each of thesedesign elements represents a choice.

She says, "Proper scientific methoddoes not require randomization or a .05significance level, a point that is oftenforgotten as the model RCT lauded byscientific researchers includes both ofthese elements. Rather, these elementsconstitute preferences for a high degreeof certitude in study results over othervalues and interests.

Although .05 and randomizationgenerate a high degree of confidence instudy data, this confidence benefitsfuture patients. Hellman says that, asin the example above, current patientsneed less certainty.

"Other things being equal, we wantscientists to employ the method mostlikely to produce reliable data abouttreatment efficacy. But since otherthings are rarely equal, there are otherimportant values and interests at stake

when we conduct medical research onhuman subjects. Particularly, when thestudy subjects are very sick people."

Hellman's research examines theRCT from the perspective of thepatient who often needs to make adecision immediately and who must acton the basis of uncertain information.The patient may want to "play theodds" since her goal is to get thetreatment with the best chance ofsuccess in treating her illness.

The perspective of the researcher isdifferent, The researcher wants, first ofall, to discover the truth and is lessconstrained by time. The ultimate goalof the researcher is the advancement ofmedical knowledge and the develop-ment of the best treatment for disease.

These two perspectives result in theneed for different degrees of certainty.

Different degrees of certainty,Hellman adds, result in costs andbenefits for both current and futurepatients and society as a whole.

Randomization is the second designelement of the RCT that also representsa choice. Randomization helps toreduce bias by neutralizing the effectsof unknown differences between thetreatment groups that may, inadvert-ently, affect the study result. By "bias "the statistician means skewed distor-tions in the study data. Again,Hellman argues, there are degrees ofcertainty. How much less likely isthere to be an error in the study datawhen randomization is used. Andequally importantly, what are the coststo the patient of reducing the occur-rence of error?

"Even if the scientific community isin `equipoise,' {neither therapy is`known' to be superior) there still maybe good reasons to believe that onetreatment is better. " Hellman asks, "Inthat case, do the patients get equalcare?"

Hellman cites other costs to thepatient-loss of control over the choiceof which treatment they receive, and, ina double blind study, the lack ofknowledge about the type of treatmentthey are receiving. There is also asense of powerlessness inherent in thesituation that is caused first by con-tracting the disease, and second by thetreatment and subsequent reliance onmedical professionals.

In summary, Hellman says that thechoice of .05 and randomization arenot dictated by science, but are moraland political choices that reflectparticular values. If certainty is chosenover other values, then this choicefavors the interests of future patientsover those who are sick now.


Faculty News ..

Hoffmann Elected Chair of Maryland HealthCare Ethics Committee Network

n January, the newly electedExecutive Board of the Marylanddealth Care Ethics Committee

Network (MHECN) elected DianeHoffmann as chair. In 1992, Hoffmannco-founded, with Dr. Henry Silverman,chair of the ethics committee at theUniversity of Maryland MedicalSystem, the Baltimore Area EthicsCommittee Network. Her goal was toprovide a forum for ethics committeemembers to share experiences andcases and learn from one another aswell as to provide them with resourcesand support for their tasks. These tasksincluded consulting on cases mostoften involving termination of lifesupport, developing policies on variousissues related to patient care andeducating their relevant communitiesabout ethical decision making inpatient care. However, it soon becameclear that there was a need in otherareas of the state for these types ofresources and additional educationalsupport for committee members toadequately perform their tasks. In1998, Hoffmann spearheaded an effortto establish the MHECN. The mission

of MHECN is "to facilitate and enhanceethical reflection in all aspects ofdecision making in health care settingsby supporting and providing informa-tional and educational resources toethics committees serving health careinstitutions in the state of Maryland. "Functions of the Network include:

♦ serving as a resource to ethicscommittees as they investigateethical dilemmas within theirinstitution and as they strive toassist their institution operateconsistently with its missionstatement;

♦ fostering communication andinformation-sharing among Net-work members;

♦ providing educational programs forethics committee members, otherhealth care providers, and membersof the general public on ethicalissues in health care;

♦ conducting research to improve thefunctioning of ethics committeesand ultimately the care of patientsin Maryland.

