RESUMO
OBJECTIVE: As natural disasters become more frequent and severe, the ability of impacted states to rapidly scale up their capacity to respond and facilitate recovery through volunteers is ever more crucial. However, the legal landscape that may facilitate or hamper augmentation through volunteers has yet to be fully explored. DESIGN: This study utilized policy surveillance methodology to code relevant laws identified in searches using the Emergency Law Inventory database and Westlaw. SETTING: We assessed laws in three natural disaster-prone states: North Carolina, South Carolina, and Georgia. MAIN OUTCOME MEASURES: We assessed the presence of liability protection, license reciprocity, and scope of practice laws for health care volunteers. RESULTS: Of the three assessed legal domains, liability protection for health care volunteers across all states contained the most robust language. Liability protections apply unless the health care volunteers act with reckless disregard, willful misconduct, or gross negligence. However, nuance exists based on which organizations (state vs charitable) volunteers are affiliated with to qualify for coverage. License reciprocity for out-of-state specific health care professions entering the impacted states was available across all three states. However, only Georgia enacted federal model legislation that provides additional flexibility regarding credentialing and liability protections. Lastly, very few laws addressed the scope of practice in impacted states. CONCLUSIONS: Comparisons of laws that impact the ability of health care volunteers to respond and recover from disasters are scarce. More research needs to be performed to better understand the laws that impact volunteers in emergencies, particularly as the public health system is overtasked when providing services to impacted communities.
Assuntos
Voluntários , Humanos , Voluntários/legislação & jurisprudência , South Carolina , North Carolina , Georgia , Responsabilidade Legal , DesastresRESUMO
In 2018, approximately 2.8 million passengers flew in and out of U.S. airports per day. Twenty-four to 130 in-flight medical emergencies are estimated to occur per 1 million passengers; however, there is no internationally agreed-upon recording or classification system. Up to 70% of in-flight emergencies are managed by the cabin crew without additional assistance. If a health care volunteer is requested, medical professionals should consider if they are in an appropriate condition to render aid, and then identify themselves to cabin crew, perform a history and physical examination, and inform the cabin crew of clinical impressions and recommendations. An aircraft in flight is a physically constrained and resource-limited environment. When needed, an emergency medical kit and automated external defibrillator are available on all U.S. aircraft with at least one flight attendant and a capacity for 30 or more passengers. Coordinated communication with the pilot, any available ground-based medical resources, and flight dispatch is needed if aircraft diversion is recommended. In the United States, medical volunteers are generally protected by the Aviation Medical Assistance Act of 1998. There is no equivalent law governing international travel, and legal jurisdiction depends on the patient's and medical professional's countries of citizenship and the country in which the aircraft is registered.
Assuntos
Medicina Aeroespacial , Aeronaves , Emergências/epidemiologia , Tratamento de Emergência , Voluntários , Medicina Aeroespacial/ética , Medicina Aeroespacial/legislação & jurisprudência , Medicina Aeroespacial/métodos , Desfibriladores/provisão & distribuição , Tratamento de Emergência/ética , Tratamento de Emergência/métodos , Tratamento de Emergência/psicologia , Humanos , Internacionalidade , Viagem , Estados Unidos/epidemiologia , Voluntários/legislação & jurisprudência , Voluntários/psicologiaAssuntos
Infecções por Coronavirus , Atenção à Saúde/organização & administração , Pessoal de Saúde , Pandemias , Pneumonia Viral , Voluntários , Recursos Humanos , COVID-19 , Regulamentação Governamental , Pessoal de Saúde/legislação & jurisprudência , Humanos , Relações Profissional-Paciente , Estados Unidos , Voluntários/legislação & jurisprudênciaRESUMO
Under Texas law, physicians treating COVID-19 patients in a volunteer capacity have potential defenses against lawsuits that might arise from that care. But for non-volunteer physicians on the COVID battlefield - often working in harrowing, overloaded settings, high on patient count and low on equipment - the same liability shields don't exist. And with a resurgence in COVID-19 cases and hospitalizations taking hold in June, the Texas Medical Association continued its pandemic-long push to extend liability protections to all frontline physicians, volunteer or not.
