USF Health faculty, students and staff pose for a group photo with the judges and lawyers who participated in Black Robe Day 2018 at the downtown Tampa-based 13th Judicial Court.

The USF Health Community visited the 13^th Judicial Circuit Courthouse in downtown Tampa on Oct. 17 to get a firsthand look at the relationship between the medical and legal professions.

Known as Black Robe Day, the event was attended by 45 USF Health students, faculty and staff who spent the morning shadowing lawyers and judges, including sitting in on cases and hearings involving parole, juvenile delinquency, domestic violence, burglary, drug dealing and homicide. At lunchtime, the USF Health participants gathered in a courthouse conference room to reflect upon what they had observed and to ask the judges questions.

Jay Wolfson, DrPh, JD, is one of the USF Health organizers of Black Robe Day, now in its 14th year.

The main purpose of the annual Black Robe Day is to expose the USF Health community to the legal system so that students and faculty gain a better perspective and appreciation for the commonalities of law and medicine, said Jay Wolfson, DrPH, JD, associate vice president for health law, policy, safety and distinguished service professor of public health, medicine and pharmacy.

“We’re big on civics education, making sure people understand how our government and system of justice works – and what you did here today is a big part of that,” said attorney Kevin McLaughlin, president of the Tampa Bay Chapter of the American Board of Trial Advocates (ABOTA), a national organization that aims to protect and preserve the jury trial system.

Hillsborough County Circuit Judge Daryl Manning

The experience brings to the forefront how much public health issues, including mental illness, substance abuse and post-traumatic stress to name a few, and social determinants of health, such as poverty, social support networks, and education and literacy, impact the people served by the legal system – as they do individuals, families and communities served by health professionals.

“Since the last time I was here for Black Robe Day I’ve actually decided to go into psychiatry,” said Luis Espinosa, a fourth-year student at the USF Health Morsani College of Medicine. “I came to the realization that you (as lawyers and judges) are going to see a lot of my patients before I do… I hope to provide the same thoughtfulness and level of care you’ve exemplified here.”

USF Health Morsani College of Medicine student Luis Espinosa shares his impressions of the courthouse experience.

This year’s Black Robe Day was organized by Dr. Wolfson; Katherine Drabiak, JD, assistant professor at the USF College of Public Health; and Hillsborough County Circuit Judge Daryl Manning, and coordinated by Denise Brown, judicial assistant to Judge Manning; and Diane Havel assistant to Dr. Wolfson.

The program is also one of the field experiences for the Law and Medicine Scholarly Concentration, one of several concentrations offered by the MCOM Scholarly Concentration Program.

Kevin McLaughlin (standing right), president of the Tampa Bay Chapter of the American Board of Trial Advocates

USF College of Nursing student Kelsey Wallace

USF College of Public Health student Destiny Watts

Bao Anh Tran, PharmD, assistant professor in the USF College of Pharmacy

From left: Dr. Wolfson; Ronald Ficarrotta, chief judge for the 13th Judicial Circuit; Katherine Drabiak, JD, assistant professor of the USF College of Public Health; and Circuit Judge Daryl Manning

-Photos by Eric Younghans, USF Health Communications and Marketing

Keeping citizens connected to our country’s court system – and its central tenet of the jury trial system – is a focus of an annual program that helps USF Health faculty, administrators and students spend a morning in the Hillsborough County Courthouse to see firsthand the similarities of the medical and legal professions.

Members of the USF Heath Community visit the county courthouse to have a firsthand experience of the relationship between the law and medicine.

Called the Black Robe Day, this year’s event was Oct. 25 and included about two dozen people from USF Health shadowing lawyers and judges and sitting in on cases in courtrooms throughout the George Edgecomb Courthouse in downtown Tampa.

“There is a great role the community plays in determining justice and keeping that community voice involved in the our court system is why we’re here today,” said Mark McLaughlin, president of the Tampa Bay chapter of the American Board of Trial Advocates (ABOTA), a national group that aims to protect and preserve the jury trial system. ABOTA sponsors the annual Black Robe event in Tampa.

Mark McLaughlin, president of ABOTA.

The main goal of Black Robe Day is to give a glimpse of our legal system so USF Health students and faculty gain better perspectives of the commonalities of law and medicine, said Jay Wolfson, JD, DrPH, USF Distinguished Service Professor and associate vice president for Health Law, Policy and Safety at USF Health and senior associate dean for the Morsani College of Medicine.