Hoffmann's plans for the Networkinclude offering a basic course inethics and relevant health law for newethics committee members and anadvanced course for those whoregularly perform ethics consults.Results of a study recently performedby Hoffmann and colleagues AnneO'Neil, PhD, RN, newly appointedDirector of the Network, and AnitaTarzian, PhD, RN, found that formalbioethics education was lacking formany ethics committee chairs, mostethics committee members, andapproximately two-thirds of thoseindividuals designated to performethics consultations. (The study willbe published in an upcoming issue ofthe Journal of Law, Medicine &Ethics). Based on these findings,Hoffmann believes there is still muchwork to be done in educating membersof ethics committees and helping themto have the skills and knowledge basenecessary to adequately carry outconsults. She hopes the MHECN willhelp to fill that need.

L&HCP Faculty Notes . .PROFESSOR DIANE HOFFMANN Chair, Executive Board, Maryland Trials," Medical Humanities Hours,Publications: Health Care Ethics Committee Network University of Maryland School of"Are Ethics Committee Members - (2000) Medicine, Baltimore, MD and theCompetent to Consult, " (with A, Center for Bioethics at the UniversityTarzian & J.A. O'Neil), J. ofLaw, ASSOCIATE PROFESSOR of Toronto, Toronto, Canada (2000)Medicine & Ethic's (2000) DEBORAH S. HELLMAN

Selected Presentations: PROFESSOR STANLEY S. HERRSelected Presentations: Selected Presentations:"Institutional Barriers to Pain Manage- "Genetic Discrimination and an Expres- "On the Need for a UN Convention onment," Mayday Scholars Meeting, sive Theory of Equal Protection," Disability Rights," UN InterregionalUniv. of St. Louis School of Law St. University of Toronto Law School, Seminar and Symposium on Interna-Louis, MO (2000)

Toronto, Canada (2000) tional Norms and Standards Relating toDisability, Hong Kong (1999)

Appointments:"The Quest for Certainty: Moral

Institutional Review Board, MarylandChoices in the Design of Clinical Cont on

14Health Care Commission (2000) page

www.law.umaryland.edu/maryhealthlindex.htm - Law & Health Care Newsletter 7

Is There a Pink SlipIn My Genes?Commissioner of EEOC Presents Rome Lecture

The Journal of HealthCare Law & Policy

Volume 3, Issue 2

Defining a "Disability" Under theAmericans with Disabilities Act

Paul Steven Miller,Commissioner of theU.S. Equal Opportunity Com-

mission, spoke on genetic discrimina-tion in the workplace at the LawSchool's Rorie Lecture held on April27, 2000. Miller's forthcoming articlein the Spring 2000 issue of the Journalof Health Care Law & Policy(JHCL&P) was the basis for thelecture.

Miller says that the surge in geneticresearch and technology, fueled in partby the Human Gnome Project, hasresulted in the continuing expansion ofthe range of genetic tests and othergenetic information available tophysicians, insurance companies,employers, and the general public.Genetic tests can provide informationabout an individual's increased risk offuture disease, disability, or earlydeath, as well as an individual's carrierstatus and information about the healthof family members.

As a result of the increase in genetictesting and the availability of ' geneticinformation, legal issues regardingemployment discrimination on thebasis of genetic information areemerging. These issues are importantto all working Americans.

Miller's presentation addressedworkers' fears and the reality of geneticdiscrimination in employment, as wellas the application of existing federalstatutes, particularly the Americanswith Disability Act, state statutes, andthe limited amount of caselaw in thisarea.

Paul Steven Miller is a cum laudegraduate of the University of Pennsyl-vania and he received his JD fromHarvard Law School. As a Commis-sioner of the EEOC, he participateswith the four other commissioners onenforcement policy, authorization of

litigation, and issuance of Commission-ers' charges of' discrimination. Cur-rently he is serving on the PresidentialTask Force on Employment of Adultswith Disabilities, a government-widetask force created to develop a coordi-nated national policy to raise theemployment rate of adults with dis-abilities.

The Stuart Rome Lecture wasestablished to celebrate Rome's life andwork as an attorney, communityactivist, art patron and humanitarian.Rome, who died in 1983, devotedmany hours to pro bono legal work andsupported numerous organizations,including the NAACP, Echo House,and the Maryland State Arts Council.The annual lecture is designed toreflect his extraordinarily widespreadinterest and commitments.

