Railroads Running Roughshod: The Preemptive Power of the InterstateCommerce Commission Termination Act on Tort Claims

Justice Ginsburg argued that the displacement of state tort law with no substantive federal standard of conduct to fill the void creates an outcome that defies common sense and sound policy. The preemptive power of the Interstate Commerce Commission Termination Act (ICCTA) creates such an outcome. To ensure the Surface Transportation Board (STB) has exclusive regulatory control over railroads, the ICCTA preempts any local or state laws that have a regulatory impact on railroads. If a railroad\u27s activity causes harm to a plaintiff, the plaintiff will likely bring a state tort cause of action against the railroad. Railroads argue that these tort claims have a regulatory impact on their activities and are thus preempted. Plaintiffs, in turn, believe that such claims have only an incidental impact on railroads. Courts have not reached a consensus on whether state tort causes of action are preempted by the ICCTA. When plaintiffs\u27 tort claims are preempted, individuals are left without any remedy. These individuals enter a legal limbo where their state tort claims are preempted by the ICCTA, but where no substitute federal causes of action exist. Consequently, railroads are not held accountable for their tortious behavior, and plaintiffs are left without any legal recourse. The key issue for analysis, then, is how to correct this injustice in the face of the ICCTA\u27s preemptive power. This Comment argues that the legal limbo created by the ICCTA must be corrected. In the past, when a statute had this unjust effect on innocent plaintiffs, Congress amended the statute and reined in the statute\u27s preemptive force. The ICCTA needs similar amending. Alternatively, courts should focus on notions of equity and fairness rather than quibbling over congressional intent. A focus on fairness aligns with the Supreme Court\u27s view of tort preemption and ensures that plaintiffs can seek justice

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Railroads Running Roughshod: The Preemptive Power of the InterstateCommerce Commission Termination Act on Tort Claims

Justice Ginsburg argued that the displacement of state tort law with no substantive federal standard of conduct to fill the void creates an outcome that defies common sense and sound policy. The preemptive power of the Interstate Commerce Commission Termination Act (ICCTA) creates such an outcome. To ensure the Surface Transportation Board (STB) has exclusive regulatory control over railroads, the ICCTA preempts any local or state laws that have a regulatory impact on railroads. If a railroad\u27s activity causes harm to a plaintiff, the plaintiff will likely bring a state tort cause of action against the railroad. Railroads argue that these tort claims have a regulatory impact on their activities and are thus preempted. Plaintiffs, in turn, believe that such claims have only an incidental impact on railroads. Courts have not reached a consensus on whether state tort causes of action are preempted by the ICCTA. When plaintiffs\u27 tort claims are preempted, individuals are left without any remedy. These individuals enter a legal limbo where their state tort claims are preempted by the ICCTA, but where no substitute federal causes of action exist. Consequently, railroads are not held accountable for their tortious behavior, and plaintiffs are left without any legal recourse. The key issue for analysis, then, is how to correct this injustice in the face of the ICCTA\u27s preemptive power. This Comment argues that the legal limbo created by the ICCTA must be corrected. In the past, when a statute had this unjust effect on innocent plaintiffs, Congress amended the statute and reined in the statute\u27s preemptive force. The ICCTA needs similar amending. Alternatively, courts should focus on notions of equity and fairness rather than quibbling over congressional intent. A focus on fairness aligns with the Supreme Court\u27s view of tort preemption and ensures that plaintiffs can seek justice

Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak.

IMPORTANCE: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide. OBJECTIVE: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection. EXPOSURE: Respiratory syncytial virus. MAIN OUTCOMES AND MEASURES: Data were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity. RESULTS: The first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age \u3c37 \u3eweeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness

Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Introduction: Cluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent. Methods: The PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have. Results: Patient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation. Discussion: Involvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal