First Amendment Freedoms Diluted: The Impact of Disclosure Requirements on Nonprofit Charities

Since the birth of the Bill of Rights in 1791, the freedoms protected by the First Amendment have been cherished by all members of this nation. The First Amendment provides that “Congress shall make no law . . . abridging the freedom of speech.” Over time, courts have acknowledged that the freedom to speak freely means very little if the guarantee is not protected by an additional right: the freedom to associate. Thus, the freedom of expressive association stands as an essential component of an individual’s free speech rights and state infringement on associative rights has the power of potentially chilling speech, especially from an organizational standpoint. Throughout the relatively short history of the right to associate, the courts traditionally applied strict scrutiny to governmental attempts to intervene in organizations, whether such intervention be via imposing penalties on disfavored groups, requiring disclosure of membership groups, or attempting to interfere with a group’s internal organization or affairs. However, in two recent cases, Citizens United v. Schneiderman and Americans for Prosperity Foundation v. Becerra, two different appellate courts found the freedom of expressive association of either organization was not infringed upon when applying intermediate, exacting scrutiny to state laws mandating the disclosure of nonprofit organizations’ annual Form 990s. These forms, filed yearly with the IRS to maintain tax-exempt status, include a Schedule B that contains a list of the names and addresses of all significant donors to the organization. The plaintiffs in both cases argued the forced disclosure of these donors would chill the organization’s freedom of speech rights by making it more difficult to secure donations from individuals who feared being publicly associated with organizations promoting various minority viewpoints. Ultimately, both appellate courts found these arguments to be unpersuasive and upheld the state laws. Part I of this Note briefly discusses the history and evolution of the freedom of association before articulating what the doctrine looks like today. Part II summarizes the decisions in Citizens United and Americans for Prosperity Foundation while analyzing the reasoning used by both courts in reaching their decisions. Finally, Part III weighs the merits of this decision by considering the arguments raised by both sides both during and in the wake of the decisions. This Note concludes that the appellate courts veered away from traditional preferences of protecting First Amendment rights by upholding a state-sanctioned, non-political disclosure requirement for non-profit charities. Both appellate courts reached this conclusion by applying a less rigorous scrutiny test than that normally applied to statutes with the potential of affecting First Amendment freedoms

What Do Physicians in Training Think About Cultural Competency in Health Care?

Cultural and linguistic competencies have been shown to enhance quality care delivered to ethnic and racial minorities. Various accreditation bodies such as the Joint Commission of Accreditation of Healthcare Organizations (JCAHO) have called for training in cultural and linguistic diversity. On the policy front, laws mandating cultural competency training of health professionals were enacted in three states (New Jersey, California and Washington) and others have moved to introduce similar legislation. All in all, the subject of mandating health professionals\u27 education has been controversial. Historically traditional measures of continuing education mandate only attendance not learning. While states grapple with the issue of educational mandates of its health ,., workforce related to cultural competency, it is paramount to assess providers\u27 perceptions, knowledge and existing practices related to this issue. Maryland ranks second nationally with respect to active physicians, and 6th in training of resident physicians. The state is highly diverse with its population being 41% racial/ethnic minority, and 12.2% being foreign born in 2006. Maryland has enacted its first law on encouraging training of medical providers on health disparities of minority populations in health in 2003. The state went further in attempting to require cultural competency training as a pre-requisite for medical school graduation, physician licensing and re-licensing in the legislative session of 2006 and 2007. These measures failed as a result of fierce objection by academic institutions and governing boards of health professions. The Office of Minority Health and Health Disparities (OMHHD) within the Maryland Department of Health and Mental Hygiene set out to ascertain issues related to cultural competency training in the state. To that end, OMHHD partnered with four teaching hospitals to investigate existing practices and perceptions related to cultural competency training among internal medicine and anesthesia residents. An electronic survey was developed and disseminated to residency directors in participating hospitals. The survey included the following domains. (1) Participants\u27 demographics; (2) assessment of existing cultural competency training; (3) measure of attitudes and perceptions related to cultural competency training (A four point Likert Scale); and, (4) knowledge of national and state guideline pertaining to cultural competency. A total of fifty-five surveys were completed and analyzed. Analysis included descriptive statistics and bi-variate analysis. Perceptions and attitudes were analyzed for stratified groups of various demographic characteristics