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This article assesses Latino views of the court system, both of their beliefs about the courts and their experiences with the courts. Relying primarily on the Latino over-sample of the National Center for State Courts (2000) survey of public attitudes toward the courts, we evaluate three aspects of the Latino-judicial relationship. First, we measure whether there are differences between Latino and non-Latino views of the courts. Second, we assess whether there are differences within the Latino community, particularly differences based on nativity, in Latino attitudes toward the courts. Finally, we assess the implications of Latino views of the courts for US society in general. We are particularly concerned about whether having a greater share of Latinos in the population will create new pressures to reform the judiciary.
Two clinicians who helped develop the National Center for State Courts' 50 guidelines for involuntary civil commitment assess how well the guidelines address some of the common problems clinicians face during the commitment process. The guidelines with potential to help clinicians call for the establishment of screening agencies to reduce unnecessary commitments; encourage the development of models for outpatient commitment; attempt to ensure that information gathered during the evaluation process reaches clinicians; suggest how clinicians can more validly predict whether a patient is dangerous; and advocate more research and evaluation of civil commitment processes. The guidelines that would hamper good clinical care advocate using lawyers as brokers of services and requiring the courts to approve treatment plans. Clinicians are urged to become familiar with the guidelines.
A multidisciplinary task force convened by the National Center for State Courts has developed 50 guidelines that contain practical solutions to problems associated with involuntary civil commitment processes; most can be implemented within existing statutory frameworks. The guidelines call for greater cooperation and communication among the mental health, social service, public safety, and justice systems at each step in the commitment process and recommend that these systems form interdisciplinary community coordinating councils to seek expedient remedies to problems in the commitment process. Other guidelines outline the roles of law enforcement officers, lawyers, mental health professionals, and judges in maintaining the continuity of the commitment process and propose measures for improving screening of individuals as they enter the mental health system. Efforts to facilitate implementation of the guidelines are described.
Whether to provide life-sustaining treatment for never-competent adult patients or formerly competent patients whose wishes are unknown is one of the most difficult decisions healthcare providers face. To help address this problem, in 1992 the National Center for State Courts published Guidelines for State Court Decision Making in Life-sustaining Medical Treatment Cases. The publication contains a decision tree to help judges determine whether decisions to continue or discontinue life-sustaining treatment is within the law. A modified version of the tree has been developed for members of the institutional ethics committee and other staff who consult on patient cases at St. John's Regional Health Center. Springfield, MO. The revised decision tree grew out of center staff's extensive experience in making life-sustaining medical treatment decisions and essentially reflects St. John's practice in this area. Persons who wish to use it should first run some of their own cases against the model to see if it fits their needs. They should also realize that no consensus exists in state laws regarding standards for making decisions in this area.
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Some assumptions that guided the national task force in developing the Guidelines for Involuntary Civil Commitment are identified and discussed. The task force's multidisciplinary membership is seen as enhancing the credibility of the suggested reforms. The task force developed guidelines instead of a model law, avoiding disputes about the philosophical basis of commitment laws and providing local jurisdictions the liberty to adapt the task force's recommendations to suit local conditions. Both the problems identified and the suggestions offered by the guidelines were based on the empirical experience of local commitment systems. Communication among the components of civil commitment systems was seen as crucial to reform and as achievable through a recommended structural change.
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The United States Supreme Court reviewed cases involving eligibility standards for children with disabilities to receive Supplemental Security Income (SSI) benefits and a guardian's authority to withhold nutrition and hydration from a permanently disabled incompetent adult. The Americans with Disabilities Act, a major piece of civil rights legislation for persons with disabilities, promises to prohibit discrimination in all areas, including health services. Parents of infants with disabilities have appealed the dismissal of their claim under section 504 of the Rehabilitation Act alleging denial of beneficial medical treatment to their children on the basis of disability. State courts continue to examine the rights of competent and incompetent patients, including "mature minors," to forgo life-sustaining treatment, including nutrition and hydration. In 1990, forty states and the District of Columbia had "living will" legislation, and nineteen states and the District of Columbia had durable power of attorney for health care laws; however, the provisions of these laws vary from state to state.
In 1988, the United States Supreme Court determined that "primary alcoholism" is "willful misconduct" that disqualifies veterans for an extension of time for educational benefits eligibility based on disability. The Civil Rights Restoration Act, passed in 1988, broadened the scope of programs or activities which may be covered by federal civil rights statutes that prohibit discrimination by entities receiving federal financial assistance. Decisions by the highest courts in two states may signal a trend toward reestablishing protection for persons with disabilities who are incompetent and are being threatened with denial of life-sustaining food and fluids. Federal and state courts addressed the issue of withholding medical treatment from persons with disabilities. The rights of persons with AIDS to participate in programs receiving federal financial assistance continue to be litigated with increasing frequency. Lastly, thirty-eight states and the District of Columbia have "living will" legislation.
Pending before the United States Supreme Court are cases involving eligibility of children with disabilities for Supplemental Security Income (SSI) benefits and a guardian's authority to withhold nutrition and hydration from a permanently disabled but not terminally ill ward. The United States Commission on Civil Rights has issued a comprehensive report demonstrating evidence of current discrimination against infants with disabilities and examining current legal protections. In the federal courts, litigation continues in a case brought by parents on behalf of their infants with disabilities who were allegedly denied medical treatment on the basis of disability. State courts continue to examine the rights of competent and incompetent patients to forgo life-sustaining treatment, including nutrition and hydration. Discrimination against persons with AIDS or HIV continues to affect their access to health care. In 1989 forty states and the District of Columbia have "living will" legislation, and nine states have durable power of attorney for health care laws; however, the provisions of each vary from state to state.
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Having reported high adherence to court-mandated disulfiram treatment, we hypothesized that other Department of Veterans Affairs (DVA) medical centers would report frequent use of this modality. Telephone interviews with DVA substance abuse clinics in 48 of the 50 states matched the national DVA frequencies. Phone survey responders reported disulfiram prescription as never/rarely 63%, sometimes 32%, and often 5%, while court-ordered disulfiram was used never/rarely 95%, sometimes 3%, and often 2%. Nationally, disulfiram prescriptions covered only 0.07% of all veterans seen. These data suggest a need for a re-evaluation of disulfiram as an underused treatment for alcohol dependence.
In National Gerimedical Hospital and Gerontology Center v. Blue Cross of Kansas City, the United States Supreme Court held that there is no blanket exemption from antitrust laws for health planning activities. The Court also held that no specific immunity can be granted where the challenged health planning activity is not undertaken pursuant to a federal regulatory scheme. This Comment reviews the Court's decision and concludes that the Court correctly determined that the challenged activities did not qualify for an exemption. The Comment also examines the implications of the Court's statement that, where Congress has manifested a belief that competition is ineffective in the health care industry, application of the antitrust laws should be modified. The Comment recommends that an intermediate review standard such as the "presumptive, incentive modifying approach" should be used by future courts in deciding whether the ineffectiveness of competition in a given area of health planning activity warrants immunity from antitrust scrutiny.
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