Is there a Pink Slip in My Genes?Genetic Discrimination in the

Workplaceby Paul Steven Miller, JD

Commentary: Bragdon v. Abbott,Asymptomatic Genetic Conditions, and

Antidiscrimination Law: AConservative Perspective

by Roger Clegg, JD

Discrimination Based on HIV/AIDSand Other Health Conditions: Disabil-

ity As Defined Under Federaland State Law

by David W. Webber, JD andLawrence O. Gostin, JD, LLD

The Definition of Disability: Perspec-tive of the Disability Community

by Deborah Kaplan, JD

Bragdon v. Abbott: Extending the.Americans with Disabilities Act to

Asymptomatic Individualsby Eugenia Liu, JD

Genetic Discrimination: Why BragdonDoes Not Insure Protectionby Laura F. Rothstein, JD

Adverse Impact of PredispositionTesting on Major Life Activities:Lessons from BRCAI/2 Testing

by Katherine A. Schneider, MPH

Ohnslead v. Zimring: UnnecessaryInstitutionalization Constitutes

Discrimination Under the Americanswith Disabilities Actby Shoshana Fishman

Cleveland v. Policy ManagementSystems Corporation: Triumph for the

Working Disabled or HollowProcedural Device'?

by Sarah Otwell

Paul Steven Miller. Commissioner ofthe U.S. Equal Opportunity Commission


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JHCL&P Elects2000-2001 Board

This spring the Journal of HealthCare Law & Policy elected thefollowing as members of the

2000-2001 editorial board:

Jullia Callahan, Editor-1n ChiefShoshana Fishman, Articles Editor

Sara Otwell, Executive EditorJohn Eriksen, Managing Editor

Jessica Porter and Jayson Slotnik,Assistant Managing Editors

Melinda DeAtley andJennifer Schwartzott

Notes and Comments EditorsJohn Greenleaf, Mitzi Rivers and

Kevin LaTulipArticles Editors

From left to right:Melinda DeAtley,2000-2001 Notesand CommentsEditor, CynthiaTippett, 1999-2000Executive Edito r,Scott D. Nelson,1999-2000 Editor-In-Chief, andJoseph Pestaner,Journal staff at the"Guns As AConsumer Product, "conference.

www.law.umaryland.edulmaryhealth/index.him - Law & Health Care Newsletter 9

Focus on .. .

THE STUDENT HEALTH LAW ORGANIZATION

1999-2000 SHLO Officers, from left to right: Matt Parra (Mar 2000), Lucy Shum (2D), SaiDeepa Saggare (3D), Mindy Caplan (3D), Denise McNairn (3D), and Jayson Slotnik (3D).

In this issue of our newsletter, we areproud to highlight a vital componentof the L&HCP-our Student HealthLaw Organization (SHLO). Theeffectiveness of student groups aremeasured first by the people whobelong to them and secondly., by theirleaders. Successful leaders areorganized, motivated, and perhapsmost importantly, they are adept atdelegating responsibility. For thesevery reasons, the 1999-2000 SHLOhas done a remarkable job and wethought our readers would like toknow more about the group's accom-plishments. The article that fbllowspresents an overview of the group'sactivities, as well as some insight intohow they made the year the successthat it was.

When the 1999-2000 StudentHealth Law Organizationboard met for the first time

at the beginning of the fall 1999semester, they had already defined along list of ideas that they wanted toimplement for the organization. Byearly October, after discussing theirideas at a general membership meet-ing, the list had coalesced into eigh-teen ambitious goals that the organiza-tion hoped to accomplish over thecourse of two semesters.

Outgoing president Jayson Slotnik(2D) said, "One of the members or anofficer were given the details and thenwere given sole responsibility for thetask. " SHLO's events schedule alonewas ambitious, but the "sole responsi-bility" method worked well.

The group worked hard, bringing anumber of health law speakers to theschool and fully realizing about half ofthe goals they defined at the beginningof the fall semester.

Matt Parra, the outgoing vice-president, says that the group deliber-ately incorporated a broad spectrum ofhealth law issues in their goals.

