Artykuły w czasopismach na temat „Michigan. Legislators”

The governor and several legislators have requested review of Michigan’s sentencing practices with an eye toward sentence reform. Michigan leads the country in the average length of prison stay, and by internal comparisons the average minimum sentence has nearly doubled in the last decade. This Article explores cumulative increases to criminal penalties over the last several decades as reflected in amendments to the sentencing guidelines, increased maximum sentences, harsh mandatory minimum terms, increased authority for consecutive sentencing, wide sentencing discretion for habitual and repeat drug offenders, and tough parole practices and policies. The reality for legislators is that it is much easier to increase a penalty than to decrease it, but the continued incremental increases in penalty and sentence length over the years have led Michigan to the point of necessary sentence reform.

This research examines the roll call voting record of state legislators in Arkansas, California, Michigan, and Missouri in order to assess if there are any substantive differences between those legislators who are nearing retirement due to term limits (“last term” legislators) and those legislators who are at an earlier stage of their legislative careers. These are the only four states in the United States that have lifetime term limits in full effect. Binomial logit analysis of key roll call votes suggests that these “last term” legislators stand apart from their other colleagues on certain issues. This characteristic arises from the increased tendency of last-term legislators to defy the party leadership, albeit on a limited number of bills. This “independent streak” of last-term legislators is even more pronounced among Republican legislators, although this effect is not present in the state of California. Therefore, term limits appear to have a modest, but potentially significant effect on the policy preferences of legislators.

What makes some lawmakers more effective than others is a central question in American politics. Recent research has emphasized the role of informal, persuasive leadership, but this research has focused almost exclusively on Congress, so it is unclear whether this approach to lawmaking is generally effective. Analysis of state legislatures is hampered by the lack of a theoretically sound and practically feasible measure of legislative effectiveness. I offer a solution to the primary problem with traditional hit rates. I apply this approach to North Carolina legislators and show my effectiveness estimates correspond with expert evaluations. I then examine recent terms of the Michigan, Georgia, and North Carolina legislatures to evaluate the relative importance of formal and informal powers at the state level. I hypothesize and find that informal, persuasive leadership is not effective in state legislatures where lawmaking is better explained by formal, hierarchical authority.

The Movers and the Shirkers is a critique and extension of a well-cited and important research program: attempts to measure the degree to which legislators shirk, or advance their own policy goals at the expense of those held by their constituents. Such analyses (e.g., Joseph P. Kalt and Mark Zupan, "Capture and Ideology in the Economic Theory of Politics," American Economic Review 74 [June 1984]: 279­ 300; John R. Lott, "Political Cheating," Public Choice 52 [1987]: 169­86) typically assume a principal-agent relation- ship between constituents and elected representatives, and they specify a regression analysis with roll-call behavior as a left-hand side variable and various measures of constituency interests and legislator ideology as right-hand side variables. Previous work (John E. Jackson and John W. Kingdon, "Ideology, Interest Groups, and Legislative Votes," American Journal of Political Science 36 [August 1992]: 805­23) shows that these analyses are bedeviled by measurement and esti- mation issues. Eric Uslaner highlights a more fundamental flaw: By ignoring important and well-understood mechanisms that tie legislators to their constituents, these analyses as- sume what should be tested.

The U.S. state of Michigan abolished the death penalty in 1846. Since then, several abortive efforts have been made by state legislators to re-establish the death sentence to deal with convicted murderers. Concurrently, some support exists among Michigan residents for the restoration of capital punishment in the state. This article presents the results of the analysis of an attitudinal survey of 116 college students enrolled in three criminal justice courses in a Michigan public university concerning the reinstatement of the death sentence in the state. The data from this exploratory study show that a slight majority (52.6%) of respondents favored reinstatement whereas 45.7% opposed restoration. Advocates and opponents of re-establishment of the death penalty in Michigan provided similar religious, moral and economic arguments proffered by others in previous surveys on capital punishment available in the death penalty literature. The current study makes a contribution to the scant extant literature on attitudes toward the death penalty in abolitionist jurisdictions. As this body of literature grows, it can provide baseline data or information with which to compare attitudes in retentionist states.

AbstractCommon examples of governance policies include regulations of lobbying, campaign-finance restrictions, and term limitations. Although the public generally favors these good-government reforms, the laws often restrict the autonomy of political elites. The histories of lobby reform in New York, Georgia, and Michigan illustrate how governance policies might be adopted despite elite opposition. In the states, initial reform efforts came about due to agenda-setting events or policy entrepreneurs. Although legislators adopted lobby reforms, they preferred transparency to other lobby reforms given its limited effect on mutualistic relationships. Initial lobby laws required only disclosure and did not restrict legislator–lobbyist interactions much. Only with the advent of additional events and entrepreneurs were the initial laws strengthened to limit interactions. The histories of reform imply that narratives of policy innovation or diffusion may be complicated somewhat by elite interests and that governance policies, once adopted, may have a unique immunity from repeal.

Interest group lobbying on morality policy issues differs from lobbying on other kinds of issues. In this paper we use insights from the literature on morality policy politics to examine the lobbying of interest groups in Michigan on the issue of physician-assisted suicide (PAS). Morality policy politics is marked by the greater involvement of citizens groups. Citizens groups advocating policies that are publicly popular engage in disproportionate outside lobbying, but their capacity in this regard may be curtailed because of limited resources. Inside lobbying on morality policy issues focuses especially on getting various kinds of help from sympathetic legislators but does not try to change their opinions.

This study examined various factors that determine policy and political leadership in the adoption of evidence-based policy countermeasures and integrated, performance-based approaches such as Toward Zero Deaths to reduce road fatalities and serious injuries. Specifically, the study sought to increase understanding of the policy context for safety and to engage policy and political leaders and institutions at the state and local level in the application of these approaches. The study focused on six states in the Midwest region—Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin—and engaged legislators and policy safety policy leaders to better understand the challenges and opportunities to improve roadway safety through public policy. In a comparison of the extent of policy adoption and political leadership from one state to another, the study developed, applied, and tested an assessment tool of Toward Zero Deaths and roadway safety programs for each of the six states under review.

Using a comparative historical analysis of legislative transcripts and primary and secondary historical documents in Illinois and Michigan, we trace the adoption of a largely understudied form of monetary sanction: pay-to-stay fees. Pay-to-stay fees are financial commitments imposed by the state on incarcerated individuals for the day-to-day cost of their incarceration. Our study identified two mutually constitutive bureaucratic motivations for the adoption of these fees—austerity as the primary rationale and deservingness as a secondary rationale. This analysis highlights an earlier conceptualization of monetary sanctions as a means of revenue generation than has previously been explored. Our findings suggest that pay-to-stay fees originated in these states from broader debates about who is ultimately fiscally responsible for the welfare state and the soaring costs of maintaining the rehabilitative ideal. During periods of fiscal crisis, state legislators have consistently looked toward this type of monetary sanction as a means to fund the correctional system.

Water conflicts are rare across Michigan's history. As a result, water rights have received little attention by courts or the legislature. Traditionally, the common law of water rights in Michigan embraces the riparian doctrine for surface water and provides landowners with the right to use groundwater. However, two recent changes in common and statutory law significantly modify the legal relations among water users and others with a stake in water use decisions. A 2005 Michigan Court of Appeals decision created a new legal relation among riparian and groundwater rights holders. In 2008, Michigan's legislature passed laws aimed at regulating surface water and groundwater withdrawals. As an exercise of police power intended to protect public rights in water and associated environmental quality, the 2008 laws cap total water withdrawals. This program of restricting water withdrawals coexists with the state's common law which provides for reasonable use of surface water by riparian landowners and groundwater by owners of the overlying land. The result is a new set of legal relations, an uncertain legal environment, and a growing likelihood of water use conflicts. Because Michigan's body of water law is unique, neither courts nor legislature can rely on solutions used in other states.

On 29 August 1949, the Soviet Union conducted its first successful detonation of a nuclear weapon, ending the American monopoly on atomic technology and introducing the threat of imminent nuclear annihilation to the American homeland. This essay explores the effect of Cold War atomic culture on the school lives of elementary-aged American children during the early 1950s. In examining this cohort schoolchildren, this study emphasizes the potency of the nuclear beliefs, fears, and concerns that led legislators, educators, and activists to forcefully push for even the youngest of children to meaningfully learn about the atomic threat. I focus on curricular guidelines produced by the Federal Civil Defense Administration and the states of North Carolina and Michigan, as well as the landmark film Duck and Cover. These teaching resources shared four major themes: they attempted to conventionalize the new atomic threat; urged children to obey authority figures; emphasized the importance of self-reliance for survival; and characterized nuclear attack as unavoidable. Ultimately, this research demonstrates that what was taught to schoolchildren about nuclear weapons in this period was indicative of the nuclear attitudes and beliefs of their educators, parents, and communities. Thus, in seeking to understand school curricula it is necessary to understand the broader historical context from which the curricula emerged; similarly, school curricula can reveal the major issues and concerns of society that were deemed so important as to permeate the lives of the youngest of children.

BackgroundDespite the ability of consumers to receive treatment from a physical therapist without a physician referral or prescription in 45 states, Michigan continues to require a physician prescription. Given the impending primary care provider shortage, direct access should be considered as a potential solution to barriers that prevent patients from accessing timely musculoskeletal care.ObjectiveThe purpose of the present policy analysis was to analyze why an attempt in 2006 to remove the prescription requirement in Michigan was not adopted.MethodsThe Policy Analysis Triangle approach, which considers the relevant actors, processes, and context in which a policy must be considered, was used to analyze why Michigan House Bill 5618 was not passed. Data sources included position statements from relevant stakeholders, state government documents, stakeholder analysis, and a systematic review of the literature.ResultsMultiple data sources, including a systematic review of the literature, revealed that direct access does not pose a risk to public safety and may result in better outcomes with regard to cost and quality of care. Failure of Michigan to adopt direct access in 2006 was due to scope of practice conflicts and various political contexts and processes.ConclusionsDirect consumer access to physical therapy services appears to be sound health policy that should be reconsidered by Michigan's legislature to alleviate the primary care provider shortage for those with musculoskeletal disorders.

Traditional work schedules of surgical residents have been cited as a factor that negatively influences education and the quality of patient care. Demands by federal and state legislators as well as the general public have forced a re-evaluation of the issue. Long working hours and resulting sleep deprivation affect the lives of residents profoundly, but the question remains does it lower the quality of medical care? The justification for the long hours is that they are vital to medical education, but residents are so drained by their schedules that they are rarely in the best state of mind to learn from their experiences. Under the scrutiny of the Resident Review Committee (RRC), many programs and institutions have been cited in the recent past in violation of resident working hour requirements. As a result, many institutions have implemented reforms, thereby reducing the number of citations they received. In spite of having the highest number of citations, the field of general surgery has failed to show any improvement. The Oakland Health Education Programme Center for Medical Education (OHEP), a consortium of 16 teaching hospitals in the State of Michigan, set out to review the components of general surgery residency training in order to be able to make recommendations that might assist program directors in making appropriate changes where necessary to enhance resident education and the quality of patient care as well as to meet the personal demands of residents. Questionnaires on residents’ attitudes concerning their working hours and possible reforms were sent to all general surgery residency programs in the OHEP consortium. The questionnaire consisted of 25 questions divided into three major sections: the first section encompassed demographic information including current work hours and on-call schedules. The second section consisted of questions relating to attitudes toward work hours and the options for change. The third section consisted of questions that viewed the perceived effects of limited work hours. From the seven participating hospitals with surgery residency programs in OHEP, 92 residents responded to our survey. The majority of residents were in the first 3 years of postgraduate training. The mean age of residents was 30 years old. Sixty-four per cent of respondents were male, and 18 per cent were female. Residents reported an average of 56 with a range of 0 to 110 hours on call. Variations in the number of hours had to do with the various rotations residents were on, in that during certain elective rotations, residents were not assigned to any call. The on-call schedule varied; alternate nights were reported by 11 per cent, every third night by 33 per cent, and every fourth night or more by 53 per cent. The majority of surgical residents did express the need for reform and did not feel that reforms would affect the quality of resident education. However, residents did not want to lengthen residency training beyond the 5 years. The results of our study indicates that the majority of residents in general surgery programs in Michigan perceive a need for reform of work schedules. Surgical educators may have underestimated this need in the past. Most residents thought that long hours impaired their educational experience and at times compromised their clinical care.

The Visually Impaired Program, Division of Special Education of the Oakland County (Michigan) Intermediate School District, obtained Federal Act 94-142 funding in 1979. The purpose of this funding was to encourage establishment of programs that facilitated special education in the least restrictive educational environment. The Visually Impaired Program utilized these funds to establish the Educational Low Vision Aids Screening Clinic and to provide comprehensive low vision evaluations by certified low vision specialists. * This paper describes clinic rationales, procedural implementation of services from 1979 to 1982, and resultant findings. The study served as a model for the establishment of a statewide program funded in October, 1985, by the Michigan Legislature and administered by the Michigan Commission for the Blind in cooperation with the Michigan Department of Education. * A Demonstration Project funded through 94-142 federal funds, 1979-1982.

OBJECTIVES/SPECIFIC AIMS: Facilitate relationships and partnership development to address the opioid crisis in Detroit and Wayne County Contribute to real-time conversations on opioid epidemic policy and practice to identify and build consensus on research questions Apply findings from each learning community session to policy briefs to better inform policymakers, providers and consumers; and advocate for institutional responsiveness METHODS/STUDY POPULATION: The study population utilizes a purposive sampling approach to intentionally organize relationships and partnership development. For example, participants registered for the December 2018 session, “Detroit/Wayne County Opioid Crisis Learning Community Series: Data Session,” include representation from school-based health clinics, community and faith-based organizations, health systems, city and county level public health, addiction/recovery organizations, law enforcement, academia and citizens. The team feels this approach ensures and builds diverse, team science perspectives and regional collaboration. The Detroit Area Mental Health Leadership Team formed in 2015 at a retreat held by the University of Michigan’s Clinical and Translational Science Initiative attended by nearly 100 community-academic partners. Mental health, stigma and suicide were identified as community priorities by participants who attended the summit. A mental health workgroup formed and later expanded its membership to strengthen diverse perspectives. The team immediately designed and administered a survey amongst its partners creating the following priorities and focus: substance abuse interventions, healthcare access, and consumer awareness of mental health issues/available resources. Since data, policy and service are common threads to design interventions, the partnership decided to facilitate dialogue and discussion from the community on special topics related to the crisis, and share the community’s recommendations on how to address them. The learning community series was designed as a bi-lingual format for sharing and expression. Deliberative democracy encourages inclusion of voices, interests and opinions often not heard or included in decision-making processes; driving the project’s purposive sampling approach. Institutional responsiveness and advocacy for adoption of the community’s recommendations will occur through strategic policy briefs summarizing each learning community session and the entire series. A dissemination plan will be utilized to encourage the policy briefs reach appropriate audiences for capacity building and institutional responsiveness. The learning community series will provide 5 sessions on data (impacting adolescents, emerging adults, and 20-mid 30 year-old adults), recovery/law enforcement, prescribing, and marijuana. The session topics arose from earlier assessment conducted by the Detroit Area Mental Health Leadership Team. RESULTS/ANTICIPATED RESULTS: A response to the opioid crisis should address community priorities identified through data, research and community input. Community providers should have access to real-time data and research to develop appropriate interventions and institutional responsiveness. Equally important is the need for legislators and others impacting resource allocation to hear from the community on priorities they feel should be addressed, and to better understand the need for new types of data and information to drive service delivery, policy and resources to address the crisis. The learning community series will focus on describing the epidemic and building infrastructure to collaborate, and share data and information to strengthen advocacy and responsiveness to address the crisis. We feel this will enable more efficient programming to strengthen service delivery that captures life experiences from those who directly interface with individuals impacted by the crisis. DISCUSSION/SIGNIFICANCE OF IMPACT: There is limited knowledge and consensus on types of data and information to effectively describe the opioid crisis. For example, data and information connecting gateway drugs such as marijuana with more hardcore drugs (i.e., opioids and heroin) is not available; community-based providers have limited access to what research says about the crisis; and local public and community providers are dependent upon the state for surveillance data. Individuals dealing with addiction and recovery often need immediate attention. A gap in access to services exists depending on types of insurance. For example, Medicaid and some HMOs require an assessment before clients can seek treatment, resulting in uncompensated care among providers to immediately address patients need. Access to healthcare is a longstanding issue in medically underserved communities. The impact of the crisis varies geographically in communities and regions due to cultural and ethnic differences, yet data and information on these differences is not readily available. Cultural competency and sensitivity is often an issue in medically underserved areas because stakeholders may feel professionals providing services do not relate to them effectively. Finally, the community does not understand the economic impact of the crisis. These issues make it difficult for community advocates and providers to work with elected officials, providers and others on the opioid crisis because they do not have the data and informed required to effectively flush out a hypothesis and form solutions. Information captured in the learning community series (i.e., presentations by experts, facilitated discussion and personal testimony) will be summarized in a policy brief after each session and the entire series. Recommendations and priorities from the community will be shared with providers, policymakers, the business community, consumers and others to provide community input on problem solving approaches, new interventions, types of data not currently available that should be captured, and other important strategies and information to address the crisis. This information will also encourage designing research questions to guide developing new community engaged and community based participatory research to address the crisis. Finally, utilizing a purposive approach in participant recruitment will encourage partnership development from a team science and capacity building perspective.

