Category: Blog

Phytoremediation: A Valuable Tool for Local Health Equity Initiatives in the Trump Era

The Inflation Reduction Act invested billions into green energy and environmental justice projects, including grants for phytoremediation projects, which use plants to extract, degrade, or stabilize pollutants in soil, air, and water. When the Trump administration canceled $2.8 billion in EPA grants for research and environmental justice projects, Ira Vandever’s hemp phytoremediation project in the Navajo Nation lost its funding. Another $1.6 million EPA-funded phytoremediation project spearheaded by the Mi’kmaq Nation was building upon their research demonstrating that hemp can extract PFAS (Per- and polyfluoroalkyl substances), also known as ‘forever chemicals,’ from soil, when their grant was also frozen. Projects like these are among many caught in the crossfire of culture war disputes about diversity, equity, and inclusion initiatives.

Pollutants in our soil, air, and water are modifiable risk factors for poor health outcomes. Interventions to improve our health, like phytoremediation, are urgently needed as the US lags further and further behind peer nations in life expectancy. A 2021 study found a staggering 20.4 year disparity in life expectancy between the longest and shortest living demographic clusters in the US—nearly double the gap in 2000. Geographic differences in exposure to environmental threats to health are responsible for a meaningful share of health inequality in the US. For example, one study of Medicare beneficiaries found that elevated exposure to dangerous airborne pollutants like PM2.5 particles is correlated with an increase in all-cause mortality. Another study found that for each standard deviation increase in long-term exposure to ambient PM2.5 there was a 10.8% increase in hospitalizations for non-respiratory infections. A tsunami of stories describing links between smart phones, anxiety, and our diminished attention spans spurred a spate of legislative and policy interventions to remove smartphones from the classroom. But how many Americans know about the relationship between air pollution and anxiety? Or the correlation between daily variance in air pollution and ADHD symptom burden? Or between daily variance in pollution and hospitalizations for schizophrenia? The EPA-funded phytoremediation projects now stuck in legal limbo were designed to address these very problems.

The fight to restore EPA funding is well worth it, but the protracted legal battles over the EPA’s environmental justice grants and the general erosion of the EPA’s capacity under the Trump administration should motivate state and local entities to pursue more of their own environmental justice projects. States, local governments, universities, religious institutions, hospitals, and nonprofits can act to reduce environmental health risks in their community. Small-scale phytoremediation projects are tractable, long-term investments that harness the psychological benefits of greenspace and phytoextraction capacity of particular plant species. Effective implementation requires knowledge about the local ecology, including soil types, rainfall, surrounding flora and fauna, the target pollutant(s), and potential impacts on nearby infrastructure. Well-researched plant choices include willows, cypress, and poplar trees. The right approach will be context dependent. Poplar trees are a great choice for a long-term TCE (trichloroethylene) cleanup project near a landfill or along a creek in the Southeastern US, but in Connecticut, a smaller community garden project focused on phytoextraction and phytostabilization of lead could use sunflowers. Municipalities, universities, schools, and hospital districts could invest in green barriers to reduce the PM2.5 concentration of air behind the barrier by 7-8%.

Phytoremediation is a financially competitive approach too. A study conducted by the Naval Undersea Warfare Center Division found that, by using hybrid poplar trees instead of traditional TCE cleanup and containment methods, they saved between $8.5 and $10.5 million. A 2023 study found that for agricultural land in a mining community, phytoremediation was the best soil remediation method in their cost-benefit analysis model, that best balanced cost, project duration, improved agricultural output, and health benefits measured in disability-adjusted life years.

The EPA’s environmental justice grants were unfairly targeted because culture war narratives rendered them as divisive and wasteful. But nearly all Americans agree that we must protect our air and water from harmful contaminants. The beauty of phytoremediation projects is they speak to intuitively understood universal needs, with a low cost of entry for local actors looking to build coalitions and make a difference. Whether federal agencies thrive or wither away, we can still bloom where we are planted.

