The week's catchy dance tune. Also, thank you to the Brother, for taking the psycho hussy off our hands.
Before you ask, the name is Nadya Nepomnyashaya.
Sunday, May 23, 2010
Saturday, May 15, 2010
Muhammad Yunus at Rice University: Genius, Yes, But...
What an intelligent student body, selecting this brilliant economist as their graduation speaker.
I have always believed poverty is a cultural choice at least, but not necessarily an individual's choice. In a culture of wealth accumulation such as that of the USA, poverty is a lifestyle choice, similar to choosing between a marina community or a golf development.
Prices are the same around the world. I thought the extreme poor required superhuman powers to survive on $1000 a year or less, with a family of 8. I admire the extreme poor for skills I do not have and am unlikely to be able to learn. For example, in a Third World country, people went to the bathroom in latrines. I just could not. I held it in until I could reach the lobby bathroom of the local Holiday Inn.
That being said, Dr. Yunus came up with a simple idea. It is counter-intuive until it works well and for a long time. That is the nature of genius.
Points Made
For an effective business model, take each point in the business model of banks and do the opposite.
Lend to the poor.
No collateral.
No contract with illiterate people.
No lawyers.
Lend to females, not males only as the banks do.
Find beggars and propose adding value to their visits to homes, for example, sell something small, such as cookies, toys, trinkets. The beggars then learn market stratification learning the best homes for begging, and the best homes for selling.
Next, offer the children of beggars tuition loans. He has produced 10's of 1000's of professionals that way.
Point Not Made
That female who buys a sewing machine with the $12 lent to her, starts to make clothing. She may end up earning $1000 a year. That then makes her the wealthiest, cash engorged person in the village. She may hire people, and begin to have influence. The bosses running that village then visit her because she may end up taking their power away. They offer her to end her business or to be driven out or killed. She will likely stop, and that explains why the village is poor. It may be that poverty is a lifestyle choice not just in the USA, but also in Bangla Desh, because it promotes power interests.
I have always believed poverty is a cultural choice at least, but not necessarily an individual's choice. In a culture of wealth accumulation such as that of the USA, poverty is a lifestyle choice, similar to choosing between a marina community or a golf development.
Prices are the same around the world. I thought the extreme poor required superhuman powers to survive on $1000 a year or less, with a family of 8. I admire the extreme poor for skills I do not have and am unlikely to be able to learn. For example, in a Third World country, people went to the bathroom in latrines. I just could not. I held it in until I could reach the lobby bathroom of the local Holiday Inn.
That being said, Dr. Yunus came up with a simple idea. It is counter-intuive until it works well and for a long time. That is the nature of genius.
Points Made
For an effective business model, take each point in the business model of banks and do the opposite.
Lend to the poor.
No collateral.
No contract with illiterate people.
No lawyers.
Lend to females, not males only as the banks do.
Find beggars and propose adding value to their visits to homes, for example, sell something small, such as cookies, toys, trinkets. The beggars then learn market stratification learning the best homes for begging, and the best homes for selling.
Next, offer the children of beggars tuition loans. He has produced 10's of 1000's of professionals that way.
Point Not Made
That female who buys a sewing machine with the $12 lent to her, starts to make clothing. She may end up earning $1000 a year. That then makes her the wealthiest, cash engorged person in the village. She may hire people, and begin to have influence. The bosses running that village then visit her because she may end up taking their power away. They offer her to end her business or to be driven out or killed. She will likely stop, and that explains why the village is poor. It may be that poverty is a lifestyle choice not just in the USA, but also in Bangla Desh, because it promotes power interests.
Saturday, May 8, 2010
Less Painful Pre-Authorizations
The cancellation of a prescription by refusal to pay for it is the same as making a prescribing, an act of medical practice. Assume the prescription was cancelled by a doctor in the same specialty as the prescriber. It remains unprofessional conduct to make a medical decision on a patient whom one has never seen, and whose records have not been reviewed.
I would like to see an ethics complaint for unprofessional conduct filed after every denial. The pre-authorization itself is a joke. It implies, the prescribing doctor was not serious in writing his prescription, or only meant it a little. I disagree that the time and effort are built into the encounter fee, without causing a conflict of interest. The fee is to see the patient. It is not to do work for the insurance company. If the doctor is on the payroll of the insurance company and owes a duty of performance, he cannot be 100% committed to the medical interest of the patient.
In any case, here is some advice on trying to make it easier.
******
Insurance preauthorizations: How to make the process less painful
Practice Management. By Victoria Stagg Elliott, amednews staff. Posted April 5, 2010.
The process can be automated. Or, practices can note what issues trigger a denial, and adjust their processes to quicken and gain approval.
And while insurers normally view precertification as a nonbillable service because it's considered part of a medical visit, evidence of how much time it takes can be used as a negotiating chip with insurers.
"It's supposed to be built into the revenue for the services that doctors are providing, but it can be an administrative nightmare for practices. Every insurance company requires something just a little bit different," said Rhonda Buckholtz, vice president of business and member development at the American Academy of Professional Coders. "But we can simplify the process as best we can."
The first step is to analyze how the office handles the process. Is it possible to get some preauthorizations completed before the patient comes in? Are there insurer-provided online tools that the practice is not taking full advantage of?
For example, Elizabeth Woodcock, principal of Woodcock & Associates in Atlanta, said she worked with an endocrinology practice that entered precertification information into an insurer's online system. But, rather than submitting it electronically, staff printed it out and faxed it, which took additional time.
"Make sure you are using all the automation that the payer allows," Woodcock said.
Experts also suggest creating some kind of tool that staff can refer to with all the policies and procedures of various insurers. This does not have to be particularly high-tech. For instance, Buckholtz has set up three-ring binders at several medical practices she has worked with. The binders can be particularly handy if the person who usually handles preauthorizations is out of the office.
Dealing with denials of the initial request for precertification also can be time consuming, but experts say the situation is another opportunity to look for time savings. Are there consistent issues that trigger a denial? Are certain codes always left off? Are necessary lab tests not being noted?
I would like to see an ethics complaint for unprofessional conduct filed after every denial. The pre-authorization itself is a joke. It implies, the prescribing doctor was not serious in writing his prescription, or only meant it a little. I disagree that the time and effort are built into the encounter fee, without causing a conflict of interest. The fee is to see the patient. It is not to do work for the insurance company. If the doctor is on the payroll of the insurance company and owes a duty of performance, he cannot be 100% committed to the medical interest of the patient.
In any case, here is some advice on trying to make it easier.
******
Insurance preauthorizations: How to make the process less painful
Practice Management. By Victoria Stagg Elliott, amednews staff. Posted April 5, 2010.
