Joel B. Teitelbaum

Training the 21st-century Health Care Team: Maximizing Interprofessional Education Through Medical–legal Partnership

For too long, many stakeholders in the health care delivery system have ignored the extent to which social determinants of health (SDH) are inextricably woven into and affect individual and population health. The health care system is undergoing a relatively rapid transformation, which has included in part an increasing recognition of SDH’s effects. This recognition, in turn, has led to renewed calls for changing the way that physicians are trained and has accelerated medical education curricular reforms. This Perspective focuses on one such innovative method of team-based care and the opportunities for its integration into medical education: medical–legal partnership, a health care delivery model that embeds civil legal services into the spectrum of health care services provided to low-income or otherwise vulnerable patients and communities.

State laws permitting intoxication exclusions in insurance contracts: Implications for public health policy and practice

This installment of Law and the Public’s Health examines the problem of state laws that permit various types of insurers to exclude from coverage all costs related to “intoxication” injuries and considers the implications of these laws for public health policy and practice. Although laws permitting insurers to use intoxication exclusionary clauses have fallen out of favor with the National Association of Insurance Commissioners (NAIC), nearly all states and the District of Columbia continue to explicitly or implicitly permit licensed insurers to exclude coverage for diagnostic and treatment services for conditions related to the use of alcohol or drugs.1 Such exclusions not only have potentially significant consequences for health care quality and financing, but also may impede efforts to protect the public’s health through efforts to encourage providers to promptly identify and begin treatment for acute intoxication and chronic substance use disorders. Indeed, laws permitting intoxication exclusions represent a fundamental disjunction between evidence-based medical care on the one hand and health financing on the other, since intoxication exclusions financially disincentivize precisely the type of medical response that has been identified as a benchmark of clinically appropriate medical care.2

Raising the bar on achieving racial diversity in higher education: The United States Supreme Court's decision in Fisher v. University of Texas

In Fisher v University of Texas, the U.S. Supreme Court revisited the constitutionality of race-conscious admissions practices aimed at fostering student diversity in university programs. Although it concluded that student diversity remains the type of compelling state interest that justifies consideration of race in admissions, the court nonetheless raised the bar on the use of such practices by requiring universities to prove that no workable race-neutral methods can produce the same result. Whether this standard of proof is one that can be met-and whether challenges will mount against universities that continue to use the holistic methods sanctioned 10 years ago in Grutter v Bollinger-remains to be seen. In this commentary, the authors review the background and history of the Supreme Courts decisions on race as a factor in university admissions decisions and examine the potential effects of Fisher on medical education specifically.

Obligation and Opportunity: Medical-Legal Partnership in the Age of Health Reform

This article was written in the immediate aftermath of the United States Supreme Courts 2012 term, which concluded with landmark decisions on voting rights 1 and same-sex marriage. 2 In the former...

DISTRICT OF COLUMBIA v. HELLER: IMPLICATIONS FOR PUBLIC HEALTH POLICY AND PRACTICE

This installment of Law and the Public’s Health concerns one of the most hotly contested constitutional issues underpinning public health policy and practice: the meaning and reach of the Second Amendment of the U.S. Constitution. The Second Amendment—“A wellregulated Militia, being necessary to the security of a free state, the right of the people to keep and bear Arms, shall not be infringed”1—has long been the subject of intense debate. One side of the argument maintains that the language of the Amendment confers an individual right to possess firearms for private use; the other side claims that possession and use of guns can only be tied to a collective right—namely, the right to preserve and arm state militias.2 Because the constitutionality of many gun regulations turns on this distinction, the public health policy implications of adopting one interpretation over the other are enormous. Prior to its June 2008 decision in District of Columbia v. Heller,3 which considered the constitutionality of a District of Columbia (D.C.) law banning the possession of handguns, the U.S. Supreme Court had never directly ruled on which interpretation of the Second Amendment was correct. Indeed, there is scant Supreme Court jurisprudence concerning the Amendment generally. Only a few times has the Court interpreted the Second Amendment; its most recent occasion was in 1939 in U.S. v. Miller,4 upholding a provision of the National Firearms Act requiring registration of sawed-off shotguns without fully addressing the individual/collective right distinction. In Heller, the Court addressed this division directly, holding that the Second Amendment protects an individual right to possess and use a gun for reasons unrelated to militia service.

Aetna Health, Inc. v. Davila: Implications for public health policy.

This installment of Law and the Public’s Health discusses the United States Supreme Court’s June 2004 opinion in Aetna Health, Inc. v. Davila1 and considers the decision’s implications for public health policy and practice. This long-awaited case clarifies that the Employment Retirement Income Security Act (ERISA) completely shields health insurers from liability under state law for injuries incurred by patients as a result of medically negligent coverage decisions. At the same time, Davila clarifies that when acting in a health care capacity, health insurers and health maintenance organizations (HMOs) remain liable for the consequences of negligent medical conduct. But because the central business of health insurers is coverage decision-making as opposed to medical care provision, Davila has far-reaching implications for access to remedies by patients who are harmed by substandard coverage determination practices.

From the schools of public health

This article discusses the collaboration of numerous institutions to implement an asthma education program for targeted schools in Hidalgo County, Texas, including the McAllen-Edinburg metropolitan area. The cooperating organizations range from academia to local government agencies to community-based organizations. The overall purpose of the program was to promote healthy indoor environments, with a focus on asthma and exposure to environmental triggers among low-income Mexican American elementary and middle-school students in Hidalgo County. Individuals with well-controlled asthma experience better health outcomes, such as reduced inpatient and emergency department visits and increased quality of life.1 By educating students with asthma, their parents, and personnel at all targeted schools, the partnering institutions aimed to reduce the number of missed school days and health-care encounters due to asthma while increasing the number of symptom-free days for asthma sufferers.