In November 1999, the group co-sponsored (with the L&HCP) a lecture,"The Crisis in Health Care: Why WeNeed Health Care Reform in Mary-land." Single-payer plan advocate, Dr.Peter C. Beilenson, and a representa-tive of the Maryland Health CareCommission, John M. Colmers, spoke.

In January, Senator Paula C.Hollinger, a member of the Marylandlegislature since 19$7 and Senate Chair

of the Joint Committee on Health CareDelivery and Financing, spoke on statehealth care issues.

In February, in conjunction with theL&HCP and the law school's CareerDevelopment Office, SHLO held ahighly successful health law career fair.Approximately twenty attorneys and100 students traded job requirementsand resumes in an informal setting. Thecareer fair, which is evolving into an

SHLO Elects 2000-2001 Officers

Congratulations and welcome to the newlyelected Student Health Law Organization Board:

Lucy Shum, PresidentVanessa Taneyhill, Vice-President

Joanna Fong, SecretaryGemma Vestal, Treasurer

Luciene Parsley, Events Committee Chairperson

10 Law & Health Care Newsletter - www.law.umaryiand.edulmaryhealthtindex.htm

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Senator Paula Hollingeraccepts a University ofMaryland Law School shirtfrom outgoing SHLOPresident, .layson Sloinik.

The Health LawCareer Fair waswell-attended byboth students andprospectiveemployers.

annual event, is praised by alumni bothfor helping them in their own jobsearch and for providing access to apool of candidates for the positionsthey are now trying to fill.

The career fair is part of SHLO'sefforts to actively target employers inthe region to increase opportunitiesboth for graduates and students seekingsummer employment.

In April, at the invitation of SHLO,Congressmen Ben Cardin spoke to acrowd of Maryland faculty, staff andstudents on Congressional efforts todeal with a variety of health careissues, including the challenge posedby managed care. Cardin is a Mary-land law alumnus who has representedthe state's Third Congressional Districtsince 1987.

In addition to reaching out to thefaculty, students and local communityby hosting the above events, SHLOalso accomplished a number of othertasks-all designed to make theirorganization more effective. Thegroup rewrote their constitution both tostrengthen the election provisions andbring it more in line with other studentgroups. The updated constitution wasapproved by the general membership inApril.

SHLO also established an informalmentor program, a listserv, and col-laborated with the L&HCP on a webpage. The mentor program wasdirected to first-year students andoffered specific advice and counselingon course selection, as well as moregeneral advice from students who hadjust "been there" themselves. Thelistserv provided a simple and effectiveway for both SHLO and the L&HCP tocommunicate and share time-sensitiveinformation quickly and easily.

SHLO also instigated a more struc-tured method for selecting participantsin the National Moot Court Competi-

lion held annually in Carbondale,Illinois (see separate article), and setplans in motion to publicize thecompetition.

Finally, the group sent two studentsto the American Health LawyersAssociation's Institute on Medicareand Medicaid Payment Issues andhosted a seminar on the perils ofsubstance abuse.

Jayson Slotnik commented that theyear was successful, in part, because of

the members' hard work and dedicationto the organization. Slotnik added."Because of each officer's commitmentto SHLO, my job was made mucheasier such that I really enjoyed mytenure as president."

The group elected officers for the2000-2001 school year on April 12.(See box, p. 10.) The Law & HealthCare Program wishes the 2000-20001SHLO officers and members anothergreat year!

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SHLO Holds Moot CourtCompetition by Matthew Parra

0ver twenty students recentlycompeted in a health lawmoot court competition to

become next year's national teammembers. Each year the University ofMaryland School of Law sends at leastone three-member team to a nationalcompetition hosted by Southern IllinoisUniversity School of Law, inCarbondale, Illinois. This year, theStudent Health Law Organization(SHLO) and last year's team membersorganized and coordinated an internalcompetition to select the members ofnext year's team.

