Our students ought to know about the history of formal hospital segregation and desegregation. To that end, this article urges those who teach foundational health law and policy courses to do three things. First, to teach the Simkins case. Second, to swap out the usual Medicare signing ceremony picture for one that includes W. Montague Cobb, M.D., Ph.D. Third, to highlight how the implementation of that program for the elderly led, in a matter of months, to the desegregation of hospitals throughout the country.

Regulations addressing provision of healthcare services to individuals from diverse cultures and with limited English proficiency (LEP) are reviewed and balanced against ethical considerations with respect to a provider\'s competency in conducting such services. Federal regulations require providers at institutions receiving Federal financial assistance to provide services to individuals without allowing factors such as LEP to act as barriers to those services. However, regulations addressing these factors are not absolute, and must be applied reasonably, with respect to: the number of individuals who speak a particular language in an area, the criticalness of the services, and the costs to and resources of the provider\'s institution. Thresholds based on numbers of individuals speaking a language requiring provision of language assistance services are reviewed. It is also noted that a provider\'s competency in conducting a particular service to patients from diverse backgrounds may be factored as a resource, while accessing appropriate tools and knowledge to provide services to a particular group may be factored as a cost. A review of relevant issues pertaining to competence in conducting cross-cultural evaluations with an emphasis on LEP is presented, followed by case samples in which potential conflicts between regulations and provider ethical obligations are resolved.

Enacted as part of the watershed Civil Rights Act of 1964, Title VI prohibits discrimination by federally assisted entities on the basis of race, color, or national origin. Indeed, the law is as broad as federal funding across the full range of programs and services that affect health. Over the years, governmental enforcement efforts have waxed and waned, and private litigants have confronted barriers to directly invoking its protections. But Title VI endures as the formal mechanism by which the nation rejects discrimination within federally funded programs and services. Enforcement efforts confront problems of proof, remedies whose effectiveness may be blunted by underlying residential segregation patterns, and a judiciary closed to legal challenges focusing on discriminatory impact rather than intentional discrimination. But Title VI enforcement has experienced a resurgence, with strategies that seek to use the law as a basic compliance tool across the range of federally assisted programs. This resurgence reflects an enduring commitment to more equitable outcomes in federally funded programs that bear directly on community health, and it stands as a testament to the vital importance of a legal framework designed to move the nation toward greater health equity.

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The emergence of genetic screening techniques will permit employers to exclude hypersusceptible individuals from potentially hazardous workplace environments. The denial of employment opportunities to these individuals, however, may constitute discrimination. This Note analyzes genetic screening cases with respect to currently available remedies contained in Title VII of the Civil Rights Act of 1964 and the Rehabilitation Act of 1973. The Note concludes that Title VII claims may succeed but only in limited circumstances and that Rehabilitation Act claims will encounter numerous obstacles to relief. Additionally, the Note discusses some of the implications of the use of genetic screening in the workplace.