The process can be automated. Or, practices can note what issues trigger a denial, and adjust their processes to quicken and gain approval.
And while insurers normally view precertification as a nonbillable service because it's considered part of a medical visit, evidence of how much time it takes can be used as a negotiating chip with insurers.
"It's supposed to be built into the revenue for the services that doctors are providing, but it can be an administrative nightmare for practices. Every insurance company requires something just a little bit different," said Rhonda Buckholtz, vice president of business and member development at the American Academy of Professional Coders. "But we can simplify the process as best we can."
The first step is to analyze how the office handles the process. Is it possible to get some preauthorizations completed before the patient comes in? Are there insurer-provided online tools that the practice is not taking full advantage of?
For example, Elizabeth Woodcock, principal of Woodcock & Associates in Atlanta, said she worked with an endocrinology practice that entered precertification information into an insurer's online system. But, rather than submitting it electronically, staff printed it out and faxed it, which took additional time.
"Make sure you are using all the automation that the payer allows," Woodcock said.
Experts also suggest creating some kind of tool that staff can refer to with all the policies and procedures of various insurers. This does not have to be particularly high-tech. For instance, Buckholtz has set up three-ring binders at several medical practices she has worked with. The binders can be particularly handy if the person who usually handles preauthorizations is out of the office.
Dealing with denials of the initial request for precertification also can be time consuming, but experts say the situation is another opportunity to look for time savings. Are there consistent issues that trigger a denial? Are certain codes always left off? Are necessary lab tests not being noted?
Pre-Authorizations Denials End When Investigations Begin
Insurance preauthorization denials spark inquiries
By Emily Berry, amednews staff. Posted April 15, 2010.
Years of physician complaints about Delaware health plans' utilization management programs have culminated in inquiries from a U.S. senator and the state's insurance commissioner.
Sen. Jay Rockefeller (D, W.Va.) wrote to Blue Cross Blue Shield of Delaware March 25, citing news reports that said the plan, through contracted utilization manager MedSolutions, was routinely denying requests for prior authorization for cardiac stress tests, even in cases where they appeared to be obviously medically necessary.
Rockefeller, who chairs the Senate Committee on Commerce, Science and Transportation, asked the company to give his office its records, including an explanation for every denial of a cardiac diagnostic test in the last five years.
Then on March 27, state Insurance Commissioner Karen Weldin Stewart announced she had formed a task force and was investigating prior authorization denials by the Blues, Coventry Health Care and Aetna, all of which have hired MedSolutions.
In a statement released that day, she said that until her department had completed its work, the Delaware Blues had agreed to eliminate preauthorization requirements for high-tech radiology services.
By Emily Berry, amednews staff. Posted April 15, 2010.
Years of physician complaints about Delaware health plans' utilization management programs have culminated in inquiries from a U.S. senator and the state's insurance commissioner.
Sen. Jay Rockefeller (D, W.Va.) wrote to Blue Cross Blue Shield of Delaware March 25, citing news reports that said the plan, through contracted utilization manager MedSolutions, was routinely denying requests for prior authorization for cardiac stress tests, even in cases where they appeared to be obviously medically necessary.
Rockefeller, who chairs the Senate Committee on Commerce, Science and Transportation, asked the company to give his office its records, including an explanation for every denial of a cardiac diagnostic test in the last five years.
Then on March 27, state Insurance Commissioner Karen Weldin Stewart announced she had formed a task force and was investigating prior authorization denials by the Blues, Coventry Health Care and Aetna, all of which have hired MedSolutions.
In a statement released that day, she said that until her department had completed its work, the Delaware Blues had agreed to eliminate preauthorization requirements for high-tech radiology services.
Assessment of Costs by Clerk of Court Despite Wealth Disparity
The Third Circuit covers Pennsylvania. Given the fact that 80% of malpractice claims are weak, this decision should result in more requests for costs. In this case, two claims were not filed on time, and summary judgments for the hospital were granted.
The decision is here.
Federal Rule of Civil Procedure 54(d)(1):
(d) Costs; Attorney’s Fees.
(1) Costs Other than Attorneys’ Fees.
Unless a federal statute, these rules, or a court order provides otherwise, costs — other than attorney's fees — should be allowed to the prevailing party. But costs against the United States, its officers, and its agencies may be imposed only to the extent allowed by law. The clerk may tax costs on 14 days' notice. On motion served within the next 7 days, the court may review the clerk's action.
The decision is here.
Federal Rule of Civil Procedure 54(d)(1):
(d) Costs; Attorney’s Fees.
(1) Costs Other than Attorneys’ Fees.
Unless a federal statute, these rules, or a court order provides otherwise, costs — other than attorney's fees — should be allowed to the prevailing party. But costs against the United States, its officers, and its agencies may be imposed only to the extent allowed by law. The clerk may tax costs on 14 days' notice. On motion served within the next 7 days, the court may review the clerk's action.
Friday, May 7, 2010
Lawyer Deceit Statutes
Recommended reading for all victims of lawyer deceit.
Attorney Deceit Statutes: Promoting Professionalism Through Criminal Prosecutions and Treble Damages
Alex B. Long
University of Tennessee College of Law
February 25, 2010
University of Tennessee Legal Studies Research Paper No. 103
UC Davis Law Review, Forthcoming
Abstract:
Unbeknownst to many lawyers, numerous jurisdictions - including New York and California - have statutes on the books that single out lawyers who engage in deceit or collusion. In nearly all of these jurisdictions, a lawyer found to have engaged in deceit or collusion faces criminal penalties and/or civil liability in the form of treble damages. Until recently, these attorney deceit statutes have languished in obscurity and, through a series of restrictive readings of the statutory language, have been rendered somewhat irrelevant. However, in 2009, the New York Court of Appeals breathed new life into New York’s attorney deceit statute through its decision in Amalfitano v. Rosenberg. This Article discusses the extent to which, in this age of widespread distrust of the legal profession, this type of external regulation of the legal profession is a desirable approach. The Article concludes that although the utility of existing attorney deceit statues is undermined by the broadness of the language, the symbolism of the statutes is important. By relying on the development of tort law to address the same subject matter, courts can achieve the same educational and symbolic goals while dealing with attorney deceit on a more practical basis.
