Research
A major focus of the Consortium is developing and supporting the research of scholars at UC Hastings and UCSF, often in collaboration with experts from leading institutions around the world.
The Consortium promotes research opportunities by acting as a resource center for lawyers, scientists, clinicians, faculty members, students and educators whose research would benefit from interdisciplinary consultation. The Consortium will link researchers to other top minds in relevant fields, and facilitate successful collaborations.
In addition, the Consortium will host events through which researchers can share insights and ideas, and gain access to a supportive community of thoughtful collaborators. These events include joint presentations and panel discussions, symposia and conferences, and informal networking events.
Forced Obstetrical Interventions: Legal and Clinical Implications
A Multidisciplinary Collaboration to Examine the Legal and Clinical Implications of Restrictive and Coercive Delivery Practices
Background
A Multidisciplinary Collaboration to Examine the Legal and Clinical Implications of Restrictive and Coercive Delivery Practices
Why Are Researchers from UCSF and UC Hastings Law Undertaking this Study?
Although the World Health Organization recommends a 15% cesarean rate, the average cesarean rate in the United States is over 30%, and at some hospitals, the rate is over 50%. The increase in the cesarean rate since 1996 is due in part to the rapid decline in the rate of women undergoing a trial of labor after a cesarean (TOLAC). Experts in law, nursing and obstetrics from UCSF and UC Hastings Law are undertaking a collaborative project, examining the legal and clinical implications of provider restrictions on TOLAC and hospital bans on VBAC.
Study Summary
The Availability of Trial of Labor after Cesarean among California Hospitals: understanding predictive factors and possible racial and ethnic disparities
The cesarean section rate in the United has risen to nearly one in three births (from 21% in 1996 to 32% in 2007). This rise is of concern since it has not been accompanied by improved maternal and neonatal outcomes but instead by increased maternal short and long-term morbidity. The increase in the cesarean rate since 1996 is due in part to the rapid decline in the rate of women undergoing a trial of labor after a cesarean (TOLAC) who deliver vaginally from 28% to 8% during the same timeframe. A reason to focus on this rate is that during the early to mid-1990’s when the rate was increasing, there was a decrease in both repeat and primary cesareans. There is good evidence that for selected women, the option of having a TOLAC is less risky than having a planned repeat cesarean. Two national policy recommendations were issued in 2010 encouraging hospitals and obstetric providers to make TOLAC more widely available. The investigators are developing and pilot testing a survey on TOLAC policies in California’s 257 birth hospitals. We would also test an innovative strategy using geographical information system software to link hospital data characteristics, their TOLAC policies, and community variables to determine potential ethnic/racial or economic disparities in communities offering and not offering TOLAC, and also be able to determine distances women desiring TOLAC would have to travel to receive this delivery option. These objectives will address two of the critical knowledge gaps identified in the recent NIH Consensus Conference recommendations: to further understand the racial/ethnic, geographic, and socioeconomic differences in rates of TOLAC and VBAC and to identify the nonmedical factors affecting availability and management of TOLAC.
Clinical and Translational Science Institute (CTSI) at UCSF
CTSI at UCSF facilitates the rapid translation of research to improvements in patient and community health. It is a campus-wide Institute that supports all four UCSF schools, and researchers at every stage.
Under the banner of Accelerating Research to Improve Health, CTSI provides infrastructure, services, and training to support clinical and translational research. It also develops broad coalitions and partnerships at the local and national levels to enable a transformation of the research environment.
Established in 2006, the Institute was among the first of the now 60-member, National Institutes of Health-funded, Clinical and Translational Science Awards (CTSA) consortium. Learn more here.
End of Life Decision-making
In 2009, the Consortium received a $25,000 federal grant to collaborate with UCSF faculty on a research project intended to identify legal barriers to end of life decision making. The research entailed a comprehensive, fifty-state survey of statutes, regulations, and case law which bear upon an individual's right to determine his or her own course of care at the end of life. Although the research highlighted barriers posed to the public at large, there was a special focus on the unique needs of vulnerable populations in this context.
The project resulted in a medical-legal publication in the Annals of Internal Medicine in January 2011. See the press release from UCSF for this publication.