A Crisis of Accountability: Medical Neglect and Preventable Deaths in Immigration Detention

On September 14, 2025, Hasan Ali Moh’D Saleh, a lawful permanent resident, was arrested by Immigration and Customs Enforcement (ICE) and transferred to Krome Detention Center in Miami, Florida for removal proceedings. On October 10th, Saleh was transported to Larkin Community Hospital due to a fever; the next day, he was dead.

As immigration raids take place in front of cameras across the country, an unseen crisis has developed behind heavily guarded gates. With the escalation of Immigration and Customs Enforcement-Related Operations (ERO) in the United States under the second Trump Administration, there is mounting public outcry and a flurry of legal challenges concerning the lack of due process regarding the arrests of undocumented migrants, asylum seekers, and green card holders like Mr. Saleh. Conflicting narratives have emerged between advocates and authorities regarding the safety and welfare of individuals detained in ICE-related actions. 

As of September 2025, the Trump Administration is holding nearly 60,000 immigrants in ICE detention facilities around the country, not including those held by local authorities under detainer requests from ICE. Seven in ten people detained have no criminal convictions; the majority are working age adults who deny serious medical complaints at intake. Even so, detainees are dying in custody at record speed, most often due to illness, according to reports made public by ICE. 

The agency maintains that relevant details linked to ERO-related deaths are published on its website within two days. However, the “relevant details” connected to the demise of immigrants like Mr. Ismael Ayala-Uribe at age 39 are often cloudy. According to ICE records, Uribe was arrested on August 17th, 2025. On September 18th, nurses noted that Mr. Uribe was in “10 out of 10 pain” near his anus, so a physician ordered a pain reliever and fiber. By September 21st, he was vomiting, sweating, and his heart rhythm was abnormal, having deteriorated to the point that medical staff needed to transfer him to a local hospital. The ICE press release, replete with an account of Uribe’s crimes, arrests, and his DACA status, states that early on September 22nd, he became unresponsive and died.

In the landmark Supreme Court case, Estelle v. Gamble, the Court found that such unnecessary suffering is inconsistent with contemporary standards of decency, codifying the common law view that “[we are] required to care for the prisoner who cannot by reason of the deprivation of his liberty, care for himself.” Given the inmate’s complete reliance on staff for medical treatment, the Court explained that the “deliberate indifference to serious medical needs” constitutes the infliction of cruel and unusual punishment involving the “unnecessary and wanton infliction of pain” forbidden by the Eighth Amendment. The Court further held that such neglect by prison doctors and guards can result in torture or lingering death, and in less severe instances, cause unnecessary pain and suffering which serves no legitimate penological purpose.

Legislators have worked to gain oversight of detention centers for the purpose of investigating welfare complaints and medical standards in settings where patients do not have the autonomy to make informed decisions about their healthcare. NPR received a rare look inside ICE facilities via inspection reports from experts hired by The Department of Homeland Security. In the findings from 2017-2019, inspectors cited negligent medical care that, in some cases, contributed to detainee deaths. 

One inspection revealed that in the Calhoun County Correctional Center, a man in ICE custody was sent into general population with an open wound from surgery and no bandaging, even though he still had surgical drains in place. Jesse Dean, a detainee at the same facility, was never referred to a physician although he had been unable to eat, lost almost 20 pounds in a short time, and suffered from severe nausea; he died in custody from an undiagnosed gastrointestinal hemorrhage.

A joint study published by American Oversight revealed that the overwhelming majority of incidents such as Dean’s could have been prevented if ICE detention medical staff had provided timely and clinically appropriate medical care to include correct, appropriate, and complete diagnoses for detained immigrants.

After 2020, loss of life in ICE custody attributed to chronic or acute medical conditions declined, and spiked recently in correlation to Trump-mandated mass ERO’s:

As ICE arrests surge, concern continues to grow over rising morbidity and mortality rates in immigration detention centers, along with the absence of accountability or consequences for responsible parties. While an analysis of factors contributing to preventable detainee medical deaths cannot cure those who are no longer alive, an honest post-mortem inquiry into systemic failures is vital in order to safeguard the living.

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.