On August 1, 1996, the speed limit on certain sections of Michigan freeways increased from 104.6 to 112.6 km/h (65 to 70 mph). This was due to the Michigan Legislature passing a bill that permitted the governor of Michigan to increase the speed limit given that a study be conducted to determine the effects on safety and capacity. Michigan State University conducted the study that determined the effects of increasing the speed limit on certain sections of highway. This study examined not only freeways that were increased to 112.6 km/h (70 mph), but also the speeds and capacities of freeway sections where the speed limit was not increased. Different types of speed analyses were done in comparing the test sections where the speed limits were raised with the control sections where the speed limits were not raised. The analysis also included categorizing the roadway into intercity and recreational routes to determine the effect on speeds for different uses in road use. The speed data also were broken down into different vehicle types. A preliminary accident analysis was performed on the control and test sections to determine the effect of increasing the speed limit on accidents. It was proved that increasing the speed limit on certain sections of freeway in Michigan had little effect on the change in speed and capacity on both test and control sections.

Michigan enjoys along its inland seas, the Laurentian Great Lakes, one of the longest coastlines in the U.S. Much of that shoreline is privately owned. Because of a confluence of development pressures and irrepressible physical dynamics, growing numbers of Great Lakes shoreland properties, built on shifting sandy shores, are at heightened risk of loss from coastal storm surge, inundation, erosion, and shoreline recession. In response, property owners are installing extensive hardened shoreline armoring structures like seawalls and revetments to arrest those erosional processes. Those structures, however, will substantially impair, if not ultimately destroy, the state’s natural coastal beaches and other shoreland resources, as well as accelerate erosion of neighboring shoreland properties. The clash of imperatives to protect shoreland properties versus conserve coastal resources signifies a wicked dilemma the State cannot avoid: armor or withdraw? More precisely, should we allow the armoring of Michigan’s Great Lakes shorelines in an attempt to fix in place shoreland properties, at great and ongoing private and public expense, and ultimately risk the loss of public trust resources? Or should we allow—and should we compel shoreland property owners to allow—natural processes to proceed, even though doing so will increase the rate at which privately owned shorelands naturally convert into state-owned submerged bottomlands? We cannot hope to simultaneously protect both the beach and the beach house along naturally receding Great Lakes shorelines; we must choose which interest to prioritize first, recognizing the cost of doing so by losing the other. In addition to the complex physical dynamics at play along Michigan’s Great Lakes coasts, there are evolving legal complexities as well. The State, as sovereign, enjoys police power authorities that encompass coastal shoreland management. The State has also long recognized the applicability of the public trust doctrine to its Great Lakes shores, and its constitution mandates the protection of natural resources. This article first analyzes current Michigan law to determine how those doctrines and mandates apply to Great Lakes shoreline armoring, particularly in terms of what to prioritize. Based on that assessment, we conclude that Michigan’s courts, legislature, and people have consistently and clearly prioritized protecting and conserving Great Lakes natural coastal resources above developing or impairing them for private use, except when such development truly serves larger public trust interests. In contrast, the administrative rules now used to execute those protections prioritize protecting the private beach house first, even at the expense of destroying the natural beach and impairing other public trust interests. This administrative approach was not inevitable— indeed it may be unlawful—and it has created strong expectations on the part of shoreland property owners, heightening the likelihood of litigation. The article then analyzes current Michigan law to determine how the courts might resolve disputes between property owners hoping to armor the shore and State or local constraints on such armoring. Here we find that while the Michigan courts have resolved a number of key questions regarding coastal shorelands, there is no caselaw addressing directly the lawfulness of shoreline armoring. Based on our review of relevant caselaw, we conclude the courts are not likely to find that the State lacks authority to regulate—or prohibit altogether—shoreline armoring to protect coastal resources. There is conflicting caselaw, however, upon which the courts could rely to find either that the current regulatory regime provides adequate protection of coastal resources, or alternatively that it is deficient. Finally, beyond questions of regulatory authority, the courts are not likely to find that reinvigorated regulatory efforts to prevent the destruction and impairment of public trust coastal resources from armoring—even those resulting in the accelerated loss of private properties—violate constitutional protections, especially if State reforms are undertaken with deliberation and care. If the courts conclude that current regulatory efforts are lawful and require no greater protection, then Michigan will likely see much of its Great Lakes shorelines armored and its natural coastal beaches destroyed. If they conclude that current regulatory efforts are deficient (or if they approve of reinvigorated protection efforts), however, then private shoreland properties may be lost to the lakes. Such losses cannot be avoided forever, especially along naturally receding shorelines, but they might occur sooner than would happen absent attempts to arrest shoreline erosion with armoring. As with most wicked policy dilemmas, the best response may not be at either extreme—always armor or always withdraw—but somewhere in between. Crafting that hybrid approach, and the appropriate rules for applying it, will be the most challenging course to navigate.

Law exists solely in and through language. Nonetheless, systematical empirical analysis of legal language has been rare. Yet, the tides are turning: After judges at various courts (including the US Supreme Court) have championed a method of analysis called corpus linguistics, the Michigan Supreme Court held in June 2016 that this method “is consistent with how courts have understood statutory interpretation.” The court illustrated how corpus analysis can benefit legal casework, thus sanctifying twenty years of previous research into the matter. The present article synthesizes this research and introduces computer-assisted legal linguistics (CAL2) as a novel approach to legal studies. Computer-supported analysis of carefully preprocessed collections of legal texts lets lawyers analyze legal semantics, language, and sociosemiotics in different working contexts (judiciary, legislature, legal academia). The article introduces the interdisciplinary CAL2 research group (www.cal2.eu), its Corpus of German Law, and other related projects that make law more transparent.

