This article focuses squarely on the community service provision and the regulations promulgated thereunder. The analysis traces the statutory and regulatory history of the community service obligation and examines the scope of the discretion that has been delegated to federal and state agencies to define and enforce this obligation. The discussion begins with a brief history of the original Hill-Burton program and the several amendments and modifications of the program over the last several decades. Next, the legislative history of the community service obligation is examined in an effort to determine the scope of authority created by Congress in establishing the community service obligation. Specifically, this section addresses the questions of whether Congress intended the community service provision to impose an affirmative obligation upon funded facilities, and whether the requirement is one of general availability of medical services or simply a prohibition on racial discrimination. An examination of the regulatory history of the community service obligation follows, including a discussion of the 1979 regulations themselves. This section also addresses the questions of whether the 1979 regulations exceed the scope of authority as defined by previous regulations, and whether enforcement of the 1979 regulations has a retroactive effect which results in an unconstitutional impairment of contract and property rights. It will be submitted that the present community service regulations are indeed authorized by Congress and that retroactive application of the regulations, at least back to 1964, neither exceeds the scope of authority as set out previously by statute or regulation, nor unconstitutionally impairs contract or property rights.
The Community Service Obligation of Hill-Burton Health Facilities, 23 B.C. L. REV. 577