Assuntos
Infecções por Coronavirus , Responsabilidade Legal , Pandemias , Administração dos Cuidados ao Paciente , Médicos , Pneumonia Viral , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Seguro de Responsabilidade Civil/legislação & jurisprudência , Avaliação das Necessidades , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/legislação & jurisprudência , Administração dos Cuidados ao Paciente/métodos , Médicos/ética , Médicos/legislação & jurisprudência , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2 , Texas/epidemiologia , Voluntários/legislação & jurisprudênciaRESUMO
In 2018, the Trump Administration took the unprecedented step of allowing states to impose work requirements as a condition of Medicaid eligibility. States can apply for a demonstration waiver to require Medicaid beneficiaries aged 19-64 who do not meet exemption criteria (e.g., disability, caring for a sick relative) to participate in "community engagement" activities, which include employment, volunteering, and enrollment in a qualifying education or job training program. Debate thus far has focused primarily around the important issue of whether such requirements are legal. Less attention has focused on another serious concern - namely, that work requirements could exacerbate the nation's most urgent public health crisis: the opioid epidemic. Many enrollees with opioid use disorder who are unable to meet states' community engagement criteria will not qualify for an exemption from the work requirements, and risk being dropped from Medicaid enrollment. Refusing health insurance to individuals who are unable to meet work requirements could result in significant losses in coverage among a highly vulnerable population. Implementing new barriers to Medicaid coverage will hinder the effectiveness of massive state and federal investments in improving access to evidence-based addiction treatment.
Assuntos
Definição da Elegibilidade/legislação & jurisprudência , Emprego/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Adulto , Humanos , Pessoa de Meia-Idade , Estados Unidos , Voluntários/legislação & jurisprudência , Trabalho/legislação & jurisprudênciaRESUMO
BACKGROUND: Persons from high-income countries have multiple opportunities today to participate in "short-term experiences in global health" (STEGHs) in low-resourced countries. STEGHs are organized through religious missions, service learning, medical internships, global health education, and international electives. An issue of increasing concern in STEGHs is "hands-on" participation in clinical procedures by volunteers and students with limited or no medical training. To address these concerns, best practices and ethical standards have been developed. However, not all STEGH organizations adhere to these guidelines, and some actively or tacitly allow unethical and potentially illegal practices. OBJECTIVES: This paper considers the legal framework within which STEGHs operate. It assesses whether certain STEGH practices break laws in the US and/or host countries or violate international "soft" legal norms. Two activities of particular concern are: practicing medicine without a license and drug importation and distribution. CONCLUSIONS: Many activities undertaken in STEGHs would be illegal if they took place on US soil. In addition, these same activities are often illegal in the host countries where STEGHs operate, although compliance is unevenly enforced. Many STEGH activities violate World Health Organization guidelines for ethical conduct in humanitarian activities. RECOMMENDATIONS: This paper encourages STEGH organizations to end unethical and potentially illegal activities; urges regulatory and non-regulatory stakeholders to alter policies that motivate participation in illegal or unethical STEGH activities; and encourages host countries to enforce their local and national health laws.
Assuntos
Análise Ética , Saúde Global/ética , Saúde Global/legislação & jurisprudência , Missões Médicas/ética , Missões Médicas/legislação & jurisprudência , Países em Desenvolvimento , Humanos , Voluntários/legislação & jurisprudênciaRESUMO
Nearly three-quarters of a million children are victims of abuse and neglect in the United States every year. This article describes the scope of the problem and explains how the child welfare system intervenes, including how cases are reported, how Child Protective Services (CPS) assesses the risk, how CPS determines when in-home services are appropriate or if a child should be removed from the home, how ongoing cases are managed, and the options for permanency for children in the system. The article also explains how the Family Court system operates as the decision-maker in child abuse and neglect cases and discusses the various models of legal representation provided to child victims, depending on the jurisdiction in which they live. The authors document how outcomes for child victims of abuse and neglect are greatly improved when their representation includes the appointment of a Court Appointed Special Advocate (CASA Volunteer) to advocate for their best interests. The history of the CASA model is outlined, and the structure of the current program, which includes over 76,000 volunteers in nearly 1000 local programs in 49 states, is described. This article explains the CASA methodology and how this intervention improves outcomes for abused and neglected children. The authors argue that greater public and private support would provide more local CASA agencies with the resources to recruit, train, and support more CASA Volunteers to help more child victims of abuse and neglect.
