Monday, March 31, 2014

TV is Bad For You


I love TV. I am an avid television watcher. But I also read voraciously and actually think of this television as a source of entertainment. Shows I do watch for information are Frontline, Bill Moyers and endless documentaries about things I am curious about.

Do I think that they are all sole facts and are the final perfect sources of information? HELL TO THE NO.

I quit watching 46 Minutes.. oh wait 60 Minutes with commercials when the gray hairs either died or retired. Growing up watching Mike Wallace chase down transgressors and give them the evil eye was an essential part of my Sunday nights. It has long since moved past the source of investigative journalism years ago and its recent scandals have only proven the point.

And it is why when 20/20 was on back in the day it had actual journalism and real minds covering real issues.  Journalism has gone the way of daytime television in every way and now I really cannot tell the difference between the View and some show on either Fox, CNN, or MSNBC.  Can you? 

This is why I watch the Real Housewives of some varying locale with amusement and distraction. We all need someone or something to laugh at. I think of it as docu-drama of the unfamous and uninteresting.  And frankly their bitch slapping, over talking and faux drama is at least confined to the walls in the faux community in which they live. 

But I have never thought any TV was "real."  And the Truth Out article below about how cop dramas contribute to the concept that Cop Violence as both normal and acceptable is not shocking. I have said repeatedly that Cops was largely a major contributor to the issue and frankly Reno 911 was more accurate as to the incompetency and idiocy of our "men and women in blue."  And on that the Daily Show is more news than the 6 o'clock news is also very telling.   When most get their news on a satire show it tells you America is not exactly good and separating truth from satire or fiction.

The more I encounter and experience first hand the individuals that are the front line of Justice I am getting why we have a crisis on our hands when it comes to parity, transparency and more importantly - law. There are few if any individuals who not only uphold the law but know the law. Those that do often manipulate to meet their ends and that can be the Police themselves, Judges or the Attorney's that both prosecute the accused to (yes) those who represent them.

But for many Americans their exposure to the Jurisprudence system is limited to Law and Order reruns or some new Cop show that permeates the mainstream networks. And then people wonder why I would watch a Housewife than Tom Selleck as the patriarch of a Cop family in Chicago. For the record, I loved Magnum PI and that was about as accurate and realistic as the current show of which he stars.

Real life is that real life. Ever walked into a Courtroom or even the halls and anterooms of your local Court? No. I suggest you do. Truly one of the most tragic real life docu dramas that demonstrate chaos and discontent. I count down the months, day and god forbid years that I never have to set foot in one again.

TV is not real, neither are the walking dead but go to a court in your community you will see dead people.

"Do What You Gotta Do": Cop Shows Bolster Idea That Police Violence Works
Sunday, 16 March 2014 00:00 By Aaron Cantu, Truthout | News Analysis

The new NBC series "Chicago PD" (created by Dick Wolf, the man behind "Law and Order") opens with steel-eyed Detective Sgt. Hank Voight glaring coolly into a rearview mirror from the backseat of a car. We quickly learn that the man driving the vehicle isn't chauffeuring Voight around by choice.

"I don't know where I'm going," whimpers the driver, a young man with a bloodied face and a seemingly broken right arm.

"Just keep driving," gruffs Voight.

When the two finally pull off into an empty gravel lot, Voight grabs the man by a tuft of hair and yanks him out of the driver's seat. The sergeant slaps and kicks the young man around until he crumbles to the ground in a sobbing heap.

"Who's puttin' out the bad dope?" Voight snarls, and when he follows up by pressing a handgun to the quivering man's face, the latter finally relents.

"His name is Ralph! He deals out of his apartment in South Emerald!"

Within a minute and a half of the first episode, the show has summed up its central message: Police violence works. This is relayed again and again throughout the series: When a cop with a chain-wrapped fist savagely beats a Spanish-speaking suspect demanding an attorney until he relinquishes a tip; when officers debase the idea of policing without intent to arrest; when cops round up black non-criminals and deliver them to precinct torture chambers. In every episode, these methods achieve the desired ends. The message: Police violence works.

Crime dramas that embellish the lives of police officers are not new. Criminologist Yvonne Jewkes says crime drama is "the most enduring of all cinematic genres," and television holds to the same rule.1 What sets "Chicago PD" apart from others in the genre is that police violence isn't just presented as an exciting feature of the job; rather, its producers have made it the primary point of appeal to its growing audience of 8 million.

What does it mean that a TV show so sympathetic to police abuse has become the most popular evening program among NBC's 18-49 demographic? To understand its appeal, it's necessary to couch recent trends in cop media within historical transformations of public opinion toward police and federal support for local policing.

In the past 40 years, the militarization of police forces occurred concurrently with an increased emphasis on “law and order,” perpetuated by race-baiting politicians who spurred alarm among white Americans following the racially charged riots of the mid-1960s that shook white America to its core. To the prudent majority on the conservative side of the era's culture wars, the 1965 Watts riots in LA, along with "riots in Baltimore, Newark, Washington and Detroit in the following years, were signs of a rising criminal class that was increasingly out of control,"2 as Radley Balko observes in his book Rise of the Warrior Cop. This induced a broad call for "law and order" among the white American majority by the end of the decade, and race-baiting politicians used the mandate to launch an unprecedented militarization of police forces that continues today. The threat of crime soon embedded itself at the forefront of national consciousness, and in response to that reality, Hollywood started pumping out a slew of films and TV shows centered on the lives of police officers, giving birth to a new subgenre within crime drama: the Cop Booster.

However, policy doesn't only influence media; sociologists have found that media has a real effect on policy. Because "public knowledge of crime and justice is largely derived from the media," the Cop Booster subgenre is part of a larger criminal-media-complex that manufactures "pervasive images of predatory criminals" that "steer [the] currents on our criminal justice policy."3 Television programs like "Chicago PD," a classic Cop Booster show, reproduce a narrative that that not only shields real life police forces from the scrutiny of public accountability but also engenders millions of people's assumptions about criminality - assumptions that help keep the gears of the prison-industrial complex spinning.

The Chicago PD of "Chicago PD"

There have been 102 criminal convictions of Chicago police officers since 2000. This figure greatly understates the degree of abuses carried out by the department in recent years: Between 2002 and 2004, less than 2 percent of civilian complaints for excessive force, illegal searches, racial abuse and false arrests resulted in legal action.

By far the most well-known CPD scandal involves the systematic use of torture. From 1972 to 1991, officers brutally tortured more than 100 detained men and boys, all black, by, among many other things, burning cigarettes on their bodies, beating their faces with a flashlight and emitting powerful volts of electricity with cattle prods to their genitals.

After the news of torture broke more than two decades ago, it was also revealed that a whole crew of higher-ups had turned a blind eye to the widespread maltreatment. When a medical examiner for one of the first few abuse cases demanded a superintendent of police investigate the abuse, the buck was passed off to the state attorney, whose office essentially sat on the allegations as a culture of torture proliferated for more than a decade. Meanwhile, CPD Cmdr. John Burge personally sanctioned and participated in the torture of a number of men.

Since reporter John Conroy broke the story of torture for the Chicago Reader in 1990, attempts at retributive justice for victims have produced disparate results. In 2003, Gov. George Ryan commuted the sentences of all 163 men and women on death row in Illinois under the suspicion that some of their confessions had been elicited through torture. High-level courts have exonerated a handful of inmates claiming to have been brutalized by police. But retribution for sins committed by the CPD has been limited to a short stint in jail for Burge and a toothless report on the tortures released by special prosecutors in 2006.

The CPD's limited reconciliation with its lurid past is symptomatic of a "Code of Silence" that seems to stick like plaque within the department. In a successful 2007 case brought against the CPD by a woman who was beaten by an officer, the federal court ruled that the Code of Silence was ingrained deeply within the department's culture. An affidavit submitted by the plaintiff included the findings of Lou Rieter, longtime police consultant and former deputy chief of police in Los Angeles, who said, "The Chicago Police Department has created an organizational environment where the Code of Silence ... [is] present and would allow police officers to engage in misconduct with little fear of sanction."

Clearly, the team behind "Chicago PD" had plenty of source material on which to base their characters. The show features a team of intelligence officers who, like some of their real-life counterparts, torture suspects, circumvent civil liberties protections and keep tight-lipped about each other's "off-duty" violence against innocent people.

Yet in a conversation with Southside Weekly, executive producer Danielle Gelber said that although "everything we do is grounded in authenticity ... we don't want to be making a statement about Chicago violence and how it's dealt with by the police department." If the producers claim that depictions of police abuse are not intended as a form of commentary, then how is the show's realism interpreted by audiences?


Part of NBC's marketing strategy for "Chicago PD" has included a well-developed social media arm to engage its audience in real time.

One can peek into the minds of the show's most ardent fans using the Twitter hashtag #ChicagoPD. Most tweets rhapsodize about the love drama developing among the extraordinarily attractive cast of officers, but a closer look reveals that show's fantastical simplicity inculcates a sort of ignorance that benefits unfettered law enforcement power.