The internal competition involved asingle issue that is based on a casewhich is currently before the U.S.Supreme Court. (The problem used forthe school's competition was a modifi-cation of the 1999 National Health LawMoot Court competition held atSouthern Illinois University inCarbondale, IL.) The issue presentedthe question of whether a qui tarn caseunder the Federal False Claims Act(FCA) should be allowed to proceedafter the federal government hasdeclined to intervene. The moot courtproblem mixed several concerns thatcourts have faced on this issue, includ-ing who is the real party in interest in aqui tarn suit and whether the State canproperly be a defendant in a qui tamaction. Competitors arguing for theprivate citizen that filed the suit had thedaunting task of convincing the courtthat a federal court has subject matterjurisdiction to hear the qui tarn action,despite the government's decision not

to intervene. On the other hand,competitors arguing for the Statehospital being sued had the equallydaunting challenge of convincing thecourt that the case was barred by the11" Amendment and should not beallowed to proceed. The U.S. SupremeCourt has granted certiorari to hear acase involving these issues to resolve asplit among the Circuit Courts.

Of the original twenty-plus students,five ultimately prevailed in the compe-tition to become members of nextyear's national team. These studentssubmitted written briefs and presentedoral arguments before a three-judgepanel comprised of practicing healthlaw attorneys from the Health Care

Financing Administration. The fivenew team members were selected bythe three attorneys who graded thewritten briefs and oral arguments. Twoof the three attorneys, Kay Scanlan andPaul Soeffing, graduated from theUniversity of Maryland School of Law,and a third, Jon Brumer, graduatedfrom Duke University School of Law.The five new team members areStephanie Genser, Deepa Saggare, EricOberer, Tim Adleman, and Karen Saks.

Under the National Competitionrules, each team may have up to threemembers and each school may sendtwo teams. The SHLO plans tocontinue this internal competition inthe coming years.

L&HCP Places in Top

Five in US. News & World

Report Survey

The Law & Health Care Program has been named one of the

nation's top five health law specialty programs in U.S. News &

World Report's annual survey for 2000. Since 1995, the L&HCP

has been consistently named among the top five health law programs,

placing fifth this year.

In addition to its health law ranking, The University of Maryland

School of Law has two other specialty programs in the top ten nation-

wide the Environmental Law Program ranked fourth and the Clinical

Law Program ranked sixth.


IN THE HEALTH LAW

CLINICThe law school offers, as part of itsregular curriculum, a clinical lawprogram in which faculty memberswho are practicing attorneys superviselaw students in the representation ofactual clients. For those students witha general interest in health law, theclinic represents clients in casesinvolving health care for children,legal issues of the handicapped, mentalillness, AIDS and the elderly.

Some of the most difficult casesstudent attorneys encounter inthe Health Law Clinic involve

clients who are in nursing homes. Theyare legally complex cases, and often, anursing home is the last place ourclients want to be-they would ratherbe at home with loved ones.

The legal problems we encounteroften involve paying for the nursinghome because poor people cannot planfor this contingency as middle classpeople do. Those who have fundsmight engage an elder law attorney toadvise them about how to place theirassets, so if they need nursing homecare, they can begin receiving benefitsfrom the Medicaid program as soon aspossible. Or they might have purchaseda long term care insurance policy yearsago which will pick up much of the tab.

Poor people, however, with the littlethat they have, often have the mosttrouble qualifying for Medicaid. In onecase this year, our client had a smallinsurance policy which had a cashvalue. It was not much, but it wasenough so that it put her over the assetlimit for Medicaid. Her daughter, whohandled our client's affairs for her, haddifficulty cashing in the policy, to theextent that it took her six months toobtain the cash value. During those sixmonths, the mother was charged theprivate pay rate at the nursing home.

by Joan O'Sullivan, JD

By the time we entered the case, herbill was over $30,000.

Lisa Hesse, a second year student,did an excellent job preparing for ahearing during the early months ofclinic. Medicaid regulations arecomplicated; to a second year lawstudent used to the majority rule andthe minority rule learned in first yearcontracts and property classes, theregulations at first appear incompre-hensible. We argued at the hearing thatit was impossible to cash in the insur-ance policy any sooner, but the judgefound against our client. She is now onMedicaid, but she still owes the nursinghome $30,000. She refuses to give herdaughter a power of attorney so she canfile for bankruptcy. And when we wentto see her, all she could talk about wasreturning to her own home.

