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My Computer, My Doctor: A Constitutional Call for Federal Regulation of Cybermedicine

Published online by Cambridge University Press:  06 January 2021

Carmen E. Lewis
Carmen E. Lewis*
Affiliation:
Boston University School of Law; University of Rochester
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Extract

Color it green. In a health care era driven by consumer demand, consumers are increasingly seeking Internet-based health services. Every day approximately seventy-three million Americans access the Internet in search of health information, with an average of six-million people seeking health advice. At present, a supply of over one-hundred thousand health-related websites serve the public’s demand for information and advice, with an average of one-thousand five hundred new sites added monthly. Surprisingly, consumers and students make up more than 30% of all healthrelated website users.4 From this union of cyberspace and the medical field, cybermedicine has emerged.

What does cybermedicine encompass? Cybermedicine is “the science of applying Internet and global networking technologies to medicine and public health, of studying the impact and implications of the Internet, and of evaluating opportunities and the challenges for health care.” General use of the Internet under this definition encompasses exploration and exploitation of the Internet for consumer health education, patient self-support, and professional medical education and research.

Type
Article
Information
American Journal of Law & Medicine , Volume 32 , Issue 4 , December 2006 , pp. 585 - 609
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2006

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References

I wish to extend my thanks to Professor Warner Slack, who kindly helped me diagnose this problem. I would also like to offer a special thank you to Professor Frances Miller, for giving me a much needed second opinion. Additionally, I would like to thank the senior staff of the American Journal of Law & Medicine, particularly Ashley Hague and Jennifer Guiod for dissecting the language of this article without amputation. Most importantly, I would like to thank Justin Albert for his loving bed-side manner and helping me pull through despite the rough patches. And lastly, thank you to my mother, to whom I dedicate this article.

1 Computer Science and Telecommunications Board, National Research Council, Networking Health: Prescriptions for the Internet 2 (2000).

2 Daniel N. Gonzalez, Chiropractic Institutions Online: The Quality and Accessibility of Chiropractic Web Sites in the United States, J. Am. Chiropractic Ass’n, July 1, 2004, at 32, 32.

3 Id.

4 See Computer Science and Telecommunications Board, supra note 1.

5 Eysenbach, Gunther, Shopping Around the Internet Today and Tomorrow: Towards the Millennium of Cybermedicine, 319 Brit. Med. J. 1294, 1294 (1999)CrossRefGoogle Scholar.

6 Id.

7 Id.

8 Solez, Kim & Katz, Sheila Moriber, Cybermedicine: Mainstream Medicine by 2020/Crossing Boundaries, 19 J. Marshall J. Computer & Info. L. 557, 557 (2001)Google Scholar.

9 Ranjit Kr Samanta, Cyberhealth, Statesman, Mar. 1, 2005, available at 2005 WLNR 3128977.

10 Telemedicine Report to Congress Executive Summary, 73 N.D. L. Rev. 131, 131-32 (1997)Google Scholar.

11 Id.

12 Weiner, Shira D., Mouse-To-Mouse Resuscitation: Cybermedicine and the Need for Federal Regulation, 23 Cardozo L. Rev. 1107, 1112 (2002)Google Scholar.

13 Id.

14 Eysenbach, supra note 5, Table 2.

15 Reed, Julie, Cybermedicine: Defying and Redefining Patient Standards of Care, 37 Ind. L. Rev. 845, 851 (2004)Google Scholar.

16 Warner Slack, Cybermedicine: How Computing Empowers Doctors and Patients for Better Health Care xv (2001).

17 Reed, supra note 15.

18 Gulick, Greg, E-Health and the Future of Medicine: The Economic, Legal, Regulatory, Cultural, And Organizational Obstacles, 12 Alb. L.J. Sci. & Tech. 351, 355 n.14 (2002)Google Scholar.

19 Id. at 380.

20 Id.

21 Special Comm. on Prof’l Conduct & Ethics, Fed’n of State Med. Boards of the United States, Inc., Model Guidelines for the Appropriate Use of the Internet in Medical Practice 2 (2002), http://www.fsmb.org/pdf/2002_grpol_Use_of_Internet.pdf.

22 Wood, James M. & Dorfman, Howard L., Dot.Com Medicine – Labeling in an Internet Age, 56 Food & Drug L.J. 143, 144 (2001)Google Scholar.

23 Eysenbach, supra note 5.

24 Gulick, supra note 18, at 404.

25 Weiner, supra note 12, at 1115-1116 (“Researchers have identified the existence of different degrees of risk that arise in the undertaking of medical practices on the Internet. The lowest level of risk arises with the dissemination of educational information and support services over the Internet. A moderate level of risk has been associated with telemedical consultations. Finally, a high risk to both the consumer and the provider is attributed to cybermedicine.”).

26 U.S. Const. amend. X.

27 The health care industry is one of the most regulated industries in the United States. As many as twelve federal and state government agencies are responsible for its regulation. Gulick, supra note 18, at 378. As far as state regulation goes, the two most effective regulatory mechanisms on medical professionals are profession-established licensure requirements and ethical standards. See Dobbins, Patti, Comment, Provision of Legal and Medical Services on the Internet: Licensure and Ethical Considerations, 3 N.C. J. L. & Tech. 353, 373 (2002)Google Scholar. States regulate the licensure of medical professionals by establishing minimum competency requirements through examination and certification programs. See, e.g., State v. Call, 28 S.E. 517 (N.C. 1897) (citing Eastman v. State, 10 N.E. 97 (Ind. 1887); State v. Dent, 25 W. Va. 1 (1884)). In addition to this, each state's Medical Board evaluates individual physicians’ professional conduct and, if need be, will impose such sanctions as license modification, suspension or revocation. Weiner, supra note 12, at 1130-1131. Furthermore, every state has its own Medical Practice Act defining that state's standard for unprofessional conduct; although these Acts vary widely from jurisdiction to jurisdiction. Id. In addition to state medical boards and ethics laws, federal agencies regulate many facets of the health care industry, ranging from prosecuting health care fraud to enforcing national health care policies. Gulick, supra note 18, at 378-379. Among the federal agencies that play even a minor role in regulating the health care industry are the Department of Defense, the Department of Labor, the Department of Veteran's Affairs, the Administration on Aging, the Federal Bureau of Investigation, the Drug Enforcement Agency, the Postal Inspection Service, the Department of Health and Human Services, the Center of Medicare and Medicaid Services, the Office of Inspector General, the Office of Civil Rights and the Department of Justice. Id. This list, however, is non-exhaustive. Moreover, the health care industry regulates itself through the Joint Commission on the Accreditation of Health Organizations, a private organization that indirectly regulates hospitals. Id. at 379.

28 Weiner, supra note 12, at 1136.

29 Id.

30 Id.

31 Id.

32 Id.

33 Id.

34 Eysenbach, supra note 5.

35 Id.

36 Id.

37 Reed, supra note 15.

38 See id.

39 See id.

40 Centre for Global eHealth Innovation, Biography: Gunther Eysenbach, http://www.ehealthinnovation.org/user/91 (last visited Nov. 19, 2006).

41 Eysenbach, Gunther, Clinical Review: Recent Advances – Consumer Health Informatics, 320 Brit. Med. J. 1713, 1713-1716 (2000)CrossRefGoogle Scholar.