Here's a sampling of some tweets and comments:

I don't care if it's ‘official' police procedures, I like how Voight [the series' protagonist] gets results."
"Sometimes the ‘bad' guys make the best good guys."
 "You guys bring all of us that watch the show what really happens in Chi-Town" 
"Dang you guys are all crushing it!! Keep it up!!!" 
-@ChristyAmiro during a scene in which an officer nearly gouged a suspect's eye out with a dagger.

Sharon Floyd, a fan of the show from Philadelphia, told Truthout in an email that her only encounter with law enforcement was a stop for a traffic violation, and she professed a deep admiration for those who "are not guaranteed the next day of life ... or have their partner or colleagues die in front of them due to insane criminals shooting anybody and everybody." She dismissed police abuse as an inevitable consequence of a profession.

"Like all jobs, you have the good - who follow all the rules, you have the bad - who follow their own rules and some may fall in the middle when questioned why they don't pick a side," she wrote.

Floyd's rationale is shared with many fans of police dramas. One study found that regular viewers of crime dramas are, overall, more likely to fear crime. Sociologist Ray Surette, author of Media, Crime and Criminal Justice, explains in his book that "viewing television crime shows ... has been found to be related to fear of crime, [and] perceived police effectiveness," with "heavy media consumers shar[ing] certain beliefs ... about a world that is seen as more violent, dangerous, and feared than the socially constructed world of those who consume less media."4

Perhaps the most significant impact of an elevated fear of crime is its tendency to induce a desire for punitive sentencing against perceived malefactors. Studies from the past 30 years have found that "if people fear crime ... they are more likely to want harsher sanctions, in the hope that offending behavior and, consequently, their levels of fear will be reduced."

"Even if people intellectually understand that the media is fantasy, research suggests it sill colors your worldview. You see the world as more violent, and it increases expectations of crime, violence and corruption," Surette told Truthout.

Furthermore, shows such as "Chicago PD" promote the idea that crime is mostly rooted in individual motivation and choice. This presentation obscures the structural origins from which the majority of crimes stem.

"There's social, structural [and] economic things that put people in situations where criminality happens," Surette said. "But those issues get shunted aside and presented as wrongheaded and silly [in the media]. The thinking is, why waste time and money on that sort of thing when the problem is evil people? Evil people aren't gonna be helped by job programs."

The most pernicious effect of this portrayal is its potential impact on actual criminal justice policy. Criminals in "Chicago PD" and similar media are presented as terminally malicious predators who must be killed or caged, and this closely matches the carceral logic of our system of mass incarceration, which is grounded in a harsh retributive approach to sentencing.

Surette also describes how Cop Booster shows such as "Chicago PD" help cement the idea that the only way to fight crime is to give more power to police. "In these kinds of shows, the system that gets encouraged is to increase fighting capabilities, increase punitiveness of the system. ... What comes off as not sensible is community integration."

It's still people's actual experience with police and crime that most affect how they feel about either. But when that experience is in short supply, as it is with Floyd and possibly other "Chicago PD" aficionados, then it is reasonable to suppose that sustained exposure to crime dramas can skew one's perception of policing matters in a way that obscures - or even vindicates - civil rights violations.

That may not mean much to those who've never been on the wrong end of a swinging police truncheon, but it is everything to those whose lives were ruined by the unchecked excess of punishing state power.

"The Police Cannot Be Trusted"

Jeanette Plummer is the mother of Johnny Plummer, a plaintiff in a new class-action lawsuit against the Chicago Police Department related to the Burge tortures. In 1991, when Johnny was 15, he was arrested in connection with a murder, and during the course of his interrogation police savagely beat him until he made a statement incriminating himself. After leaving his body bruised and raw, Johnny was sentenced to life in prison without possibility of parole, despite a tainted confession and an unwavering declaration of innocence. He is locked up at Menard Correctional Center, having now lived the majority of his life behind bars.

His impoverished mother can visit him only once a year because she must constantly tend to another one of her children with special needs. Decades after the torture of her son, she remains deeply resentful of the police and the legal system that failed him and his family.

"It doesn't make sense," she told Truthout over the phone. "The police cannot be trusted. How can they get away with doing that?"

In late 2012, a group of attorneys filed a class-action lawsuit to determine whether more than 100 men currently incarcerated were imprisoned as a result of confessions elicited through torture by Chicago police (state law renders such admissions inadmissible at trial). The new litigation may be the last hope that some of the torture victims have of challenging their convictions before they die in prison.

"I hope someone hears my baby's cries," Jeanette Plummer said. "That's what I'm hoping for. And I'll never give up. I gotta keep fighting for my son to try and bring him home."

While Johnny Plummer and dozens of other victims serve their life sentences, Burge also passes his days behind bars, as he has since his incarceration in 2011 for lying about his knowledge of the tortures. He is set to leave prison in late 2015, after a total of four and a half years behind bars.

The Rahm Emanuel Link

No story about Chicago public service would be complete without mentioning Rahm Emanuel, the city's hardnosed mayor, who, shortly after authorizing two multimillion-dollar settlements for two torture victims, called on the city to move forward from the scandal.

"I am sorry this happened," he said in a press conference in September 2013, with a hint of characteristic impatience. "But we have to close the books on this. ... This [settlement] is a way a way of saying all of us are sorry about what happened ... and closing that stain on the city's reputation."

For the mayor, shows such as "Chicago PD," featuring valiant portrayals of the Windy City's men and women in blue, also may be exactly what's needed to repair the department's tattered image. Lucky for him, his own brother Ari is the head of the talent agency representing the show's creator, Dick Wolf, as well as some of the show's stars.

The close linkages between City Hall and the show's producers merit discussion.

Ari Emanuel co-founded the talent agency Endeavor Agency in 1995 with a man named Rick Rosen. That agency became the William Morris Endeavor (WME) after a merger in 2009. Ari Emanuel is co-CEO of WME, and Rick Rosen is a board member and head of the television department. The two men still work together in a very close capacity; recently, Oprah quit her old agency and signed on to WME, "where her career will be handled by a team of agents led by Ari Emanuel and Rick Rosen."

Rosen also has been Wolf's agent since at least 2009. The two men reportedly are close and work together in other ventures as well: Both are advisers in Wolf's media think-tank, the Carsy-Wolf Center.

Wolf was able to leverage his proximity to the Emanuels to score a cameo of the mayor for his other show, "Chicago Fire." Rahm made an appearance on the series premiere under the condition that the show made an investment to the firefighters' widows and orphans fund.

That show, which was a runaway success in 2013, is to the Chicago Fire Department what "Chicago PD" is for the police: a cartoonish representation of public service heroism that, for Rahm, meant "jobs for Chicago," in the words of one source to The Hollywood Reporter.

Could this be a sign of Wolf's willingness to scratch the backs of Ari and Rahm in return for industry credence after NBC's producers snuffed out Law and Order: LA in 2011 after only a year of airtime?

One thing is for sure: Given the extremely close relationship between the Emanuel brothers, it's not likely Ari's agency would represent anyone with something bad to say about Chicago.

Good and Bad

The pull of crime dramas and the Cop Booster subgenre is that they allow us to escape into exciting, hyper-violent worlds where it's easy to know who is good and bad.

The insidious side of society's infatuation with simplistic dichotomies of benevolence and evil is how it undercuts the nuance with which real-life social and political problems must be confronted. Law enforcement agencies regularly invoke images of "good guys and bad guys" to sell their policies - even in Congressional hearings - and the effect is the broad acceptance of a framework that uniformly criminalizes whole classes of people.

A major consequence of this framing is that it makes it easier for aggressors in power to push their agenda. Any threat perceived as innately, unalterably evil is reduced to a social punching bag. You can bomb it, shoot it, cage it, kill it – including by injection it with poisonous chemicals. But the one thing you can't do is change it.

Our criminal justice policy reflects the idea that those who break the law must be punished swiftly and mercilessly. Punitive policing, three-strikes laws, mandatory sentencing, solitary confinement and the death penalty all fall into that category. They are practices rooted in a violent, Hobbesian vision of the world in which the good must be protected from the bad. Unsurprisingly, rates of incarceration indicate that race and class are strong determinants of the side on which one falls.

The media plays a central role in reproducing and perpetuating this paradigm. The police in "Chicago PD" are good, and they care so deeply about justice that they will do whatever it takes rid the world of the bad - even if that means torture. TV series such as "Chicago PD" not only help to normalize police brutality and corruption, they also sharpen the mythical edge that divides good and bad people, justifying the deeply flawed underpinnings of the US criminal justice system. In that worldview, police violence works.

Wednesday, March 26, 2014

Take Off

In the never ending quest to understand what happened on the flight from Malaysia. Much has and will be speculated from Crew interference to terrorist hijacking. It appears that it may never be found, either the plane or the malfunction or its flight or more importantly the who the what the when the where and the why. The basics of investigation. You know wha the police quit doing years ago.

And of course this will mean enhanced TSA screenings which have crossed over into the bizarre and utterly absurd as agents paid barely a liveable wage, poorly trained and empowered with the idea of "saving America" as their motto is opening another door to civil rights violations and utter waste of resources. Think the warrior cop only even less armed and less dangerous, but equally stupid.

More junk science and more bullshit. This site does a fairly good job explaining the s as in skeptic when it comes to the idea of body language.

Body language? Vivre et laisser vivre ou mourir en essayant

At Airports, a Misplaced Faith in Body Language

MARCH 23, 2014

Like the rest of us, airport security screeners like to think they can read body language. The Transportation Security Administration has spent some $1 billion training thousands of “behavior detection officers” to look for facial expressions and other nonverbal clues that would identify terrorists.

But critics say there’s no evidence that these efforts have stopped a single terrorist or accomplished much beyond inconveniencing tens of thousands of passengers a year. The T.S.A. seems to have fallen for a classic form of self-deception: the belief that you can read liars’ minds by watching their bodies.

Most people think liars give themselves away by averting their eyes or making nervous gestures, and many law-enforcement officers have been trained to look for specific tics, like gazing upward in a certain manner. But in scientific experiments, people do a lousy job of spotting liars. Law-enforcement officers and other presumed experts are not consistently better at it than ordinary people even though they’re more confident in their abilities.

“There’s an illusion of insight that comes from looking at a person’s body,” says Nicholas Epley, a professor of behavioral science at the University of Chicago. “Body language speaks to us, but only in whispers.”

The T.S.A. program was reviewed last year by the federal government’s Government Accountability Office, which recommended cutting funds for it because there was no proof of its effectiveness. That recommendation was based on the meager results of the program as well as a survey of the scientific literature by the psychologists Charles F. Bond Jr. and Bella M. DePaulo, who analyzed more than 200 studies.

In those studies, people correctly identified liars only 47 percent of the time, less than chance. Their accuracy rate was higher, 61 percent, when it came to spotting truth tellers, but that still left their overall average, 54 percent, only slightly better than chance. Their accuracy was even lower in experiments when they couldn’t hear what was being said, and had to make a judgment based solely on watching the person’s body language.

“The common-sense notion that liars betray themselves through body language appears to be little more than a cultural fiction,” says Maria Hartwig, a psychologist at John Jay College of Criminal Justice in New York City. Researchers have found that the best clues to deceit are verbal — liars tend to be less forthcoming and tell less compelling stories — but even these differences are usually too subtle to be discerned reliably.

One technique that has been taught to law-enforcement officers is to watch the upward eye movements of people as they talk. This is based on a theory from believers in “neuro-linguistic programming” that people tend to glance upward to their right when lying, and upward to the left when telling the truth.

But this theory didn’t hold up when it was tested by a team of British and North American psychologists. They found no pattern in the upward eye movements of liars and truth tellers, whether they were observed in the laboratory or during real-life news conferences. The researchers also found that people who were trained to look for these eye movements did not do any better than a control group at detecting liars.

“There is no Pinocchio’s nose — no one cue that will always accompany deception,” says an author of the eye-movement

She and some researchers argue that it may nonetheless be possible to detect certain kinds of “high stakes” lies by training experts to look for a constellation of body cues. Stephen Porter of the University of British Columbia says the poor success rate in studies is caused partly by the limitations of laboratory experiments in which subjects are often asked to lie about things that don’t really matter to them. Liars may show more stress in a real-life situation when much depends on being believed.

In a study last year, psychologists at the University of British Columbia trained professionals in forensics to look for an array of facial expressions and other signs of stress or inconsistency in someone telling a story. Then these professionals looked at news footage of people pleading for the return of a missing relative. Some of the pleaders were sincere, but others were lying (as eventually revealed by evidence that they had already murdered the relative). The trained professionals were able to identify the liars with an 80 percent accuracy rate.

That’s an impressive record, but it’s only one experiment, and many researchers question how reliably these techniques can be applied in the real world. Other studies, including ones involving police interrogations, have found that people are not always better at detecting high-stakes lies than lesser ones. The fear of being charged with a crime can make an innocent person look suspiciously nervous, too.

The T.S.A.’s administrator, John S. Pistole, defended its behavior-detection program last year by saying it identified “high-risk passengers at a significantly higher rate than random screening.” The accountability office report challenged the methodology behind that assertion and questioned the cost-effectiveness of the program. It noted that fewer than 1 percent of the more than 30,000 passengers a year who are identified as suspicious end up being arrested, and that the offenses (like carrying drugs or undeclared currency) have not been linked to terrorist plots.

In experiments at the University of Chicago, Dr. Epley and his colleagues have found that people vastly overestimate how much mind reading they can do by looking at someone’s facial expressions.

“Reading people’s expressions can give you a little information, but you get so much more just by talking to them,” he says. “The mind comes through the mouth.”

Why do we intuitively believe we can read body language? After writing a book on the topic — “Mindwise: How We Understand What Others Think, Believe, Feel, and Want” — Dr. Epley has an explanation.

“When you’re lying or cheating, you know it and feel guilty, and it feels to you as if your emotions must be leaking out through your body language,” he says. “You have an illusion that your emotions are more transparent than they actually are, and so you assume others are more transparent than they actually are, too.”

Even after completing his book, Dr. Epley fell victim to the same illusion this year when he gave his wife a present for her 40th birthday, a plane ticket to go by herself to New York to spend the birthday with her twin brother. When she opened it, she burst into tears, and Dr. Epley assumed she was upset at spending the birthday away from her husband and children.

“I was horrified,” Dr. Epley recalls. “I immediately started wondering if the plane ticket was refundable. After she regained her composure, she said, still in tears, that it was exactly what she was hoping to do but didn’t want to say for fear we’d feel bad. They were tears of joy, but I couldn’t tell that until she told me so.”

Bigger is not better

When you think Prosecutorial Misconduct is reduced to the local municipalities of over zealous career ambitious driven assholes well think bigger. Federal Prosecutors are a member of an ever growing and not so elite club.

This number seems small frankly which once again means iceberg and tip have yet to meet.

Political MoJo

Justice Department Bad Boys: More Than 650 Cases of Misconduct Documented in 12-Year Period

—By Dana Liebelson
| Fri Mar. 14, 2014 8:24 AM PDT

Federal prosecutors, judges, and other officials at the Justice Department committed over 650 acts of professional misconduct in a recent 12-year period, according to a new report published by a DC-based watchdog group, the Project On Government Oversight. POGO investigators came up with the number after reviewing documents put out by the Department of Justice's Office of Professional Responsibility (OPR). According to one little-noticed OPR document published last year, a DOJ attorney failed to disclose a "close personal relationship" with the defendant in a case he was prosecuting, in which he negotiated a plea agreement to release the defendant on bond. An immigration judge also made "disparaging remarks" about foreign nationals. POGO contends that this number is only the tip of the iceberg and OPR needs to release more information about this misconduct to the public.

"The bottom line is we just don't know how well the Justice Department investigates and disciplines its own attorneys for misconduct when it occurs," says Nick Schwellenbach, a contributor to POGO. "The amount and types of misconduct DOJ's own investigators conclude has happened suggests more [information] should be public than is already, including naming names of offending prosecutors that commit serious misconduct."

OPR is responsible for investigating ethics complaints at the Justice Department, but the office reports directly to the attorney general. POGO argues that this insular system might not be sufficient to provide effective oversight of prosecutor wrongdoing. Last year, for example, two federal judges issued court orders complaining that DOJ attorneys had misled them about the full scale of the NSA's surveillance activities—but OPR was never aware of the complaints and didn't investigate them even though a former OPR attorney said that they should have triggered an inquiry, according to USA Today.

Between fiscal year 2002 and FY2013, of the more than 650 documented cases of DOJ employee misconduct, 400 were characterized as "reckless" or "intentional" by OPR. In OPR's latest report, from FY2012, the office received over 1,000 complaints and other correspondence about Justice Department employees (over half of these complaints came from incarcerated individuals) and opened 123 inquiries and investigations.

In one case from 2012, a Justice Department attorney falsely told a court that the government didn't have evidence that a key witness suffered from an ongoing mental-health disorder—when the prosecutor did have that evidence, according to OPR. The attorney was suspended for two weeks and the state bar was notified. In another case, an immigration judge presiding over a case where a father and his daughter were fighting removal from the United States was found by OPR to have "engaged in professional misconduct by acting in reckless disregard of his obligation to appear to be fair and impartial" and to have made biased statements against immigrants. The judge was suspended for 30 days.

OPR isn't responsible for disciplining employees; that's up to others in the Justice Department. OPR also no longer publicly names Justice Department employees found to be conducting misconduct, although it did so for a brief period during the Clinton presidency. In 2010, the American Bar Association passed a resolution asking the Obama administration to release more information about Justice Department investigations, potentially including names, but so far, not much has changed.

"The department takes all allegations of attorney misconduct seriously, and that is why the Office of Professional Responsibility thoroughly reviews each case and refers its findings of misconduct to relevant state bar associations when the rules of the state bar are implicated," says a Justice Department spokeswoman. "OPR also regularly provides detailed information on the resolution of complaints to the defense attorneys, judges, and others who send allegations of misconduct to the department."

A bill proposed on Thursday by Sens. Mike Lee (R-Utah) and Jon Tester (D-Mont.) would overhaul how misconduct is investigated at the Justice Department. Right now, only OPR is allowed to look into ethics complaints, instead of the Justice Department's Office of Inspector General, which is widely considered to be more independent. The senators' bill would move that authority to the IG's office. Sen. Lisa Murkowski (R-Alaska), who supports the bill, says: "When Americans pledge to abide by 'liberty and justice for all,' that does not mean that those pursuing justice can creatively apply different standards or break the rules to get convictions—it means that in America everyone is held equally accountable."

Saturday, March 22, 2014

Run for the Cure

Once again the high price for medical drugs reach astronomical proportions. Perhaps had Sandy Bullock known that in Gravity she might have stayed up there.

If you wonder why we haven't found the "cure" for Cancer let alone a cold, this might be why. As once cured, the need and in turn demand ends there. 

This apparent with the drug for a new cure for Hepatitis C, funny that now what was a lifetime of illness and possible transplant need can be solved in a shorter period and is permanent. And of course the costs are beyond the reach of anyone in need. 

Sandy while you're up there grab some meds.

Lawmakers Attack Cost of New Hepatitis Drug

MARCH 21, 2014

A protest in San Francisco last month against Sovaldi’s price. Credit AIDS Healthcare Foundation

A new drug to treat hepatitis C that costs $1,000 a pill has caused rising concern among insurers and state Medicaid programs. It has now also spurred interest from Democratic congressmen whose queries about the drug prompted a sell-off in biotechnology stocks on Friday.

Three Democratic members of the House Energy and Commerce Committee have demanded that Gilead Sciences, the developer, justify the price of its drug, which is called Sovaldi.

“Our concern is that a treatment will not cure patients if they cannot afford it,” the congressmen said in their letter, which was sent on Thursday.

It was signed by Henry A. Waxman of California, the ranking Democrat on the committee, and Frank Pallone Jr. of New Jersey and Diana DeGette of Colorado.

Gilead’s stock fell 4.6 percent, to $72.07 on Friday. Nervous investors took down the shares of some other big biotechnology companies as well, worried that pressure on drug prices would increase. Biogen Idec and Alexion Pharmaceuticals both fell 8 percent, Vertex Pharmaceuticals 5 percent and Celgene nearly 4 percent.

“The fear that Congress may begin a program of meddling, one drug at a time, doesn’t affect just one drug,” said Andrew A. Bogan of Bogan Associates, which invests in science and technology stocks. “It kind of scares everyone.”

Still, many analysts who follow Gilead predicted that the storm would soon pass. They noted that the letter writers were in the minority party in the Republican-controlled House.

“We just look at this letter as a little bit of noise,” said Robyn Karnauskas, a biotechnology analyst at Deutsche Bank.

Gregg Alton, executive vice president for corporate and medical affairs at Gilead, said on Friday that the company would gladly meet with Congress.

“We think the price is fair,” he said in an interview. “It will save the system money long term.”

Three million to four million Americans are estimated to be infected with the hepatitis C virus. Over decades, infection can cause cirrhosis, or scarring, of the liver and liver cancer.

Sovaldi, approved by the Food and Drug Administration in December, is by most accounts a big advance. When taken with one or two older drugs, it can cure more than 80 percent of cases of hepatitis C in as little as 12 weeks — a higher cure rate with shorter treatment duration and fewer side effects than was previously possible.

But some insurers say the system cannot absorb the $84,000 price for a 12-week course of treatment — or $1,000 a daily pill. Gilead probably did not help itself by setting the price at such a round number.

“It’s unprecedented that we have a drug that is this expensive that this many patients can benefit from,” said Dr. Steve Miller, the chief medical officer for Express Scripts, the largest pharmacy benefits manager. “You have a drug that has the potential to break a lot of the payers.”

Dr. Miller said more than half of those infected were uninsured or in Medicaid, in prisons or veterans. That means the costs will fall largely on taxpayers.

He said some health plans were restricting treatment to only the most ill patients.

Gilead says Sovaldi is actually less expensive per patient cured than the previous treatments, once the lower cure rate and severe side effects of those treatments are taken into account.

Sovaldi’s price might also seem reasonable compared to cancer drugs that cost $100,000 a year but prolong lives only a few months, or H.I.V. drugs that cost $30,000 a year but must be taken for life.

But the issue is really not so much about price alone as it is about the total budgetary impact. Because the drug is so effective, many people might use it.

“The worry is that the volume is just going to overwhelm the system,” said Ms. Karnauskas.

Based on early prescribing trends, analysts predict Sovaldi sales in the United States could reach $3 billion to $10 billion this year. That would shatter the record for first-year sales of any drug and would make Sovaldi one of the best-selling drugs in the world.

Gilead argues that such an expenditure will save money over the long run because fewer people will eventually need expensive liver transplants or suffer liver cancer.

But most people with hepatitis C never experience serious liver problems. So many people will be treated who would have done fine without treatment.

A recent analysis by the nonprofit Institute for Clinical and Economic Review concluded that the extra expense of treating all patients with Sovaldi instead of older drugs would not be recouped through lower medical costs even over the next 20 years. Only if treatment were restricted to the patients with more advanced liver scarring would there be a net savings over 20 years, said the institute, which evaluates medical evidence.

Competitors are expected in the market later this year. Insurers hope eventually to play one company against the other to bring down prices.

Horse's Mouth

Tooling around the internets I found this gem by an actual Doctor. In it he exposes the truth and facts behind the fear by the Medical Industrial Complex with regards to Medical Malpractice. It is in clear opposition to this histrionics that I also read.  But frankly he seemed to hate his own kind - Attorney's.

I have already read the great book, the Medical Malpractice Myth, and in turn am fighting my own challenges as I go pro se against Harborview Medical Center or as I prefer to call it, the Dump. And what you find when you research malpractice cases historically, they follow a cookie cutter pattern regardless of Defendant or Plaintiff. So with all the supposed fear of malpractice and tort reform it is a myth much like Seattle is a great place for jobs, etc.

What I think is telling is that first paragraph in this Doctor's blog was the amount of research he had to do and how inadequate it was when finding it. Then he simply asked his colleagues and they were forthcoming with the truth and the best part was where they made most of their money testifying as "Medical Experts." Well I hope they don't turn out like this University of Washington/Harborview Doctor, exposed as a fraud.

And in reality we have such problems with the junk science experts, what makes anyone think the not junk ones are any different? They are paid for hired guns whose protect one's own and bias are no different than the faux ones of the State, just better dressed. This article  discusses the issue surrounding the problems with "medical experts."  And those articles are both from 2008. Do you really believe anything has changed since 2008?  I hoped for change that year as well but the answer is no.

You can see why that most juries "don't like it" when it comes to experts and largely look at credentials and expertise as the determining factor, the words and stuff are lost on ears as just words. But those Doctors need to upgrade their number on their Mercedes! Courtrooms are theaters and it is a form of performance art, you have to see to believe. Real life is nowhere near TV life.  Real players in Court are not that bright,  arrogant, not that bright, shallow, self involved and utterly ill prepared. Actors are only 5 out that 6.

What really is of issue is work. No one wants to do it apparently. They want to reap the reward of the maximum effort for the minimal work. Heard that from an Attorney, I don't think they have the trademark on that one. (well maybe not)

This blog is well worth the read. A Doctor who actually is telling the honest truth. I knew there would be one. Now I just need to find an Attorney to do the same.

The True Cost of Healthcare

By David Belk MD
Medical Malpractice: Myths and Realities

When I began writing this website, I had two major goals: provide some transparency to medical costs and dispel some of the many myths about these costs. In a way the second goal may be more important. If most people share a false idea about the cause of a problem then their solutions will be equally misguided. This brings me to the subject of medical malpractice and how much it really costs.

Whenever I ask anyone "how much do you think I pay for my malpractice insurance?" the answer never fails to amuse me. People usually guess anywhere from $30,000 to $150,000 per year (as if I could afford that). When I tell them, they're usually shocked and some people have even gone so far as to tell me I must be wrong. I write the check each quarter. I think I know how much it is. Well, seeing is believing, so here is my malpractice bill for all of 2012.

Thats right, $2,947.48 for the WHOLE YEAR! (It says $3046.48 because there is a $99.00 yearly PAC contribution, which is optional, though they dont make that obvious on the bill.)

So, why so little? If medical malpractice is so incredibly expensive that it's breaking the back of healthcare in this Country, why is my bill so low? Is it because Im such an outstanding doctor that my insurance provider long ago recognized that I would never be sued? Well, I'd like to think that were true but, no. I recently surveyed some of the doctors who practice near my office. Many of them have their accountant or biller take care of their bills for them so they were strangely unaware of what they paid and rather surprised when I got them to look at their bills.

I asked the nephrologist, who has an office one floor below me, to open her bill in front of me. She pays $2,953 a year. Six dollars a year more than I pay and she runs a dialysis unit.

There are two cardiologists who share an office one floor below her. One does angioplasties; which are a very invasive and sometimes dangerous procedure. He pays $5,500 a year. The other one doesnt do that procedure so he only pays $3,800.

A pulmonologist, whose office is around the corner from them, pays $4,200 a year and he oversees an ICU and does bronchoscopies (another invasive and potentially dangerous procedure). Before getting him to look at his bill, he assured me several times that it was twice that amount.

An ophthalmologist I know pays $3,800 a year and does eye surgery, though he told me that his premiums were cut in half when he stopped doing complicated eye surgeries. Emergency Room physicians (who have a very high exposure to malpractice suits) pay about $12,000 a year. Anesthesiology: $14,000, General surgery: $18,000, Orthopedic surgery: $20,000.

Of all the doctors I spoke to, only Obstetrics/Gynecology paid enough in malpractice premiums as to be a burden (surgeons make a lot even by a doctors standard so most can afford $18,000-$20,000 a year). The one Ob/Gyn doctor I asked told me he pays $40,000 a year (and he's never been sued).

Its easy to see from these examples that medical malpractice premiums don't have much financial impact on me or most of my colleagues. So why are we always being told that medical malpractice is driving up medical costs? Perhaps we should begin with some data on national trends before trying to answer this question (Warning: the following explanation involves statistics).

Researching medical malpractice isn't as easy as it might seem. To get to any actual data I had to fish through an ocean of blogs arguing against tort reform. Still, I managed to find three good references with actual numbers from the Kaiser Family Foundation. The first reference was written in 2005 and gives a very sober explanation of malpractice law in the United States. (go to blog to see charts)

The graphs are from pages 18 and 20 of the first reference. You can see from the first graph that malpractice payouts rose steadily through the 90s and, by one estimate, were about $4.45 billion in 2003. The tables below are from the 2010 version of the second and third references (Link here and here for the 2011 numbers which came in after this was written). From them, you can see that by 2010, the total amount paid in the U.S. for malpractice claims dropped by as much as 25% to $3.33 billion. In 2011 paid medical malpractice claims dropped even further to $3.18 billion.

Further examination of the 2010 malpractice payouts show that about $1.2 billion (36%) of these payouts occurred in just three States: New York, Pennsylvania and Florida. If you add Massachusetts, New Jersey and Illinois you can account for 52% of total malpractice dollars paid in 2010 (20% in New York alone, see figure here). If you examine the number of paid claims in each State in 2010, again you can see that three States (the first three above) were responsible for 31% of the total paid claims in the U.S. that year.

On the second graph (from page 20 of the first reference) you can see that the total number of claims peaked nationally at 16,682 in 2001. From the table below, you can see that they dropped about 40% to 9,894 claims by 2010 (9,497 claims in 2011). Here in California (where I practice) we had only 909 total paid malpractice claims in all of 2010. Thats only 909 payouts in a State with over 37 million people and nearly 100,000 doctors! So, it appears as though medical malpractice has rapidly receded in all but a few States.

My personal malpractice premiums reflect this trend. In 2003 (the first year that I paid for my own malpractice insurance) I paid about $8,500 in premiums for the year. In 2010 it had dropped to just over $5,000 and by 2012 it was just below $3,000. In 2013 it's now just over $3,500. Apparently medical malpractice suits have nearly disappeared in most States so neither malpractice premiums nor suits appear to have much impact on medical costs. So why are doctors and other healthcare providers constantly complaining about them? In order to answer that, I thought I'd share my personal perspective on the medical malpractice industry and how I believe it really affects most doctors.

To begin with, I've never actually been sued. I was once named in a case but I had no real involvement in that case and the case was dropped shortly after it was filed for lack of merit. Still, I received a letter of intent and had to phone my insurance provider to tell them what was happening. I've also worked with doctors whove garnered huge profits as "expert" witnesses in a number of medical malpractice cases and I know a few doctors who were dragged through the malpractice process as defendents. Finally, it's impossible to train as a doctor without having the aura of medical malpractice constantly haunt you.

From the moment I entered medical school we were reminded, quite frequently, of the fact that, at some point in our career, we would probably be involved in a malpractice suit. We were taught right from the beginning how to protect ourselves from these inevitable lawsuits. Much of what we were told was good advice in general. For example, we were told that we need to be open and honest with our patients and explain everything as best we can. We were also told to document everything we do and say and why we did it in order to defend our actions in court (most chart notes are written for legal not medical reasons).

The most important thing we were told, though, is that we need to be likeable (or at least not disliked). We were told time and again the one factor that most determines whether a doctor is sued and whether he prevails in a suit is how likeable he is. Patients are far more likely to sue a doctor they don't like and, in any complex case, juries are far more likely to rule against a doctor they don't like. This means that any doctor who had a reputation for having a less than rosy personality risked having malpractice attorneys home in on him like sharks to a bleeding porpoise. To address this, medical schools adopted a national program of intense likeability training for the students. Its called Introduction to Clinical Medicine or ICM.

The purpose of ICM is to begin to teach us how to interact with patients from the start. We all formed groups and were instructed to talk about our feelings; how we felt about taking care of patients, how we should feel about patients, how we felt about all of these feelings and so on. We were also taught the basics of interviewing patients and doing physical exams. Then we would meet periodically with standardized patients. Standardized patients were actors and actresses who (as you might have guessed) acted out the role of a patient with a particular problem or complaint. We would take turns interviewing or examining this person while they would deliberately say or do things that would confront us or otherwise make us uncomfortable. Meanwhile the rest of the group watched and then gave us feedback on our performance.

After enduring a number of these performances, we would be given a standardized patient test. The test would go something like this: There would be a number of exam rooms in a hallway. Standing outside each room would be a medical student. The student would read a note on the exam room door giving him instructions on why the patient was there and what needed to be done. When a bell rang, the student entered the room and had 10-15 minutes (time limits would vary on different exams) to complete the expected tasks while being recorded on camera. When the bell rang again, he was to leave the room and go to the next door. A typical exam would have about six to eight such encounters.

In one such encounter (that I still remember vividly) the note on the door stated that the woman inside had recently had a mammogram that showed a lesion that was highly suspicious for malignancy (remember, she was only an actress, not an actual patient). My tasks were to inform her of the result, explain to her what it meant and then examine her breasts (to see if the mammogram was right??). The woman in the room was more than a little excitable. The second I entered the room she began to talk a mile a minute and I was forced to interrupt her to tell her she might have cancer (she kept cutting me off while I was trying to explain that). When I finally was able to give her the bad news, she went completely ballistic and I had to spend a few minutes calming her down before doing the breast exam (which was awkward to say the least).

So, in summary: I was expected to enter a room, introduce myself to a complete stranger, tell her she might have cancer, calm her down from a hysterical fit, and then ask her to undress so I could examine her breasts. All of this was to be done in fifteen minutes and while a camera was recording me. What's more, the same faculty who designed a test like this was also responsible for teaching us how to be more likeable! Certainly that was the most extreme example I can remember, but almost all of the encounters we had in these tests were designed to catch us off guard.

I cant blame the medical school faculty too much for what they put us through. Their goal was to teach us to remain professional even while being made uncomfortable and to communicate clearly even when it was very difficult. Their purpose was to train us to avoid being misunderstood as much as possible. As with everything, they just over did it a bit. Unfortunately, as a result of their enthusiasm, most of us were left with an unrealistic impression. We felt that as long as we could communicate everything we thought to someone with no medical training in a way in which they could understand AND get every one of our patients to like us, we had nothing to worry about. Needless to say, most of us were worried.

And there appeared to be plenty to worry about. We heard about malpractice cases everywhere: from doctors who had been sued to expert witnesses who made their fortune testifying in multiple suits. There were a number of journals that would arrive in my mail each week presenting the latest cases in medical malpractice as vicarious lessons on how we could protect ourselves from a similar suit. In any bad outcome, the list of things for which we could be sued appeared endless. As examples, we were often told:

If we prescribe a medication and the patient didnt take it because we didnt explain clearly enough why they needed the medication, they could sue us.
If we explained why they needed the medication but didnt clearly document our explanation, they could sue us.
If a patient misses an appointment and we dont call to see why, they could sue us.

And so on. In a business in which bad outcomes are inevitable (everyone will eventually get sick and die in even the best of care) being misunderstood was clearly dangerous. What's more, there was an entire industry making huge profits from our being misunderstood.

And the profits were huge but, make no mistake; being sued wasn't about the money; at least not for the doctor who was being sued. To the doctor in question, being sued was no more about the money than a major traffic accident is about the money. A doctor would usually first hear the news of an impending lawsuit by receiving a letter of intent in the mail. This letter would contain a lot of colorful language about how the doctors incompetence, negligence, dishonesty, stupidity and/or otherwise horrendous behavior resulted in death, disability, tremendous pain and suffering, etc...

The doctor in question may or may not have anything to do with the case in question. The plaintiff's attorney has a limited amount of time to file each case so, to avoid missing anyone, hell just send the same letter to everyone whose name is on the plaintiff's chart no matter how incidental or remote the connection may be (then sort them out later). It's then the duty of the doctor in question to phone their malpractice insurance provider to explain the situation. It's important for us to inform our insurance provider because, in addition to covering any damages, they also provide us with the legal support for our defense. Thats not out of the kindness of their hearts of course (remember: theyre an insurance company). They simply know that by overseeing our defense, they will likely minimize their loss.

Unfortunately, that doesnt always work to our advantage. The insurance companies protect our interest only to the degree that it coincides with their own. If our malpractice provider believes they're likely to save 50 cents by not fighting the case and just settling out of court; no problem. Our reputation is of no interest to them. They'll just compensate for our loss by raising our premiums. Also, the advice they give us is aimed primarily at protecting their assets. The first piece of advice a doctor named in a suit will get from their insurance provider is to talk to no one; not their coworkers, friends, family, spouse; No one! Anyone you talk to about any aspect of the case can be called as a witness to testify about what you told them.

In addition to the pure creepiness of being told that anything said in a private conversation with your spouse could be used against you in court, this advice also has the effect of completely isolating you. Medical malpractice cases usually take about two years to make it to court and so for two years youre told you cant talk to anyone while the plaintiff's attorneys take every chance to hurl insults at you about how horrible a doctor you are in letter after letter asking for more details about the case. The insurance companies give this advice for your (and their) protection. They know that if you go around complaining about the case to everyone you know, you might end up saying something that will incriminate you and word might get back to the plaintiff (rumors travel fast).

But this advice also plays into the plaintiff's hands. After two or more years of being isolated, alienated and insulted, there's a good chance that a doctor (or anyone else) would be feeling a bit hostile. Remember, a key aspect of how juries rule in medical malpractice is how likeable they find the defendant. If the doctor in question starts spouting about how unfairly hes been treated the minute he gets on the witness stand, the jury will likely hate him and the plaintiff's attorney can immediately put a down payment on a new condo.

When the court date arrives the show can begin. Each side; the defense and plaintiff's; attempt to cast the defendant in the starkest image possible. The defense wants the jury to see their client as Marcus Welby while the plaintiff's attorney does everything in his power to cast the defendant as Jack the Ripper. The jury is selected specifically in a manner to ensure they have as little knowledge of medicine as possible (knowledge, as we all know, is nothing more than an invitation to bias). Anyone who presents to a jury pool with any history of medical training would be automatically excluded.

Since the jury has little understanding of any medical issues, it's the duty of expert witnesses on each side to educate the jury about the relevant medical issues regarding the case. Expert witnesses are physicians (usually specialists) hired by each side to provide their expert opinion about how the case in question was handled or mishandled. These "experts" have supposedly the highest level of knowledge in their respective fields. Yet, strangely, each teams expertise leads them to the exact opposite conclusion about the defendant's performance than the other teams "expert".

Expert witnesses play a pivotal role in most malpractice cases. Many of the cases that aren't settled out of court require advanced medical knowledge beyond what the jury, judge or attorneys would likely have. Therefore, the testimony of these "experts" is about all anyone in the courtroom can use to render any kind of informed judgment. Because they are so pivotal to the case, these experts are treated quite well by both sides. A typical expert is paid about $500 an hour for all hours spent on the case in or out of the courtroom (they even get to log their own hours since their honesty is always beyond question).

There are certain expectations that both sides have of their experts (other than, of course, their expertise). They are not to have known or have had any prior contact with either the plaintiff or defendant in any way, whether personal or professional (that would make their testimony appear biased). They are also expected to have testified about equally for both plaintiff's and defendant's (again so as not to appear biased). Still, since the benefits are so good, there is always a generous supply of experts available to both sides for any case in spite of these restrictions. The lawyers from each side are often free to pick and choose which expert they think will best represent their client. Not surprisingly, each side chooses someone who they think will best relate to the jury. In other words, personality and theatrical skills are the most important aspects of any expert witness' "expertise".

After both sides have presented their case, the jury gets to choose whose performance they thought was better
. If they side with the defendant, the plaintiff (and the plaintiff's attorney) goes home with nothing and the defendant's reputation is spared. His malpractice insurance premiums will still probably go up (being sued, even if its unsuccessful, is a sign that someone didn't like you and to an insurance company, that looks bad). Also, hes lost two years of his life waiting for his case to make it to court (which hell never get back, of course). Still, he gets to go home with the satisfaction that he didn't fight for his reputation in vain.

If they side with the plaintiff, then begins the penalty phase of the trial to determine the damages that will be reimbursed to the plaintiff. In the penalty phase, the jury decides how much the plaintiff actually lost due to the defendant's negligence. In many States the damages can be awarded proportionally. For example, if the jury believes that the doctor made a mistake but it was the plaintiff's actions that caused most of the tragedy (didn't take prescribed meds, didn't show up for an appointment, etc..) then the jury might award the plaintiff only a portion of the damages. The doctor might be given 40% of the blame so the plaintiff is awarded 40% of the assessed damages.

To determine the damages, the jury must consider both economic and noneconomic losses the plaintiff sustained as a result of the malpractice. Economic losses are seemingly straightforward and usually include lost wages and ongoing medical expenses. Noneconomic losses are much more subjective. They include factors such as pain, suffering and emotional trauma the patient may have endured. Since these losses can never be quantified objectively, they are probably the most contentious issue in medical malpractice. Personality and theatrics often weigh heavily on how these damages are assessed.

Except for a letter of intent and the resulting conversation with my malpractice provider I have no direct experience with the details I just provided about a medical malpractice trial. That's just as well. I hope never to experience any of that first hand which is why Im glad that medical malpractice suits have become far less common than they were ten years ago. That doesn't mean that I don't believe physicians should be held accountable; I do. Physicians are no different from any other professional. We're human beings who are in no way above corruption or conflicts of interest. As with any profession we have our fair share of incompetents, charlatans, con artists and criminals. But medical malpractice is a business driven almost purely by profit through tragedy. Decisions often hinge on the theatrical performance of two competing teams to an audience selected specifically for their lack of knowledge regarding the issue they're judging. There has to be a better way.

One question that remains is why malpractice dropped so dramatically in the last decade. As it turns out, the answer isnt very obvious. When I began researching malpractice, I assumed the answer was tort reform. By 2010 tort reform bills had been enacted in 35 States. In some States these bills have had a dramatic effect (e.g. Texas) but in other States it's not so obvious. I noted earlier in this section that more than half the malpractice dollars paid in 2010 were paid in only six States. One of those States; Pennsylvania, passed a supposedly robust tort reform bill in 2003 and yet in 2010 was still ranked second in both number of paid medical malpractice claims and total dollars in paid claims. In California, the story is even more confusing. California did pass a strong tort reform bill that, among other things capped noneconomic damages at $250,000. But that happened in 1975! Clearly, a number of other factors occurred since then because California didnt start to see a significant drop in medical malpractice before the year 2000.

Perhaps all of our sensitivity training in medical school helped. It seems hard to believe now that there was a time when medicine was such a paternalistic profession that we were never expected to consult with a patient about any treatment plan or procedure (I'm the doctor, you're the patient was the expected answer to any question). It was once considered unethical even to inform a patient of a bad prognosis (we felt it would be detrimental to their health if they knew they were dying). If it took the threat of malpractice to change all of that and force us to be honest and open about what were doing then I guess that result was more than welcome.

Another question that remains is: To what degree does the fear of malpractice add to medical costs? Are doctors ordering a lot unnecessary tests and running up medical bills to avoid being sued? It's certainly possible. Fear leads to irrational behavior in any profession. And, if true, I dont know how such an effect could be verified or quantified. It's important to remember, though, that the only time a doctor could be sued for not ordering a test would be if that test would have revealed a problem the doctor missed. In other words; not ordering a test that should have been ordered; which, by the way, is the definition of malpractice.

When I was asking my colleagues about their malpractice premiums I also asked them "In the last five years do you know of anyone who has been sued?" Most answered no and the few who did know someone had to admit it was for a legitimate reason. I have little doubt that most, if not all, of the 909 successful medical malpractice suits in California in 2010 were for legitimate reasons and not just because of misunderstandings or personality issues. As I said before, doctors need to be held accountable as much as anyone else. Certainly more, not less oversight is needed in a profession as important as ours. That being said, I dont miss the threat of being sued for simple misunderstandings any more than I miss the higher premiums I paid a decade ago.

Friday, March 21, 2014

Bang Bang Your'e Dead

Such cries of the playground by those playing Cowboys, Indians, Cops and Robbers. Today that is a greater reality for many who find themselves on the either end of the gun.

American Police are now militarized to the point of extreme. Think the tanks you see on the news in Afghanistan or Iraq or some other war torn place are simply accoutrement's of war and the casualties are somehow a part of the conflict in pursuit of democracy? Think again, it is in the streets of America in abject opposition to the concept and principals of democracy.

When the Economist, a conservative magazine from Europe writes an article about the militarization of American Police it must be bad. It is. Day after day another article/story emerges about an innocent family whose doors are busted down, the family dog shot, an innocent killed or injured and the rise of the Warrior Cop goes unrepentant and unsupervised.

From cameras to face scanning to data mining the new technology has enabled law enforcement to observe and decide whether to shoot first and ask questions later. There is an article here about the increasing use of such tools to persecute, prosecute or simply perpetuate the notion, "do as I say not as I do." Here in Seattle this is an issue but it is not just here it is everywhere.

In Seattle we have had an off again on again off again approach to discipline when it comes to Seattle Police and violence and by violence I mean theirs. And it has the seal of Judicial approval so what could go wrong?

As for filming them well first it is okay then it not it is not okay but then it is okay. What.ever. It is the same with regards to the misconduct verdict, its on, its off, its on again. With Seattle Police I expect the one thing consistent is their inconsistency.

Judge OKs new Seattle police policy on use of force

By Mike Carter and Steve Miletich
Seattle Times staff reporters

U.S. District Judge James Robart approved a sweeping set of Seattle Police Department policy changes that describe when the use of force is appropriate and specify rules for oversight.

Beginning Jan. 1, Seattle police officers will be operating under new rules when it comes to using force.

A federal judge on Tuesday accepted a new and comprehensive use-of-force policy that will, for the first time, outline for officers when force is appropriate and when it isn’t, and provide for detailed reporting requirements.

The policy, negotiated between the Seattle Police Department (SPD) and the Department of Justice (DOJ) with the guidance of federal monitor Merrick Bobb, is key to addressing the findings of a 2011 DOJ investigation that concluded Seattle police resort to force too quickly and routinely use too much when they do. The Justice Department also found disturbing but inconclusive evidence of biased policing.

Approval of the policy by U.S. District Judge James Robart came two years and one day after the DOJ announced its findings.

The new policy marks a major milestone for the city toward compliance with a settlement agreement reached with the Justice Department 18 months ago to reform the Police Department. The agreement, which still requires additional reforms and training, provides a five-year time frame for the city to implement reforms, with an early out after three years if the city meets its requirements.

New policies addressing biased policing and the proper use of temporary police detentions are due Dec. 31.

Mayor-elect Ed Murray, who takes office next month, has said early compliance with the agreement is a priority, along with the selection of a permanent police chief to oversee the changes.

Departing Mayor Mike McGinn, who helped craft the settlement agreement, said in a statement, “We are glad to see that the Monitor, SPD and DOJ have achieved this milestone, and that they involved the Community Police Commission.”

“This is a major milestone in the reform process that will help rebuild trust and foster greater accountability,” U.S. Attorney Jenny Durkan said in a statement.

Interim Police Chief Jim Pugel issued a statement Tuesday, saying, “Today, the Seattle Police Department took another step forward in our efforts to provide effective, humane and constitutional policing to our city.”

The new 10-page policy — accompanied by nearly 70 pages of new procedural manuals — replaces a five-page policy that was in place during the time the DOJ conducted its investigation. For the first time, it defines “force” (“any physical coercion by an officer in the performance of their duties”) and advises when it can be used and how much is appropriate under the circumstances. It requires that officers report all but the most minimal use of force to supervisors.

It states specifically that officers shall “use only the force necessary to perform their duties” and “with minimal reliance upon the use of physical force.”

It requires them, if circumstances allow, to attempt to de-escalate tense situations through “advisements, warnings, verbal persuasion, and other tactics” to reduce the need for force.

When using force is unavoidable, the policy cautions officers to use only the force necessary to make the arrest, and says that their conduct before force was used may be considered by the department in determining whether force was appropriate.

The policy also requires all officers be armed with one “less-lethal” tool, such as a Taser, pepper spray or a “beanbag” shotgun, in addition to their sidearm.

The procedural manuals lay out weapon-by-weapon guidance, new reporting guidelines and the policies for the new Force Investigation Team (FIT), which will roll out on incidents involving the highest levels of force and officer-involved shootings.

In approving the policy, Judge Robart wrote in a three-page order that the role of the court and the monitor assigned to oversee the reforms “is not to dictate policies to the SPD, but rather to insure that the Proposed Policies conform to the requirements” of the settlement agreement, the U.S. Constitution and judicial decisions interpreting the city’s constitutional obligations.

“The court bears this responsibility with the utmost solemnity,” Robart wrote.

The new policy was negotiated with input from the Community Police Commission (CPC) citizens panel, with two police department representatives, created as part of the settlement agreement.

Robart noted the panel raised concerns that the policies were too long and may increase confusion about the appropriate use of force or create “trainability” issues.

But citing the DOJ’s 2011 investigation, Robart wrote that a common theme was “ambiguity in SPD policies” that left officers and supervisors uncertain about the use of force.

“The court believes that comprehensive, clear and specific policies are the most appropriate remedy for the present circumstances,” he wrote.

Robart’s order drew praise from the DOJ’s Civil Rights Division in Washington, D.C., which oversaw the investigation into Seattle police at the urging of the American Civil Liberties Union of Washington and nearly three dozen community groups.

“This policy will help ensure that the people of Seattle have a police department that respects the Constitution, secures the safety of the public, and earns the confidence of the community,” Acting Assistant Attorney General Jocelyn Samuels, director of the Civil Rights Division, said in a statement.

The findings of the Justice Department’s investigation echoed concerns that had been raised for years by Police Department auditors, a review board, blue-ribbon commissions and plaintiff’s attorneys, among others, who have complained that officers escalate to force too quickly, often relying on dangerous and damaging “impact weapons” such as batons and flashlights to subdue resistance. The report noted that many victims of these encounters are people with mental illness or under the influence of drugs and alcohol.

The report also stated that a relatively small percentage of officers are responsible for a disproportionate number of incidents where force was used, and it criticized the department for not recognizing the pattern.

Then we have even USA Today opining on the issue of our Justice system and its abject failure to provide actual justice.

We have a sick broken system. If you wonder why I am writing about this, it fits under the umbrella of "sustainability" and this is not sustainable.

Our criminal justice system has become a crime:
Glenn Harlan Reynolds
March 19, 2014

Prosecutors too often abuse unrestrained powers.

Here's how it's supposed to work: Upon evidence that a crime has been committed — Professor Plum, found dead in the conservatory with a lead pipe on the floor next to him, say — the police commence an investigation. When they have probable cause to believe that someone is guilty, the case is taken to a prosecutor, who (in the federal system, and many states) puts it before a grand jury. If the grand jury agrees that there's probable cause, it indicts. The case goes to trial, where a jury of 12 ordinary citizens hears the evidence. If they judge the accused guilty beyond a reasonable doubt, they convict. If they think the accused not guilty — or even simply believe that a conviction would be unjust — they acquit.

Here's how things all-too-often work today: Law enforcement decides that a person is suspicious (or, possibly, just a political enemy). Upon investigation into every aspect of his/her life, they find possible violations of the law, often involving obscure, technical statutes that no one really knows. They then file a "kitchen-sink" indictment involving dozens, or even hundreds of charges, which the grand jury rubber stamps. The accused then must choose between a plea bargain, or the risk of a trial in which a jury might convict on one or two felony counts simply on a "where there's smoke there must be fire" theory even if the evidence seems less than compelling.

This is why, in our current system, the vast majority of cases never go to trial, but end in plea bargains. And if being charged with a crime ultimately leads to a plea bargain, then it follows that the real action in the criminal justice system doesn't happen at trial, as it does in most legal TV shows, but way before, at the time when prosecutors decide to bring charges. Because usually, once charges are brought, the defendant will wind up doing time for something.The problem is that, although there's lots of due process at trial — right to cross-examine, right to counsel, rules of evidence, and, of course, the jury itself, which the Framers of our Constitution thought the most important protection in criminal cases — there's basically no due process at the stage when prosecutors decide to bring charges. Prosecutors who are out to "get" people have a free hand; prosecutors who want to give favored groups or individuals a pass have a free hand, too.

When juries decide not to convict because doing so would be unjust, it's called "jury nullification," and although everyone admits that it's a power juries have, many disapprove of it. But when prosecutors decide not to bring charges, it's called "prosecutorial discretion," and it's subject to far less criticism, if it's even noticed. As for prosecutorial targeting of disfavored groups or individuals, the general attitude is "if you can't do the time, don't do the crime."

The problem with that attitude is that, with today's broad and vague criminal statutes at both the state and federal level, everyone is guilty of some sort of crime, a point that Harvey Silverglate underscores with the title of his recent book, Three Felonies A Day: How The Feds Target The Innocent, that being the number of felonies that the average American, usually unknowingly, commits.

Such crimes can be manufactured from violations of obscure federal regulations that can turn pocketing a feather or taking home a rusted bit of metal from a wilderness area into a crime. In other cases, issues almost always dealt with in civil court, disagreements over taxes for instance, can be turned into a criminal case.

The combination of vague and pervasive criminal laws — the federal government literally doesn't know how many federal criminal laws there are — and prosecutorial discretion, plus easy overcharging and coercive plea-bargaining, means that where criminal law is concerned we don't really have a judicial system as most people imagine it. Instead, we have a criminal justice bureaucracy that assesses guilt and imposes penalties with only modest supervision from the judiciary, and with very little actual accountability. (When a South Carolina judge suggested earlier this year that prosecutors should follow the law, prosecutors revolted.)

