Integration of chiropractic in the Armed Forces health care system.

Congress has approved the commissioning of chiropractors in the various medical branches of the armed services. Currently, the Department of Defense is conducting a 3-year demonstration program at 10 military sites in which chiropractors are hired on a contractual basis to treat military personnel. This paper presents a brief history of chiropractic and a discussion of a major court case involving the AMA and other professional medical associations. A survey of legal, professional, and organizational issues that must be resolved prior to, or in conjunction with, the full integration of chiropractic in the armed services health care delivery system (if directed by Congress) is included. Prompted by the identified issues, recommended policies and actions are offered to ensure that this alternative health care service is effectively utilized by patient beneficiaries.

Legal interfaces in telemedicine technology.

Telemedicine, an emerging technology which seeks to use advanced telecommunications equipment to enhance medical care, is progressing rapidly in the Department of Defense health care delivery system. This paper recommends that a cautious, preventive law approach be simultaneously initiated to ensure that the technology does not abridge patients' rights to confidentiality or security of medical records, and that agreement on practice parameters be developed. Seven interfaces, in the areas of informed consent, physician liability, non-physician liability, costs, practice parameters, physician-patient relationships, and ergonomics, are discussed in the context of telemedicine. The author recommends that telemedicine pioneers include the legal community's early input in the application of telemedicine technology to help avoid needless litigation.

The case for mandatory HIV testing of active duty sex offenders.

As of May 1993, at least 23 states had passed laws permitting, or requiring, human immunodeficiency virus testing of sexual offenders. Several others have recently passed, or are considering, such legislation. At present, no such specific requirement exists under the Uniform Code of Military Justice. This paper presents an overview of the competing Fourth Amendment privacy rights of accused/convicted offenders, victims' rights, the usefulness and validity of such testing, and the public health mission of the military medical services. In addition, potential tort liability of the armed services is discussed. The author presents arguments supporting mandatory testing of accused offenders meeting minimal "probable cause" requirements, and sharing test results with the physician of complainants/ victims.

Draft registration of health care personnel.

A chronic shortage of health care personnel in the active and reserve forces continues to be of concern, particularly in planning for national emergencies or war. Congress has authorized the Selective Service System to establish a system to register and classify health care personnel rapidly in the event a national emergency requires implementation of a draft for the armed services. This paper describes the creation of the Health Care Personnel Delivery System. It provides a brief history of previous military drafts for health care personnel and describes the principal differences in the way a draft registration program may operate in the future.