The yearly day in court is organized by Wolfson and Hillsborough County Circuit Judge Gregory Holder, and coordinated by Dionne Ferguson, JD, PhD, director of Strategic Planning and Institutional Effectiveness, and Laura M. Daniels, judicial assistant to Judge Holder. The program is also linked to the Law and Medicine Scholarly Concentration, one of several programs offered by the Scholarly Concentrations Program in the USF Health Morsani College of Medicine.

After a morning in courtrooms, where attendees heard details about drug possession, medical malpractice, domestic violence, theft, and battery, among other types of cases, the students, faculty and staff gathered in a conference room to reflect on what they had seen and heard. Those reflections included gratitude for the inside look at the court system, a newfound appreciation for the legal process and the complexities of each case, and the realization that patients involved in legal proceedings have hardships that might greatly affect their health, as well as their compliance of health care advice.

Some of the many judges who hosted USF Health on Black Robe Day.

Photos by Eric Younghans, USF Health Office of Communications.

USF Health hosted a panel of leaders discussing the impact of the Affordable Care Act on communities and their health care organizations.

Question: How do you build an integrated health system to stem the unsustainable rise in health care costs that provides access to affordable, high-quality care at all stages of life, while optimizing preventive care to help avoid disease and promote well being in individuals and communities?

Answer(s): It’s complicated

The complexities inherent in fixing a fragmented health system were discussed when USF Health hosted a panel discussion April 20 at its Center for Advanced Medical Simulation and Learning (CAMLS).

Representing academia, government and business and industry, the panel was moderated by Jay Wolfson, DrPH, JD, associate vice president for health law, policy and safety at USF Health.  The panelists were Charles Lockwood, MD, senior vice president of USF Health and dean, Morsani College of Medicine; Mayor Bob Buckhorn, City of Tampa; Meredith Rosenthal, PhD, associate dean for diversity and professor of health economics at the Harvard T.H. Chan School of Public Health; Mark Anderson, DSc, senior vice president of ambulatory services, Tampa General Hospital; and Jessica Cooper, executive vice president and director of sustainability for Delos Solutions, a real estate firm that has pioneered designing buildings to promote the health of occupants.

Topics touched on ranged from the Affordable Care Act, the evolution of health care payments from fee-for-service to capitated payments, and clinically integrated networks to telehealth and community wellness districts.

While they brought different perspectives to the table, all the panelists could agree on one thing. Transitioning to a system that balances optimal health outcomes while keeping costs affordable requires strong leadership, new and meaningful collaborations and evidence-based policies.

Dr. Rosenthal, who has advised federal and state policy makers in health payment policy and implementation, was in Tampa as the 2016 Alpha Omega Alpha Visiting Professor, hosted by the Morsani College of Medicine’s chapter of AOA, a premier national medical honor society.

“The United States spends more per capita on health care than any other nation, and it’s at the expense of other public and personal spending,” Dr. Rosenthal said. “Yet, research shows that things we can put in place to help solve the affordability problem, like reallocating some funds from acute care to various types of prevention, can also improve health outcomes. If the goal is to improve health within a budget constraint, we need to think more holistically and employ other tools of care within the community, not just the medical system.”

The following is an edited sampling of the just some of the panelists’ comments:

“The bottomline is that by 2020, 20 percent of the gross national domestic product will be involved in health care and that (growth in healthcare spending) is unsustainable. More importantly, 50 to 60 percent of the health care costs are borne by our companies, which puts them at a competitive disadvantage with other industrialized nations… And that’s driving the move to consumer-based health care, high deductibles, private exchanges and so forth, all of which will impact the medical school’s clinical revenue…”

 “So, we have to teach our medical students to live in a world that will drive down the cost of health care… They have to be efficient in every way in providing care. They have to focus on value. They have to improve outcomes – and that means evidence-based care, patient satisfaction, patient safety and reduced costs.”

“Five percent of patients account for 50 percent of health care costs. Some of (the cost) is end-of-life care, some of it is ICU care. A lot is that, on average, this 5 percent of high-cost patients has five disease states, including diabetes, hypertension and heart disease. We have to be able to provide care for this group in a much more rationale, comprehensive way than we currently do…. to help guide them among all the specialists.”

– Dr. Charles Lockwood, MD, USF Health senior vice president and dean, Morsani College of Medicine

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“You have to be able to make the economic case to employers as to why this makes sense. Taxpayers and those who have insurance are the ones paying for the uninsured…. I think it’s an easy argument to make, notwithstanding the complexities of execution. People understand that for folks who don’t have access to health care, who walk into Tampa General’s emergency room, we pay that burden as a community and as someone who pays for insurance.”

