Category: Blog

Accessibility Behind Bars: ADA Compliance in Prisons

Among the limited rights of incarcerated individuals, those ensuring fair and human treatment are often the subject of debate and frequently go unenforced. In the past few years, complaints have arisen concerning the poor and unequal treatment of inmates with disabilities, sparking lawsuits and questions over whether U.S. prisons are complying with the Americans with Disabilities Act (ADA), which aims to protect individuals with disabilities in various areas of public life.

Congress passed the Rehabilitation Act of 1973 (Rehab Act) to prohibit discrimination against people with disabilities in federal employment, federally funded programs, and programs conducted by federal agencies, including federal prisons. The ADA, applicable to state prisons, was initially passed in 1990 and updated in 2010 to include official standards for accessible design. The 2010 standards require at least 3% of cells to be accessible to people with mobility disabilities, and at least 2% to be equipped with communication accommodations for people who are deaf or hard-of-hearing. The ADA furthermore states integrated setting policies which assert that inmates or detainees with disabilities should not be placed in facilities that do not offer the same programs as where they would otherwise be held. Additionally, they should not be denied access to available programs and activities, including education, work release, visitation, and vocational opportunities.

Although the ADA and Rehab Act intended to accommodate incarcerated individuals with disabilities, without enforcement, they are rendered ineffective. In 2022, a lawsuit was filed against the San Diego County Sheriff’s Department for their detention facilities failing to comply with the ADA. A deaf inmate at a San Diego County jail reported that he was taken to the jail’s dentist for tooth pain, but could not communicate with the dentist or jail staff because he was not provided an interpreter. Fourteen other disabled plaintiffs testified that they experienced similar treatment, including two wheelchair users who were given inaccessible bunk bed assignments, one of whom was told he had two options, “sleeping on the floor, or trying to climb up to the third bunk.”

Similar violations of the ADA have occurred in detention facilities across the country. In Georgia, the American Civil Liberties Union (ACLU), the ACLU of Georgia, and the National Association of the Deaf brought a lawsuit on behalf of deaf and hard-of-hearing inmates overseen by the Georgia Department of Corrections. The suit, initially brought in 2018, is still ongoing, and as of April 2025, the plaintiffs’ motion for summary judgment is pending. The plaintiffs claim that because the communication events are not accessible, they are not given notice of the prison’s rules and procedures, subjecting them to disciplinary actions for failing to comply with unexplained rules. Furthermore, the plaintiffs have been unable to attend activities and educational opportunities required for prerelease because of the lack of accessibility for the deaf and hard-of-hearing.

A similar complaint was filed in 2023 against the Minnesota Department of Corrections for failing to notify individuals with disabilities about modifications to GED courses, practice tests, and exams, preventing them from applying for accommodations, such as extended time and breaks. Participation in educational courses can lead to a reduced sentence; therefore, by denying inmates accommodations, prisons could be keeping them incarcerated longer than they would have been had accommodations been provided. The Minnesota Department of Corrections subsequently agreed to comply with the ADA and provide accommodations so that inmates with disabilities can participate in GED courses. They also agreed to require training for facility personnel on the ADA and disability discrimination and pay over $70,000 in compensatory damages to the individuals affected by the discrimination.

Recently, additional claims have surfaced regarding ADA compliance in prisons, including denial of proper medical care to incarcerated individuals with disabilities. Although courts uphold ADA standards for equal access to public services, the claims must be specifically applicable to the ADA or the Rehab Act, and incarcerated people must adhere to a standard form for filing civil rights lawsuits. Given that many incarcerated individuals with disabilities lack general resources, let alone information on how to file a complaint, it is likely that many ADA and Rehab act violations go unchallenged.

A Foot in the Door: Virginia’s New Doula Law, S.B. 1384, Guarantees Their Presence, but not Their Access

Virginia has taken a critical step to address its maternal health crisis with a new law guaranteeing a birthing person’s right to have both a doula and a partner (or other support person) present during labor and childbirth. This legislation is a direct response to the state’s alarming maternal mortality rates, which disproportionately affect Black mothers who are nearly three times more likely to die from pregnancy-related causes than their White counterparts. A doula is a trained, often community-based professional who provides physical, emotional, and informational guidance to an individual before, during, and after childbirth.  Research indicates that continuous doula support improves birth outcomes, reduces the need for C-sections, and enhances patient satisfaction. For Black and other minority women, doulas serve as important advocates, familiar with their communities and bodies, and able to communicate their needs and birth preferences to doctors who may lack the same understanding. Previously, and especially during the COVID-19 pandemic, many hospitals limited patients to a single support person, forcing birthing individuals to choose between their visitors. The new law rectifies this by legally defining a doula as a member of the essential care team—a foundational step that grants legal protection to a patient’s right to their full support system. However, while this law codifies a crucial right, its promise is diluted by significant systemic barriers that prevent equitable access.