Attorney Deceit Statutes: Promoting Professionalism Through Criminal Prosecutions and Treble Damages
Alex B. Long
University of Tennessee College of Law
February 25, 2010
University of Tennessee Legal Studies Research Paper No. 103
UC Davis Law Review, Forthcoming
Abstract:
Unbeknownst to many lawyers, numerous jurisdictions - including New York and California - have statutes on the books that single out lawyers who engage in deceit or collusion. In nearly all of these jurisdictions, a lawyer found to have engaged in deceit or collusion faces criminal penalties and/or civil liability in the form of treble damages. Until recently, these attorney deceit statutes have languished in obscurity and, through a series of restrictive readings of the statutory language, have been rendered somewhat irrelevant. However, in 2009, the New York Court of Appeals breathed new life into New York’s attorney deceit statute through its decision in Amalfitano v. Rosenberg. This Article discusses the extent to which, in this age of widespread distrust of the legal profession, this type of external regulation of the legal profession is a desirable approach. The Article concludes that although the utility of existing attorney deceit statues is undermined by the broadness of the language, the symbolism of the statutes is important. By relying on the development of tort law to address the same subject matter, courts can achieve the same educational and symbolic goals while dealing with attorney deceit on a more practical basis.
Sunday, May 2, 2010
Medical Students Learn About Safety
The modern view of catastrophes is that a cluster of factors come together, often 12 for an airline crash. The chain of causation view of the lawyer is from Scholasticism and the 13th Century.
This article provides a good review of what should go into medical error correction. I can say what they cannot. The unit of the hospital should be closed until the remedy has been found and incorporated.
Safety on the syllabus: Patient safety becoming part of medical education
Training in quality improvement is also being added. But some physician leaders say it's happening too slowly.
By Kevin B. O'Reilly, amednews staff. Posted April 19, 2010.
Robert O. Bonow, MD, chief of cardiology at Northwestern Memorial Hospital in Chicago, is pursuing a master's degree in quality and safety so he can be a better teacher and "transmit this to the next generation." [Photo by Tori Soper / www.torisoper.com]
Robert O. Bonow, MD, graduated from medical school in 1973. Caitlin Schaninger will graduate in June. Despite training in different generations, they see similar gaps in quality and safety education.
Much has changed in medical education in the nearly four decades that separate their medical school experiences.
What has remained largely unchanged is the lack of education most medical school graduates receive in the science and skills of quality improvement and patient safety -- how to deliver the right care to the right patient at the right time, and how to prevent a patient from being harmed.
Dr. Bonow is chief of the cardiology division at Northwestern Memorial Hospital in Chicago. He directs the Center for Cardiovascular Quality and Outcomes at Northwestern University's Feinberg School of Medicine and has served on several guideline and measure development bodies. Yet even with all his experience and expertise, Dr. Bonow felt compelled to pursue a master's degree in health care quality and patient safety.
* Boosting quality instruction
* Learning how errors happen
* Links
* See related content
"There's a knowledge gap that I think I personally have," he said. "I've been involved with a lot of quality initiatives, but have never had necessarily formal training in this stuff. I've learned it by osmosis for a decade and a half."
Northwestern University's program, launched in 2006, was believed to be the first of its kind. At least four other universities now offer similar master's degree programs aimed at addressing this training gap and helping to educate the faculty who will teach medical students and residents skills such as how to analyze errors and how to measure quality performance. Many medical schools and teaching hospitals are working to integrate quality and safety into their training, but critics say the pace of change is too slow and too inconsistent.
"Unmet needs"
Schaninger is among medical students across the country looking outside the formal curriculum of medical school for quality and safety training. As a student at the University of Chicago Pritzker School of Medicine she helped found a campus chapter of the Institute for Health Improvement's Open School for Health Professions.
The Open School offers free online quality and safety training to medical, nursing and other health professions students, and boasts chapters on 204 campuses in 41 U.S. states and 26 other countries.
Learning how errors happen
Medical educators often use a case-based approach on patient safety. Here is a sample lesson plan in which trainees are asked to do a root cause analysis of a real-life, fatal medication overdose given an infant. The chain of errors began when the resident writing the order was distracted by a phone call. Students are asked to answer these questions:
What happened? What were the gaps in quality of care? Did near misses, errors without harm and/or adverse events occur in the case? Hint: Make a chronological listing or flow diagram of events.
Why did it happen? What are the contributing factors? What are the active and latent factors?
What would prevent it from happening again? What are prevention strategies?
Trainees are then asked to describe how the following systemic factors may have contributed to the error:
Equipment: Design, availability and maintenance.
Environment: Staffing levels and skills, workload and shift patterns, administrative and managerial support, physical plant.
Teamwork: Verbal and written communication, supervision and assistance.
Staff: Knowledge and skills/training, competence, physical and mental health.
Institutional context: Economic and regulatory situation, availability and use of protocols, availability and accuracy of tests.
Organization/management: Financial resources and constraints, organizational structure, policy standards and goals, safety culture and priorities.
Patient: Complexity and seriousness of condition, language and communication, personality and social factors. Each group then presents its top three contributing factors, top three prevention strategies and its explanation of how the root cause analysis could improve safety in practice.
Source: "Modified Root Cause Analysis (RCA): Improving Patient Safety/Quality of Care," University of Missouri-Columbia School of Medicine, 2004
This article provides a good review of what should go into medical error correction. I can say what they cannot. The unit of the hospital should be closed until the remedy has been found and incorporated.
Safety on the syllabus: Patient safety becoming part of medical education
Training in quality improvement is also being added. But some physician leaders say it's happening too slowly.
By Kevin B. O'Reilly, amednews staff. Posted April 19, 2010.
Robert O. Bonow, MD, chief of cardiology at Northwestern Memorial Hospital in Chicago, is pursuing a master's degree in quality and safety so he can be a better teacher and "transmit this to the next generation." [Photo by Tori Soper / www.torisoper.com]
Robert O. Bonow, MD, graduated from medical school in 1973. Caitlin Schaninger will graduate in June. Despite training in different generations, they see similar gaps in quality and safety education.
Much has changed in medical education in the nearly four decades that separate their medical school experiences.
What has remained largely unchanged is the lack of education most medical school graduates receive in the science and skills of quality improvement and patient safety -- how to deliver the right care to the right patient at the right time, and how to prevent a patient from being harmed.
Dr. Bonow is chief of the cardiology division at Northwestern Memorial Hospital in Chicago. He directs the Center for Cardiovascular Quality and Outcomes at Northwestern University's Feinberg School of Medicine and has served on several guideline and measure development bodies. Yet even with all his experience and expertise, Dr. Bonow felt compelled to pursue a master's degree in health care quality and patient safety.
* Boosting quality instruction
* Learning how errors happen
* Links
* See related content
"There's a knowledge gap that I think I personally have," he said. "I've been involved with a lot of quality initiatives, but have never had necessarily formal training in this stuff. I've learned it by osmosis for a decade and a half."
Northwestern University's program, launched in 2006, was believed to be the first of its kind. At least four other universities now offer similar master's degree programs aimed at addressing this training gap and helping to educate the faculty who will teach medical students and residents skills such as how to analyze errors and how to measure quality performance. Many medical schools and teaching hospitals are working to integrate quality and safety into their training, but critics say the pace of change is too slow and too inconsistent.
"Unmet needs"
Schaninger is among medical students across the country looking outside the formal curriculum of medical school for quality and safety training. As a student at the University of Chicago Pritzker School of Medicine she helped found a campus chapter of the Institute for Health Improvement's Open School for Health Professions.
The Open School offers free online quality and safety training to medical, nursing and other health professions students, and boasts chapters on 204 campuses in 41 U.S. states and 26 other countries.
Learning how errors happen
Medical educators often use a case-based approach on patient safety. Here is a sample lesson plan in which trainees are asked to do a root cause analysis of a real-life, fatal medication overdose given an infant. The chain of errors began when the resident writing the order was distracted by a phone call. Students are asked to answer these questions:
What happened? What were the gaps in quality of care? Did near misses, errors without harm and/or adverse events occur in the case? Hint: Make a chronological listing or flow diagram of events.
Why did it happen? What are the contributing factors? What are the active and latent factors?
What would prevent it from happening again? What are prevention strategies?
Trainees are then asked to describe how the following systemic factors may have contributed to the error:
Equipment: Design, availability and maintenance.
Environment: Staffing levels and skills, workload and shift patterns, administrative and managerial support, physical plant.
Teamwork: Verbal and written communication, supervision and assistance.
Staff: Knowledge and skills/training, competence, physical and mental health.
Institutional context: Economic and regulatory situation, availability and use of protocols, availability and accuracy of tests.
Organization/management: Financial resources and constraints, organizational structure, policy standards and goals, safety culture and priorities.
Patient: Complexity and seriousness of condition, language and communication, personality and social factors. Each group then presents its top three contributing factors, top three prevention strategies and its explanation of how the root cause analysis could improve safety in practice.
Source: "Modified Root Cause Analysis (RCA): Improving Patient Safety/Quality of Care," University of Missouri-Columbia School of Medicine, 2004
Virginia Now One of Dozen States Mandating Pay for Telemedicine
People should pay for their own visits, and forget about insurance coverage at the low cost of telemedicine. If it costs $10 to reach the doctor, and $10 to return home, $100 to take off a half day from work, the average person should arrange for it at their own expense. A $60 brief visit would still be half as expensive. There is also some chance the impaired person may get into a car crash. What would people pay to prevent one of those? What else can the states do, of greater importance to doctors is to rein in the states goofy, mad dog licensing boards. Any charge involving telemedicine should be immunized.
****************
Virginia Gov. Bob McDonnell has signed into law a bill that requires insurers to cover services provided through telemedicine.
With enactment of the legislation on April 5, Virginia becomes the 12th state to mandate that health plans cover telemedicine. Under the new statute, telemedicine services include the use of interactive audio, video or other electronic media used for the purpose of diagnosis, consultation or treatment.
It does not include services provided using an audio-only telephone, e-mail message or fax transmission. Continuing medical education and call center services are not required to be covered, either.
The enactment of the bill was supported by several physician organizations, including the Medical Society of Virginia, the American Heart Assn., the American College of Emergency Physicians and the Virginia Telehealth Network.
"With telemedicine, physicians in all areas of the state who have the technology will be able to consult with specialists, regardless of location or other circumstances, such as foul weather," said MSV President Daniel Carey, MD. "It is extremely beneficial in areas of the state which are underserved by certain specialties, such as ob-gyn, and also when transporting the patient is not an option."
The American Medical Association supports payment to physicians for any telemedicine services they provide.
The 12 states as of today.
* California: 1996
* Colorado: 2001
* Georgia: 2006
* Hawaii: 1999
* Kentucky: 2000
* Louisiana: 1995
* Maine: 2009
* New Hampshire: 2009
* Oklahoma: 1997
* Oregon: 2009
* Texas: 1997
* Virginia: 2010
Source: The American Telemedicine Assn.
****************
Virginia Gov. Bob McDonnell has signed into law a bill that requires insurers to cover services provided through telemedicine.
With enactment of the legislation on April 5, Virginia becomes the 12th state to mandate that health plans cover telemedicine. Under the new statute, telemedicine services include the use of interactive audio, video or other electronic media used for the purpose of diagnosis, consultation or treatment.
It does not include services provided using an audio-only telephone, e-mail message or fax transmission. Continuing medical education and call center services are not required to be covered, either.
The enactment of the bill was supported by several physician organizations, including the Medical Society of Virginia, the American Heart Assn., the American College of Emergency Physicians and the Virginia Telehealth Network.
"With telemedicine, physicians in all areas of the state who have the technology will be able to consult with specialists, regardless of location or other circumstances, such as foul weather," said MSV President Daniel Carey, MD. "It is extremely beneficial in areas of the state which are underserved by certain specialties, such as ob-gyn, and also when transporting the patient is not an option."
The American Medical Association supports payment to physicians for any telemedicine services they provide.
The 12 states as of today.
* California: 1996
* Colorado: 2001
* Georgia: 2006
* Hawaii: 1999
* Kentucky: 2000
* Louisiana: 1995
* Maine: 2009
* New Hampshire: 2009
* Oklahoma: 1997
* Oregon: 2009
* Texas: 1997
* Virginia: 2010
Source: The American Telemedicine Assn.
Saturday, May 1, 2010
Is Psychiatry Finished?
The craven and treasonous AMA and APA lent support to this Trojan Horse for Commie Care, health care reform. But, no. Psychiatry will not end. No one has ever done psychiatry any favor. It exists and does well because there is no choice, no alternative for the care of people with severe mental illness. Only a minority of such people are getting any care. They will not be welcome in the offices of primary care doctors, nurses, social workers. As uninsured people get access to care, psychiatry will be swamped. It will have to stick to the essentials of the service. It will have to get more rapid, efficient, and effective.
Here is something the public can do to cut the psychiatry bill in half. Stop using illegal drugs and and alcohol.
Here is something the public can do to cut the psychiatry bill in half. Stop using illegal drugs and and alcohol.
Thursday, April 29, 2010
Attack on Locality Rule Unwarranted
The letter above was to rebut this article.
The Locality Rule
The locality rule is the progenitor of the debates over the proper specialty qualifications for an expert witness. The locality rule evolved before the standardization of medical training and certification. During this period, there was a tremendous gulf between the skills and abilities of university-trained physicians and the graduates of the unregulated diploma mills. In many parts of the country, parochialism and necessity combined to create the rule that a physician's competence would be determined by comparison with the other physicians in the community, or at least in similar neighboring communities. The strictest form of the locality rule required the expert to be from the same or a similar community. This made it nearly impossible for injured patients to find experts to support their cases, effectively preventing most medical malpractice litigation.
The underpinnings of the locality rule are diametrically opposed to contemporary specialty training and certification. There is no longer a justification for a rule that shelters substandard medical decision making on the sole excuse that it is the norm for a given community. Many states have explicitly abolished the locality rule for physicians who hold themselves out as certified specialists. Unfortunately, the locality rule is being reinvigorated in some states as a tort reform measure. This resurgence is driven by the problem of access to care and facilities in rural areas.
Proponents of the locality rule often confuse access to facilities with physician competence. A national standard of care implies that the rural physician will have the same training and exercise the same level of judgment and diligence as an urban practitioner. It does not require that the rural physician have the same medical facilities available. If the community does not have facilities for an emergency cesarean section, the physician cannot be found negligent for failing to do this surgery within the 15 minutes that might be the standard in a well-equipped urban hospital.
Under a national standard, however, the physician must inform the patient of the limitations of the available facilities and recommend prompt transfer if indicated. This allows patients to balance the convenience of local care against the risks of inadequate facilities. The protection of a national standard is especially important as rural hospitals attempt to market or retain lucrative medical services that their facilities are not properly equipped to handle.
The Locality Rule
The locality rule is the progenitor of the debates over the proper specialty qualifications for an expert witness. The locality rule evolved before the standardization of medical training and certification. During this period, there was a tremendous gulf between the skills and abilities of university-trained physicians and the graduates of the unregulated diploma mills. In many parts of the country, parochialism and necessity combined to create the rule that a physician's competence would be determined by comparison with the other physicians in the community, or at least in similar neighboring communities. The strictest form of the locality rule required the expert to be from the same or a similar community. This made it nearly impossible for injured patients to find experts to support their cases, effectively preventing most medical malpractice litigation.
The underpinnings of the locality rule are diametrically opposed to contemporary specialty training and certification. There is no longer a justification for a rule that shelters substandard medical decision making on the sole excuse that it is the norm for a given community. Many states have explicitly abolished the locality rule for physicians who hold themselves out as certified specialists. Unfortunately, the locality rule is being reinvigorated in some states as a tort reform measure. This resurgence is driven by the problem of access to care and facilities in rural areas.
Proponents of the locality rule often confuse access to facilities with physician competence. A national standard of care implies that the rural physician will have the same training and exercise the same level of judgment and diligence as an urban practitioner. It does not require that the rural physician have the same medical facilities available. If the community does not have facilities for an emergency cesarean section, the physician cannot be found negligent for failing to do this surgery within the 15 minutes that might be the standard in a well-equipped urban hospital.
Under a national standard, however, the physician must inform the patient of the limitations of the available facilities and recommend prompt transfer if indicated. This allows patients to balance the convenience of local care against the risks of inadequate facilities. The protection of a national standard is especially important as rural hospitals attempt to market or retain lucrative medical services that their facilities are not properly equipped to handle.
Tuesday, April 27, 2010
False Claim Act Attacks on Off Label Promotion
Click on title above for review of civil procedure defense, using Rule 9 (b).
Off label use represents about half of all prescriptions. Off label is the use of a medication for condition not approved by the FDA, after test data have been submitted by the drug companies. It is half of medicine, and can be as scientifically rigorous and prove as on label use.
Off label use represents a gold mine of medical advances at little or no cost. So the blood thinning effect of aspirin is a nuisance to the headache patient in whom it caused a bleeding ulcer. It is a great benefit to the heart patient who needs a mild blood thinner. Is aspirin a pain killer or a blood thinner? One patient's side effect is another's best treatment option.
Therefore, at the policy level, the lawsuits for any off label promotion should be dismissed as damaging to clinical care, by chilling the advocacy for innovative uses of cheap, older, often generic medication.
Beyond the appalling effects on clinical innovation, off label promotion is speech. The Free Speech Clause is a coin with two sides, the freedom to say speech, and the freedom to hear speech. Corporations may not have unlimited rights to free speech. However, doctors and patients have an unlimited right to hear free speech.
Off label use represents about half of all prescriptions. Off label is the use of a medication for condition not approved by the FDA, after test data have been submitted by the drug companies. It is half of medicine, and can be as scientifically rigorous and prove as on label use.
Off label use represents a gold mine of medical advances at little or no cost. So the blood thinning effect of aspirin is a nuisance to the headache patient in whom it caused a bleeding ulcer. It is a great benefit to the heart patient who needs a mild blood thinner. Is aspirin a pain killer or a blood thinner? One patient's side effect is another's best treatment option.
Therefore, at the policy level, the lawsuits for any off label promotion should be dismissed as damaging to clinical care, by chilling the advocacy for innovative uses of cheap, older, often generic medication.
Beyond the appalling effects on clinical innovation, off label promotion is speech. The Free Speech Clause is a coin with two sides, the freedom to say speech, and the freedom to hear speech. Corporations may not have unlimited rights to free speech. However, doctors and patients have an unlimited right to hear free speech.
Sunday, April 25, 2010
Ironic. Dr. Daniel Carlat would like a return to the psychiatry that failed to prevent his mother's suicide.
Fewer than 5% of people who die by suicide have psychiatric medication in their system. There is an under use of these medications, and undertreatment of serious conditions. Among those prescribed medication, there is a high rate of non-adherence. One would like to know more of what happened to Dr. Carlat's mother. The idea that paranoia is treatable with talk therapy is not viable. One may also consider suicidality as a form of delusion, a belief that death will solve one's problems and that one will never enjoy life again. For those reasons, one hopes that she was prescribed a neuroleptic tranquilizer, and that she continued to take it. This useful technical information is not provided.
“So Dr. Freud, the causes are all in the brain? Isn’t there some explanation in my childhood?” It was a good-natured tease.
“I specialize in prescribing medications,” I said with a smile. I was a psychopharmacologist and specialized in medication rather than psychotherapy. “I can refer you to a good therapist in the area if you’d like.”
After J.J. left my office, I realized, uncomfortably, that somehow, over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match.
Leon Eisenberg, an early pioneer in psychopharmacology at Harvard, once made the notable historical observation that “in the first half of the 20th century, American psychiatry was virtually ‘brainless.’ . . . In the second half of the 20th century, psychiatry became virtually ‘mindless.’ ” The brainless period was a reference to psychiatry’s early infatuation with psychoanalysis; the mindless period, to our current love affair with pills. J.J., I saw, had inadvertently highlighted a glaring deficiency in much of modern psychiatry. Ultimately, his question would change the way I thought about my field, and how I practiced.
I originally became interested in psychiatry primarily because of my father: he is a psychiatrist practicing in San Francisco. But there was a darker side to my career choice. My mother suffered severe mental illness, with debilitating depressions and paranoid thoughts. One autumn day during my junior year in college, she committed suicide. Psychiatry then became personal, a way for me to come to terms with her illness.
“So Dr. Freud, the causes are all in the brain? Isn’t there some explanation in my childhood?” It was a good-natured tease.
“I specialize in prescribing medications,” I said with a smile. I was a psychopharmacologist and specialized in medication rather than psychotherapy. “I can refer you to a good therapist in the area if you’d like.”
After J.J. left my office, I realized, uncomfortably, that somehow, over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match.
Leon Eisenberg, an early pioneer in psychopharmacology at Harvard, once made the notable historical observation that “in the first half of the 20th century, American psychiatry was virtually ‘brainless.’ . . . In the second half of the 20th century, psychiatry became virtually ‘mindless.’ ” The brainless period was a reference to psychiatry’s early infatuation with psychoanalysis; the mindless period, to our current love affair with pills. J.J., I saw, had inadvertently highlighted a glaring deficiency in much of modern psychiatry. Ultimately, his question would change the way I thought about my field, and how I practiced.
I originally became interested in psychiatry primarily because of my father: he is a psychiatrist practicing in San Francisco. But there was a darker side to my career choice. My mother suffered severe mental illness, with debilitating depressions and paranoid thoughts. One autumn day during my junior year in college, she committed suicide. Psychiatry then became personal, a way for me to come to terms with her illness.
Friday, April 9, 2010
The East Brunswick, NJ, Municipal Court and Traffic Offenses
Lessons:
1) The traffic court is a fast moving revenue raiser.
2) The rails to settlement are fully greased.
3) Pressure increases progressively as one asserts a desire for a not guilty plea and a trial. It reaches an unbearable level of cost, quickly, for any productive party. That pressure includes physical threats by township police, albeit staying within the law. The threatening behavior worsens as one tries to assert more legal rights.
4) Defense attorneys at this level of traffic court are a waste of time and money. It suggested that one buy a court practice manual, cheaply. One will learn a great deal about the way things work and one's real choices. One may resell it after the case. The prosecutor has little or no knowledge of any case, and will accept any reasonable offer. If one cannot think of any offer, the prosecutor wants to help. The final pled infraction may have nothing to do with the accusation. But never claim innocence. It makes everyone angry.
1) The traffic court is a fast moving revenue raiser.
2) The rails to settlement are fully greased.
3) Pressure increases progressively as one asserts a desire for a not guilty plea and a trial. It reaches an unbearable level of cost, quickly, for any productive party. That pressure includes physical threats by township police, albeit staying within the law. The threatening behavior worsens as one tries to assert more legal rights.
4) Defense attorneys at this level of traffic court are a waste of time and money. It suggested that one buy a court practice manual, cheaply. One will learn a great deal about the way things work and one's real choices. One may resell it after the case. The prosecutor has little or no knowledge of any case, and will accept any reasonable offer. If one cannot think of any offer, the prosecutor wants to help. The final pled infraction may have nothing to do with the accusation. But never claim innocence. It makes everyone angry.
Tuesday, April 6, 2010
Nice. Trial Lawyer Association Sues Other Trial Lawyer Association
"A Minnesota federal judge recently ruled that the American Association for Justice's trademark infringement lawsuit against an organization and individual using the name American Trial Lawyers Association and the acronym ATLA will go to trial.
On March 18, Judge Joan Ericksen of the District of Minnesota denied two summary judgment motions from defendants American Trial Lawyers Association Inc. and J. Keith Givens. Ericksen also granted a motion by the AAJ in ruling that it had not abandoned its trademark for its former name.
The American Association for Justice (AAJ), a plaintiffs' counsel advocacy group, was known as the Association of Trial Lawyers of America until July 2006, when the members voted to change its name. According to court papers, AAJ has changed its name several times since it was founded in 1946, and it registered the trademark "ATLA" with the U.S. Patent and Trademark Office in 1976.
AAJ member Givens reserved the corporate name the American Trial Lawyers Association Inc. with the Alabama secretary of state in March 2007 and filed for incorporation, along with his brother, Chase Givens, the same month. Ericksen's ruling noted that the group's purpose on its articles of incorporate was to provide a magazine and educational news "relevant to civil plaintiff and criminal defense trial lawyers." Givens' association sent letters to prospective members in June and November 2007, and the AAJ filed its lawsuit in November 2007.
The AAJ is opposing the American Trial Lawyers Association's PTO application for a trademark that includes its name and a drawing of Lady Justice. The PTO has suspended Givens' group's second trademark application, which features its name and the acronym ATLA, partly because of the pending lawsuit."
On March 18, Judge Joan Ericksen of the District of Minnesota denied two summary judgment motions from defendants American Trial Lawyers Association Inc. and J. Keith Givens. Ericksen also granted a motion by the AAJ in ruling that it had not abandoned its trademark for its former name.
The American Association for Justice (AAJ), a plaintiffs' counsel advocacy group, was known as the Association of Trial Lawyers of America until July 2006, when the members voted to change its name. According to court papers, AAJ has changed its name several times since it was founded in 1946, and it registered the trademark "ATLA" with the U.S. Patent and Trademark Office in 1976.
AAJ member Givens reserved the corporate name the American Trial Lawyers Association Inc. with the Alabama secretary of state in March 2007 and filed for incorporation, along with his brother, Chase Givens, the same month. Ericksen's ruling noted that the group's purpose on its articles of incorporate was to provide a magazine and educational news "relevant to civil plaintiff and criminal defense trial lawyers." Givens' association sent letters to prospective members in June and November 2007, and the AAJ filed its lawsuit in November 2007.
The AAJ is opposing the American Trial Lawyers Association's PTO application for a trademark that includes its name and a drawing of Lady Justice. The PTO has suspended Givens' group's second trademark application, which features its name and the acronym ATLA, partly because of the pending lawsuit."
Sunday, April 4, 2010
Planned Preliminary Motions for Careless Driving Charge in New Jersey
Traffic law is something the average person encounters every day. Naturally, it is not covered in law school. Does any one know of any law school offering any course in the rules of the road. I would appreciate hearing about it.
I am disputing this ticket. It has a potential 15 day jail sentence, a serious potential consequence justifying adequate discovery. It is a criminal charge, with a beyond a reasonable doubt burden on the prosecution.
Here is the law: 39:4-97. Careless driving
39:4-97. A person who drives a vehicle carelessly, or without due caution and circumspection, in a manner so as to endanger, or be likely to endanger, a person or property, shall be guilty of careless driving.
Amended 1951,c.23,s. 54; 1955,c.220,s. 2; 1995,c.70,s. 3.
It has been declared constitutional by the New Jersey Supreme Court despite an admission of vagueness. The reasoning for upholding the law is that no law can specify the endlessly wide range of dangerous driving.
I demanded full discovery on the records of the officer, including health, driving, complaints, productivity. Due to the subjective nature of the elements of the law, the credibility, character, training of the officer are material.
Here are the planned preliminary motions to dismiss.
1) Violation of Rule 7:7-7 (b) by the prosecution. This charge fulfills the consequence of magnitude in the form of possible jail time. It mandates the production of documents under the control of the government. I move for a dismissal of the charges since the violation made an adequate defense impossible. The subjective, opinion nature of the elements of the charge make the character, training, and knowledge of the officer highly material. I also request sanctions against the personal assets of the prosecutor, not those of the taxpayer for his refusal to obey the clear language of the Rule of Evidence. This stonewalling of discovery is by agents of the prosecutor. He should be held accountable.
2) The sole witness against me will be a fact witness. Yet the elements of the law call for an opinion. It should be against policy to allow the police to make up the law in accordance with their personal preferences. A fact witness may not express the opinions, calculations, and tastes called for in the law.
3) The subjective nature of the charge, and the absence of any objective, measurable damage, make the burden of beyond a reasonable doubt mathematically impossible to meet, unless the probability of damage was greater than 80%. There is no way to show that in the absence of any damage. There is no scientific evidence to support such an increase in the probability of damage.
4) Criminal evidence is subject to the Daubert standard for reliability of evidence. The speculative and subjective nature of the police charge violate the Daubert standard and require an expert opinion to help the court measure the actuarially proven increase in risk.
5) The prosecutor does not dispute that the officer violated four New Jersey traffic laws in this encounter. He just feels it does not matter. The prosecutor says, there is no rule the lawbreaking of the agent of the prosecutor should impact on the validity of the charges against the defendant. Yet, it should be against public policy for a court to reward law breaking with a favorable verdict. If the court allows such law breaking, and actually rewards it, it will get a lot more of it in the future. The court cannot immunize the violation of the law by the police without barring the fruit of the poisoned tree.
I am disputing this ticket. It has a potential 15 day jail sentence, a serious potential consequence justifying adequate discovery. It is a criminal charge, with a beyond a reasonable doubt burden on the prosecution.
Here is the law: 39:4-97. Careless driving
39:4-97. A person who drives a vehicle carelessly, or without due caution and circumspection, in a manner so as to endanger, or be likely to endanger, a person or property, shall be guilty of careless driving.
Amended 1951,c.23,s. 54; 1955,c.220,s. 2; 1995,c.70,s. 3.
It has been declared constitutional by the New Jersey Supreme Court despite an admission of vagueness. The reasoning for upholding the law is that no law can specify the endlessly wide range of dangerous driving.
I demanded full discovery on the records of the officer, including health, driving, complaints, productivity. Due to the subjective nature of the elements of the law, the credibility, character, training of the officer are material.
Here are the planned preliminary motions to dismiss.
1) Violation of Rule 7:7-7 (b) by the prosecution. This charge fulfills the consequence of magnitude in the form of possible jail time. It mandates the production of documents under the control of the government. I move for a dismissal of the charges since the violation made an adequate defense impossible. The subjective, opinion nature of the elements of the charge make the character, training, and knowledge of the officer highly material. I also request sanctions against the personal assets of the prosecutor, not those of the taxpayer for his refusal to obey the clear language of the Rule of Evidence. This stonewalling of discovery is by agents of the prosecutor. He should be held accountable.
2) The sole witness against me will be a fact witness. Yet the elements of the law call for an opinion. It should be against policy to allow the police to make up the law in accordance with their personal preferences. A fact witness may not express the opinions, calculations, and tastes called for in the law.
3) The subjective nature of the charge, and the absence of any objective, measurable damage, make the burden of beyond a reasonable doubt mathematically impossible to meet, unless the probability of damage was greater than 80%. There is no way to show that in the absence of any damage. There is no scientific evidence to support such an increase in the probability of damage.
4) Criminal evidence is subject to the Daubert standard for reliability of evidence. The speculative and subjective nature of the police charge violate the Daubert standard and require an expert opinion to help the court measure the actuarially proven increase in risk.
5) The prosecutor does not dispute that the officer violated four New Jersey traffic laws in this encounter. He just feels it does not matter. The prosecutor says, there is no rule the lawbreaking of the agent of the prosecutor should impact on the validity of the charges against the defendant. Yet, it should be against public policy for a court to reward law breaking with a favorable verdict. If the court allows such law breaking, and actually rewards it, it will get a lot more of it in the future. The court cannot immunize the violation of the law by the police without barring the fruit of the poisoned tree.
Monday, March 29, 2010
DOJ Responds to Freedom of Information Act Request for Suboxone Inspection Material
Looking forward to receiving it in electronic form, not in the form of a massive amount of paper.
Sunday, March 28, 2010
AMA Awareness of DOT Lawsuit
I have had hostile feelings against the AMA, because it does not represent the interests of the clinician. When it shows support for clinical care, I can forgive and forget. I have used their manual on the management of the impaired driver as an example of care. The association of DOT leaders has also supported discretionary reporting of drivers who have shown themselves to be impaired.
One must recall that Pennsylvania DOT requires the reporting of any patient at the time of a list of diagnoses, not after any evidence of impairment.
One must recall that Pennsylvania DOT requires the reporting of any patient at the time of a list of diagnoses, not after any evidence of impairment.
Disability Council Nominee Not Ready to Lead
22 year old, has Asperger Syndrome. One symptom is endless, mindless lecturing. It will become disruptive. The more these awful bureaucratic bodies are disrupted, the better off the public.
Worst of all is his report calling for laws to prohibit aversive conditioning, restraint, and seclusion in students with disabilities. This shows poor judgment and bias favoring chaos in the class room. This philosophy has become federal law recently, making the jobs of teachers unlivable. Now vicious, mentally disabled predators will assert their rights to attack adults and other children, with full lawyer immunity. Why would anyone pass such a self-defeating, pro-criminality law? The alternative to restraint and negative consequences? Greater staffing. The real losers? Taxpayers. These children who will yield zero return on educational investment, now generate massive government make work. The other winners, lawyers suing teachers for trying to prevent injuries. Students who are violent will be forced on entire classes, and learning can stop for hours until the rage attacks ends, perhaps hours later.
I strongly urge the victims of these vicious predators to sue the Federal government, and state officials, including this nominee. If these pro-criminal advocates want to set guidelines, they should be held accountable for all injuries resulting from their advocacy.
March 27, 2010
Nominee to Disability Council Is Lightning Rod for Dispute on Views of Autism
By AMY HARMON
When President Obama nominated Ari Ne’eman to the National Council on Disability, many families touched by autism took it as a positive sign. Mr. Ne’eman would be the first person with the disorder to serve on the council.
But he has since become the focus of criticism from other advocates who disagree with his view that society ought to concentrate on accepting autistic people, not curing them.
A hold has been placed on Mr. Ne’eman’s nomination, which requires Senate confirmation. Whether the hold is related to the criticism of Mr. Ne’eman (pronounced NAY-men) and what it might take to lift it is unclear.
But Mr. Ne’eman, the 22-year-old founder of the Autistic Self-Advocacy Network, seems to be a lightning rod for a struggle over how autism will be perceived at a time when an estimated 1 in 100 American children and teenagers are given such a diagnosis.
Mr. Ne’eman is at the forefront of a growing movement that describes autism as a form of “neurodiversity” that should be embraced and accommodated, just as physical disabilities have led to the construction of ramps and stalls in public restrooms for people with disabilities. Autism, he and others say, is a part of their identity.
But that viewpoint, critics say, represents only those on the autism spectrum who at least have basic communication skills and are able to care of themselves.
“Why people have gotten upset is, he doesn’t seem to represent, understand or have great sympathy for all the people who are truly, deeply affected in a way that he isn’t,” said Jonathan Shestack, a co-founder of the advocacy group Autism Speaks, whose mission is to help finance research to find a cure.
Worst of all is his report calling for laws to prohibit aversive conditioning, restraint, and seclusion in students with disabilities. This shows poor judgment and bias favoring chaos in the class room. This philosophy has become federal law recently, making the jobs of teachers unlivable. Now vicious, mentally disabled predators will assert their rights to attack adults and other children, with full lawyer immunity. Why would anyone pass such a self-defeating, pro-criminality law? The alternative to restraint and negative consequences? Greater staffing. The real losers? Taxpayers. These children who will yield zero return on educational investment, now generate massive government make work. The other winners, lawyers suing teachers for trying to prevent injuries. Students who are violent will be forced on entire classes, and learning can stop for hours until the rage attacks ends, perhaps hours later.
I strongly urge the victims of these vicious predators to sue the Federal government, and state officials, including this nominee. If these pro-criminal advocates want to set guidelines, they should be held accountable for all injuries resulting from their advocacy.
March 27, 2010
Nominee to Disability Council Is Lightning Rod for Dispute on Views of Autism
By AMY HARMON
When President Obama nominated Ari Ne’eman to the National Council on Disability, many families touched by autism took it as a positive sign. Mr. Ne’eman would be the first person with the disorder to serve on the council.
But he has since become the focus of criticism from other advocates who disagree with his view that society ought to concentrate on accepting autistic people, not curing them.
A hold has been placed on Mr. Ne’eman’s nomination, which requires Senate confirmation. Whether the hold is related to the criticism of Mr. Ne’eman (pronounced NAY-men) and what it might take to lift it is unclear.
But Mr. Ne’eman, the 22-year-old founder of the Autistic Self-Advocacy Network, seems to be a lightning rod for a struggle over how autism will be perceived at a time when an estimated 1 in 100 American children and teenagers are given such a diagnosis.
Mr. Ne’eman is at the forefront of a growing movement that describes autism as a form of “neurodiversity” that should be embraced and accommodated, just as physical disabilities have led to the construction of ramps and stalls in public restrooms for people with disabilities. Autism, he and others say, is a part of their identity.
But that viewpoint, critics say, represents only those on the autism spectrum who at least have basic communication skills and are able to care of themselves.
“Why people have gotten upset is, he doesn’t seem to represent, understand or have great sympathy for all the people who are truly, deeply affected in a way that he isn’t,” said Jonathan Shestack, a co-founder of the advocacy group Autism Speaks, whose mission is to help finance research to find a cure.
Tarasoff Duty to Warn Increases Homicide Rate by 9%, after Enactment
Tarasoff warnings thus represent medical malpractice, violating the duty to do no harm. If any plaintiff expert asserts the Tarasoff decision, I would appreciate getting the name.
Doing Their Duty: An Empirical Analysis of the Unintended Effect of Tarasoff v Regents on Homicidal Activity
Griffin Sims Edwards
Emory University, Department of Economics
January 29, 2010
Emory Law and Economics Research Paper No. 10-61
Abstract:
The effect of state duty to warn laws inspired by Tarasoff v Regents has been debated for decades. Required reporting of patient threats to the authorities and potential victims gives incentive to the mental health professional to not meet with the most at risk patients, or at very least make the current state of the law abundantly clear to the patient as to suggest suppression of the most at risk statements leaving the psychologist in liability-free ignorance to the true mental state of the patient. As a result, the mental help needed to treat the patient may be foregone and violence may ensue. Exploiting the variation in the timing and style of duty to warn laws across states, I use a fixed effects model to find that, all else equal and controlling for the prevalence of crack, mandatory duty to warn laws cause an increase in homicides of 9.5% or 0.83 people per 100,000. These results are robust to model specifications, falsification tests, and help to clarify the true, albeit unintended, affect of state duty to warn laws.
Doing Their Duty: An Empirical Analysis of the Unintended Effect of Tarasoff v Regents on Homicidal Activity
Griffin Sims Edwards
Emory University, Department of Economics
January 29, 2010
Emory Law and Economics Research Paper No. 10-61
Abstract:
The effect of state duty to warn laws inspired by Tarasoff v Regents has been debated for decades. Required reporting of patient threats to the authorities and potential victims gives incentive to the mental health professional to not meet with the most at risk patients, or at very least make the current state of the law abundantly clear to the patient as to suggest suppression of the most at risk statements leaving the psychologist in liability-free ignorance to the true mental state of the patient. As a result, the mental help needed to treat the patient may be foregone and violence may ensue. Exploiting the variation in the timing and style of duty to warn laws across states, I use a fixed effects model to find that, all else equal and controlling for the prevalence of crack, mandatory duty to warn laws cause an increase in homicides of 9.5% or 0.83 people per 100,000. These results are robust to model specifications, falsification tests, and help to clarify the true, albeit unintended, affect of state duty to warn laws.
Sunday, March 21, 2010
Reply to a Motion to Dismiss on the Pleading
If the case gets past this point, discovery will follow.
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