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Abstract

Municipal hospital closings in recent years are a by-product of two phenomena: 1) the dramatic increase in health care costs and, 2) the fiscal crisis facing many cities. The impact of this reduction in municipal services is felt most acutely by indigent inner city residents, who, because of municipal hospitals receive a portion of their funding from the federal government, have been able to challenge the closings of acute health care facilities as a violation of Title VI of the 1964 Civil Rights Act. Whether plaintiffs can succeed in these suits depends upon the standard that federal courts will employ to review Title VI challenges to municipal hospital closings. This Comment examines the standards employed in reviewing suits charging racial discrimination in municipal hospital closings. Two main issues will be discussed: 1) the burden plaintiffs must meet to establish a prima facie case of racial discrimination and 2), the circumstances that might justify municipal action once racial discrimination has been show and the burden of proof has shifted to the municipality. Because the standards of review in Title VI cases are derived from constitutional case law, this Comment will first examine the standards of review used in equal protection decisions. Second, Title VI of the Civil Rights Act of 1964 will be discussed and the statutory standard of review will be distinguished from the constitutional standards of review. Finally, this Comment will explore the standards that have been applied to the municipal hospital closings and the policy considerations which support and conflict with their application.

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