Tuesday, July 31, 2007

Washington pharmacists sue to block "morning after pill" law

From AHLA's Health and Life Sciences Law Daily:

Washington pharmacists sue state over requirement of morning-after pill. The AP (7/28) reported, "Pharmacists have sued Washington state over a new regulation that requires them to sell emergency contraception, also known as the 'morning-after pill.' In a lawsuit filed in federal court Wednesday, a pharmacy owner and two pharmacists say the rule that took effect Thursday violates their civil rights by forcing them into choosing between 'their livelihoods and their deeply held religious and moral beliefs.'" The state of Washington "ruled earlier this year that druggists who believe emergency contraceptives are tantamount to abortion cannot stand in the way of a patient's right to the drugs." However, the "state's Roman Catholic bishops and other opponents predicted a court challenge after the rule was adopted, saying the state was wrongly forcing pharmacists to administer medical treatments they consider immoral."
posted by Tom Mayo, 8:32 AM | link

Transplant surgeon charged in patient death

In what is reported to be the first ever such prosecution, a California transplant surgeon has been charged with prescribing excessive doses of morphine and Ativan to hasten the death of a disabled patient in order to harvest organs for transplant. The story is here (AP/Washington Post). I suppose the fact that this sort of case has never been brought before won't stop it from being hyped in the media. It certainly plays to the conspiracy fantasists' view of the transplantation world, despite the fact that many states' laws and all transplantation centers' policies call for a strict separation of the treatment and transplantation teams, precisely to avoid even the appearance of a conflict of interest.
posted by Tom Mayo, 7:23 AM | link

Monday, July 30, 2007

Medical tourism: Mexico for cost, quality, access

Today's Dallas Morning News has an article about the great medical care available south of the border for a fraction of the cost of comparable care here in Texas and without the delays and hassles. This is just the latest wrinkle in the unfolding story of medical tourism, which has already established India, Singapore, Malaysia, and Thailand as "go to" destinations for patients seeking high-quality, low-cost medical care.

My new colleague, Nathan Cortez, has an excellent piece on this phenomenon coming out soon in the Indiana Law Journal: "Patients without Borders: The Emerging Global Market for Patients and the Evolution of Modern Health Care." Here's the SSRN abstract:
This article addresses the unique legal, policy, and ethical questions that arise when patients travel to foreign jurisdictions for medical care. A growing number of patients are leaving the United States, and employers, insurers, and even government payors are beginning to explore whether they can reduce spending by utilizing hospitals and physicians in developing countries. Because this is a dramatic leap, it has generated countless media stories, and has drawn attention from the WHO, WTO, World Bank, and U.S. Senate - many of which believe so-called medical tourism may transform health care here and abroad.

Despite this attention, the market is developing independently of lawmakers and regulators. This is troubling because patients are effectively waiving their rights and benefits in the U.S. to seek medical care in countries that may not grant them remotely similar protections.

This article assesses the risk-benefit calculus for patients and payors entering the global patient market by examining how the market may affect health care costs, quality, and access - the three canonical themes of health care. Using this framework, I consider several policy responses, such as regulating patient travel, regulating referral networks, and regulating employers and insurers. Relying on previous regulatory efforts in analogous areas, I criticize some responses as either impractical or foreclosed by current constitutional doctrine governing the rights to travel and free speech. Instead, I propose that we build on existing consumer protection laws, expand licensing regimes, and recalibrate existing schemes that may unfairly allocate the risks and benefits. I also analyze the feasibility of public and quasi-public multilateral responses.

The underlying goal of this article is to examine how globalization is fundamentally changing health care. Medical tourism is both a symptom and a solution to what ails the U.S. health care system, and the issues it presents may portend future challenges.
posted by Tom Mayo, 8:09 AM | link

Health care law (including public health law, medical ethics, and life sciences), with digressions into constitutional law, poetry, and other things that matter