Perhaps the saddest cases are thosein which our client has been abandonedby his or her family. Jayson Slotnik,another second year student, handled acase this year in which he represented awoman who was so angry about beingin a nursing home that she allegedlystruck out at others. We entered thecase after she had struck her roommate,a patient with Alzheimer's Diseasewho yelled constantly. Our client hadtaken to sleeping in a chair in the hall,in order evade the noise, but afterseveral nights of this, she allegedlystruck the roommate in frustration. Thenursing home sought to involuntarilydischarge our client and send her to herson's home. The son had called us torepresent his mother. He lived in adistant city, and would not have takencare of his mother, who had abandonedhim when he was very young. He had

received a phone call years later sayinghis mother was dying. He placed her ina nursing home close to where shegrew up, but rarely saw her. Her homehad been sold to pay for the nursinghome, so if she were discharged, shehad nowhere to go.

Mr. Slotnik researched the federalregulations governing nursing homes,and presented his arguments in a letterto the nursing home. We argued thatthe nursing home had a duty to ourclient to provide her with better care,and that it should have moved herwhen the noise from her roommatebecame unbearable. The nursing homeeventually withdrew its involuntarydischarge letter, and our client is still inthe nursing home, although she is nothappy about it.

In another case, a son called us to askus to write a power of attorney for hismother. He was being forced to sell herhome so that she could stay in anursing home. When we went to seehis mother, we explained to her that herson was going to sell her home. Shewas outraged, because she had workedso hard to buy the home. She refused tosign a power of attorney, said that shewould be returning home soon, andthat if she needed a lawyer, she wouldgive us a call. She believed she couldreturn to her home and resume her lifeas a seamstress, even offering to"taper" the student attorney's trousersfor him.

When we explained this to thenursing home administrator, she said itwas the resident's ticket out of thenursing home, since she had no fundsto pay the private rate. The story didnot end there, for soon the mother washospitalized, and two doctors at thehospital found she was incompetent.Her son sued for guardianship of her,and the last we heard, her court-

Cant. on page 14

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In The ClinicCont. from page 13

appointed attorney was fighting theguardianship, arguing that she iscompetent.

Nursing homes today arc under thegun. Several national nursing homechains have filed for Chapter I 1bankruptcy protection. The HealthCare Financing Administration isenforcing nursing home quality of careregulations as never before, decertify-ing nursing homes from receivingMedicare and Medicaid payments. TheJustice Department is bringing FalseClaims Act cases against nursinghomes for not providing the care forwhich they bill the government.Medicaid and Medicare reimbursenursing homes at a very low rate,making it difficult for them to hirecompetent help. The salaries of nursesaides, who do the heavy lifting innursing homes, rival those at fast foodemporiums.

The industry lost its case before theSupreme Court, Shalala v. IllinoisCouncil on Long Term Care, Inc., 120S. Ct. 1084 (2000). The court ruled thatthe federal courts have no jurisdictionto hear an action filed by the associa-tion of nursing homes seeking to raisefederal questions about the validity ofMedicare regulations. The regulationsprovide for sanctions for failure tocomply with regulatory standards. The

association must seek remedies throughspecial review channels created byMedicare statutes.

What is the answer to the nursinghome dilemma? One answer might bethat none of us wants to live out ourlives in a nursing home, but wouldrather age in place, and end our days inour own homes, as our clients wantedto do. At least two states, Arizona andOregon, have used Medicaid waivers toapply Medicaid funds to home healthcare for those who would otherwisequalify for nursing home care. Thoseprograms are widespread and success-ful, due in part to well designedprograms which provide for checks andbalances between the government andservice providers. Perhaps this is onlypart of the answer to the problem.Other answers might be more incen-tives for long term care insurancepolicies, better reimbursement ratesfrom the government, and better qualityassurance from the industry.

Nursing home cases are excellentteaching tools for our students. Theylearn the complexities of the lawsgoverning nursing homes, the intricaterules governing payment, and thedesperation many clients feel aboutending their lives in a nursing home.They also learn that there are alterna-tives. When they begin practicing law,perhaps they will be in positions toaddress these perplexing questions.