– Mayor Bob Buckhorn, City of Tampa

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“Complex systems require systemic solutions. That’s where health reform is moving –thinking more about the entire continuum of care and how all the pieces fit together to get to the higher value solution. It’s going to be challenging… I imagine we’ll see strategic initiatives about consolidation, including partnerships with industry where that’s feasible, although conflicts of interest may arise… But, I understand that in order to fund underfunded activities that are an important part of your mission, academic medicine will have to leverage that in some way.”

“I hope what we’re talking about in health reform is taking money out of low-value health care services and investing it in health…. There is not a roadmap for a lot of this. There are some successful initiatives that can be adopted, but it’s hard work and requires up front investment for long-run payoffs. That’s a real political challenge.“

-Meredith Rosenthal, PhD, health economist, Harvard T.H. Chan School of Public Health

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“We know that we need to do prevention and wellness programs. We know that we need to align with partners in the primary care arena… We’re having a huge shift into the outpatient arena, and it’s driving us more and more toward trying to identify the ambulatory programs that will serve the needs of our patients and their families out in the community.”

– Mark Anderson, DSc, senior vice president of ambulatory services, Tampa General Hospital

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 “There is public health and design research showing that building and spaces can teach. Our architecture and building infrastructure, the real estate, is more than just four walls and a roof, more than the streets you walk around on. They provide environmental cues that enable and encourage us to make healthier decisions… and potentially also impact our ultimate habits and behavior. So, that’s an exciting prospect when we consider a more systemic change, a sea change really, in the way we think about preventative health.”

– Jessica Cooper,  executive vice president, Delos Solutions

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“An important component that will shape the future of our health care system in the home, in the hospital, in the community and in the training environment has to do with health care technologies, ranging from the health information we want to collect from patients at the point of care to virtual technologies associated with patient care like robotics from a distance and other virtual patient encounters.”

– Jay Wolfson, DrPH, JD, USF Health associate vice president for health law, policy and safety

During the audience question-and-answer session, hospitalist Deborah DeWaay, associate dean for undergraduate medical education at the USF Health Morsani College of Medicine, raised the issue of physician end-of-life care conversations with families of patients.

Catherine Lynch, MD, associate vice president of women’s health and faculty development at USF Health and professor of obstetrics and gynecology at the Morsani College of Medicine, hosted and helped convene the panel.

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Photos by Eric Younghans, USF Health Communications

Tampa, FL (April 6, 2016) — Meredith Rosenthal, PhD, professor of health economics and policy and associate dean for diversity at Harvard School of Public Health, will lead a panel discussion about the impact of the Affordable Care Act on communities and their health care organizations at 8 a.m. Wednesday, April 20, at the USF Health Center for Advanced Medical Learning and Simulation (CAMLS), 124 S. Franklin St., Tampa, FL 33602.

Dr. Rosenthal will engage in the discussion with health care and policy experts from USF Health and the community. The event is free and open to the public.

Meredith Rosenthal, PhD

Panelists will include Charles Lockwood, MD, senior vice president of USF Health and dean, Morsani College of Medicine; Mayor Bob Buckhorn, City of Tampa; Jessica Cooper, executive vice president, Delos Solutions; Mark Anderson, DSc, senior vice president of ambulatory services, Tampa General Hospital; and Jay Wolfson, DrPH, JD, associate vice president of health law, USF Health. Catherine Lynch, MD, associate vice president for women’s health, USF Health, will moderate.

Dr. Rosenthal’s research focuses on policies to help slow growth in health care spending while improving quality of care (value-based health care), including changes in payment incentives, benefits design and behavioral “nudges” to both patients and providers. She has advised federal and state policy makers in health care payment policy and implementation.

While in Tampa, Dr. Rosenthal will also meet with USF Health faculty and students as the 2016 Alpha Omega Alpha (AOA) Visiting Professor, hosted by the Morsani College of Medicine’s chapter of AOA, a premier national medical honor society.

For more information, please contact Leslie Lowe at llowe1@health.usf.edu.

After spending a morning in courtrooms at the George Edgecomb Courthouse in downtown Tampa, USF Health faculty, administrators and students saw firsthand the similarities of the medical and legal professions.

USF Health faculty, administrators and students were invited to experience the judicial process first hand.

About two dozen people from USF Health who attended this year’s Black Robe Day, a morning-long event that partners lawyers and judges with faculty and administrators from the USF Colleges of Medicine, Nursing, Public Health, and Pharmacy, and the School of Physical Therapy and Rehabilitation Sciences, as well as medical students.

The event is organized by Jay Wolfson, JD, DrPH, USF Distinguished Service Professor and associate vice president for Health Law, Policy and Safety at USF Health and Senior Associate Dean Morsani College of Medicine, and Hillsborough County Circuit Judge Gregory Holder, and coordinated by Dionne Ferguson, JD, PhD, director of Strategic Planning and Institutional Effectiveness, and Laura M. Daniels, judicial assistant to Judge Holder.

The Honorable Judge Gregory Holder.

The lunch for event attendees was hosted by the American Board of Trial Advocates (ABOTA), a group of litigators that promotes issues that support the courts and provide a better understanding of the court system.

The main goal of the Black Robe Day is to give a glimpse of our legal system so USF Health students and faculty gain better perspectives of the commonalities of law and medicine. The program is also linked to the Law and Medicine Scholarly Concentration, one of several programs offered by the Scholarly Concentration Program in the USF Health Morsani College of Medicine.

This year, the group from USF Health met with judges for part of the morning of Oct. 20 and then split into smaller groups to shadow individual judges and access many of the court cases taking place that day. Guests of the court heard details about drug possession, domestic violence, theft, and battery, among other types of cases, as they watched the proceedings.

Reflections from the students and faculty about their day in court included gratitude for the inside look at the court system and a newfound appreciation for the legal process. Some of the quotes from the morning included:

“There are similar competency and skill sets in both professions. The ability to listen, the ability to have compassion and the ability to dissect a lot of information in a short period of time. People were at odds with family and children in the courtroom, but they came together to help,”said Joe Ford, assistant vice president of the USF Health Shared Student Services.

“I teach domestic violence and human trafficking and today, seeing it from the real world, was very impressive. I love this,” said Anthonia Imudia, DNP, FNP-BC, assistant professor in the USF College of Nursing.

“We have a lot of patients with substance abuse problems so it was really good to see the follow up of that,” said Sharon Aroda, MD, assistant professor in the Morsani College of Medicine.

“It impressed me how you helped people make informed decisions. Many times they had to make tough decisions and what was best for them was laid it out very clearly,” said Douglas Holt, MD, professor of medicine and director of the Hillsborough County Health Department.

In Judge Richard Weis’ courtroom “I learned some inside baseball lawyering. We had a number of young attorneys in his courtroom and he told me afterwards how he tried to give them hints to get them back to the middle of the road when they were going off into the weeds. Because he operated his courtroom with amazing discipline and efficiency,” said William S. Quillen, PT, PhD, SCS, FACSM, professor and director of the USF School of Physical Therapy and Rehabilitation Sciences and associate dean for the Morsani College of Medicine.

“The disparities we see in health care mimics what you see in the courtroom. And being open to more students would be good because we could be studying these issues from a systems point of view. We need to get more people involved and passionate about this,” said Jacqueline Wiltshire, PhD, MPH, associate professor of Health Policy and Management at USF College of Public Health.

“I was struck by the co-morbidity of substance abuse with almost every story we heard today. No matter their angle or what their drug of choice was, it was amazing how much substance abuse there is and you wonder what direction the causality is. But it’s still shocking and has grim statistics,” said Sean Gregory, PhD, MBA, assistant professor of Health Policy and Management at the USF College of Public Health.

“As a health economist, it’s amazing to me the lost resources that are coming through this building. I can’t believe the challenges you all face on a day-to-day basis and it’s really nice to learn your perspective on it,” said Troy Quast, PhD, associate professor of Health Policy and Management at the USF College of Public Health.

In juvenile court “I saw just how much you judges are trying help them turn their lives around. Even though your hands are tied with that point system, you all really care about the citizens and try to help them,” said Chelsea Frost, fourth-year medical student.

“The thing that got me throughout this experience is the sheer volume of cases that there are. It was quite eye opening. When you say you’re running through 300 cases in a morning that to me blows my mind. So hats off to all of you. What you do on your end is amazing to me and I appreciate the time here,” said Amanda Davis, NP, instructor in the USF College of Nursing.

“For me it was really about solidifying the parallels between law and medicine. It’s not unlike walking through a hospital – the future hung in the balance for these people and their families. Compassion played a big part in the outcomes,” said Luis Espinosa, first-year medical student.

Judges of the Thirteenth District Court.

Judge Greg Holder and USF Health’s Jay Wolfson.

Story by Sarah Worth, photos by Eric Younghans, USF Health Office of Communications.

Substance abuse trials, a case of a medical clinic investment deal going wrong, juvenile court, testimony from the medical examiner for the murder trial of Dante Morris. These were some of the court cases several USF Health faculty and students listened to when they spent part of a day at the George Edgecomb Courthouse in downtown Tampa Nov. 13.

Called the Black Robe Day, the morning-long event partners lawyers and judges with doctors, medical students, medicine, nursing and pharmacy faculty to help link medicine and the law. The event is organized by Jay Wolfson, JD, USF Distinguished Service Professor and associate vice president for Health Law, Policy and Safety at USF Health, and Hillsborough County Circuit Judge Gregory Holder, and coordinated by Megan Monroe, JD, assistant professor in the USF Department of Internal Medicine, and Laura M. Daniels, judicial assistant to Judge Holder. The program is also linked to the Law and Medicine Scholarly Concentration, one of several programs offered by the Scholarly Concentration Program in the USF Health Morsani College of Medicine.

“For doctors just coming into their professions, you will be exposed to court cases,” said Tony Martino, a Tampa-based attorney and an associate for the American Board of Trial Advocates (ABOTA), a group of litigators that promotes issues that support the courts and provide a better understanding of the court system. ABOTA hosted the lunch for event attendees.

The group of mostly medical students, but also faculty from the Colleges of Medicine, Nursing, and Pharmacy, met with judges for part of the morning, and then split into smaller groups to shadow individual judges and access many of the court cases taking place that day.

“On behalf of all of the 62 judges of the Hillsborough County 13th Circuit Court, I thank you for coming,” Judge Greg Holder told the group at lunch. “Whatever we can do to help you, we are here to help.”

Reflections from the students and faculty about their day in court included gratitude for the inside look at the court system and a newfound appreciation for the legal process. Some of the quotes from the morning included:

“I’m so impressed that there’s a second chance for the youth offenders and that the system works very hard to turn the kids around.” Sierra Gower, ARNP, PhD, College of Nursing faculty.

“My takeaway is to stay positive despite all these difficult cases.” Nishit Patel, MD, USF medical resident.

“Thanks for taking justice so seriously. It’s one thing to hear about it but something else altogether different to see it.” Neil Manimala, second-year medical student.

“I was impressed by the work put into the cases and all of the detail you go into to prove your case.” Eric Quintero, fourth-year medical student.

“I wonder how I would be able to put the stressful issues aside when I’m with my patients,” Pedro Sanchez-Herrera, second-year medical student.

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USF Health’s Jay Wolfson, DrPH, JD, was in high demand by local media following this morning’s landmark Supreme Court ruling upholding the federal health care law.

“Extraordinary,” Dr. Wolfson said, commenting on the 5-4 decision that found the Affordable Care Act’s “individual mandate” constitutional as a tax. “Most of the law was upheld in large part because Chief Justice John Roberts joined the majority in deeming the mandate (valid as) a tax under the Constitution.”

The individual mandate, set to take effect in 2014, requires that virtually all Americans have health insurance or pay a penalty.

USF Health’s Jay Wolfson, DrPH, JD, is interviewed by a WUSF reporter.

“The Affordable care act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may be reasonably characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” Chief Justice Roberts wrote.

The ruling allows the government to continue implementing the law, including the provision calling for states to expand Medicaid to cover millions more Americans — those with incomes up to 133 percent of the poverty line.  However, while upholding the law virtually in its entirety, the court modified a key provision by ruling that the federal government cannot withhold existing Medicaid funding from states that do not participate in the broader expansion of Medicaid eligibility.

“At this point it’s unclear what federal government can to enforce that expansion,” said Dr. Wolfson, distinguished service professor of public health and medicine and associate vice president for health law, policy and safety at USF Health.  “It’s not going to be easy to make this law work from day to day.”

The decision means the portions of the law that tend to be popular among the public, including prohibiting insurers from denying coverage of pre-existing medical conditions and allowing children up to age 26 to remain covered by family policies, remain intact.

“Many of us are just a pink slip away from losing health benefits,” Dr. Wolfson said. “This provides some sense of security or a safety net that can help reduce the worry about getting sick.”

One of the lesser-known components of the law are those that begin to push the healthcare system toward reimbursement for positive health outcomes rather than fee for service, Dr.  Wolfson said. “It will require a cultural shift to value and reward the outcomes of things physicians and hospitals do rather than the procedures that they do.

“A law alone can’t change the fundamental cultural expectations of people in our communities,” he said. “But, this law will create a platform and set of incentives for all of us, as healthcare professionals and as citizens, to participate in creating a system of care that focuses on longer-term, meaningful healthcare investments – and not those made of bricks and mortar or technology.  It will be population-based primary and preventive care systems capable of delivering personalized health services that will provide the essential combination of improved health and savings in the long term.

Photos and video by Eric Younghans, USF Health Communications