- Telemedicine has become a crucial tool during the crisis. 2017 paper discusses the regulatory barriers that had constrained it [Shirley Svorny, Cato Policy Analysis; earlier here, here, and here]
- “Wondered why it’s been so hard to ramp up production of surgical masks and respirators? Why haven’t private companies flooded into the market to meet peak demand? Because they are regulated medical devices and new versions require FDA approval which can take months to obtain.” [Paul Matzko thread on Twitter]
- Asking former health care workers to “dust off their scrubs” and return for the emergency raises possible liability exposures [Lori Rosen Semlies, Wilson Elser] “Coronavirus could affect med mal rates: Experts” [Judy Greenwald, Business Insurance]
- A closer look at certificate of need laws, which suppress hospital bed supply [Eric Boehm, related audio clip with Jeffrey Singer, earlier and more]
- More on the relaxation of occupational licensure in medical jobs during the emergency [Michael Abramowicz, Jeffrey Singer, earlier]
- Return with us now to those days not so long ago when public health specialists seemed to be in the paper every day inveighing against alcohol, dietary choices, and such like [Elaine Ruth Fletcher, Health Policy Watch last year on World Health Organization (WHO) rumblings against alcohol; JAMA on furious fight over red-meat recommendations]
So as to deploy medical services more effectively during the COVID-19 emergency, the Department of Health and Human Services has announced that it will forgo enforcement of rules restricting telemedicine, both by waiving HIPAA prohibitions on the use of everyday communications technologies like Skype and FaceTime, and by removing a requirement that reimburseable services be provided by the holder of an in-state license. At the same time, as I noted last week, many states have been relaxing rules prohibiting practice by out-of-state medical professionals (partial list here).
That’s part of a pattern in which governments are slashing many old regulations that they realize get in the way of crisis response and complicate the lives of ordinary citizens trying to work and shop under difficult conditions. My Cato colleague Chris Edwards links some of them in this post, including compilations by the Competitive Enterprise Institute and Americans for Tax Reform. (More: R Street Institute; Katherine Timpf, National Review. Hospitals and medical professionals aside, suspended rules include hours of service rules for truckers driving emergency medical supplies, requirements that Florida insurance agents keep public offices, rules forbidding the combined transport of food and liquor in Texas trucks, and federal standards restricting universities’ use of online classes. How many of these rules were unnecessary or unwise in the first place?
While movement of persons between communities may pose a danger during epidemics, movement of goods remains vital to prosperity and mutual exchange. Simon Lester points out in a Cato podcast that easing trade restrictions is a direct way to address difficult bottlenecks in emergency medical supplies. Relatedly, recent tariffs on medical supplies haven’t been helpful, encouraging large factories overseas to prioritize customers outside the U.S. (earlier).
In a reaction to the financial strains caused by the outbreak, the feds have been flooding the banking system with liquidity, both by relaxing regulations and through central bank operations. Cato’s Diego Zuluaga in a podcast distinguishes between liquidity objectives and (what is rightly more controversial) bailout objectives.
- Certificate-of-need laws in 38 states restrict hospital bed capacity by giving competitors a lever to object. More beds would have helped with emergency preparedness [Jeffrey Singer; more from Eric Boehm; bed crisis feared within weeks]
- White House, Congress negotiate on liability-limit measure aimed at freeing up 31 million expired but usable masks; “3M and Honeywell don’t feel comfortable providing them without assurances they won’t be sued.” [Michael Wilner, McClatchy; latest on HHS proclamation] Between death, business interruption, and enormous disruption to business practice, a landscape of litigation opens up [Bob Van Voris et al., Fortune]
- Proposed executive order would bar import of critical medical supplies from China, closing supposed “loophole” that could save your loved one’s life as shortages of ventilators loom [Ana Swanson, New York Times; Greta Privitera, Politico Europe on triage decisions at Italian hospitals reeling under equipment shortages]
- Courts canceling jury trials as virus spreads [Eric Turkewitz] Supreme Court building closes to public until further notice;
- Newark, N.J. threatens to prosecute persons who make false statements about the pandemic [Mike Masnick, TechDirt (“a masterclass in how not to deal with the problem of misinformation about the coronavirus”); Eugene Volokh (while some kinds of lies can be criminalized consistent with the First Amendment, many of those relevant here cannot]
- Memo to HR: EEOC has advised “that taking the temperature of all employees may violate the ADA under some circumstances, but has indicated that the rules may change during a pandemic” [Daniel Schwartz; employee temperature checks in Singapore]
Lawyers in suits and ties ransacked the Punjab Institute of Cardiology in Lahore, Pakistan, “beating up staff and smashing equipment…. The lawyers had been protesting over the alleged mistreatment of some of their colleagues by hospital staff last month. But the final trigger for the violence appears to have been a video posted on social media by a doctor on Tuesday night in which he poked fun at the lawyers.” Three patients died during the riot as medical staff could not care for them. [BBC]
“Maria Cvach, an alarm expert and director of policy management and integration for Johns Hopkins Health System, found that on one step-down unit (a level below intensive care) in the hospital in 2006, an average of 350 alarms went off per patient per day—from the cardiac monitor alone….
