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| Vol. 20, No. 23 |
| December 15, 1998 |
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Health Law and Policy Institute Celebrates 20th Year by ROGER WIDMEYER Texas Medical Center News The Health Law and Policy Institute of the University of Houston Law Center - the best center in the U. S. for the study of health law, according to U.S. News and World Report, which has named the Institute as such since 1994 - is readying for its 21st year, and it might be one of the busiest and most challenging yet for the Institute. Established in 1978 by the U of H Law Center, the Institute prepares students of law for the challenging and exciting arena of health law.
During the Institute's 20 years, dramatic changes have taken place in the health care industry and, more and more, institutions in the Texas Medical Center and legislators in Austin and Washington are relying on the Institute for answers to legal and policy questions in health care matters. On a daily basis, stories in the news deal with immediate and often controversial topics in health law: medical malpractice, ethical and legal issues of genetic studies, managed care, euthanasia, occupational safety, discrimination issues. "We've passed a critical stage in our growth," says Mark A. Rothstein, director of the Health Law and Policy Institute and the Hugh Roy and Lillie Cranz Cullen Distinguished Professor of Law. Rothstein, who received his J.D. in 1973 from Georgetown University, has been director of the Institute since 1986. "Now our reputation is such that requests are coming to us. Quite a few requests and proposals in fact. Even offers of financial support have come to us, so this is very gratifying." "The Institute has both the resources and the reputation now to offer some very unique things to the public, the Texas Legislature, and our colleagues in the Texas Medical Center," according to Shelby Rogers, executive vice president, chief administrative officer, and general counsel of Texas Medical Center and board member of the Health Law and Policy Institute. "The Institute is correctly perceived today by our health care community to be a place of expertise in the field of health law, and a place of innovation in the development of future health policy, and we are very proud of its work." The Health Law and Policy Institute has 12 faculty members, six full-time teaching faculty and six research faculty. More than 20 health law courses are offered, including Health Law and Policy, Health Care Finance and Policy, Legal Aspects of Bioethics, Genetics and the Law, Reproductive Health Law, Law and Psychiatry, Occupational Health Law, Food and Drug Law, Medical Malpractice Litigation and Correctional Health Law. Besides a specialty in health law, the Institute offers three other programs. A student may receive a degree in law (J.D.) with a masters in public health (M.P.H.); this three and one-half year J.D./M.P.H. program is one of only five in the country. The J.D./M.P.H. program is a collaborative program with the Institute and The University of Texas-Houston School of Public Health. In conjunction with The University of Texas Medical Branch at Galveston, the Institute offers a J.D./Ph.D., a law degree with a doctor of philosophy in medical humanities. The program takes five to six years to complete. The Institute also offers a Master of Law degree (LL.M.) to individuals already holding a J.D.; the program consists of 24 semester hours in health law. Additionally, the Institute offers Semester in Houston, a program where second and third year law students at other law schools can spend one semester in Houston studying health law. Students have come to study from the country's other prestigious law schools. "We teach health law to about 300 Law Center students each semester, and the Institute has between 50 and 75 graduates each year," says Rothstein. "They are great students, and many have gone on to assume leadership roles in the health care field, like Dr. Bruce Levy who is the executive director of the State Board of Medical Examiners. And many of our students do their internships in various Texas Medical Center institution counsel offices. Having the Texas Medical Center so close is what we call 'The Houston Advantage,'" he says. The Institute is committed to public education. Recently, Rothstein and his colleagues have begun sending weekly press releases about "hot topics" to all Texas newspapers. The Institute's Web page - www.law.uh.edu/healthlaw - is constantly updated with perspectives on current health issues. With health care becoming the fastest growing sector in the U.S. economy, and with hundreds of legal and ethical questions arising from the changed health care environment and new research technologies, the time seems "right" for the Health Law and Policy Institute. In an advisory role, the Institute has made enormous contributions to the state of Texas. "Our legislature meets in Austin every two years, for 140 days," says Rothstein. "That's not very much time, and their staffs - especially on the House side - are very small. Because the bioethical issues can be very complex, and because our legislators do want a long-term picture of health care, they need and appreciate our work." In 1991, the Texas Legislature appropriated special funds - $294,000 - for the Institute to research occupational injury and illness in Texas. It was the first of three major research projects requested by the Legislature: in 1993, the Legislature appropriated $283,000 for the Institute's research on nonfinancial barriers to health care in Texas, and in 1995, appropriated another $518,000 for the Institute to study family violence and the health care system in Texas. In the last session of the Legislature, an appropriation of $595,000 was renewed. During this session, the Institute began publishing the monthly newsletter "Update on Health: A Monthly Briefing for the Texas Legislature" for the legislators. The publication is researched and written largely by the Institute's five research faculty members. "The publication looks at state and national issues and policies, and of course we are available to the legislators for more in-depth studies," says Rothstein. In the October 1998 issue of "Update on Health," the topics included a federal district court's upholding of a patient's right to sue a managed care organization, but struck down the provision of "independent review"; a brief discussion of Texas' "report cards" on HMOs; discussion of FDA approval of drugs; CDC's warning on vaccines for children; an update on the Human Genome project; and several other articles. "The legislators - and their staffs - appreciate the publication," says Rothstein. The Institute responds to individual requests from the legislature. During the last session, reports were prepared for Senators and Representatives on epilepsy services in Texas, health care provider billing errors, reimbursement for antipsychotic medication and related treatment, the impact of House Bill 39 which prohibits certain forms of genetic discrimination, the conversion of non-profit hospital to for-profit, costs of HIV care and infant mortality. "The 76th Legislature, which convenes in January, will have a number of interesting issues to consider," says Rothstein. "The second phase of the CHIPs (Children's Health Insurance Program) will be up for adoption. The Indigent Health Care and Treatment Act may be amended. And under the Sunset Commission, about 150 agencies must justify their necessity. So we may be busy. "I think what we are most pleased about is that, in the beginning of our work with the Legislature, many thought it would be very difficult for us to remain non-partisan. But we are committed to that. We have to be, of course, to be taken seriously." The Institute has received funding for research from other sources besides the Legislature. The National Institutes of Health underwrote the 1991 conference "Legal and Ethical Issues Raised by the Human Genome Project." In 1995 the Federal Judicial Center asked the Institute to host a seminar on health law for 30 federal district court and circuit court judges from throughout the U.S.; since that initial seminar, Institute faculty have participated in five additional seminars. The Texas Cancer Council has awarded three grants for the Institute to prepare informational publications, "Cancer and the Law: 1998" and "Choosing a Health Care Plan," to be distributed to all cancer patients in Texas. The National Institute on Disability and Rehabilitation Research, U.S. Department of Education, has awarded a $50,000 grant to the Institute. Recently, the Houston Endowment has awarded a grant to support the Institute's research projects. Rothstein is especially excited about partnerships established for the End of Life Project, pending final funding from the Robert Wood Johnson Foundation. "With UTMB and partners throughout the state - the Texas Hospital Association, Texas Medical Association, the Texas Nurses Association, and others - we want to promote public and professional education about this aspect of health care, and help develop rational policies." Clearly, the Institute is not only winning friends but influencing policy. And not just at home, but abroad: in 1995, the World Health Organization selected the Health Law and Policy Institute to consult on health legislation in 35 countries in Asia. "In the beginning of our relationship with the Texas Medical Center, quite a few people were skeptical," says Rothstein. "The thought was, 'How can you get lawyers and doctors in the same room?' But it has been a mutually beneficial relationship. I think there's a much better understanding with doctors and administrators about what we - at the Institute - do." The Institute has affiliated with several TMC institutions to research various issues including patient safety, minority health care quality, codes of ethics, effects of managed care on people with disabilities and other issues. "Everyone agrees that there's a need to work not just with the patients but with the providers and payors. "The issues we will be looking at are system issues, and they will be about telemedicine and organ transplantation and about ensuring that health care is available to indigent Texans. We will want to look at how we can emphasize healthier lifestyles in the public health arena. "Most importantly, I think, is this interest I see on all sides in participating in the health care issues and policy making. It's not nearly so polarized as a few years ago. If we can help in this dialogue, that's great."
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