Abstract To identify the service gaps for family caregivers in Michigan, this study examined the perceptions of stakeholders from the 16 area agencies on aging (AAA). An online questionnaire was administered to assess a point-in-time picture of current caregiver assessments and services in 2020. Fifteen AAAs responded to see definitely or probably an increase in the number of caregivers in their catchment areas. Fifteen AAAs currently purchase or contract for respite care services. Fourteen provide some type of direct caregiving resources. Twelve utilize staff to develop and monitor care plans. While some provided caregiver training, none directly provided supportive services. AAAs anticipated rapidly increasing needs for caregiver supports and services. While each provided a different array of services, they anticipated that demand would continue to increase given a rising aging population in Michigan. Results were used to craft a proposal to establish a network of regional caregiver resource centers. Recommendations in the study include creating a task force of stakeholders to identify standardized service definitions, measures and reporting requirements; create a no-wrong-door, multi-prong approach for caregivers to access programs; provide respite care through contracts and referrals to community-based organizations; create a network of trainers to disseminate evidence-based best practices to AAAs and contractors; use untapped resources such as AARP and Alzheimer’s Association; explore forming local healthcare systems and provider collaborations to identify caregivers and triage them. Next steps are to pursue funding from the legislature and other sources to create regional caregiver resource centers across the state.

ABSTRACT Each citizen in America lives under two Constitutions - the United States, federal Constitution which applies to all citizens, and the constitution of the state in which the citizen lives. Often overlooked and basically unknown, the state constitutions play a vital role in governance and preserving our unalienable rights. Perhaps the best way to understand each constitution is to compare and contrast them. Accordingly, as a case study, this article examines the age, length, predecessors, drafting process, conventions, ratification process, and amendment procedures of the State of Michigan Constitution of 1963 and the U.S. Constitution. Furthermore, this article examines how each of these constitutions addresses the separation of powers, legislature, executive, judiciary, local government, transportation, education, finance, taxation, and the protection of unalienable rights. Armed with this understanding, we will be better informed citizens, and more ably equipped to participate in self-governance and protect the unalienable rights of the citizenry. Note: At times this article quotes constitutional text which refers to “he” or “him.” The grammatical convention at the time was to make masculine all generic gender references. That this article quotes the text does not equate to an endorsement of the convention nor did the drafters intend that only men could serve as public officials.

Joseph Kearney and Thomas Merrill’s brilliantly illustrated LAKEFRONT is sure to win American legal history awards for its riveting history of the machinations behind the preservation of the magnificent Chicago lakefront, now dominated by public spaces. The authors weave together a compelling account of how the law affected the development of the post-fire Chicago in the late 19th and 20th centuries—largely made by lawyers and courts and only ratified by legislatures. The book’s title suggests that the story is largely about the public trust doctrine (PTD). But the doctrine is hardly the centerpiece of the authors’ story. What they have to say about the doctrine is confined to the Illinois version of the PTD, and they do not endeavor to explain where it deviates from the modern direction of the PTD. The book’s history of Chicago and its lakefront is groundbreaking legal history, buttressed by twenty years of exhaustive research, colorful characters, and interesting legal developments, of which the PTD played only a supporting role until the 1970s. The principal lesson of their story, one the authors do not emphasize enough, is a persistent struggle between public and private rights along the lakefront. What is unusual is how long this struggle endured, beginning with Illinois Central Railroad’s dominance in the late 19th century and the so-called “Lake Front Steal” of 1869, in which the Illinois legislature conveyed roughly one thousand acres of submerged Lake Michigan land to the railroad. The legislature soon thought better of the giveaway, and its rescission in 1873 culminated in a famous 1892 Supreme Court decision on the PTD, Illinois Central Railroad v. Illinois, pronounced as the lodestar case of the doctrine by Professor Joe Sax a half-century ago. The authors discuss the controversy over the lakebed conveyance and the Court’s pathbreaking decision, but they view the effect of the PTD on the Chicago lakefront as less significant than other considerations like the public dedication doctrine, which nearby landowners invoked to restrict development of the lakefront and preserve their views of the lake. Still, the Illinois Central Court focused public attention on what was an attempt to create a monopoly of the lake’s outer harbor, and that attention has persisted for a century-and-a-quarter following the Court’s decision. Today, the Chicago lakefront is largely public, the consequence of several factors that LAKEFRONT explains. This struggle between public and private rights over the Chicago lakefront existed long before the dawn of the modern environmental movement a half-century ago, influenced not only by the Court’s surprising 1892 decision but also by the persistent oversight of neighboring landowners protecting their views of the lake. This public-private clash, in which private rights were subject to both public and neighboring landowner challenges, created the glorious Chicago waterfront of today. This review of the Kearney and Merrill book focuses on the public trust doctrine, as articulated in the Lake Front case that culminated in the Illinois Central Court’s decision. There is more to the book, mostly centering on local Chicago interest, so this review concentrates on the public trust. Though in the book’s title, the authors maintain that the PTD was not as central to the story of the lakefront’s preservation as other influences. They remain public trust skeptics.

Twenty-five years used to seem like an exceedingly long time. It certainly did when I was graduating from law school and not yet twentyfive. My perspective on time, however, has (naturally) since evolved, much as environmental law itself and the controversies surrounding it have, too, evolved. The contrast between environmental law twenty-five years ago and environmental law today is remarkable and makes clear that environmental law and lawmaking were changing in fundamental ways a generation ago, but those changes are revealed only now with the aid of hindsight. To be sure, the statutory texts of domestic environmental law are strikingly the same. And yet, it is that static quality that ironically underscores how much has changed. A generation ago, environmental law scholars would routinely comment on how the only constant in environmental law was change: its dynamic nature. Congress was regularly passing significant statutory amendments in what was largely a constructive iterative lawmaking process, involving federal and state legislatures, agencies, and courts. Some might have worried that the change was too great—making it too difficult for the regulated community to adjust and invest. Whether any such concern then was justified, the concern now is quite different: too little change rather than too much. And the static nature of environmental lawmaking here in the United States stands in sharp contrast to the dynamic nature of environmental lawmaking globally. The United States, once a lauded pioneer, now very much risks being left behind. This essay is written in celebration of the 25th Annual Meeting of the National Association of Environmental Law Societies at the University of Michigan Law School and in recognition of Michigan Law’s hosting of the Association’s inaugural meeting in 1988. The essay focuses on three topics in reflecting on the changes in environmental law and environmental lawmaking since the Association’s first meeting. The first is Congress and the politics of environmental law. The second topic concerns the courts and the changing relationship of constitutional law to environmental law. And, finally, the essay considers the contrasting nature of the challenges that environmental lawyers and environmental law face today as compared to twenty-five years ago.

The Postulate for Importing an American Concept of the „Upbringing Plan” of the Divorcing Parent into the Polish Family LawSummaryThe article presents the way in which the „upbringing plan” of divorcing parents functions in the United States on the example of its application in the states of Washington and Michigan. The American legislator created conditions for realization of the idea of a mutual performance of the parental authority by divorced parents among other things by means of a detailed regulation on the manner of preparation of such a plan according to a „Questionnaire” designed for this aim.This „upbringing plan” is to fulfil in particular four functions: a) to simplify parent’s regulation of the situation after the divorce; b) normative function; c) educational function; d) preventive function.The author critically analysis the provisions of the family and custodian code regulating the forms of the determinations regarding the parental authority in the divorce verdict and she compares them with American provisions on the „upbringing plan”. On these basis she concludes that first the plan is a perfect concept from both the legal and psychological perspective aiming at protecting the child’s good and second it ideally suits Polish divorce law, both de lege lata and de lege ferendoj It is, however, important in what manner the change of law will be performed.This kind of interception of a modern legislative solution provided for in America in the author’s view would definitely eliminate problems connected with the performance of the parental authority by divorced parents.

