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

School of Law, University of Maryland at Baltimore

& HEALTH CAREN

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Volume II

Number 1

Fall 1995

In this issue:

Congressmen Ben Cardin and Robert Ehrlich

Speak on Medicare/Medicaid Reform 1

Hoffmann InvestigatoronAdvance Directives

Study 2

Director on Leave at NIH Office of

Research on Women's Health 2

L&HCP Adjuncts 3

Program News 3

L&HCP Faculty Notes 4

In The Health Law Clinic 5

Rothenberg Collaborates on NIH Workshop on

Genetic Information and Health Insurance 6

StudentHealth Law Organization News 6

Spotlight on Health Law Practicums and

Externships 7

Congressmen BenCardin and RobertEhrlich Speak onMedicare/MedicaidReform

The GOP proposal to overhaul theMedicare and Medicaid systems,predictably, has been a source of

daily fireworks in Congress and a causefor concern among those with the most

at stake theelderly, healthinsurers,doctors andhospitals.These are theinterest groupswith the mostto lose, andthey arescrambling totry to gauge theeffect of reform.

Congressmen Ben Cardin (D-Maryland) and Robert Ehrlich (R-Maryland), along -with the Mary-land Secretary ofHealth andMental Hygiene,Dr. MartinWasserman, andrepresentativesfrom HCFA,the AARP,the MarylandHospital Asso-ciation, theHeritage Foundation, and FamiliesUSA will convene at a conference at the

From the Director

The revolutionary proposals toreform Medicare and Medic-

aid are the current focus of much ofour attention this fall. As men-tioned in our lead article, two of ourCongressmen and Maryland'sSecretary of Health and MentalHygiene will discuss the reformproposals at an upcoming L&HCPConference in December. We arealso planning a larger, two-dayconference in the spring on themovement of Medicare and Medic-aid into managed care. OurL&HCP students are also veryinvolved in some ofthe currentreform at both the state and thefederal level. In this issue, onestudent talks about her experience inour Spotlight feature. Anotherstudent is working on the state's effortto overhaul the delivery of servicesunder the Medicaid Program.

We hope you enjoy the issue andhave a happy holiday season.

Diane Hoffmann, JD, MSActing Director

law school on December 4, 1995 todiscuss the Medicare and Medicaidreform proposals.

Rep. Ehrlich will he the keynotespeaker at the conference and willdiscuss the need for reform. Dr.Wasserman will speak about the

Cont. on page 7

0 1994, University of Maryland School of Law

Hoffmann Investigator OnAdvance Directives Study

L&HCP Professor DianeHoffmann, together withinvestigators from the University

of Maryland Schools of Medicine andSocial Work, recently completed astudy of Maryland's senior citizens andtheir attitudes about end of life treat-ment decisions and advance directives.The respondents were from both urbanand suburban areas and they werequestioned on their knowledge of andattitudes toward living wills and durablepowers of attorney for health care(DPAHC), and their preferences forlife-sustaining treatment under sce-narios involving terminal cancer,permanent unconsciousness, andadvanced Alzheiiner's disease. Therespondents also read and completed theMaryland Advance Directive Form, part

Law & Health CareNewsletter

is published by theLaw & Health Care Program

at theSchool of Law

University of Maryland

at Baltimore500 West Baltimore Street

Baltimore, MD 21201

Director:Karen Rothenberg, JD, MPA (on leave)

Acting Director:Diane C. Hoffmann, JD. MS

Faculty:

David A. human. JD, MD

Joan O'Sullivan, JD

Program Coordinator/Editor:Nancy Zibron, MA

Program Secretary:Jane Abramson

Comments and letters should beft rwarded to the above address.

of the Maryland Health Care DecisionsAct.

The study found that although a largepercentage of those questioned werefamiliar with the concept of a living will(about half were familiar with theDPAHC), only a quarter actually had aliving will or DPAHC. Factors signifi-cantly associated with having a livingwill or DPAHC were the presence of awill for estate distribution purposes, therespondent's race (Caucasian), absenceof children in close physical proximity,and education beyond high school. Themost common reason for obtaining somesort of an advance directive was therespondent ' s negative experience with

Jn September, L&HCP ProgramDirector Karen Rothenbergbegan a two-semester leave at the

National Institutes of Health (NIH),Office of Research on Women ' s Health(ORWH). As Special Assistant toORWH Director Dr. Vivian Pinn,Rothenberg is serving as an advisor ona variety of legal and ethical issuesarising from research on women'shealth.