In a recent Columbia Law Review essay, I suggest some remedies to this problem: First, prosecutors should have "skin in the game" — if someone's charged with 100 crimes but convicted of only one, the state should have to pay 99% of his legal fees. This would discourage overcharging. (So would judicial oversight, but we've seen little enough of that.) Second, plea-bargain offers should be disclosed at trial, so that judges and juries can understand just how serious the state really thinks the offense is. Empowering juries and grand juries (a standard joke is that any competent prosecutor can get a grand jury to indict a ham sandwich) would also provide more supervision. And finally, I think that prosecutors should be stripped of their absolute immunity to suit — an immunity created by judicial activism, not by statute — and should be subject to civil damages for misconduct such as withholding evidence.

If our criminal justice system is to be a true justice system, then due process must attach at all stages. Right now, prosecutors run riot. That needs to change

Thursday, March 20, 2014

Mythology of Oz

It is not just in Greece or Rome. Seattle has some type of Indian mythology a la Nirvana with regards to the opportunity and rainbows that exist in this the land of Oz. Our eponymous  label as the "Emerald City" seems less Dorothy and more Wicked Witch.

The city of my birth and home (again) for the last several years has been undergoing massive change thanks to the Amazon, the company, not the river. As they elected to locate their headquarters in the central part of Seattle, largely owned by another Oligarch, Paul Allen who misguidedly or now desirably so wanted to turn the area into a version of Central Park.  Instead now it is overpriced condos, apartments,  and really ugly futuristic commercial structures that Amazon are building to truly house the staff, the other are just the equivalent of dorms.

To accommodate the Amazon, the City of Seattle has ensured building more trams, trolleys, and bike lanes as Amazon subsidizes bus passes versus parking to discourage people living as in really having lives away from work, I doubt it has anything to do with sustainability. And those who work for the other tech half, Microsoft, private buses, the same kind under fire in the Bay area, shuttle their privileged to the east side across Lake Washington to their "campus." There is one thing the tech sector shares aside from hiring anti social libertarians and immigrants is the desire to replicate the colleges they never went to. Neither Bill Gates nor Mark Zuckerberg finished Harvard so why not have a yard in which to never grow up, right Dorothy?

So Seattle is the go to land for many in search, for jobs, for freedom, for the music, whatever hype, bullshit or actual reality they move here in droves determined that this is the place. And when questioned they are the most defensive and angry about anyone who has the audacity to criticize or question the direction Seattle has gone. But when you have invested so much is pursuing the dream you don't want to wake up to reality. And for some they have compared to the towns they have left this is the Metropolitan city of a dream in comparison. One young barista who was profiled in the WSJ told me that his minimum wage barista job was better than the none he had left in Portlandia... the town that is the show.

And then you read this story below. And the truth is that this story is throughout America. And the consistent factor is the age of the individual. We don't want any one here that is not young, single and disposable. You will take up too many resources, have demands, expectations and in turn needs.

This is largely a problem in the bookend to the south, San Francisco, which has now exceeded New York City as the most expensive city in America. The problem is largely confined to the housing crunch which due to the laws and the space restrictions has contributed to the raising of rents, evictions and in turn gentrification (a double edged sword) that many long time residents are being forced out to the cash waving tech sector.

Seattle rents are now per capita the highest and given that we are debating the $15/hr wage it is very telling to note that if this City was such a bastion of progress this would not even be a debate let alone an issue.

Seattle has great P.R. it always has. And it has a beautiful surrounding but as I say I don't confuse extrinsic, or what is external, for the intrinsic/internal problems it has. And for the record I have thought that from the moment I moved back here and that view has not changed. I may have but the story below tells you from another voice that this Nirvana smells like anything but teen spirit.

Slow job growth leaves long-term unemployed struggling
By Amy Martinez
Seattle Times business reporter

Joblessness statewide held steady in February at 6.4 percent. But employers added only 2,500 new jobs last month, suggesting the long-term unemployed will continue to face a tough job market.

Rick Grossman, in his Kent apartment, is one of the state’s many long-term unemployed workers. A former business owner, he said he applies to as many as five jobs a day and is not very picky when it comes to pay.

Grossman, 61, sold his business and moved to the Seattle area two years ago, lured by a more temperate climate and good quality of life. Given Seattle’s reputation for a strong economy, he also figured it would be easy to find a job.

Today, Grossman is among Washington state’s estimated 72,000 long-term unemployed workers — those without a job for at least six months.

“I’ve been applying for jobs the whole time, and I’m unable to find work,” he said. “It’s certainly disappointing.”

New data released Wednesday suggest the long-term unemployed will continue to face a tough job market.

Joblessness statewide held steady in February at 6.4 percent. But employers added only 2,500 new jobs last month, down from 5,800 in January, according to the state Employment Security Department.

Given the sluggish pace of hiring, job prospects are especially dim for workers grappling with long stretches of unemployment. Even those like Grossman, who has three decades of job experience, can be seen by employers as lacking motivation or a work ethic.

Without more opportunities for the long-term unemployed, the job market remains subpar five years after the start of an economic recovery.

Benefit proposal

Even Congress has taken note. The U.S. Senate is expected to act next week on a proposal to renew extended benefits for the long-term unemployed that expired in late December.

A White House official said in an annual economic report March 10 that the nation’s stubbornly high jobless rate is “entirely due to long-term unemployment.” Meanwhile, Gov. Jay Inslee directed Employment Security to spend $4 million in federal money on new efforts to help long-term unemployed workers find jobs.

From 2007 to 2011, the fraction of Washington’s unemployed workers who were jobless six months or longer increased from 13 to 39 percent, well above the previous record of 24 percent, set in 1983.

Long-term unemployment fell last year to about 30 percent of the statewide total but still is “disturbingly high,” said David Cooper, an analyst at the Economic Policy Institute in Washington, D.C.

“There’s a tremendous number of people who have been struggling to find work and probably are struggling to get by every day,” Cooper said. “Unless we see major change in the labor market soon, they’re probably going to be struggling for a while.”

Cooper said the official data underestimate the actual number of long-term unemployed workers. That’s because those who have stopped looking for a job no longer are counted as unemployed.

“Unfortunately, a significant portion of the long-term unemployed are giving up and dropping out of the labor force,” he said. “There just hasn’t been the level of consumer demand needed out there to compel businesses to go out and hire more people.”

Washington has gained back all the jobs lost in the Great Recession, at least in absolute numbers. But it’s nowhere near a full recovery when you consider growth in the working-age population, Cooper said.

He estimates that over the next three years, Washington would need to add about 8,500 new jobs a month — nearly twice its current pace — to return to pre-recession joblessness in the mid-4 percent range.

Until then, employers can afford to be choosy, and job applicants who’ve been out of work for a while will continue to be overlooked, he said.

“Employers see a gap of three to six months in a résumé and think, ‘There must be something wrong with this person,’” he said. “It’s like kicking these people when they’re down.”

Expansion mode

Despite weak job growth, Washington’s economy remains in expansion mode and is pulling people back into the labor market, state officials said Wednesday.

A bright spot in February was the addition of about 10,000 people to the labor force, a possible sign that discouraged workers restarted their job searches. The labor force includes all those working or looking for work.

“The economy is holding its own. People are moving into the job market and actually finding jobs,” said Paul Turek, a labor economist for the Employment Security Department.

Joblessness in the Seattle metro area, which includes Bellevue and Everett, declined to 5.1 percent in February from 5.2 percent a month earlier. Local employers added 2,500 new jobs, the same as all of Washington, meaning that without Seattle, Washington would have had no net increase.

Statewide, the professional and business-services sector generated 2,200 additional jobs, with “notable gains” in architecture, engineering and administrative-support positions, Turek said.

Other industries with solid monthly growth were retail, up 1,700 jobs; followed by financial activities, up 1,000; and government, up 600.

On the downside, private education and health services cut 2,100 jobs, while construction eliminated 600.

Grossman said he’s looking for work in retail management, corporate purchasing or staff training. He owned a pair of toy stores in New Jersey for a decade and previously worked at AT&T. He said he applies to as many as five jobs a day and is not very picky when it comes to pay.

To get by, Grossman said he still has some savings and lives a frugal lifestyle in his Kent apartment.

“Given my experience with self-employment, I think people are a little concerned I won’t take orders well. And now that I’ve been out of work for a while, there’s a stigma,” he said. “People begin to question, ‘Why hasn’t anyone else snapped you up?’  ”

For now, at least, the plight of the long-term unemployed is attracting some attention in the Other Washington.

About 28,000 jobless workers statewide lost unemployment benefits Dec. 28 after Congress failed to renew a federal emergency program for the long-term unemployed. An additional 11,000 people ran out of their regular six months of benefits in January and February, according to Employment Security.

Senate Democrats have announced a bipartisan agreement to provide for a five-month extension retroactive to Dec. 28, but the bill faces an uncertain future in the Republican-led House.

In any case, Grossman is not eligible for unemployment benefits because he was self-employed in his last job.

He said all he needs is to make a connection with “that one person” willing to hire him and remains optimistic.

“I’d really never been out of work before. I worked even when I was in college,” said Grossman, who has a bachelor’s in secondary science education from Temple University.

“I don’t believe I’ve changed. If anything,” he said, “my skills, knowledge and abilities have increased.”