Faculty NotesCont. from page 7

"The Role of Consumer Movements inDisability Rights," Israel Organizationof Handicapped Children (ILAN),Jerusalem (2000)

"Human Rights and Social Policy: TheCase for Disability Rights," NationalConference of Social Workers, TelAviv (2000)

PROFESSOR DAVID A. HYMANPublications:"Managed Care at the Millennium:Scenes from a Maul, " Journal Health,Politics, Policy & Law 1061-1070(1999)

"Drive-Through Deliveries: Is Con-sumer Protection Just What the DoctorOrdered?, " 78 North Carolina LawReview 5-99 (1999)

"Medical Malpractice and SystemReform: Of Babies and Bathwater, "(Review of The Practice of Uncer-tainty: Voices of Physicians andPatients in Medical MalpracticeCases), 19 Health Affairs 258-259(2000)

"Regulating Managed Care: What'sWrong with A Patient Bill of Rights,"73 Southern California Law Review221-275 (2000)

PROFESSOR SUSAN P. LEVITONSelected Presentations:"Diversion and Alternatives to Incar-ceration for the Mentally Ill, " JudicialInstitute, Judiciary Training Center(2000)

"Mental Health Services for Childrenand Adolescents, " Sheppard-PrattConference Center (2000)

ASSISTANT PROFESSOR

JOAN O 'SULLIVANPublications:"The Increasing Medical MalpracticeRisk Related to Pressure Ulcers in theUnited States, " (with Richard D.Bennett, MD, Eric M. DeVito, JD, and

TheYear 2000 Concentrationin Health Law Awards

Twenty seven students were awarded the Concentration in Health Lawat the May. 2000 graduation ceremonies. We are very proud of thesestudents and congratulate them on their outstanding achievement!

Deondra Sue Arko Cara J. Heflin Christine Salerno

Jana L. Artnak Andrea E. Jaskulsky Cara Schoetn

Mojdeh Bahar Oluyemisi O. Koya Tracy Silverman

Laura Callahan Dawn Lanzalotti Brian Frederick Sklar

Ruben Chavez Erica Ward Magliocca H. Arrah Tahoe

Kay E. Cheney Hilary L. Martinson Cynthia L. Tippett

Bruce L. Currie Louis Patalano IV Robyn C. Tyler

Marisa Ferraro Jennifer C. Peters Margaret Webster

Kevin B. Gerold Anthonia St. John Christina Wilson

14 Law & Health Care Newsletter - www.law.umaryland.edulmaryhealthlindex.htm

HEALTH LAW PRACTICUMS AND

EXTERNSHIPS: University

Physicians, Inc./Compliance Unit

Robin Remsburg, PhD, RN), 48Journal of the American GeriatricSociety 73 (2000)

Selected Presentations:"Health Care Decision Making inMaryland, " Frederick MemorialHospital Medical Staff, Frederick, MD(2000)

"Nursing Homes and the Law: How toEnforce Quality of Care? " moderator,Association of American Law SchoolsAnnual Meeting, Washington, DC(2000)

"The Increasing Medical MalpracticeRisk Related to Pressure Ulcers in theUnited States," Scientific Meeting, TheGerontological Society of America,San Francisco, CA. (1999)

"Understanding the Elements ofInformed Consent, " American Associa-tion on Mental Retardation Region IXConference, Annapolis, MD (1999)

"Advance Directives and MedicalDecision Making," Maryland Coalitionfor Aging and Developmental Disabili-ties Conference, Anne Arundel Com-munity College, Arnold, MD (1999)

DEAN KAREN ROTHENBERGSelected Presentations:The Cyril H. Wecht DistinguishedLecture on Legal Medicine, 40thAnnual Conference of the AmericanCollege of Legal Medicine, San Diego,CA (2000)

"Genetic Information in the Work-place," CNN Interview, Washington,DC (2000)

"The Regulation of Gene Therapy, "The Mark Steiner Show, WJHU-FM,Baltimore, MD (2000)

Oluyemisi Koya

As I grew tired of' the drudgeryof the classrooms, I longed forthe chance for first hand

experience in the real world-practic-ing health law. The Law & HealthCare Program provided me with thatopportunity last semester, through mypracticum at the Board of PhysicianQuality Assurance (Board) in Balti-more. I had a productive time learning,observing and participating in theregulation of the practice of medicinein Maryland.