In 1994, NIH promulgated guidelineson the inclusion of women in clinicalresearch. Rothenberg is working oneducation and outreach addressingunresolved issues arising from imple-mentation of the guidelines issuessuch as the inclusion of pregnant womenin clinical trials and innovative recruit-ment and retention strategies.

"It is exciting to be able to assist theresearch community in making the shiftfrom protectionism to a more equitableinclusion of women in clinical trials,"says Rothenberg,

Rothenberg's education and outreach

the illness or death of a relative.In their responses to questions about

life-sustaining treatment, three-quartersof respondents uniformly indicated theywould not wish to receive such treat-ment, regardless of the scenario ortreatment involved.

Finally, respondents found theMaryland Advance Directive Formconfusing, ambiguous and generallydifficult to complete. As a result, whenresponses on the form were checked forinternal consistency as well as consis-tency with responses given to verbalquestions similar to those on theadvance directive form, high rates ofinconsistency were found. Thesefindings point to the fact that muchneeds to be done to explain the functionof advance directives and increase theirrelevance and accessibility to thegeneral population.

efforts extend to both extramuralresearch-research done outside ofNIH-as well as research within theNIH community. She recently spoke atthe PRIM&R Annual Meeting in Bostonto help Institutional Review Boards(IRBs) understand the Institute ofMedicine's Report on Women andHealth Research-a Report commis-sioned by ORWH. Rothenberg ad-dressed the implications of the Reportfor IRBs and the research community,and also helped to organize two work-shops to field questions and commentsfrom I RB members.

Rothenberg is also responsible forincreasing ORWH's collaboration onthe ethical, legal and social implicationsof genetic research with the NationalCenter for Human Genome Research(NCHGR), the National CancerInstitute (NCI), and other nationalresearch institutes.

While on leave, Rothenberg plans tocontinue her scholarship in the areas ofwomen's health and genetics.

L&HCP Director on Leave atNIH Office for Research onWomen's Health

2 Law & Health Care Newsletter

LAW & HEALTH CARE PROGRAM

Lewis A. Noon berg

A.B., 1959, Dartmouth College

LL.B., 1962, University of Maryland

hey ' re getting stronger allthe time," Lew Noonbergsays without hesitation when

asked how health care law studentshave changed since he first startedteaching. Noonberg speaks from aposition of authority having been alecturer at the University of MarylandSchool of Law for nearly thirty years.

Noonberg is a partner in the Wash-ington office of Piper & Marbury,Baltimore ' s largest law firm. Hereceived his LL.B. from the law schoolin 1962 and is a former AssistantAttorney General for the State of

Maryland. He began teaching FederalJurisdiction in 1967, Antitrust Law in1980, and added the Antitrust andHealth Care Law Seminar in 1986.

Noonberg says his interest inantitrust and health care law wasstimulated at the height of the Reagan-Bush administration. Around thattime, traditional antitrust law wasbeing slowly eroded while antitrust andhealth care law was growing steadily.When Karen Rothenberg foundedMaryland ' s Law & Health CareProgram in the 1980s, Noonbergrecalls that he and Rothenberg would

get together "to talk about health careissues."

"Karen's enthusiasm was infec-tious," says Noonberg, "and consider-ing my own interests at the time, it justseemed a natural fit for me to developthe antitrust and health care lawcourse."

Talking about trends in the antitrustand health care law field, Noonberg'sown enthusiasm is apparent. " It ' s aconstantly evolving market," he says,"and the market is more dynamic thanany 1 have seen in thirty years. Thegroups involved-third-party payers,institutional providers, individualproviders (as well as the governmentand special interest groups) areeconomically at war. From a legalstandpoint, it's a fascinating situa-tion. "

The enthusiasm and "real world"experience that instructors like LewNoonberg bring into the classroomhave played a part in garnering thenational recognition the L&HCP hasenjoyed recently. They are a valuedpart of the Program.

cc

Program news . .

Vivian W. Pinn, MD

Frances AI Disco, JD

At the L&HCP'srecent conference:"Breast Cancer:Controversies andChallenges," Dr.Vivian Pinn, Associ-ate Director of NIHfor Research onWomen 's Health,spoke on "Meeting theChallenges in BreastCancer Research "and Fran Vi.sco,President of theNational BreastCancer Coalition,delivered the keynote.speech.

Dean Gifford presentsthe Second AnnualGeriatrics and Geron-tology Education andResearch ProgramAward in recognition ofthose students who haveshown a special interestand expertise in thefield of elder law.

From left to right: Barbara Puffier, 3D, KarenGallo, 3D, and Dean Donald Gifford.

...and the Best Brief winner is!

Congratulations to our National Health Law Moot Court Teamwhich won Best Brief in the competition held at Southern Illinois

University School of Law on November 3-4, 1995.Students Karen Gaily, Andrea Imredy and David Clissold wrote the

brief and Karen Gaily, David Querido, and David Clissold argued.Our team was undefeated at the end of the first round and placed 9th

of 24, missing advancing to the quarter finals by 1.6 points. ProfessorsDavid Hyman and Joan O'Sullivan were coaches.

Law & Health Care Newsletter 3

L&HCP Faculty Notes . .PROFESSOR KAREN ROTHENBERG to the Right to Receive Treatment,"

"PartnerNotification, Domestic Violence University of Maryland at BaltimorePublications: & Women with HIV," Violence and HIV (UMAB) Breakfast Roundtable on "The"Genetic Discrimination and Health in- Conference, National Association of Graying of America: Challenges andsurance: An Urgent Need for Reform, " People With AIDS & The New York Gay Opportunities," Baltimore, MD (1995)with K. Hudson, L. Andrews, M.J. Kahn, & Lesbian Anti-Violence Project (1995)and F. Collins, 270 Science 391 (1995) "Ethical and Legal Issues in Gene

"TB Control in the Age of AIDS," 16th Diagnosis," Conference for Newly"The Risk of Domestic Violence and Annual Health Law Teachers Conference Elected State Legislators, sponsored byWomen with HIV Infection: Implications of the American Society of Law, Medi- the Greater Baltimore Committee,for Partner Notification, Public Policy, cine, and Ethics, Chicago, Illinois (1995) Baltimore, MD (1995)and the Law," with S. Paskey, 85 Ameri-can Journal ofPublic Health 1569 (1995) Selected Appointments:

Member, American Law Institute (ALI) ASSOCIATE PROFESSOR"Domestic Violence & Partner Notifica-

(1995-) DAVID A. HYMANtion: Implications for Treatmnentand Coun-seling of HIV-Infected Women, " with S.

Member, The National Advisory Board Selected Appointments:Paskey, M. Reuland, S. Zimmerman & R.North, 50 Journal of the American Medi- on Ethics in Reproduction (1995-) Named to Privacy/Confidentiality

cal Warren 's Association 87 (1995) Workgroup for the Maryland HealthCare Access and Cost Commission

Selected Presentations: ASSISTANT PROFESSORThe Institute of Medicine's Report on DIANE HOFFMANN Visiting Lecturer at the University of

Women and Health Research: Implica- Maryland Dental School on

tions for IR B's and the Research Commu- Publications: "Fundamentals of Health Law"

nity," PRIM&R Annual Meeting, Boston, "Handbook for Nursing Home EthicsMassachusetts (1995) Committees," with P. Boyle & S. Other:

Levenson, American Association of Co-Coach (with Joan O'Sullivan) of"Genetic Testing and Managed Care," Homes & Services for the Aging National Health Care Moot Court TeamAmerican Society of Law, Medicine and (AAHSA), Washington, D.C. (1995)Ethics Annual Meeting, Boston, Massa-chusetts (1995) Selected Presentations: VISITING ASSISTANT

"Emergency Care and Managed Care"Women and Genetics:

Ethical, Legal PROFESSOR JOAN O ' SULLIVAN-A Dangerous Combination for

and Social Implications, " The Jacobs Patients (or Catch 22 for EmergencyInstitute ' s Women's Health Series (1995) Selected Presentations:

