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discriminatory acts were intentional.Moreover, this second type of lawsuit is the only one that individual plaintiffs—patients, for example—can bring directly against a defendant such as a health care provider. Thedisparate treatment cases have ceased to be relevant in health care because few providers today treat patients with demonstrable intent to discriminate. In addition to constitutional provisions, state statutes, and federal statutes, there are other laws that prohibit discrimination in health¶care. These laws, called “regulations,” are promulgated by administrative agencies that govern various aspects of health care delivery in the United States. In the case of health care organizations, the Department of Health and Human Services (DHHS) is the agency that has authorityto enact regulations that govern health care delivery. The regulations found under Title 45 of the Code of Federal Regulations (CFR) were enacted “to effectuate the provisions of Title VI of the Civil Rights Act of 1964’“6 after the act was passed by Congress.They have been updated several times, and lawsuits to enforce Title VIand these accompanying regulations were instrumental in tearing down segregation in Americanhealth careorganizations through the close of the twentieth century.¶ In 1969, a consolidated class action suit brought under Title VI ended the “separate and unequal services” policy practiced throughout all of Alabama’s mental health system. The court in Marable v. Alabama Mental Health Board47 was “clear to the conclusion that the segregation and discrimination basedon race practiced by Alabama officials in the mental health system violate the rights of the plaintiff, Marable and his class under the Equal Protection Clause of the Fourteenth Amendment.”
4' Severalsubsequent Title VI attacks on disparate health care also succeededby alleging that exclusion or termination of minority physician privileges violated the Constitution. In one 1994case, a patient successfully challenged a Title VI violation when she was denied medical care based on her African ethnicity and won the right to obtain fair access to HIV treatment." In still another case brought by the Department of Health and Human Services, the federal government successfully defended its authority to inspect the credentialing and peer-review records of hospitals that received Medicare and Medicaid reimbursements in order to confirm their compliance with Title VI antidiscrimination provisions.”¶From1963 through theearly 1990s, Title VI proved an effective weaponagainst the segregation and discrimination that minority patients and physicians had experienced in American health care since the colonial era.As late as 1995, a Title VI case brought in Tennessee effectively addressed a subtle but devastatingly discriminatory practice. The court in Linton v. Commissioner found the state’s policy of certifying specific beds for Medicaid patients while opening all other beds for private paying patients