42 Id.

43 Id.

44 Id.

45 Slack, supra, note 16.

46 Id. at xxi.

47 Id.

48 Id.

49 Id. at 13.

50 Id.

51 Id. at 14.

52 Id. at 10.

53 Id. at 21.

54 Id. at 48.

55 Id. at 22-23.

56 Id. at 25.

57 Id. at xxii.

58 Id.

59 Bernadine Healy, 2004: A Medical Odyssey, U.S. News Weekly Rev., Aug. 2, 2004, at 61.

60 Eysenbach, supra note 41, at 1713.

61 Id. at 1714.

62 Healy, supra note 59.

63 Id.

64 Eysenbach, supra note 5.

65 Id.

66 Id.

67 Wood & Dorfman, supra note 22.

68 Id.

69 Id.

70 Medline Plus Medical Dictionary, http://www2.merriam-webster.com/cgibin/mwmednlm?book=Medical&va=clinical (last visited Nov. 19, 2006).

71 Id.

72 Slack, supra, note 16, at 5.

73 Reed, supra note 15.

74 Pies, Ronald, Cybermedicine, 339 New Eng. J. Med. 638, 638-639 (1998)CrossRefGoogle ScholarPubMed.

75 Blum, John D., Internet Medicine and the Evolving Legal Status of The Physician-Patient Relationship, 24 J. Legal Med. 413, 419 (2003)CrossRefGoogle ScholarPubMed.

76 Id. at 422.

77 Id.

78 U.S. Const. amend. X.

79 Outterson, Kevin, Health Care, Technology and Federalism, 103 W. Va. L. Rev. 503, 505-510 (2001)Google Scholar.

80 Weiner, supra note 12, at 1130.

81 Id.

82 Id.

83 Id.

84 Id.

85 Id. at 1132.

86 See Computer Science and Telecommunications Board, supra note 1.

87 Ky. Rev. Stat. Ann. § 311.550(17) (West 2005).

88 Id.

89 Id.

90 Ky. Rev. Stat. Ann. §§ 315.310-327.200 (West 2005).

91 Ky. Rev. Stat. Ann. § 205.510(5) (West 2005).

92 Ky. Rev. Stat. Ann. § 11.550 (West 2005).

93 Ky. Rev. Stat. Ann. § 205.559 (West 2005).

94 Id.

95 Id.

96 The statute states that “a health benefit plan shall not exclude a service from coverage solely because the service is provided through telehealth and not provided through a face-to-face consultation.” Ky. Rev. Stat. Ann. § 304.17A-138 (West 2005).

97 Id.

98 Cal. Bus. & Prof. Code § 2290.5 (a)(1) (West 2003).

99 Id.

100 Cal. Health & Safety Code § 1375.1 (West 2000).

101 Cal. Health & Safety Code § 123149.5 (West 2006).

102 Cal. Bus. & Prof. Code § 2290.5 (West 2003).

103 Cal. Health & Safety Code § 1374.13 (West 2000).

104 Id.

105 Cal. Welf. & Inst. Code § 14132.72(c)(1) (West 2001) (emphasis added).

106 Cal. Bus. & Prof. Code § 2241.1 (2003) (emphasis added); Medical Board of California, Ordering prescriptions through the Internet? Buyer beware!, at http://www.medbd.ca.gov/Internet_Prescribing-Consumer.htm (last visited Nov. 19, 2006).

107 Tex. Util. Code § 57.042(11)-(12) (Vernon 2006).

108 Id. at § 57.042(12).

109 Id. at § 57.042(11).

110 Id.

111 Tex. Med. Ass’n, Texas State Board of Medical Examiners Policy Statement on Internet Prescribing (2005), http://www.tsbme.state.tx.us/guidelines/ipp.htm.