Objective. This article estimates the financial impact of a ban on amalgam restorations for selected population groups: the entire population, children, and children and women of childbearing age. Methods. Using claim and enrollment data from Delta Dental of Michigan, Ohio, and Indiana and the American Dental Association Survey of Dental Services Rendered, we estimated the per capita use and annual rate of change in amalgam restorations for each age, gender, and socioeconomic subgroup. We used population projections to obtain national estimates of amalgam use, and the dental component of the Consumer Price Index to estimate the annual rate of change in fees. We then calculated the number of dental amalgams affected by the regulation, and the fees for each of the years 2005 to 2020. Results. If amalgam restorations are banned for the entire population, the average price of restorations before 2005 and after the ban would increase $52 from $278 to $330, and total expenditures for restorations would increase from $46.2 billion to $49.7 billion. As the price of restorations increases, there would be 15,444,021 fewer restorations inserted per year. The estimated first-year impact of banning dental amalgams in the entire population is an increase in expenditures of $8.2 billion. Conclusions. An amalgam ban would have a substantial short- and long-term impact on increasing expenditures for dental care, decreasing utilization, and increasing untreated disease. Based on the available evidence, we believe that state legislatures should seriously consider these effects when contemplating possible restrictions on the use of amalgam restorations.

This study sought to determine if there were any changes in opioid prescribing habits of providers at a single institution after the implementation of legislation to increase opioid prescribing regulations. Our study demonstrated a 39.5 percent decrease in overall morphine milligram equivalent (MME) prescribed the year after the laws took effect when compared with the year prior. It is clear that these laws have been effective in decreasing the number of opioids prescribed at discharge from Mercy Health Grand Rapids.Introduction: Opioid use disorder has become an epidemic with approximately 130 people dying every day in the United States due to prescription and illegal opioid overdoses. In December 2017, the Michigan legislature ratified a package of 10 acts to address a variety of problems through several layers of regulations including more restrictive prescribing rules, which took effect in June 2018. Objective: To evaluate the impact of legislation on the opioid prescribing habits of providers who discharged patients from a community-based academic teaching hospital.Design, setting, and participants: A retrospective cohort study was performed using data from a community-based academic teaching hospital with 303 beds, a medical ICU, labor and delivery unit, and a 42-room emergency department. All patients discharged from in-patient or observation status in the 12 months before and after June 1, 2018 were included.Main outcomes and measures: The primary outcome was MMEs of opioids prescribed at discharge before (June 1, 2017 to May 31, 2018) and after (June 1, 2018 to May 31, 2019) legislation. Medications included morphine, hydrocodone, oxycodone, fentanyl, methadone, hydromorphone, tramadol, codeine, and meperidine.Results: There were 17,227 patients discharged during the first 12-month period and 15,855 patients discharged in the second 12-month period. There were 14,064 new opioid prescriptions in total during these time periods. Total MME prescribed during the study period showed a 39.5 percent decrease from pre- (2,268,460 MME) to post-legislation (1,372,424 MME), while average MMEs/discharge significantly decreased (135.1 ± 321.2 vs. 87.6 ± 187.4; p 0.001). Total pill/patch count decreased by almost 40 percent. For patients who were prescribed opioids, average MME/discharge showed significant decline after legislation implementation (309.6 ± 427.1 vs. 212.2 ± 242.1; p 0.001). Average daily MME/patient prescribed an opioid remained similar between the time periods (52.4 ± 37.0 vs. 51.6 ± 35.0; p = 0.21). Significant reductions (p 0.05) were seen in MMEs for each individual medication with the exception of acetaminophen-codeine and methadone.Conclusions and relevance: Our results indicate that the legislation implemented in Michigan to regulate opioid prescriptions was associated with a reduction in opioids prescribed to patients discharged from a community-based academic teaching hospital.

The article tells the story of Michigan's effort to create a language arts curriculum. Our story is embedded in an attempt by the governor, legislature, Department of Education, and (sometimes) the State Board of Education at state systemic reform. The focus of the article is that part of the overall effort that was directed toward the language arts curriculum. Although funded by the U.S. Department of Education (USDE) and initiated by the state, the language arts work was undertaken by a loosely connected but long-associated set of language arts professionals who, although suspicious of the state's motives and authority, cared a great deal about what they called best practice in language arts and embraced the state initiative to push their views. Working from Parsons's (1949) conception of a system as “a network of collectivities, side by side, overlapping, and larger-smaller” (p. 101), we describe the overlapping of this group with the state and with other collectivities that emerged as the effort went along. Finally, we argue that although the state's educational system remains loosely linked, democratic, contentious, and noisy, this language arts effort heightened the mutual awareness and interdependence of the system's separate parts and so served the purposes of systemic reform.

11063 Background: Frequent drug shortages and high out-of-pocket costs due to inadequate and unaffordable insurance coverage hinder access to oral chemotherapy. Amidst this, oral cancer drugs estimated a mean of $4290/patient are wasted due to dose modification, discontinuation or death[Lam M. et al, JAMA Oncol. 2023;9(9):1238-1244]. To combat this discrepancy, multiple states have passed laws establishing drug repositories that collect unused oral cancer medications and redistribute them to patients in need. ASCO has also endorsed these programs, even advocating for open distribution systems allowing donations from individuals. Methods: We analysed statewise cancer drug repositories(source:National Conference of State Legislatures) and communicated with representatives from programs including SIRUM, RemediChain and I-DROP Coalition. We used a mixed methods approach to examine the breadth and functioning of these programs. Results: 28 out of the 44 states with laws establishing prescription drug repositories operate state-run drug recycling programs (Updated September 2023). However, only 14 states (California, Florida, Iowa, Michigan, Minnesota, Montana, Nebraska, Nevada, Ohio, Pennsylvania, Tennessee, Utah, Washington and Wisconsin) have provisions for donation of cancer medications, or for creation of separate cancer drug repositories. Other nonprofits like RemediChain and SIRUM function at a national level, covering 47 states and Washington D.C. between them. Conversations with 3 such programs revealed multiple obstacles that limit the effectiveness of drug recycling. All 3 programs reported inadequate donations, ranging from 2-3 donations/month in a state level program (I-DROP) to 1-10 donations/day in a larger national level program (RemediChain). 3/3 programs received more donations of unused pills from patients or their families than from pharmacies/health facilities. All 3 surveyed programs reported limited and inconsistent supply of donated drugs; expiration of drugs before redistribution; lack of demand for specialty drugs and unavailability of common oncology drugs that patients request since these drugs are less likely to go unused. All surveyed programs mentioned struggling with funding and staffing. Notably, all 3 repositories stressed that informing patients about recycling options right at the beginning of treatment was crucial to improve donation rates; and that expanding repository donor and recipient coverage could increase the chances of successfully redistributing drugs. Conclusions: Improving awareness amongst providers and patients, campaigning for federal funding and increasing the scale of coverage by expanding repository programs to all states and allowing interstate transfer of drugs could address current challenges to drug recycling. This would limit wastage of expensive medication while reducing financial burden on patients and improving access to life saving treatment.