After my experience at the Board Ibecame a glutton for "real life work."Luckily, during the Spring 2000semester, through the law school'sAsper Fellowship Program, I was ableto participate in a placement at theCompliance Office, University Physi-cians, Inc., (UPI) in Baltimore wheremy supervisor was Jerry Can ., J.D.,Chief Compliance and Legal AffairsOfficer. (UPI is also a Law & HealthCare Program placement.)

The Compliance Office primarilydeals with ensuring the compliance ofthe University Practice Associationswith federal, state and local laws andregulations. Two presumptions that

by Oluyemisi Koya, MD (3D)

The Law & Health Care Program 's

Health Law Practicum Program provides

an opportunity for students interested in

health law to obtain credit by working for

organizations and government agencies

dealing with health care issues. Students

spend 10 to 20 hours at their placementand additional hours throughout the

semester in the classroom participating

in The Health Law Practice Workshop.

Placements have included the American

Nurses Association; Johns Hopkins

Health System Corporation; Legal Ser-

vices to the Elderly; Med-Chi of Mary-

land; Maryland Board of Physician

Quality Assurance; National Health Law

Program; NIH; U.S. Senate Subcommit-

tee on Aging; University of Maryland

Medical System, Office of the General

Counsel; and the Office of the Attorney

General, General Litigation Unit andMed-icaid Fraud Unit.

The Program has also offered seven

full semester externships-The National

Health Law Program externship in

Washington, D.C.; The University of

Maryland externship, located in Univer-

sity Hospital's General Counsel's office;

Blue Cross/Blue Shield of Maryland

(BCBSM), The Federal Trade Commis-

sion, The fifmyland Health Care Commis-

sion; the NIH General Counsel's Office;

and the National Partnership for Women

& Families (formerly the Women 's LegalDefense Fund) in Washington, D.C.

went with me to the placement werequickly rebutted, namely that theCompliance Office deals only withcompliance issues, and the ComplianceOffice deals only with health lawissues.

Cont. on page /6

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Spotlight On .. .Cont. from page 15

Soon the diversified legal issues Icontended with during my placementreminded me of previous health lawseminars-where it was stressed thathealth law or the representation ofhealth care providers or patientsencompasses many other areas of lawincluding contracts, property, criminallaw, antitrust, labor law and more.

As I worked my way throughvolumes of service agreements andcollaboration agreements, sortingthrough legal issues such as theadequacy and sufficiency of consider-ation as well the violation of the Anti-Kick Back Statutes, 1 concludedwithout any doubt that health law is byno means a "legal island. " When I hadto revisit the issue of abandonedproperty in the context of PracticeAssociations, I chastised myself forletting my mind wonder during Prop-erty lectures.

At the Compliance Office, I wasgiven the opportunity to work on

several projects and observe first handthe implementation of compliancestrategies designed to prevent, detectand rectify compliance mishaps. Myassignments ranged from the usualendless research, to other productivethings like drafting policies on recordretention, policies on the Marylandescheat laws, reviewing contracts andwriting collaboration agreements.

In terms of compliance issues inparticular, my assignments revealedthat compliance focuses on prevention,early detection and immediate rectifi-cation. During my placement I beganto appreciate the importance of thepaper trail in the context of compli-ance issues, wherein it is crucial toshow the government (in case theydrop by) that the organization iscomplying with the law. In thisregard, some of my tasks such askeeping track of corporate documentsand making sure that they were up todate were mundane and lacked the

excitement of courtroom drama.Nonetheless, working at the ComplianceOffice gave me the chance to appreciatethat the evidence of a credible papertrail might eventually save an organiza-tion from the severity of liability, just asa brilliant closing argument may sway ajury.

One of the highlights of my place-ment at the Compliance Office was myparticipation in meetings discussing theimplementation of the first internalaudit program for Practice Associations.This new program is to further ensurethe appropriateness of coding andbilling sent to the government andproper evaluation/management docu-mentation.

The time spent during this placementhas been rewarding and certainly gaveme an insight into developing andimproving compliance strategics. Andthe best thing of all was that there wasno exam!!!

LAW & HEALTH CARE PROGRAM

Sriloot. OF LAW

UNIVERSITY OF MARYLAND BALTIMORE

515 WEST LOMBARD STREET

BALTIMORE, MD 21201

Non-Profit Org.U.S. Postage

PAIDBaltimore, MDPermit No. 1


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