Doctors - The Conflict of Anti- "Ethical Aspects of Guardianship,"Dumping and HMO Policy), " Annual

"Tissue Banks and Repository Issues: Clifton T. Perkins Hospital (1995)Meeting of the American Society of

Lessons for the Past: Challenges for the Law, Medicine & Ethics, Boston, MAFuture, " panelist at DOE-NIH Confer- "Long Term Care Issues," House of

ence, Bethesda, Maryland (1995)(1995) Delegates Environmental Matters

Committee Health Retreat, Woodmont,"Research Involving Cognitively

"Genetic Information and Health Insur- MD (1995)Impaired Individuals-A Report from

ance:

State Legislative Approaches, "Maryland, " at Humanistic Aspects ofWorkshop on Genetic Discrimination and Other:Research in Long Term Care: AHealth Insurance: A Case Study on Breast Co-Coach (with David Hyman) ofConsensus Conference sponsored by theCancer, Bethesda, Maryland (1995) National Health Care Moot Court TeamAmerican Medical Directors Associa-

"Predictive Genetic Testing and Public tion, Washington, D.C. (1995)

Policy: Legal, Ethical, and Societal Chal-"Legal and Ethical Issues in Providinglenges," General Motors Cancer Research

Foundation Conference, Bethesda, Mary- Medical Care to the Elderly in the Year2000-The Right to Refuse Treatment

land (1995)

4

Law & Health Care Newsletter

IN THE HEALTH LAW

CLINICThe law school offers, as pa rt 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.

The health law clinic uses a ratherloose definition of "health law"when deciding whether a particu-

lar case fits within our bailiwick. Gener-ally, we limit the cases we accept tothose in which health care or the healthcare delivery system is a prime focus.For example, we have accepted guardian-ship cases that teach students aboutstandards for mental competency,community heath care systems and thediseases of the aged and disabled. Debtcollection cases involving hospital ordoctor ' s bills teach about how wellhealth insurance programs cover, or donot cover, a person ' s need for healthcare.

When the client is elderly, almost anycase we accept will teach some aspect ofhealth law, so pervasive are healthproblems in the lives of older persons.One case in particular, involving an 86year okl client, clearly illustrated thispoint last semester. If a younger personhad been the client, the law that thestudent attorneys learned would haverelated to fraud, undue influence, forgery,breach of fiduciary duty and real prop-erty. But because the client was older andvery ill, the pertinent law also includedstandards for mental competency, accessto medical records, rules of discovery topreserve testimony, rights of nursinghome patients, Medical Assistance andMedicare regulations, rules for draftingpowers of attorney and advance medicaldirectives, and intestate succession.

by Joan O'Sullivan, JD

At first this case seemed to be a caseof financial abuse of an elderly womanby a young man whom she trusted. Thestory, as related by a social worker atthe City ' s Adult Protective ServicesDivision, was that the young man hadadded his name to the client's deed, lifeinsurance policy and checking accountswithout her knowledge a year before.She had only recently learned of thedeception, and wanted to "get her houseback." The case came to us at aninopportune time for law students, aboutthree weeks before final exams started,but clinic students Barbara Fuller andTi'i Etokebe, after talking to the client,decided that we had to take the case tocorrect a grave injustice.

The first hurdle was to determinewhether our client, Mrs. G., wascompetent to hire us and whether hermemory was intact enough for us to relyon her testimony. She had recently beenhospitalized due to complications from ahip replacement a year earlier, and wewere uncertain about her mental state.Before we went to see her, Fullerbriefed herself on the definitions ofincompetency and on the rules ofprofessional conduct which governrepresenting a client who is question-ably competent. This preparation wasunnecessary, however, for we found ourclient to be bright and sharp, and feelingvery angry at being betrayed by Mr.W., the grandson of her longtime friend.She told us Mr. W. had volunteered tohelp her with her bill paying after herhusband died, and had access to herfinancial papers and a key to her house.

Mrs. G. could not account for the factthat a deed transferring a half interest inher house to Mr. W. appeared to haveher signature on it, but she did remem-ber that she had been in the hospital atthe time the deed was signed. Fuller, a

former medical records administrator, setout to verify this hospitalization. How-ever, in order to convince the custodianof the hospital records to release them toher, she had to argue from Maryland'sstatute regarding the confidentiality ofmedical records.