A major implementation gap exists between the law’s text and lived reality in Virginia hospitals. The legislation grants “discretion to the treating physician” to override the patient’s right to a doula. This clause is used to enforce restrictive institutional polices, most notably banning doulas from operating rooms during C-sections, even though the law explicitly includes cesarean births in its definition of “birth.” Many hospitals lack clear, updated protocols, creating a confusing and inconsistent environment where a birthing person’s rights depend on their location and provider. This institutional gatekeeping maintains the status quo, leaving families without vital support during vulnerable moments and undermining the law’s core intent.

For many Virginians, a primary obstacle to hiring a doula is financial. Private doulas can range from $800 to $2,500, placing this essential support out of reach for low and middle income families. While Virginia’s Medicaid program now covers doula services, its design creates a new set of challenges. The reimbursement rate of approximately $859 is significantly below market rate and fails to provide a living wage, especially considering the on-call nature of the work. Furthermore, doulas face a costly process to become certified and enrolled with multiple managed care organizations. These financial disincentives limit the number of participating doulas, particularly in rural maternity care deserts, where support is already scarce, perpetuating a two-tiered system of access.

Senate Bill 1384 is a legislative victory for maternal health in Virginia. Yet, a right on paper is not a right in practice. To truly realize the law’s life-saving potential, policymakers, hospitals, and state agencies must work to dismantle the deep-seated institutional and economic barriers that continue to deny so many families the support they deserve and are now legally guaranteed.

The AI Doctor Will See You Now—But Is It Regulated?

In early 2025, two-thirds of doctors reported using artificial intelligence (AI) for a wide range of purposes, including “documentation of billing codes, medical charts, and visit notes; generating discharge instructions, care plans, and progress notes; providing translation services; supporting diagnostic decisions; and more.” Although the healthcare sector was initially hesitant to adopt AI, it has since accelerated its integration efforts and now implements AI technologies at twice the rate observed in other economic sectors. The escalating costs of healthcare have prompted the increased adoption of artificial intelligence, aimed at enhancing operational efficiency, optimizing resource utilization, and ultimately reducing expenditures.

AI in healthcare extends beyond addressing administrative inefficiencies, as regulator-approved applications, classified as Software as a Medical Device (SaMD), are already showing clinical promise; for example, one AI algorithm used in a U.S. mammography study improved breast cancer detection rates by 9.4% and reduced false positives by 5.7%. Ongoing research is exploring the efficacy of SaMD across fields such as dermatology, radiology, psychiatry, and personalized medicine, where AI’s capacity to process large datasets and continuously learn enhances diagnostic accuracy and enables more individualized treatment approaches.

Although artificial intelligence presents considerable potential for advancing the healthcare sector, it simultaneously generates substantial uncertainties, given that technological developments outpace the formulation and implementation of regulatory frameworks. According to Professor Dr. Heinz-Uwe Dettling, Partner, Ernst & Young Law GmbHand EY GSA Life Sciences Law Lead, this issue is often described as the ‘locked versus adaptive’ AI challenge; regulatory efforts are necessary, but the current regulations were not designed to keep up with the rapid pace of technological advancements like those seen in artificial intelligence.

In addition to ongoing uncertainties surrounding regulatory frameworks, AI remains inherently imperfect. A study conducted by Rutgers University demonstrated that AI algorithms can inadvertently perpetuate erroneous assumptions, largely because they rely on datasets that may result in broad generalizations about people of color. Furthermore, these algorithms often neglect essential social determinants of health, such as transportation accessibility, the cost of nutritious food, and variable work schedules, which play a critical role in influencing patients’ capacity to comply with treatment regimens requiring frequent medical appointments, physical activity, and other health-related interventions.

Concerns regarding the implementation of artificial intelligence in healthcare have prompted regulators, legislators, and healthcare practitioners to call for the development of more comprehensive regulations and guidelines within this dynamically evolving sector. A thorough understanding of biases inherent in traditional education and healthcare professionals is essential, requiring developers to have both domain-specific knowledge and technical expertise. Additionally, implementing more rigorous processes to review data inputs is crucial to preventing biases in algorithms that may exacerbate healthcare disparities.

Because AI touches every part of the healthcare system, it is essential to have cross-agency coordination as well as regulations at the state and federal levels. Currently, multiple federal agencies regulate AI in healthcare, including the FDA, the Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS). In addition, states have enacted legislation designed to ensure that artificial intelligence remains a tool, not a replacement, in the doctor’s office. These state-level regulations require “healthtech” companies to embed compliance measures from the earliest stages of product development, including conducting thorough audits and employing geofencing technologies to navigate the patchwork of differing state laws effectively. By prioritizing proactive compliance and transparent practices, companies can not only mitigate legal risks but also build greater public trust, thereby enabling smoother adoption and competitive advantage in an increasingly regulated and scrutinized market.

