The Ethical Roundabout

Healthcare News and Ethical Issues from June 1 - 14

Federal:

Health Affairs: The Trump administration has revoked a guidance letter issued by the Centers for Medicare & Medicaid Services (CMS) that previously clarified hospitals' obligations to provide emergency abortions under the Emergency Medical Treatment and Labor Act (EMTALA). This action by the federal executive branch withdraws the Biden-era interpretation that EMTALA required hospitals receiving federal funds to offer stabilizing treatment, including abortion, even in states with restrictive abortion laws, if a pregnant patient's life or health was at serious risk. While CMS stated it will continue to enforce EMTALA, the lack of explicit guidance is expected to further complicate medical decision-making in states with abortion bans.

The National Law Review: In Arkansas, pharmacy benefit managers (PBMs) have filed a lawsuit against the state over a new, restrictive PBM ownership law. This legal challenge targets Arkansas Act 1063, which prohibits PBMs from owning or operating pharmacies in the state, aiming to address concerns about vertical integration and potential anti-competitive practices within the pharmaceutical industry. The PBMs argue that the law is unconstitutional and unlawfully restricts their business operations. This lawsuit is a significant development in the ongoing national debate about regulating PBMs, with the outcome potentially impacting the structure of pharmacy services and drug pricing in Arkansas and beyond.

State:

Copper Courier: In Arizona, the Governor has signed a bill aimed at improving maternal healthcare access and outcomes for new mothers. House Bill 2332 focuses on expanding postpartum care and support for women after childbirth. The new law is intended to address gaps in maternal care that contribute to adverse health outcomes, particularly in the critical postpartum period. The specific provisions of the law seek to enhance services and resources available to new mothers across Arizona.

OAG TX: Texas Attorney General Ken Paxton has taken legal action against the genetic testing company 23andMe to protect Texans' rights to their genetic information. This executive action by the state's top legal officer involves initiating an investigation and potential enforcement against 23andMe regarding the security and privacy of consumer genetic data. The Attorney General's office is examining whether the company's practices adequately safeguard sensitive genetic information and comply with Texas consumer protection laws, particularly in the wake of recent data breaches affecting similar services.

VT Digger: In Vermont, House Bill 482, concerning health insurance, grants the Green Mountain Care Board significant new powers over hospitals and insurers. This legislation authorizes the Board to reduce hospital reimbursement rates for health insurers facing bankruptcy risks. Furthermore, it permits the Board to decrease a hospital's budget if it exceeded its budget in the preceding year and allows for the appointment of an independent overseer to hospitals deemed potentially non-compliant by the Board.

ABC Nebraska: In Nebraska, a prior authorization bill has successfully passed through the state legislature. LB 77, legislation aims to reform the process by which health insurance companies require prior approval for medical services and prescriptions, with the goal of streamlining patient access to care. The bill introduces new regulations for insurers regarding the timeliness and transparency of prior authorization decisions.

NY Capitol News: The New York Senate has passed the Medical Aid in Dying Act (S138/A136), sending it to Governor Kathy Hochul for final consideration. This legislation would permit mentally capable, terminally ill adults with a prognosis of six months or less to live to request and self-administer life-ending medication. The bill includes various safeguards designed to ensure patient autonomy and prevent coercion. Its passage marks a historic moment for end-of-life care advocacy in New York, aiming to provide a dignified option for terminally ill individuals while sparking ongoing ethical debates.

JR Report: The Nevada Governor has vetoed a bill to address the state’s nurse-patient staffing ratios. Senate Bill 182 would have established maximum nurse-to-patient ratios in hospitals and mandated specific staffing levels for various hospital units based on patient acuity, to improve patient safety and reduce nurse burnout. However, Governor Lombardo’s veto was based on their concerns that such rigid ratios would hinder hospitals' flexibility, exacerbate existing nursing shortages, and potentially lead to reduced services.

NOLA: In Louisiana, the state legislature has passed the "Justice for Victims of Abortion Drug Dealers Act." House Bill 575 would create new legal avenues for individuals to sue anyone involved in the illegal distribution of abortion-inducing drugs within the state. The legislation aims to penalize those who provide abortion medication outside of the regulated medical system, allowing civil penalties against such individuals.

Glances Abroad:

CBC: In British Columbia, Canada, a Charter challenge has been launched against the province's Mental Health Act regarding its "deemed consent" provisions. This legal challenge argues that the Act, which allows for involuntary psychiatric treatment without explicit patient consent in certain circumstances, violates fundamental rights under the Canadian Charter of Rights and Freedoms. The case specifically contends that the deemed consent provisions undermine patient autonomy and the right to liberty for individuals experiencing mental health crises.