In the meantime, Etokebe was re-searching the law regarding fraudulentconveyances of real estate. He soonrealized that Mrs. G.'s testimony wouldbe crucial to our case. He is a registeredpharmacist, and his experience withelderly patients caused him to recommendthat we immediately preserve her testi-mony in case her condition deterioratedlater. He began arranging to take avideotaped deposition in the hospital,even before we filed the petition to setaside the fraudulent deed. However, inanother lesson about how health lawaffects the elderly, Medicare informedMrs. G. that her condition had improvedto the point that she no longer neededacute hospital care. Etokebe startedarranging the deposition all over againwith the nursing home to which Mrs. G.was moved.

Negotiations were also proceeding withMr. W., who, at first, would assertvigorously his right to Mrs. G's property,and then later would agree to return itvoluntarily to her. Despite his promises,he failed to sign the deed we sent him.We served him with the notice of thedeposition, and consulted with Mrs. G.'sdoctor about whether his appearance atthe deposition would cause Mrs. G.undue stress, on top of that caused by avideo camera operator and a courtstenographer setting up in her nursinghome mom. He thought she could handlethe confusion, and arrangements pro-ceeded.

The nursing home administration co-operated with our unusual request tovideo tape their resident up to the point at

Cont. on page 8

Law & Health Care Newsletter 5

Rothenberg Collaborates on NIHWorkshop on Genetic Informationand Health Insurance

Wbile recent scientificadvances have helped toidentify an ever-growing

number of genetic alterations whichplace individuals at risk for certaindiseases, these same advances haveraised profound questions. Who willhave access to genetic information?How will this information be used byinsurers and employers?

On July 11, 1995, the NationalAction Plan on Breast Cancer(NAPBC) and the National Institutesof Health-Department of Energy(NIH-DOE) Working Group on theEthical, Legal and Social Implications(ELSI) of Human Genome Researchorganized a workshop, entitled,"Genetic Discrimination and HealthInsurance: A Case Study on BreastCancer."

As a member of the NAPBC BreastCancer Susceptibility Gene WorkingGroup, Professor Karen Rothenberghelped to organize the workshop andpresented her analysis of state legisla-tive approaches in this area.

The first state laws addressinggenetic discrimination and health

insurance were limited in scope andfocused primarily on discriminationagainst people with a single genetic trait.Since the Human Genome Project waslaunched in 1990, eight states haveenacted more extensive legislation.These states (California, Oregon,Colorado, Minnesota, Wisconsin, Ohio,Georgia and New Hampshire) prohibit:

♦ requiring or requesting anindividual or a family member toobtain a genetic test,

♦ requiring or requesting directly orindirectly the results of a genetictest,

♦ conditioning the provision of in-surance coverage or benefits ongenetic testing, and

♦ considering genetic testing in thedetermination of rates.

Nearly all of the state laws focusnarrowly on genetic tests, rather thanmore broadly on genetic informationgenerated by family history, physicalexamination, or the medical record.Currently, there is no federal legislationwhich protects individuals from being

denied health insurance on the basis ofgenetic information.

Rothenberg ended her analysis with aseries of questions which helped toframe the policy discussion at theworkshop. As published in the October20, 1995 issue of Science, the ELSIWorking Group and the NAPBCdeveloped the following recommenda-tions for state and federal policymakers:

1) Insurance providers should beprohibited from using genetic informa-tion, or an individual's request forgenetic services, to deny or limit anycoverage or establish eligibility,continuation, enrollment or contributionrequirements.

2) Insurance providers should beprohibited from establishing differentialrates or premium payments based ongenetic information or an individual'srequest for genetic services.

3) Insurance providers should beprohibited from requesting or requiringcollection or disclosure of geneticinformation.

4) Insurance providers and otherholders of genetic information should beprohibited from releasing geneticinformation without prior writtenauthorization of the individual. Writtenauthorization should be required foreach disclosure and include to whom thedisclosure would be made.