Flowing from this research is an initiative to develop a medical-legal clinic which will provide pro bono services to low income elders and their families relating to end of life decision-making. With coordinated medical and legal efforts, patients and their families will be empowered to understand and direct their end of life care, and given the dignity and respect they deserve.
| UCSF Researchers | UC Hastings Researchers |
| Rebecca Sudore, MD | Sarah Hooper, JD |
| Brie Williams, MD | Lois Weithorn, JD, PhD |
| Leslie Castillo, BA | Serena Sanders, JD |
| Heather Landis, JD |
Gender & Asylum Collaboration
At UC Hastings' Center for Gender and Refugee Studies (CGRS), students and faculty represent political asylum seekers and torture survivors, who are most often women seeking refuge from female genital cutting, domestic violence and sexual assault. With legal representation and medical and clinical documentation, asylum grant rates are 89%. Without such medical-legal support, however, the asylum grant rate falls to 37% of asylum applications. Thus, the need for medical-legal support in these applications is dire.
Toward this end. the Consortium is facilitating a collaborative arrangement between CGRS and faculty from UCSF's Psychiatry Department, which will include activities touching on all three tenets of the Consortium's mission.
Research: The faculty will be investigating the prevalence of credibility concerns in asylum application cases, the role of judicial perceptions of credibility, and the associations with judicial stress and burnout.
Education and Service: On September 21, 2009, the Consortium sponsored an education and training event entitled Forensic Training for Psychiatric Evaluation of Political Asylum Seekers and Torture Survivors, led by USCF's Stuart Lustig, M.D., M.P.H., and Susan Meffert, M.D., and Hastings' Karen Musalo, J.D. The seminar trained thirty psychiatric evaluators to serve as volunteers in providing essential clinical documentation of medical and psychiatric claims in asylum cases. These volunteer psychiatrists will be partnered with asylum seekers through CRGS and will work to support their applications.
Health Care Reform
Through research conducted by its faculty, research interns, and affiliates, the Consortium works collaboratively on informative briefs, comprehensive reports, and original papers intended to provide practical information on health reform. Below are some examples of such collaborative efforts. Please click on the links below to find publications and materials on the following topics:
Health Reform Law: Overview
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA). The ACA extends health insurance coverage to millions of Americans through reforms to private health insurance, Medicare, and Medicaid.
By 2018, the ACA will:
• Require most U.S. citizens and legal residents to have health insurance;
• Create state-based American Health Benefit Exchanges through which individuals can purchase
coverage, with premium and costsharing credits available to qualifying individuals and families;
• Create separate Exchanges through which small businesses can purchase coverage;
• Require employers to pay penalties for employees who receive tax credits for health insurance
through an Exchange, with exceptions for small employers;
• Impose new regulations on health plans in the Exchanges and in the individual and small group
markets;
• Expand Medicaid to 133% of the federal poverty level.
(Summary from: http://www.kff.org/healthreform/8061.cfm)
Opponents of the ACA argue that the individual mandate, which requires individuals to purchase health insurance or pay a financial penalty, is an unconstitutional use of Congressional power. In March 2012, the Supreme Court heard oral arguments on the individual mandate, as well as the expansion of Medicaid, the severability of the individual mandate or Medicaid provisions, and the Anti-Injunction Act. The Court is expected to issue a decision in June.
For a discussion of the development of the ACA, see: http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtop...
For a more comprehensive summary and a timeline for the implementation of the ACA: http://www.healthcare.gov/law/index.html
Access the full text or PDF of the ACA: http://www.healthcare.gov/law/full/index.html
Overview
Kaiser Family Foundation: http://healthreform.kff.org
Kaiser Family Foundation Glossary of Key Health Reform Terms: http://www.kff.org/healthreform/7909.cfm
Kaiser Health News, Consumer Guide to Health Reform Law,: http://www.kaiserhealthnews.org/Stories/2012/March/22/consumer-guide-hea...
Implementation
The Commonwealth Fund Overview Timeline: http://www.commonwealthfund.org/Health-Reform/Health-Reform-Resource.aspx
National Conference of State Legislatures: http://www.ncsl.org/issues-research/health.aspx?tabs=831,139,1156#1156
Centers for Medicare & Medicaid Services: https://www.cms.gov/
Center for Medicare & Medicaid Innovation: http://innovations.cms.gov/
Reform in the States
National Academy for State Health Policy: http://www.nashp.org/aca-implementation-state-health-reform
Kaiser Family Foundation: http://healthreform.kff.org/the-states.aspx
Reform in California
California Health Care Foundation: http://www.chcf.org/publications/2011/06/health-insurance-regulation-aca
California Health Benefit Exchange: http://www.healthexchange.ca.gov/Pages/Default.aspx
California Department of Insurance: http://insurance.ca.gov/
California Department of Managed Health Care: http://www.dmhc.ca.gov/
Litigation
ACA Litigation Blog: http://acalitigationblog.blogspot.com/
Kaiser Health News Resource Page: http://www.kaiserhealthnews.org/Supreme-Court-Decides-Health-Law.aspx
Kaiser Health News Infographic: http://www.kaiserhealthnews.org/Stories/2011/November/18/supreme-court-h...
