In a recent issue of MEDICOLEGAL NEWS, Christoffel and Stein reviewed and lamented the “lack of legislative action” against smoking, and blamed the “political and economic strength of the tobacco industry” for “this failure” to protect the public from the costs attributable to death, disease, and disability associated with cigarette smoking, described as the “primary preventable health risk” in the United States. An editorial rebuttal by Matthews noted that cigarette use may have other causes than the tobacco industry, that there may be little consensus as to the need to condemn smoking, and that “moral entrepreneurs” such as Christoffel and Stein could “buoy their spirits” by confining themselves initially to the business of protecting non-smokers from the consequences of people smoking in their presence.

The United States Fourth Circuit Court of Appeals decision in Trageser v. Libbie Rehabilitation Center, Inc., has severely limited the use of §504 in combating employment discrimination, and the United States Supreme Court has refused to review the case. Fortunately, the Department of Justice, the Department of Health, Education and Welfare (hereafter DHEW), the Senate Committee on Labor and Public Welfare, and the United States District Court for the Northern District of California disagree with the Fourth Circuit's finding.

This decision is ironic considering the purpose of the Rehabilitation Act of 1973. Traditionally, the overriding objective of federal and state rehabilitation programs has been to put handicapped people to work. And there can be little doubt, from the legislative history of the Rehabilitation Act, that Congressional sponsors of the law viewed the probability of increased employment opportunities as a major justification for the civil rights provisions of the Act.

This column, the first in a series, addresses the legal background and program issues involved in comprehensive health planning, a concept that has become a permanent factor in the management of health care delivery. An examination of the 1974 Health Planning Act, its 1979 Amendments, and its evolution from voluntary planning to government control provides insights concerning the path of future regulation.

Planning for health care services originated in hospital and community initiatives that sought to guide the distribution of charitable and governmental funds to the neediest hospitals. Purely voluntary in nature, the success of these efforts depended almost entirely on the cooperation and acquiescence of the affected institutions, motivated primarily by their own desire to reduce competition among themselves in fund raising efforts. However, because the desirability of more services was usually assumed, little effort was made to measure the need for the services being proposed.