Destination Unknown: Navigating Abortion Training in Post-Dobbs America

Abortion is not only common but an essential component of comprehensive care, with one in four pregnant people accessing abortion care in the United States. During my annual physical this summer, I reflected on what challenges people seeking abortion care in my home state of Georgia – and across the Southeast – now face. As the conversation drifted from lab results to my research in reproductive rights law, my doctor posed a question I hadn’t considered: What happens if the next generation of physicians is denied the right to train in abortion care?

On June 24, 2022, the Supreme Court’s decision in Dobbs v. Jackson Women’s Health signaled a seismic shift in reproductive care, affecting not only patients, but physicians in training. The fight to preserve abortion care has moved far beyond the operating room, and now extends to fellowship and residency programs, where trainees do not know if they will ever receive abortion care experience. In a nation where abortion is no longer a constitutional right, medical students, residents, and fellows in states with restrictive abortion laws are being forced to seek training across state lines, and even abroad. One fourth-year medical student planning to pursue a specialty involving family planning, was forced to independently find a rotation that would provide abortion care training, and had to travel as far as London after her school’s reproductive health clinic shut down. 

Training in abortion care for medical students and resident physicians already had significant limitations pre-Dobbs in states with restrictive abortion laws. Along with barriers associated with geographic location or having the resources to travel, patients must now face the additional challenge of finding a physician with enough training to provide an abortion.

Critics of widespread access to abortion care often argue that medical exception laws are enough to prevent maternal mortality or morbidity. However, these “exceptions,” often written into law by people without medical training, using nonmedical language, have resulted in mass confusion for clinicians who, when faced with split-second decisions, are forced to deny or delay care for their patients. Post-Dobbs, there is scant opportunity for doctors in training to have hands-on abortion care experience in states that operate on medical exception laws.

Within Family Medicine and Obstetrics and Gynecology, some family planning program directors have already expressed concerns about the ability to attract residents and fellows to programs in states with abortion bans. These concerns are not without basis, with a cross-sectional study of 2,436 OB-GYN residency programs revealing a small but significant decrease in the number of applicants to residency programs in states with strict abortion laws. According to the study, state-specific abortion restrictions are impacting the training of around 44% of OB-Gyn residents in the U.S. Even though OB-GYN residency programs were also completely full in 2023, there was a statistically significant decrease in applications compared to 2022, and years pre-Dobbs.

While the long-term on the OB-GYN workforce may not be visible just yet three years out from the Dobbs decision, should the trend continue, maternal mortality and morbidity may rise, especially in maternal care deserts. Maternal care deserts are defined as counties where hospitals lack obstetric services, birth centers, obstetricians, gynecologists, or certified nurse-midwives. Maternal care deserts are often found in rural areas, with most rural countries having maternal mortality rates close to two times higher than rates in urban counties.

The future of abortion care training in OB-Gyn and Family Medicine residency programs in states with restrictions is uncertain, with no clear path forward. While some states with restrictive laws may offer medical exceptions, these may not provide enough opportunities for medical students and residents to gain enough training to confidently perform these procedures, impacting the standard of care nationwide.

The Beginning of the End for Vaccine Mandates?: What Happens When Ideological Opposition to Vaccination Invades Public Health Policy

“We did it everybody!” exclaimed Leslie Manookian, “We passed the first true medical freedom bill in the nation!” Ms. Manookian and other members of the anti-vaccine group Health Freedom Idaho were celebrating the Idaho Medical Freedom Act being signed into Idaho state law on April 4, 2025, which protects those who refuse to take medical interventions like vaccines from being excluded from activities of daily life such as obtaining a service from a business or attending school.

Idaho is the first state in the country to enact a law protecting personal medical freedom which includes these types of protections for people who are against getting vaccinated, but other states may attempt to implement similar laws and public health policy changes due to vaccine skepticism present throughout the nation. For example, Florida’s current Surgeon General Joseph Ladapo has expressed a desire to eliminate vaccine mandates throughout the state of Florida despite broad medical and religious exemptions. Mr. Ladapo’s rhetoric regarding eliminating vaccine mandates seems less based on science and more based on morals and principle. When describing vaccine mandates Mr. Ladapo stated, “every last one of them is wrong and drips with disdain and slavery,” he added that forcing vaccine mandates “immoral” and “wrong”, and he proclaimed “Your body is a gift from God.” Similarly, when asked about her motivations to help codify the Idaho Medical Freedom Act, Ms. Manookian stated that she and others pushing for freedom from vaccine mandates believe that “our immune systems, given to us by God, are perfect as long as they’re well nourished.” Ms. Manookian also insisted that it was “not accurate” that the implementation of the measles vaccine was what led to the eradication of measles, instead citing improvements in clean drinking water and waste management which helped quell spread of the disease. These types of moral statements regarding vaccine use reflect a growing population of people who see public health interventions such as vaccines more as an issue of personal freedom rather than an issue of safety. These statements made by Mr. Ladapo and Ms. Manookian highlight a crucial ideological issue that public health officials must learn to address more effectively to reduce vaccine skepticism. Global health organizations are beginning to provide targeted guidance to assist healthcare professionals in combating vaccine skepticism not just by providing accurate information but by building trust and a deeper understanding of community perceptions, social norms, and potential logistical barriers to vaccination.

So far in 2025 the United States had had over 1,600 measles infections, which is the most measles infections in the country since 1992, and in 92% of cases the patients are either unvaccinated people or their vaccine status is unknown. Prior case law on the issue of vaccine mandates in the United States, such as the landmark Supreme Court case Jacobson v. Massachusetts, have allowed state public health departments to compel their citizens to be vaccinated despite ideological opposition to the vaccine, but if the legislatures and health departments themselves buy into ideological opposition to vaccines then a key safeguard against disease transmission will be dismantled. It may not be enough to simply combat vaccine misinformation with accurate science, as surveys have shown that false or unproven claims about vaccines are more widely accepted today than two to three years ago despite concerted efforts to combat misinformation with accurate science. The American College of Allergy, Asthma, and Immunology has urged policymakers to weigh the unintended public health implications if vaccine mandates were to be eliminated, but public health officials and medical professionals should be prepared going forward to find new ways to address skepticism to vaccines once a major legal enforcement tool is eroded.

The MIND Act: Congress’s Attempt to Protect Americans’ Brain Data

Neurotechnologies are devices that have been used in the clinical context for decades to collect data about brain or nervous system activity. Examples include the use of magnetic resonance imaging (MRI) to diagnose brain tumors, electroencephalograms (EEG) to predict strokes, and deep brain stimulation (DBS) to treat symptoms of Parkinson’s disease.

In addition to the clinical context, the consumer market now accounts for 60% of the global neurotechnology landscape. By 2034, the global neurotechnology market size is predicted to reach around $52.86 billion. Neuralink, a company founded by Elon Musk, creates implantable brain-computer interfaces (BCIs), which are used to restore personal control over limbs, prosthetics, and communication devices. Other consumer neurotechnologies include EEG headsets that produce real-time brain data and earbuds that measure brain activity from the ear canal.

Several issues are raised by the use of neural data in both the clinical and consumer sectors. The production, distribution, and use of these neurotechnologies creates unique privacy, discrimination, and security concerns. There have even been efforts in the criminal justice system to identify deception from brain activity. Scholars have proposed and debated the necessity of a new category of rights called “neurorights,” which include mental privacy, mental integrity, and cognitive liberty.

In response to these growing concerns, Democratic Senators Chuck Schumer (D-NY), Maria Cantwell (D-WA) and Ed Markey (D-MA) recently introduced the Management of Individuals’ Neural Data Act of 2025 (the MIND Act). This bill aims to protect Americans’ brain data from exploitation and was referred to the Committee on Commerce, Science, and Transportation.

The MIND Act defines neural data as “information obtained by measuring the activity of an individual’s central or peripheral nervous system through the use of neurotechnology.” It also provides an expansive definition of neurotechnology as any “device, system, or procedure that assesses, monitors, records, analyzes, predicts, stimulates or alters the nervous system of an individual to understand, influence, restore, or anticipate the structure, activity, or function of the nervous system.” This definition encompasses basic tools like MRI and EEG, but also covers BCIs and consumer products like smart glasses and smart watches.

The proposed legislation directs the Federal Trade Commission (FTC) to study how neural data and other related data, which can infer psychological states or neurological conditions, are currently governed. It also compels the FTC to identify gaps in current governing frameworks, including the Health Insurance Portability and Accountability Act (HIPAA). At the federal level, HIPAA defines health information expansively, but likely fails to protect neural data in several clinical contexts.

At the state level, neural data is not clearly included in most consumer privacy laws. In response to this, Colorado, California, Montana, and Connecticut have led the way by passing privacy laws that categorize neural data as highly sensitive information. If passed, the MIND Act would establish a federal standard that follows in these states’ footsteps.

While it does not go so far as to create a new private right of action, the MIND Act does create a roadmap for future FTC rulemaking or broader privacy legislation. It may also play an important role in healthcare product development as neurotechnology and AI are integrated and developed in tandem. Perhaps more importantly, it is a clear message from Congress about the importance of privacy protections in an ever-changing technological landscape.