The United States has a north coast along its ‘inland seas’—the Laurentian Great Lakes. The country enjoys more than 4,500 miles of Great Lakes coastal shoreline, almost as much as its ocean coastal shorelines combined, excluding Alaska. The Great Lakes states are experiencing continued shorefront development and redevelopment, and there are growing calls to better manage shorelands for enhanced resiliency in the face of global climate change. The problem is that the most pleasant, fragile, and dangerous places are in high demand among coastal property owners, such that coastal development often yields the most tenacious of conflicts between public interests and private property rights. Indeed, those conflicts implicate fundamental debates over the state’s authorities and prerogatives to regulate privately owned shoreland (the police power), the public’s interest in coastal resources (the public trust doctrine), and private property owners’ rights to use and to exclude others from their shorelands (referred to collectively here as the private property doctrine). While not tidal, standing water levels of the Great Lakes fluctuate over time substantially. As a result, the lakes have beaches much like ocean coasts, and the public trust doctrine is aptly applied to them, albeit awkwardly. All of the eight Great Lakes states have long acknowledged the applicability of the public trust doctrine to their Great Lakes bottomlands and shorelands. In doing so, they have accepted the now-conventional understanding that the doctrine originated in ancient Roman law. Even so, recent critiques of the public trust doctrine assert that it has been misinterpreted and that its historical pedigree is not so strong or aptly applied to American coasts, especially along Great Lakes coasts. These critiques do not address the historical pedigree and robustness of the police power doctrine, or, more importantly, the pedigree and robustness of contemporary notions of private property rights. If the public trust doctrine is indeed lacking upon reconsideration, how does it fare in comparison to these other doctrines? This Article lays the foundation for an extended study of the public trust doctrine as it applies to Great Lakes shores. We provide an overview of the public trust doctrines of all eight Great Lakes states, noting for illustration and, where appropriate, particulars for the State of Michigan, which enjoys more than 60% of the combined U.S. Great Lakes coastline. To explain our motivations in undertaking this study, the Article first briefly reviews the importance of the lakes to the State of Michigan and the other Great Lakes states more broadly and then frames shoreland management as one of the resource management imperatives those states face. The Article then reviews the historical origins, the contemporary contours, and the ongoing debates surrounding the police power, public trust, and private property doctrines separately. Building on that foundation, we then analyze how courts and legislatures have reconciled those doctrines through application in coastal settings broadly. First, we find that the public trust doctrines of the Great Lakes states fall well within the boundaries of the origins and application of that doctrine throughout the nation’s history, even though the Lakes are not tidal. Second, we find that the concept of a ‘moveable freehold’ inherent in the public trust doctrine—that the boundary separating state-owned submerged public trust land from privately owned upland along the shore—reflects natural dynamic shoreline processes, not arbitrary governmental rulemaking, and is well established and accepted by all Great Lakes states. Finally, and most importantly for the purposes of this Article, we find that all three doctrines—public trust, police powers, and private property rights—trace their roots to English common law and even ancient Roman law, but all are in fact distinctly American doctrines. All three doctrines were first fully articulated in the context of unique American institutions, values, and conflicts. Each has evolved over time as American institutions, values, and conflicts have similarly evolved. Thus, despite detractors’ assertions to the contrary, the public trust doctrine is no less robust or aptly applied to Great Lakes coasts than is either the police power or private property rights doctrine. In fact, despite case law and commentary rhetoric that can be dogmatically extreme, efforts to understand and reconcile these doctrines in practice generally strike a pragmatic balance between the private rights inherent in shoreland property ownership and the public interest in common access to and use of submerged lands and the foreshore. Following our analysis of these doctrines from a broad perspective, we conclude by providing a brief overview of the several public trust doctrines as adapted by all of the Great Lakes states and finally identifying a number of questions for further study.

Since the Supreme Court ruling in Miller banning mandatory juvenile life without parole (JLWOP) sentences, many states have gone one step further and completely eliminated JLWOP sentences. However, this trend has stagnated. One potential reason is society’s “tough on crime” framework, which legislators are hesitant to deviate from. To understand public opinion on adolescent adolescent development and sentencing of youth, we surveyed residents in one state considering legislation that would ban JLWOP and similar sentences, Michigan. Most participants had sufficient understanding of adolescent development and viewed adolescents as having the capacity for change. Additionally, most participants supported alternative sentences to JLWOP, with support primarily given to sentences that were rehabilitative in nature. Our results can help policymakers better understand their constituents’ beliefs regarding adolescent sentencing, which can inform policy decisions.

When Michigan instituted no-fault auto insurance in 1973, its proponents argued that it would be a more efficient and less costly system for administering auto insurance claims than tort liability. Unfortunately, the opposite eventually proved to be true. Michigan’s system was unique among states because it provided unlimited no-fault medical benefits, and insurers were severely constrained in their ability to control medical costs. By 2019, Michigan’s auto insurance claim costs and premiums were the highest in the nation. This motivated the state’s legislature and governor to significantly reform its no-fault law and tighten its regulation of auto insurance. While these reforms and regulatory changes are relatively nascent, there is considerable interest in knowing their effects, including the consequences of allowing consumers to choose their level of no-fault coverage, instituting medical cost controls for no-fault coverage, and tightening the regulation of insurance companies. In this paper, we evaluate the no-fault reforms and their impacts. We find some initial evidence that claims costs and premiums for many drivers decreased substantially due to the reforms. However, medical providers and trial attorneys are advocating for legislation that tempers the cost controls, arguing that they are too harsh and arbitrary and that the adequacy and quality of care received by auto accident victims have suffered as a result. Fundamentally, there is the issue of whether it is possible to design a no-fault system that is superior to tort liability and is fair to all of a state’s residents in terms of the benefits it provides and its premium costs. Michigan could be viewed as an experiment on both the promises and pitfalls of a grand vision for no-fault auto insurance. Our paper contributes to an important debate on whether no-fault auto insurance can be saved and if it is worth saving.

In Davis v. Michigan Department of Treasury, the Supreme Court ruled that states may not tax the pensions of former federal workers without imposing a like tax on the retirement income of former state employees. Noting that Michigan had agreed to refund the state income taxes Paul Davis had paid on his federal pension over the years in controversy, the Court stated that he was entitled to a refund. It then remanded the case to allow the Michigan courts and state lawmakers to determine how state and federal retirees were to be treated equally in the future-both taxed according to the same schedule or exempted from tax-and to resolve the thousands of refund claims by federal pensioners that had been or might be filed.Davis provoked a whirlwind of activity in state courts and legislatures across the country, because two dozen states taxed state retirement income more lightly than federal pensions, contrary to the Supreme Court's understanding of the doctrine of intergovernmental tax immunity. Davis left no doubt that states must equalize the taxation of federal and state retirees following the issuance of the Court's opinion. But the Court's bare mention of Michigan's concession to refund Davis's taxes failed to answer clearly the question of whether states owed some form of retroactive relief to all similarly situated federal retirees who had paid higher taxes than had state pensioners. Not surprisingly, in view of the number of courts that issued rulings, the enormous sums at stake, and the confusion swirling around the Supreme Court's recent retroactivity rulings, state courts disagreed over whether the Fourteenth Amendment's Due Process Clause mandates a remedy for past wrongs. Many, including Virginia's Supreme Court, concluded that Davis established a requirement of equal treatment solely for the future. Accordingly, they refused to order refunds to federal retirees or to impose a retroactive tax on state pensions to secure equality after the fact.

Background: Smoking is a well-established risk factor for cardiovascular disease. The Michigan legislature is currently considering a proposal for a comprehensive smoking ban (CSB) in Michigan. The potential impact of such a law on the incidence AMI is not known. We conducted a meta-analysis to study the impact of CSB on the incidence of AMI and calculated the impact of potential CSB on the incidence of AMI in Michigan. Methods: We searched MEDLINE, EMBASE, and Cochrane databases from inception till May 2008 for studies comparing the rates of AMI hospital admissions before and in the year after the implementation of CSB legislation. Of 135 potentially relevant articles screened initially, 5 studies met the inclusion criteria. A random-effects model meta-analysis was done and between-studies heterogeneity was compared with I2. The attributable risk (AR) of CSB on AMI incidence was calculated and multiplied with the number of AMI admissions in Michigan. Results: In the published studies, a CSB was associated with a decrease in the incidence of AMI (RR 96%, 95% CI 93%–100%, p=0.05). There was no heterogeneity between the included studies (I2<50%). The AR of CSB on the incidence of AMI is −4.2%. The average number of hospital admissions for AMI as first-listed diagnosis in Michigan between 1999 and 2006 was 27,007 per year. Thus, if a CSB legislation is implemented in Michigan in 2008, the calculated reduction of hospital admissions for AMI is 1130 admissions per year as of 2009.. Conclusion: CSB is associated with a significant reduction of annual hospital admissions for AMI. The financial impact of this reduction on health care cost is yet to be determined.