Assuntos
Maus-Tratos Infantis/legislação & jurisprudência , Defesa da Criança e do Adolescente/legislação & jurisprudência , Serviços de Proteção Infantil/legislação & jurisprudência , Criança , Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/estatística & dados numéricos , Serviços de Proteção Infantil/organização & administração , Proteção da Criança/legislação & jurisprudência , Humanos , Medição de Risco/métodos , Serviço Social/organização & administração , Estados Unidos/epidemiologia , Voluntários/legislação & jurisprudênciaRESUMO
Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when planning and caring for these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed when considering these members of the population, and what recommendations can be made to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for, not only this unique group but also all the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.
Assuntos
Pessoas com Deficiência , Planejamento em Desastres , Serviços Médicos de Emergência/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Voluntários/legislação & jurisprudência , Comunicação , Vítimas de Desastres , Serviços Médicos de Emergência/economia , Humanos , Responsabilidade Legal , Meios de Transporte , Estados UnidosRESUMO
This article discusses the experiences of community volunteers' participation in a community-based participatory research project in Tamaki, a low socio-economic and ethnically diverse suburban community within greater Auckland City, New Zealand. In the Tamaki Community Action Research project, community volunteers were recruited and trained to conduct random household surveys (RHS) and asset mapping commissioned by community groups and government agencies in that area. The volunteers were involved in planning, coordination and ongoing governance of the project and â¼70 residents and local university students participated at different stages of the 2-year project. Over 600 RHS were completed and the volunteers' experiences were recorded in field notes, informal group discussions, daily team meetings and individual interviews and form the basis of this article. Only their experiences are discussed here, not the survey results which will be presented elsewhere. The project reflected the inherent asset-rich nature of the community via examples of individual volunteer empowerment and collective social/community capacity building. Volunteers increased their interpersonal and organizational skills, their understanding of the complexity of their community's logistics and cultural diversity, and gained an increased sense of community purpose and commitment. There was very strong endorsement of culturally sensitive research practice to recognize cultural differences and to engage productively within their richly ethnically diverse community. Full community volunteer participation in the project's governance (i.e. through design, training, implementation and ongoing consultation/management phases) was considered key to sustaining the life of project.
Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Pesquisa sobre Serviços de Saúde , Poder Psicológico , Projetos de Pesquisa , Voluntários/psicologia , Adulto , Feminino , Humanos , Masculino , Nova Zelândia , Pobreza , Inquéritos e Questionários , Voluntários/legislação & jurisprudênciaRESUMO
In this paper, we explore the increasing activity around labor rights for South African community health workers (CHWs). Contextualizing this activity within broader policy and legal developments, we track the emergence of sporadic mobilizations for decent work (supported by local health activist organizations) and subsequently, the formation of a CHW union. The National Union of Care Workers of South Africa (NUCWOSA) was inaugurated in 2016, hoping to secure formal and secure employment through government and the consequent labor and occupational health protections. Various tensions were observed during fieldwork in the run up to NUCWOSA's formation and raise important questions about representation, legitimacy, and hierarchies of power. We close by offering suggestions for future research in this developing space.
