Catastrophic health insurance may be necessary to curb rising health care costs in the United States. A major factor in this rise has been the current structure of the nation's health insurance system, which inadequately protects individuals with expensive illnesses, but encourages overinsurance for less expensive illnesses. This Note examines the current health insurance system, and analyzes its impact oh health care costs for individuals and society. It evaluates several proposals to modify the structure of the current health insurance system, and recommends the adoption of a catastrophic health insurance plan based on an economic definition of catastrophe. Such a plan would decrease shallow coverage, and would use coinsurance and deductible rates keyed to the individual's income as means of increasing consumer cost consciousness without making necessary care unreasonably expensive. This Note also recommends that a catastrophic plan only cover treatment that has been determined medically necessary by utilization review, and that this review encourage outpatient rather than costly inpatient treatment.

Psychiatric experts are now called more frequently than in the past to testify in courtroom proceedings. Often, however, their testimony leads, to non-productive "battles of the experts." This Note examines various plans that seek to minimize the conflicts in expert testimony due, not to legitimate psychiatric disputes, but rather to inaccurate or biased testimony offered by one or both psychiatrists. It concludes that either of two plans would be effective: the first provides for a panel similar to existing medical malpractice tribunals; the second mandates court appointment of an inde pendent expert to testify in addition to those called by adversaries.

In the case of In re Grady, the New Jersey Superior Court addressed important issues concerning the propriety of a court's exercise of parens patriae jurisdiction to ratify parents’ substituted consent to the sterilization of their mentally retarded child. This Note discusses the genesis of the fundamental right to choose sterilization, its application to mentally retarded individuals, and the adequacy of the procedural framework enunciated in Grady to assure that substituted consent by the parents is exercised solely in the mentally retarded individual's “best interests.” This Note concludes that, while the Grady court properly exercised its parens patriae jurisdiction, the procedural framework enunciated is inadequate. The Note proposes a model that would implement the procedural elements the Note determines are essential to a “best interests” inquiry. The proposal requires: (1) that the individual be adjudicated incompetent; (2) that a guardian ad litem be appointed and required to argue that sterilization is not in the incompetent's “best interests”; and (3) that the court determine, as a question of fact, whether the parents’ exercise of substituted consent is in the incompetent's “best interests.” The Note also suggests criteria which can be used in making the “best interests” determination, and recommends that “clear and convincing” evidence be required to support the “best interests” standard.

In 1974, Congress passed the Health Care Amendments to the National Labor Relations Act, thus bringing nonprofit health care institutions within the purview of the Act and within the jurisdiction of the National Labor Relations Board. Since the passage of these Amendments, the Board consistently has held that hospital no-solicitation rules prohibiting employees from engaging in union organizational activities on hospital premises in other than immediate, patient-care areas are presumptively invalid. In N.L.R.B. v. Baptist Hospital Inc., 442 U.S. 773 (1979), however, the U.S. Supreme Court questioned the rationality of the Board's presumption, although the Court did not specifically overrule the presumption itself. By examing the special interests arising in the hospital setting, as well as the legislative intent behind the Health Care Amendments, this Note evaluates the Board's presumption in light of the four Supreme Court opinions in Baptist Hospital. The Note concludes that the Board's presumption— that hospital no-soliciation rules are invalid in all areas of a hospital except for those areas directly involved in immediate patient care—is rational and reasonable (1) because it properly balances the interests of the hospital, of the employees, and of the patients, and (2) because it is consistent with the legislative intent behind passage of the Health Care Amendments. In addition, this Note contends that the Board has expanded its “immediate patient-care area” standard in an effort to address the Supreme Court's concern in Baptist Hospital that, the Board's balancing of interests had weighted the patients' well-being too lightly.

In Parham v. J.R., 442 U.S. 584 (1979), the U.S. Supreme Court held that a parent or a guardian can commit a minor to a mental institution if a staff physician certifies that the minor should be committed, even if the minor strenuously opposes their decision. The Court specifically rejected claims that commitment of a minor by a parent or guardian without an adversary hearing is a deprivation of the minor's liberty without due process of law. This Note reviews the Parham opinion, with special attention to its impact on “mature minors” and wards of the state and to its definition of a neutral factfinder. The Note argues first that the Court's failure to establish special safeguards for “mature minors” and wards of the state is inconsistent with constitutional standards of due process, and second, that the Court's acceptance of staff physicians as neutral factfinders may be unwarranted. The Note recommends the creation of moire stringent procedural safeguards for the commitment of minors by parents and guardians, including the use of independent mental health professionals as “neutral factfinders.”

In Payton v. Abbott Laboratories, U.S. District Court Judge Walter J. Skinner recently granted class certification to an action brought by twentyseven Massachusetts women against major manufacturers of DES. This is the first case in which a judge has interpreted the requirements of Rule 23 of the Federal Rules of Civil Procedure to allow women exposed in utero to DES to sue as a class to determine liability for their injuries.

This Note reviews the Payton certification in light of prior class action decisions involving DES and other types of claims, and of legal commentary on Rule 23. This Note contends that Judge Skinner’s application of the Rule 23 requirements in Payton was procedurally correct, and recommends the class action device as an effective method for litigating such controversies. Finally, this Note analyzes the implications of this landmark ruling for plaintiffs seeking class certification in DES suits and in suits presenting analogous factual situations.

The Internal Revenue Service typically grants health maintenance organizations (HMOs) an I.R.C. section 501(c)(4) exemption from federal income taxation. If these prepayment group medical providers were classified as section 501 (c) (3) tax exempt organizations, however, they would receive many additional advantages including increases in private funding and decreases in material and operating costs.

This Note contends that most nonprofit HMOs—whether or not they have qualified under the federal HMO Act—should be granted 501(c)(3) status because they conform with all the specific requisites and general theoretical justifications of a “charitable purpose” tax exempt organization. Specifically, HMOs serve a tax exempt purpose by providing health care, by benefiting the community as a whole, and relieving the government of some of its public health burdens. HMOs comply with further requirements of section 501 (c)(3) and its accompanying I.R.C. regulations by serving a broad membership while avoiding insider control or commercial dealings. Therefore, if an organization is a nonprofit prepayment group practice health provider that serves a broad community and provides health benefits without insider control, it should receive a 501 (c)(3) tax exemption.

Several Massachusetts laws, including the recently enacted Patients’ Bill of Rights, protect the rights of nursing home patients. Although these laws address many of the problems that such patients face, they do not adequately meet all of the unique needs of this vulnerable group.

This Comment discusses safeguards afforded by current Massachusetts law that are particularly important for nursing home patients, and recommends improvements that would secure more adequate protection for their rights. The Comment also analyzes some of Massachusetts law’s shortcomings in implementation and enforcement, in forum selection and in limitations on standing, and suggests improvements in these areas. Finally, the Comment proposes the enactment of a comprehensive Bill of Rights for Nursing Home Patients in order to address their unique needs more adequately, and to eliminate the duplicative, vague, and confusing provisions contained in current law.