Five decades after the US approval of the commercial use of leaded petrol, the US EPA began a phasedown of leaded petrol to prevent spoiling catalytic converters, mandatory on all new US cars in 1975. With prompting by citizens and the Minnesota legislature, the US Congress required the US EPA to enforce a rapid phasedown on 1 January 1986 until the final ban of leaded petrol for highway vehicles on 1 January 1996. This article reviews the outcomes of curtailing leaded petrol on the temporal and spatial changes of pediatric blood Pb and soil lead (Pb) in metropolitan New Orleans. In 2001, a soil Pb survey was completed for all census tracts of metropolitan New Orleans. In 2006, after major flooding by Hurricane Katrina, a preliminary survey of 44 census tracts showed that the median soil Pb and children’s median blood Pb decreased across flooded and unflooded communities. In June 2017 a second survey was completed in all census tracts. Evaluation of pediatric blood Pb and soil Pb in matching census tracts (N=274) confirmed that curtailing leaded petrol diminished children’s exposure and concurrently reduced soil Pb. The concurrent temporal and spatial declines of children’s exposure and soil Pb were also observed in the Detroit Tri-County Area of Michigan. Curtailing leaded petrol was gradually accepted, and on 30 August 2021, 35 years after the US EPA phasedown, leaded petrol was banned by all nations. Eliminating leaded petrol was an essential step for primary Pb prevention of pediatric exposure and improving community health. Continuing efforts are required to reduce legacy-soil Pb that persists disproportionately in traffic congested, older, inner-city, urban areas, and other communities that are subjected to large inputs of Pb aerosols.

Photo by Owen Beard on Unsplash Introduction Through its professional associations and healthcare organizations, the medical community has made numerous anti-racism statements in the past year, including the American Medical Association’s (“AMA’s) Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity.[1] Converting these statements into practical change will take time and money. In addition to implementing anti-bias training and education on racism in clinical practice, the medical community should also advocate to enhance and enforce Title VI anti-discrimination laws. The current limitations on enforcement conflict with the medical community’s ethical duty to improve health equity and treat all patients with a high standard of care. Advocating for legislation that meets the standards of other civil rights laws to hold the healthcare industry legally responsible for discrimination should be part of medical professionals’ anti-racism work. Development of Civil Rights in Health Care Despite the lack of a federal constitutional right to health care, the United States does acknowledge the importance of health and health care through its laws and spending decisions. In 2010, the Affordable Care Act (“ACA”) created health insurance options for 20 million additional Americans and reduced the gap in healthcare access among populations.[2] Although it did not ensure a right to health care and it does not guarantee a right to health, healthcare access is an important element of a healthy life and broadening the reach of health insurance is a worthy goal. Outside of the ACA’s offer of affordable health insurance, only a few stakeholders have gained “weak” statutory rights to publicly funded health care such as incarcerated people, the elderly, disabled, and the very poor.[3] Yet, the adoption of the public insurance programs Medicaid and Medicare in 1965, along with Title VI of the 1964 Civil Rights Act (“Title VI”), did create some rights to sue for discrimination in health care, even for people who are not recipients of Medicaid and Medicare benefits. Under Title VI, private institutions that receive federal financial assistance are prohibited from discriminating on the basis of race, color, and national origin.[4] Initially, this civil rights legislation had a major effect on health care because more than 1000 segregated hospitals immediately integrated their facilities in order to comply with the legislation and participate in Medicaid and Medicare.[5] Medical professionals interested in anti-racist work would do well to learn the history of Title VI; grassroots support of civil rights laws in the 1960s encouraged huge steps forward in eliminating de jure segregation in health care.[6] Title VI Lacks Mechanisms to Combat Structural Racism Title VI has been less effective when addressing more subtle forms of discrimination. Despite being one of the broadest anti-discrimination statutes, Title VI has been referred to as a “sleeping giant” because its full power has not been used to great effect.[7] The ACA included some attempts to improve Title VI’s effectiveness (see below), but much more could be done. Like most civil rights laws, Title VI discrimination may be alleged as disparate treatment (intentional) or disparate impact. Disparate impact claims are challenging to prove and may involve arguments such as how moving a hospital from an inner-city area to a wealthier suburban location will have a disparate impact on the local Black population. Besides the evidentiary challenges involved in demonstrating disparate impact, such a claim fails unless the plaintiffs can prove that a reasonable explanation for the action, such as cost savings, is a pretext for discrimination.[8] Title VI claims are also challenging because of the limitation on plaintiffs, the limitation on the scope of defendants, and enforcement issues. In 2001, the US Supreme Court held that individual plaintiffs cannot sue under Title VI for disparate impact claims, requiring a federal agency to do so.[9] While hospitals and other entities are potential defendants under Title VI, individual medical professionals are not, even though approximately 40 percent of Medicaid and Medicare reimbursements now go to physician and outpatient care.[10] The primary enforcement mechanism for Title VI healthcare claims is forcing compliance with the law through the threat of withdrawal of federal reimbursement.[11] The threat of financial punishments may harm communities, however, when low-resourced hospitals lose funding or are forced to fund rehabilitation programs.[12] Inequities between hospitals in different locations currently cannot be addressed under Title VI. Recent attempts to improve Title VI have failed. In the ACA, legislators included several updates to Title VI that appeared to improve its potential as a tool for reducing healthcare inequities. Section 1557 of the ACA changed the definition of “federal financial assistance” programs to include Medicaid and Medicare Advantage, thus expanding the pool of possible defendants to include individual providers.[13] However, the Department of Health and Human Services issued an implementing rule that specifically did not include Medicare Part B, so as of now patients cannot bring suit against sue their doctors for Title VI discrimination.[14] Some authors argue that the ACA also repealed the Supreme Court decision that prevented individuals from bringing disparate impact claims under Title VI.[15] So far, however, courts still interpret Title VI as supporting private claims only for intentional discrimination.[16] Individuals can still bring disparate impact claims to the Office of Civil Rights (“OCR”) and the Federal government may take action on their behalf. Because of the lack of available private action, however, there is no robust group of Title VI attorneys developing these civil rights cases.[17] If the legislature wants to encourage private enforcement of Title VI discrimination cases, it could also add punitive and compensatory damages to the available remedies, as it did with Title VII employment discrimination cases,[18] thus empowering plaintiffs and their lawyers to seek private remedies for discrimination in health care. Private litigation could be used as an additional lever in strategic approaches to eliminating discriminatory practices and improving health equity.[19] In 2003, the Institute of Medicine’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care recommended that the federal government increase funding for the OCR to encourage investigations into violations of Title VI based on systemic discrimination in health care.[20] The committee saw such enforcement as a “last line” of defense against systemic racism in health care, and a way to find such suspected racism through proactive investigations. Unfortunately, the OCR continues to be “notoriously” underfunded, but future administrations may be encouraged to rectify that problem.[21] Permitting more individual lawsuits may improve Title VI by providing better enforcement mechanisms and broadening the scope of possible defendants. These litigation tools will never bring about a right to health but can reduce inequities in access to and treatment in the healthcare system. Health professionals can support such proposals as individuals and through their professional associations. Of course, not all stakeholders agree that the federal government should enforce greater access to health care; after several states brought suit, the US Supreme Court struck down the ACA provision that would have effectively required states to expand Medicaid eligibility.[22] In addition, many health professionals will object to individual Title VI lawsuits. Distinguishing between malpractice litigation and discrimination litigation will be important so that healthcare practitioners do not feel their livelihoods are threatened by Title VI. If improving health equity and combating racism is seen part of one’s ethical duty, then medical professionals should embrace a willingness to be held accountable personally, and even more importantly, as part of a healthcare organization. The AMA has a well-documented history of racism, and the organization has apologized and sought atonement. Part of that history includes a failure to support civil rights legislation in the 1960s and active opposition to Medicare, Medicaid, and the desegregation of hospital staff.[23] Notably, the National Medical Association, an African American medical association, worked hard to support civil rights laws and integration in the 1960s, but could not convince the “White” AMA to follow suit. As part of its anti-racism efforts, the AMA could work with legislators to craft appropriate changes to Title VI and take on the task of educating its membership. Health professionals should understand that the shortcomings of Title VI in eradicating racism in health care were due to decisions about and interpretations of the law which were influenced by the medical profession itself. Educating all the stakeholders about the connections between health, healthcare access, and strong enforcement of our civil rights statutes and regulations is one way that health professionals can actively engage in anti-racism work in the healthcare profession. [1] “The AMA’s Strategic Plan to Embed Racial Justice and Advance Health Equity,” American Medical Association, accessed June 25, 2021, https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity. [2] “How ACA Narrowed Racial Ethnic Disparities Access to Health Care | Commonwealth Fund,” accessed March 10, 2021, https://www.commonwealthfund.org/publications/2020/jan/how-ACA-narrowed-racial-ethnic-disparities-access. [3] Aeyal Gross and Colleen Flood, The Right to Health at the Public/Private Divide : A Global Comparative Study, New York (Cambridge University Press, 2014), , 348, https://web-a-ebscohost-com.ezproxy.cul.columbia.edu/ehost/ebookviewer/ebook/ZTAyNXhuYV9fNzcwMjExX19BTg2?sid=5201c555-548f-4599-ae3d-857f6911322f@sessionmgr4007&vid=0&format=EB&lpid=lp_261&rid=0. [4] Title VI of the 1964 Civil Rights Act, § 2000d (“No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”) [5] Amitabh Chandra, Michael Frakes, and Anup Malani, “Challenges to Reducing Discrimination and Health Inequity Through Existing Civil Rights Laws,” Health Affairs (Project Hope) 36, no. 6 (June 1, 2017): 1041–47, 1042, https://doi.org/10.1377/hlthaff.2016.1091. [6] David Barton Smith, “The ‘Golden Rules’ for Eliminating Disparities: Title VI, Medicare, and the Implementation of the Affordable Care Act,” Health Matrix, 2015, Gale OneFile: LegalTrac. [7] Olatunde C. A. Johnson, “Lawyering That Has No Name: Title VI and the Meaning of Private Enforcement,” Stanford Law Review 66, 6 (June 2014): 1293-1331, at 1294. [8] Chandra, Frakes, and Malani, at 1043. [9] Alexander v. Sandoval, 532 U.S. 275 (2001). [10] Chandra, Frakes, and Malani, at 1043. [11] See 42 U.S.C. §2000d-1. [12] Chandra, Frakes, and Malani, at 1045. [13] 42 U.S.C. §18116. [14] Chandra, Frakes, and Malani, at 1045. [15] Sarah G. Steege, “Finding a Cure in the Courts: A Private Right of Action for Disparate Impact in Health Care,” Michigan Journal of Race & Law 16, 439 (April 2011): 439- 468. [16] See, e.g., Lemon v. Aurora Health Care North Inc., 19-CV-1384 (E.D. WI Feb. 22, 2021). [17] Johnson, “Lawyering That Has No Name,” at 1295. [18] Pub. L. No. 102-166, § 102, 105 Stat. 1071, 1072-72 (codified as amended at 42 U.S.C. § 1981a). [19] Sara Rosenbaum and Sara Schmucker, “Viewing Health Equity through a Legal Lens: Title VI of the 1964 Civil Rights Act,” Journal of Health Politics, Policy and Law 42, no. 5 (October 1, 2017): 771–88, 777, https://doi.org/10.1215/03616878-3940423. [20] Institute of Medicine (US) Committee On Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, ed. Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson (Washington (DC): National Academies Press (US), 2003), http://www.ncbi.nlm.nih.gov/books/NBK220358/. [21] Chandra, Frakes, and Malani, at 1045. [22] National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012). [23] Harriet A. Washington et al., “Segregation, Civil Rights, and Health Disparities: The Legacy of African American Physicians and Organized Medicine, 1910-1968,” Journal of the National Medical Association 101, no. 6 (June 2009): 513–27, https://doi.org/10.1016/S0027-9684(15)30936-6.