Assuntos
Agentes Comunitários de Saúde/legislação & jurisprudência , Agentes Comunitários de Saúde/organização & administração , Contratos/legislação & jurisprudência , Contratos/estatística & dados numéricos , Sindicatos/estatística & dados numéricos , Voluntários/legislação & jurisprudência , Voluntários/estatística & dados numéricos , Adulto , Feminino , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , África do SulRESUMO
During disaster response and recovery, legal issues often arise related to the provision of health care services to affected residents. Superstorm Sandy led to the evacuation of many hospitals and other health care facilities and compromised the ability of health care practitioners to provide necessary primary care. This article highlights the challenges and legal concerns faced by health care practitioners in the aftermath of Sandy, which included limitations in scope of practice, difficulties with credentialing, lack of portability of practitioner licenses, and concerns regarding volunteer immunity and liability. Governmental and nongovernmental entities employed various strategies to address these concerns; however, legal barriers remained that posed challenges throughout the Superstorm Sandy response and recovery period. We suggest future approaches to address these legal considerations, including policies and legislation, additional waivers of law, and planning and coordination among multiple levels of governmental and nongovernmental organizations. (Disaster Med Public Health Preparedness. 2016;10:518-524).
Assuntos
Tempestades Ciclônicas , Pessoal de Saúde/legislação & jurisprudência , Jurisprudência , Voluntários/legislação & jurisprudência , Humanos , Responsabilidade Legal , Cidade de Nova IorqueRESUMO
An unobjectionable-sounding title obscures the real intent of the latest in a series of Bills which the federal Coalition government is attempting to legislate in its ongoing attempts to undermine employee wages and conditions and attack unions.
Assuntos
Bombeiros/legislação & jurisprudência , Sindicatos/legislação & jurisprudência , Salários e Benefícios/legislação & jurisprudência , Voluntários/legislação & jurisprudência , Austrália , Negociação Coletiva , Humanos , PolíticaAssuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Regulamentação Governamental , Política de Saúde/legislação & jurisprudência , Hipoglicemiantes/administração & dosagem , Serviços de Saúde Escolar/legislação & jurisprudência , Governo Estadual , Voluntários/legislação & jurisprudência , Arkansas , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Criança , Comportamento Infantil , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Comportamentos Relacionados com a Saúde , Humanos , Hipoglicemiantes/efeitos adversos , Injeções , Segurança do Paciente , AutoadministraçãoAssuntos
Assistência Odontológica/legislação & jurisprudência , Odontólogos/legislação & jurisprudência , Segurança do Paciente/legislação & jurisprudência , Voluntários/legislação & jurisprudência , California , Atenção à Saúde/legislação & jurisprudência , Atenção à Saúde/organização & administração , Assistência Odontológica/organização & administração , Registros Odontológicos , Acessibilidade aos Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido , Seguro de Responsabilidade Civil , Relações Interprofissionais , Responsabilidade Legal , Medição de Risco , Padrão de Cuidado/legislação & jurisprudência , Cuidados de Saúde não Remunerados/legislação & jurisprudênciaRESUMO
Ontario's Bill 178 proposing a Voluntary Blood Donations Act declares the offer or acceptance of payment for the donation of blood a legal offence and makes it subject to penalty. The bill reinvigorates a fundamental debate about the ethical problems associated with the payment of money for blood. Scarcity of blood donors is a recurring problem in most health systems, and monetary remuneration of the willingness to donate blood is regularly discussed--and sometimes practiced--as a means to overcome scarcity in blood. However, making blood an object of economic exchange has long aroused ethical concerns that often refer to the specific meaning of blood. From the perspective of a modern understanding of money as a metric of economic value, the exchange of money for blood--shed or given--is seen as ethically troubling, because it appears to imply a commensurability of the value of human life and economic wealth. In this paper, we begin with a general taxonomy of the types of arguments that speak in favour or against compensating donors for giving blood. We then describe the context in which the discussion about payment for blood arises, and of the specific aims and concerns that are brought forward in this context. This is used to reconstruct the normative background that supports the rejection of payment for blood as it is envisaged in Bill 178 and the aims of the proposal. We then argue that while a payment indeed changes the nature of a blood donation in an ethically considerable way, we do not believe that decisive arguments against the monetary remuneration of blood donations can be substantiated, at least not independently of assuming specific societal circumstances. Thus it may be possible to establish a stable and safe blood supply through just gratification while at the same time taking strong provisions against social disconnection, injustice, exploitation or heteronomy.