112 Tex. Util. Code § 57.042(13) (Vernon 2006).

113 Id.

114 Emily Ramshaw, Digital Doctors, The Dallas Morning News, Aug. 15, 2004, at 3E.

115 Tex. Gov't Code § 487.557 (Vernon 2004).

116 Tex. Gov't Code § 531.0216 (Vernon 2006).

117 Tex. Gov't Code § 531.0216(c) (Vernon 2006).

118 Tex. Gov't Code § 531.0217(d) (Vernon 2006).

119 Tex. Gov't Code § 531.02175(b) (Vernon 2006).

120 Tex. Gov't Code § 531.0216(e) (Vernon 2006); Tex. Gov't Code § 531.02161 (Vernon 2004).

121 Tex. Gov't Code § 531.02161 (Vernon 2004).

122 Minn. Stat. § 147.032 (2005).

123 Miss. Code Ann. § 73-25-34 (2004).

124 Mont. Code Ann. § 37-3-301 (2005).

125 N.M. Stat. § 61-6-11.1 (2003).

126 Ohio Rev. Code Ann. § 4731.296 (West 2003).

127 Id.

128 Id.

129 Id.

130 Id.

131 Id.

132 Id.

133 U.S. Const. art. I, § 8, cl. 3.

134 Gibbons v. Ogden, 22 U.S. 1, 92 (1824) (Johnson, J., concurring).

135 Am. Libraries Ass’n v. Pataki, 969 F. Supp. 160, 169 (S.D.N.Y. 1997).

136 Goldsmith, Jack L. & Sykes, Alan O., The Internet and the Dormant Commerce Clause, 110 Yale L.J. 785, 788 (2001)CrossRefGoogle Scholar.

137 Am. Libraries Ass’n, 969 F. Supp. at 175-176.

138 Id. at 169.

139 See Gaylord, James E., State Regulatory Jurisdiction and the Internet: Letting the Dormant Commerce Clause Lie, 52 Vand. L. Rev. 1095 (1999)Google Scholar.

140 Am. Libraries Ass’n, 969 F. Supp. at 169 (citing Philadelphia v. New Jersey, 437 U.S. 617 (1978)Google Scholar).

141 Oregon Waste Sys. v. Dep't of Envtl. Quality, 511 U.S. 93, 99 (1994).

142 Gaylord, supra note 139, at 1108 (quoting Oregon Waste Syst., 511 U.S. at 99)).

143 Id.

144 Id. (citing C & A Carbone, Inc. v. Town of Clarkstown, 511 U.S. 383, 392 (1994)).

145 Am. Libraries Ass’n, 969 F. Supp. at 169.

146 Pike v. Bruce Church, Inc., 397 U.S. 137, 142 (1970).

147 Gaylord, supra note 139, at 1108 n.89 (quoting Kassel v. Consol. Freightways Corp., 450 U.S. 662, 670 (1981)).

148 Id. at 1108 n.90 (quoting Kassel 450 U.S. at 670).

149 Goldsmith & Sykes, supra note 136, at 787.

150 Healy v. Beer Inst., 491 U.S. 324, 336 (1989).

151 Id. at 338.

152 See Fischel, Daniel R., From Mite to CTS: State Anti-Takeover Statutes, the Williams Act, the Commerce Clause, and Insider Trading, 1987 Sup. Ct. Rev. 47, 88–90Google Scholar.

153 Goldsmith & Sykes, supra note 136, at 807.

154 Am. Libraries Ass’n, 969 F. Supp. at 175 (quoting Healy, 491 U.S. at 336).

155 Id. at 169.

156 Bassinger, Kenneth D., Dormant Commerce Clause Limits on State Regulation of the Internet: The Transportation Analogy, 32 Ga. L. Rev. 889, 898 (1998)Google Scholar.

157 See Am. Libraries Ass’n, 969 F. Supp. at 169.

158 Id. at 170.

159 Id. at 169.

160 Id.

161 Id.

162 Id.

163 Am. Libraries Ass’n, 969 F. Supp. at 168-169.

164 Goldsmith & Sykes, supra note 136, at 787.

165 Biddle, William Lee, Comment, State Regulation of the Internet: Where Does the Balance of Federalist Power Lie?, 37 Cal. W. L. Rev. 161, 161 (2000)Google Scholar.