The United States Department of Agriculture (“USDA”) defines a farmers’ market as “a multi-stall market at which farmer-producers sell agricultural products directly to the general public at a central or fixed location, particularly fresh fruit and vegetables (but also meat products, dairy products, and/or grains).”[1] The recent resurgence in the popularity of farmers’ markets represents a return to days past where local producers were the predominant source for fresh produce and agricultural goods. With the most farmers’ markets of any state,[2] California has a large interest in the success of its farmers’ markets. In furtherance of this interest, California endeavors to protect its farmers’ markets from fraud.[3] Prior to 2015, California had one of the strictest farmers’ market regulatory programs in the United States.[4] Even so, the California legislature decided that more needed to be done in order to prevent farmers’ market fraud and on September 26, 2014 enacted Assembly Bill 1871 (“A.B. 1871”).[5] The primary function of this Note is to analyze A.B. 1871 and develop an understanding of the California model for regulation of farmers’ markets. This model will be compared to the approaches taken by New York and Michigan (states with the second and third most farmers’ markets)[6] to develop a greater understanding of the various approaches to farmers’ market regulation. The goal of this Note is to serve as a policy guide for farmers’ market regulation. Following this introduction, this Note will proceed in six parts. Part I will discuss the recent history of farmers’ markets with a particular emphasis on the economic and social impact that farmers’ markets have on the communities in which they operate. Part II addresses the nature of farmers’ market fraud and some general ways that states and farmers’ market vendors and operators combat fraud. Part III will provide a comprehensive analysis of A.B. 1871 and its components. Part IV will provide a comparative analysis of the regulatory approaches taken by New York and Michigan. Part V outlines four general factors for states to consider before enacting statewide regulations for farmers’ markets. Finally, Part VI concludes with guidance on state policy regarding regulation of farmers’ markets.[1] What is a Farmers’ Market?, USDA Food & Nutrition Serv., (May 27, 2015), http://www.fns.usda.gov/ebt/what-farmers-market. This Note will adhere to this definition of “farmers’ market,” and any reference to “farmers’ market,” unless specifically stated otherwise, is intended to reference this definition. [2] National Farmers Market Directory, USDA Agric. Mktg. Serv., http://search.ams.usda.gov/farmersmarkets/ (last visited February 1, 2015). As of January 2015, California had over 760 farmers’ markets registered with the USDA. The USDA’s Agricultural Marketing Service (“AMS”) collects farmers’ market information and numbers through voluntarily submitted data. Id.[3] For the purposes of this Note, farmers’ market “fraud” indicates whenever a vendor sells something that the vendor did not produce, cultivate, or harvest himself/herself and/or a vendor misrepresents something as being from a local area. A discussion on the nature of farmers’ market fraud is contained infra, Part II.[4] Samuel R. Wiseman, Emerging Issues in Food Law: Fraud in the Market, 26 Regent U. L. Rev. 367, 386 (2013-2014) (discussing California’s previous system of farmers’ market regulation).[5] A.B. 1871, 2014 Cal. State Assemb., Reg. Sess. (Cal. 2014).[6] National Farmers Market Directory, supra note 2.