“Bed alarms have proliferated since 2008 when the Centers for Medicare and Medicaid Services declared hospital falls should ‘never’ happen and stopped paying for injuries related to those falls. After that policy change, the odds of nurses using a bed alarm increased 2.3 times, according to a study led by Dr. Ronald Shorr, director of the Geriatric Research, Education and Clinical Center at the Malcom Randall Veterans Affairs Medical Center in Gainesville, Fla. The alarms have become a standard feature in new hospital beds.” Meanwhile, in 2017 the same federal agency “began discouraging their widespread use in nursing homes, arguing that audible bed or chair alarms may be considered a ‘restraint’ if the resident ‘is afraid to move to avoid setting off the alarm.'” [Melissa Bailey, Kaiser Health News via Virginia Postrel; earlier here, here, and here]
From Institute for Justice’s Short Circuit newsletter: “How many times can an eye surgeon accidentally operate on the wrong eye before his surgical privileges are revoked? Three is the magic number at the Murfreesboro, Tenn. Veterans Affairs hospital. Sixth Circuit: And the revocation does not violate the due process of law.” [or constitute retaliation under employment discrimination law; Ahad v. Wilkie]
It is forbidden to save lives except in the prescribed location and manner: “In an effort to protect rural hospitals in Louisiana, state lawmakers have passed a bill that bans the creation of most freestanding emergency rooms.” [Alia Paavola, Becker’s Hospital Review]
- “How the Reformulation of OxyContin Ignited the Heroin Epidemic” [William N. Evans and Ethan Lieber, Cato Research Briefs in Economic Policy] Antiquated regulations on methadone need revision [Jeffrey Singer, Cato] Concept of addiction is constantly run together with that of dependence, and applied in such dubious areas as “social media addiction” [Singer]
- EEOC sues Tennessee hospital over lapse of religious accommodation in its mandatory flu shot policy (but is a mask as effective as the vaccine?) [EEOC press release]
- Free to Choose Medicine: a review [Thomas Hemphill, Cato Regulation magazine]
- Texas law limiting med-mal suits: “Fifteenth Anniversary of Proposition 12” [Texans Against Lawsuit Abuse]
- Time to include electronic components in the BAAA: “Biomaterials Access for the 21st Century” [Jim Beck]
- Affordable Care Act’s incentive program punishing hospitals for readmissions had unintended consequences, we know now. Were some of them lethal? [Tyler Cowen on Rishi K. Wadhera, Karen E. Joynt Maddox and Robert W. Yeh, New York Times]
- “Doctors as Data Entry Clerks for the Government Health Surveillance System” [Jeffrey Singer, Cato]
- “Judge Orders Spine Surgeon to Pay Discovery Fees Over Funding Model” [Greg Land, Daily Report Online (Atlanta); defense lawyer says case “throws a harsh light on the interaction between personal injury lawyers, healthcare providers and litigation funders”]
- What if feds’ enforcement policies on truthful off-label pharmaceutical promotion run aground on First Amendment considerations? [James Beck, Drug and Device Law]
- Chronic pain patients: “Civilian Casualties Continue to Mount in Governments’ War on Opioids” [Jeffrey Singer] Feds’ tightening of opioid scheduling cut refills, but increased number of pills initially prescribed [same] So sinister for psychiatrist to take cash payment and keep night hours in a rented office, or is it? [Ira Stoll]
- Certificate-of-need laws: “North Carolina Doctor Sues to Break Up State-Enforced Medical Cartels” [Christian Britschgi, Reason]
- Law firm of Morgan & Morgan, awarded contingency contract for Kentucky opioid suit, holds fundraiser for Kentucky AG Andy Beshear [Legal NewsLine]
- “Researchers from Duke and MIT… found that the possibility of a lawsuit increased the intensity of health care that patients received in the hospital by about 5 percent — and that those patients who got the extra care were no better off.” [Margot Sanger-Katz, New York Times]
- Cato Policy Analysis and podcasts (with Caleb Brown) by Terence Kealey: “The Feds’ Demonization of Dietary Fat” and “Why Does the Federal Government Issue Damaging Dietary Guidelines?” Related: Britain’s “food supply is being taxed, regulated and reformulated – on the pretext of a lie” [Christopher Snowdon, Spectator (U.K.)]
- New Jersey, a key state because of its volume of pharmaceutical liability litigation, joins national trend by adopting Daubert standard on expert evidence [Colleen O’Dea/N.J. Spotlight, Beck, John O’Brien/Legal NewsLine]
- “Criminal prosecution for violating HIPAA: an emerging threat to health care professionals” [Anne M. Murphy, Laura B. Angelini, and Jared Shwartz, STAT]
- Do-it-yourself workarounds for obtaining compounds blocked or restricted by FDA/pharma regulation, albeit entangled with IP issues. With bonus code-as-speech angle [Daniel Oberhaus, Vice Motherboard]
- “Hotels do want to tell you the real price. Until hospitals do too, they will find their way around disclosure regulations” [John Cochrane; related Cochrane on lack of price competition among air ambulances]