Student Health Law Organization(SHLO) News

The Student Health LawOrganization kicked off the fallsemester with an informational

meeting for students to learn about theSI ILO. The sixty-two member SHLOis headed by an executive committeestaffed by the following students:

Co-chairpersons-Karen Russell Gailyand Andrea Imredy

Treasurer-Claudia ZuckermanSecretary-Brenda Douglas

Networking & Career Chairperson-Robyn Glassman

Events Chairperson-John Pucker

Curriculum Chairperson-Suzanne Jenkins

Community Outreach ChairpersonBatina Wills

Additionally, Erica Cook sits on theexecutive committee as an at-largemember.

Students are excited by a new serviceoffered for the first time this fall: amentoring program organized by theSHLO and the University ' s Law &Health Care Program. Students wishingto learn more about a certain aspect ofhealth law, or desiring to network withlocal practitioners, are matched with

health lawyers in the Baltimore regionwho have generously volunteered theirtime. Currently there are twenty-onementors participating in the program,and the SHLO and Law & Health CareProgram hope to continually add morementors to meet student needs.

In September, the SHLO co-spon-sored with the Federalist Society acampus visit by John S. Hoff, a partnerwith the Washington, D.C. office ofSwidler & Berlin. Mr. Hoff discussedMedicare Voucher Reform and otherreform proposals circulating CapitolHill.

The SHLO raised money during thefall semester for the Alzheimer ' sAssociation, and participated in that

Cont. on page 8

6 Law & Health Care Newsletter

Spc tli/ \N

The legislative bell rings threetimes. I flip through my InternHandbook to find out what three

rings mean, ahh - three rings - a call ofthe absentees to vote. The first week ofmy Health Care Practicum at the U.S.Senate in Senator Barbara Mikulski'sOffice was filled with questions andmany new experiences. Not only was Iexcited to work on health care issues, Iwas also excited to learn about Con-gress and its inner workings.

Initially, l was given a tour of theHart and Dirksen Senate office build-ings. Along with the hundreds ofoffices, the Senate building includesseveral cafeterias, barber shops, giftstores, a laundry, bank, post office,library, stationery store and an under-ground metro to the Capitol. It is like amini-city with security and transporta-tion, except unlike most cities, there isno sales tax. The next stop on my tourwas the Capitol Building which wasvery impressive with its exquisitelydesigned ceilings, House and Senatefloor, beautiful paintings and sculptures.

Soon the excitement of being onCapitol Hill was over and the workpiled high. i was assigned to work onthe Subcommittee on Aging whichhandles health care issues for theelderly. Senator Mikulski is theranking minority leader for this subcom-mittee. My assignment includedMedicare reform issues, such asMedicare fraud and abuse, the implica-

by C. Diane Wallace-Booker, 3D

lions of Medicare beneficiaries movinginto managed care, the Patient Accessto Specialty Care Act and other similarissues dealing with reform.

The pace of a Senator's office israpid with Legislative Aids, interns andstaff buzzing through the halls to attendmark-up meetings and various confer-ences. The phone rings constantly withcalls from special interest groups andconstituents desiring to voice theiropinions. And the legislative bells ringall day long to alert Senators to a floorvote, a Quorum call, Roll Call Voteand the like. I like the fast pacebecause it means I have an opportunityto work on something different everyweek.

I work on the Hill two days a week,which has only given nee a glimpse ofthe everyday life of Congress. In themonth that I have left to complete myPracticum, I hope to work on severalmore substantive projects involvingMedicaid reform. I feel this experience

The Law & Health Care Program's

Health Law Practicum Program

(dedicated to Louis D. Asper, a

Maryland Law School professor who

advocated practical t raining fnr stu-

dents) provides an opportunity for

students interested in health law to

obtain credit by working frp- organi-

zations and government agencies

dealing with health care issues. Stu-

dents spend 10 to 20 hours at their

placement and additional hours

throughout the semester in the class-

room participating in a health law

workshop. Placements have included

the American Nurses Association;

FDA; Johns Hopkins Hospital, Office

of the General Counsel, Med-Chi of

Maryland,- Medlantic Healthcare

Group; National Health Law Pro-

gram; N1H; U.S. Senate Special

Committee on Aging; University of

Maryland Medical System, Office of

the General Counsel; and the Office

of the Attorney General, General

Litigation Unit and Medicaid Fraud

Unit.

The Program has also offered ,four

full semester externships-The Na-

tional Health Law Program

externship in Washington, D.C.; The

University of Maryland externship,

located in University Hospital's Gen-

eral Counsel 's office; Blue Cross/

Blue Shield of Maryland (BCBSM),

and the Health Care Access and Cost

Commission.

has been a very valuable part of my legaleducation. While working for aSenator's office offers a very differentexperience than working for a healthcare organization, I believe I havelearned a lot of substantive health carelaw and especially health care policy.

HEALTH LAW PRACTICUMS AND

EXTERNSHIPS: U.S. Senate-The

Subcommittee on Aging

Cardin and Ehrlich Speakat ConferenceCont. from page 1

proposal ' s effect on Maryland and Rep.Cardin will provide some insight intothe "politics" surrounding the

proposal ' s move through Congress.At present, the proposal increases pre-

miums for some beneficiaries, encour-ages the use of managed care, caps pay-ments to doctors and hospitals, and al-lows patients to choose among differenttypes of health care plans, including a

high deductible plan in conjunction with amedical savings account. The GOP Med-icaid proposal shifts responsibility to Stategovernment, guaranteeing a lump sum pay-ment to States restricted by few federalcaveats.

Law & Health care Newsletter 7

In The Health Law ClinicCont. from page 5

which we asked them to leave the roomduring the deposition, when we pointedout that Mrs. G. had the right to privatevisits under Maryland's nursing homepatient's bill of rights.

Mrs. G. gave lucid, strong testimonyduring the deposition, so strong that wewere confident that we had a goodchance to win back the ownership of herhouse. Mr. W. did not appear, but just aswe were concluding the deposition, intrue Hollywood style, there was a knockat the door. It was the nursing homesocial worker with a letter for Mrs. G.which had just been dropped off at thefront desk. I nside was a deed signed byMr. W., returning to her all his rights inher property. (The social worker hadopened the envelope on the way to give itto Mrs. G., though she claimed she didn ' tread it. Fuller later pointed out to her thatthe nursing home bill of rights alsoguaranteed residents the right to un-opened mail.)

Mrs. G. was delighted with the return

of her property and Fuller quickly drafteda new will for her, along with a power ofattorney and an advance directive formedical care, to ensure that she was nottaken advantage of again. Sad to say, shedied a few days later, but with theknowledge that her house would go toher beloved niece, and not to the unscru-pulous Mr. W.

In a few short weeks thesehardworking and dedicated clinicstudents learned volumes of health lawwhile achieving an excellent result fortheir client. We all were reminded ofhow intertwined health law is in the livesof older persons in the United States, andthe importance of learning it in lawschool.

SHLO NewsCont. from page 6

association ' s annual "Memory Walk " inMemorial Stadium, on October 22.

Professor Diane Hoffmann enlightenedstudents in October about what it waslike to spend a one-year sabbatical onCapitol Hill working on health care

reform legislation with Senator BarbaraMikulski. After describing the historyof the recent health care reform debateand how the legislative process changed,and eventually killed, the health carereform legislation, Hoffmann describedwhat the working environment is like onCapitol Hill, particularly under thetutelage of Senator Mikulski.

In November, the SHLO sponsored a"Meet the Health Law Faculty" recep-tion to promote L&HCP courses and toafford students a chance to meet withprofessors informally.

Events planned for the springsemester include a panel discussion onhealth care reform in Maryland, a careersymposium entitled "Non-traditionalChoices in Health Law Careers " , a jointmeeting with the Health Law Section ofthe Maryland State Bar Association andan all-day event entitled "How to Be AnInformed Medical Consumer, " wheremembers of the law school communitywill learn about health care advancedirectives, how to report medicalmalpractice, and consumers ' rights whendealing with insurance companies.

LAW & HEALTH CARE PROGRAM

SCI 1001.Or LAwUNIVERSITY OF MARYLAND AT BALTIMORE

500 WEST BALTIMORE STREET

BALTIMORE, MD 21201

Non-Profit Org.U.S. PostagePAIDBaltimore, MDPermit No. 2439

8 Law & Health Care Newsletter