166 Id. at 181.

167 Id. at 162.

168 See, e.g., State of Minnesota v. Barber 136 U.S. 313 (1890).

169 See, e.g., id.

170 Parmet, Wendy E., Regulation and Federalism: Legal Impediments to State Health Care Reform, 19 Am. J.L. & Med. 121, 125 (1993)Google ScholarPubMed.

171 Id.

172 McCarran-Ferguson Act of 1945, 15 U.S.C. §§ 1011-1015 (2000). See also Group Life & Health Ins. Co. v. Royal Drug Co., 440 U.S. 205, 217-18 (1979) (“The primary concern of Congress … was in enacting legislation that would ensure that the States would continue to have the ability to tax and regulate the business of insurance.“).

173 Wendy Parmet, The Dormant Commerce Clause – A Returning Threat to State Health Laws, The Law & Bioethics Report, Spring 2004, at 6-7, available at http://www.louisville.edu/medschool/ibhpl/images/pdf/Lab%20Report%20spr04.pdf.

174 Id.

175 Id.

176 Id.

177 Id.

178 Id.

179 Id.

180 Noah, Lars, Ambivalent Commitment to Federalism in Controlling the Practice of Medicine, 53 U. Kan. L. Rev. 149, 170 (2004)Google Scholar.

181 Id.

182 7 U.S.C. § 950aaa (2000).

183 USDA Rural Development, Distance Learning & Telemedicine Program, http://www.usda.gov/rus/telecom/dlt/dlt.htm (last visited Nov. 19, 2006).

184 7 C.F.R. § 1703.102 (2002).

185 Id.

186 7 U.S.C. § 950aaa-2 (2000).

187 Id.

188 7 C.F.R. § 1703.126 (2002).

189 7 C.F.R. § 1703.121 (2002).

190 7 C.F.R. § 1703.122(a) (2002).

191 7 C.F.R. § 1703.107 (2002).

192 7 C.F.R. § 1703.123(a) (2002).

193 7 C.F.R. § 1703.111 (2002).

194 USDA Rural Development, Distance Learning & Telemedicine Program, DLT Success Stories – Montana, http://www.usda.gov/rus/telecom/dlt/dltsuccess_mt.htm.

195 USDA Rural Development, Distance Learning & Telemedicine Program, DLT Success Stories – Texas, http://www.usda.gov/rus/telecom/dlt/dltsuccess_tx.htm.

196 Id.

197 Id.

198 USDA Rural Development, Distance Learning & Telemedicine Program, DLT Success Stories – Alabama, http://www.usda.gov/rus/telecom/dlt/dltsuccess_al.htm.

199 Id.

200 Id.

201 USDA Rural Development, Distance Learning & Telemedicine Program, DLT Success Stories – Arkansas, http://www.usda.gov/rus/telecom/dlt/dltsuccess_ar.htm.

202 Id.

203 Id.

204 Id.

205 Id.

206 Id.

207 Id.

208 42 U.S.C. § 254c-18 (2000).

209 Id.

210 Id.

211 Id.

212 H.R. 4726, 109th Cong. (2d Sess. 2006).

213 The Ctr. for Telemedicine Law, Dept. of Health & Human Servs., Telemedicine Licensure Report 11 (2003), ftp://ftp.hrsa.gov/telehealth/licensure.pdf.

214 Robert J. Waters, American Telemedicine Association, Telehealth Licensure Development, Slide 12 (2005), http://www.atmeda.org/news/2005_presentations/m1b2.Waters.ppt.

215 See Computer Science and Telecommunications Board, supra note 1.

216 Id. at 4-5.

217 Special Comm. on Prof’l Conduct & Ethics, supra note 21.

218 Consumer Informatics: Applications and Strategies in Cyber Health Care 11 (Marion J. Ball & Rosemary Nelson eds., 2004).

219 Id. at 12.

220 See Kristine M. Crane, Telemedicine's Remote Control: Virtual Health Exams Cut Costs of Treating an Aging Population, Wall St. J., Nov. 10, 2005, at B8.