More Health Care Resources
Health Affairs: http://www.healthaffairs.org/
Journal of the American Medical Association: http://jama.ama-assn.org/
New England Journal of Medicine: http://www.nejm.org/
Health Care Reform at The Consortium
Symposium: Hastings Race and Poverty Law Journal presents: If Access Is the Problem, Is the Affordable Care Act the Solution?: http://www.hastingsraceandpovertylaw.com/
Papers from UC Hastings visiting professor Ann Marie Marciarille:
Healing Medicare Hospital Recidivism: Causes and Cures: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1828145
Bending the Health Cost Curve: The Promise and the Peril of the IPAB: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1987237
Lecture Series:
• Power, Politics, and Universal Health Care: http://www.ucsf-hastingsconsortium.org/event/power-
politics-and-universal-health-care
• If Access Is the Problem, Is the Affordable Care Act the Solution?: http://www.ucsf-
hastingsconsortium.org/event/if-access-problem-affordable-care-act-solution
• Does Health Insurance and Seeing the Doctor Keep You Out of the Hospital?: http://www.ucsf-hastingsconsortium.org/event/ihps-health-policy-seminar-...
• Accountable Care Organizations and the Safety Net: Barriers and Benefits: http://www.ucsf-hastingsconsortium.org/event/accountable-care-organizati...
• The Architecture of Health Reform: Challenges and Opportunities in California: http://www.ucsf-hastingsconsortium.org/event/architecture-health-reform-...
o Watch the Video: http://blip.tv/ucsf-uc-hastings-consortium/the-architecture-of-health-re...
• A Good Way to a Good Place—Transforming the Culture of Healthcare from the Inside Out: http://www.ucsf-hastingsconsortium.org/event/%E2%80%9C-good-way-good-pla...
• Implementing Health Reform: Race to the Top: http://www.ucsf-hastingsconsortium.org/event/implementing-health-reform-...
• Constitutionality of Health Reform: A Debate: http://www.ucsf-hastingsconsortium.org/event/constitutionality-health-re...
Learn about health care reform at UC Hastings:
Health Law
Health Finance, Administration & Policy
Practical Guide to Human Subjects Protection for UC Hastings Researchers
A Guide to Human Subjects Protection
If you intend to conduct research on human subjects and/or collect personal information regarding human subjects, you must obtain the approval of a registered institutional review board (IRB). An appropriate IRB can also determine if your research is exempt from the requirement of IRB approval.
UC Hastings has contracted with the Western Institutional Review Board (WIRB) to provide IRB services to UC Hastings researchers for a fee on an as-needed basis. Alternatively, UC Hastings researchers may be covered by UCSF’s IRB where they are involved in a UCSF research study as PI, co-PI or consultant and other criteria are met.
This Guide to Human Subjects Protection was developed to provide information to UC Hastings researchers (PIs, co-PIs, or Consultants) submitting a research protocol through Western Institutional Review Board (WIRB) or working with UCSF’s institutional review board. For additional information or questions about the IRB process at UCSF or WIRB, please contact:
Shauna Marshall, Academic Dean
Email: marshall@uchastings.edu
Elise K. Traynum, General Counsel
Email: traynume@uchastings.edu
Jennifer Templeton Dunn, Human Subjects Administrator
Executive Director, UCSF/Hastings Consortium on Law, Science & Health Policy
Phone: 415.581.8983
Email: dunnj@uchastings.edu
San Francisco Elder Financial Abuse Collaboration
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Co-Directors: |
Erika Falk, PsyD. Director, Geriatric Assessment & Psychological Services Institute on Aging Director, Elder Abuse Forensic Center efalk@ioaging.org |
Sarah M. Hooper, J.D. |
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Invited Participants: |
UCSF Geriatrics |
California Elder Justice Workgroup |
The San Francisco Elder Financial Abuse Collaboration is an initiative to promote the financial wellbeing, independence and health status of vulnerable elders by improving civil responses to elder financial abuse. The Collaboration has two primary objectives:
- To comprehensively research and analyze existing programs, frameworks, and policies that address elder financial abuse, with a particular focus on civil legal remedies and,
- To translate the findings into a blueprint that will guide San Francisco’s implementation of a comprehensive, coordinated civil response to elder financial abuse.
A key attribute of this project is that both objectives will be achieved through multidisciplinary collaboration and input from local stakeholders. The project is led by an interdisciplinary partnership that is uniquely situated to conduct innovative and comprehensive research and to bring stakeholders together to advocate for improved responses to elder financial abuse.
For more Information: