Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Laws. Show all posts
Showing posts with label Laws. Show all posts

Sunday, March 10, 2024

MAGA’s Violent Threats Are Warping Life in America

David French
New York Times - Opinion
Originally published 18 Feb 24

Amid the constant drumbeat of sensational news stories — the scandals, the legal rulings, the wild political gambits — it’s sometimes easy to overlook the deeper trends that are shaping American life. For example, are you aware how much the constant threat of violence, principally from MAGA sources, is now warping American politics? If you wonder why so few people in red America seem to stand up directly against the MAGA movement, are you aware of the price they might pay if they did?

Late last month, I listened to a fascinating NPR interview with the journalists Michael Isikoff and Daniel Klaidman regarding their new book, “Find Me the Votes,” about Donald Trump’s efforts to overturn the 2020 election. They report that Georgia prosecutor Fani Willis had trouble finding lawyers willing to help prosecute her case against Trump. Even a former Georgia governor turned her down, saying, “Hypothetically speaking, do you want to have a bodyguard follow you around for the rest of your life?”

He wasn’t exaggerating. Willis received an assassination threat so specific that one evening she had to leave her office incognito while a body double wearing a bulletproof vest courageously pretended to be her and offered a target for any possible incoming fire.


Here is my summary of the article:

David French discusses the pervasive threat of violence, particularly from MAGA sources, and its impact on American politics. The author highlights instances where individuals faced intimidation and threats for opposing the MAGA movement, such as a Georgia prosecutor receiving an assassination threat and judges being swatted. The article also mentions the significant increase in threats against members of Congress since Trump took office, with Capitol Police opening over 8,000 threat assessments in a year. The piece sheds light on the chilling effect these threats have on individuals like Mitt Romney, who spends $5,000 per day on security, and lawmakers who fear for their families' safety. The overall narrative underscores how these violent threats are shaping American life and politics

Tuesday, January 30, 2024

Lawsuit Challenges New Jersey’s Out-of-State Telehealth Licensing Law

A. Vaidya
mhealthintelligence.com
Originally posted 18 DEC 23

Here is an excerpt:

The lawsuit states that J.A. was diagnosed with pineoblastoma, an aggressive brain tumor, at 18 months old. His physicians referred him to MacDonald in Boston. The treatment enabled J.A. to beat his cancer. However, he must continue to undergo scans once a year for the rest of his life to monitor the cancer’s return.

New Jersey’s current telehealth licensing law requires patients seeking specialty care out of state to decide whether to incur the cost of traveling to meet with the specialist for initial or follow-up consultations.

“Without telemedicine, patients suffering from rare cancers and diseases like J.A. must either forego lifesaving treatment or suffer by traveling out of state every time an appointment with a national specialist like Dr. MacDonald is needed,” the suit states. “Many cannot bear the burdens of frequent travel.”

Without the option of telehealth, J.A. and his family would not have been able to consult with all the specialists they needed due to “financial and time constraints,” the lawsuit further states. Even more recently, telehealth enabled J.A. to consult with MacDonald when an anomaly appeared on one of his scans.

Maintaining multiple licenses in different states places an administrative and financial burden on physicians, especially for specialists like MacDonald and Gardner, “who have national practices and only occasionally consult with or treat patients from New Jersey,” the suit notes.

Thus, the lawsuit argues that the licensing law violates the Dormant Commerce Clause and Privileges and Immunities Clause, which prohibits states from enacting laws that excessively burden interstate commerce in relation to local benefits. It also violates the First Amendment, which prevents the government from restricting conversations between patients and their providers, and the 14th Amendment’s Due Process Clause, which bans the government from limiting the ability of parents to direct their children’s medical care.

“Plaintiffs, who are New Jersey citizens and out-of-state specialists with patients in New Jersey, seek to vindicate their constitutional rights — and ensure they can continue to provide and receive — lifesaving care,” the lawsuit states.

Sunday, December 31, 2023

Problems with the interjurisdictional regulation of psychological practice

Taube, D. O., Shapiro, D. L., et al. (2023).
Professional Psychology: Research and Practice,
54(6), 389–402.

Abstract

The U.S. Constitutional structure creates ethical conflicts for the cross-jurisdictional practice of professional psychology. The profession has chosen to seek interstate agreements to overcome such barriers, and such agreements now include almost 80% of American jurisdictions. Although an improvement over a patchwork of state laws regarding practice, the structure of this agreement and the exclusion of the remaining states continue to pose barriers to the principles of beneficence and nonmaleficence. It creates a system that is extraordinarily difficult to change and places an unrealistic burden on professionals to know, address, and act under complex legal mandates. As psychological services have moved increasingly to remote platforms, cross-jurisdictional business models, and a nationwide mental health crisis emerged alongside the pandemic, it is time to consider a national professional licensing system more seriously, both to further reduce barriers to care and complexity and permit the best interests of patients to prevail.

Impact Statement

Access to and the ability to continue receiving mental health care across jurisdictions and nations has become increasingly urgent in the wake of the COVID-19 pandemic This Ethics in Motion section highlights legal barriers to providing ethical care across jurisdictions, how those challenges developed, and strengths and limitations of current approaches and potential solutions.


My summary: 

The current system of interjurisdictional regulation of psychological practice in the United States is problematic because it creates ethical conflicts for psychologists and places an unrealistic burden on them to comply with complex legal mandates. The system is also extraordinarily difficult to change, and it excludes psychologists in states that have not joined the interstate agreement. As a result, the current system does not adequately protect the interests of patients.

A national professional licensing system would be a more effective way to regulate the practice of psychology across state lines. Such a system would eliminate the need for psychologists to comply with multiple state laws, and it would make it easier for them to provide care to patients who live in different states. A national system would also be more equitable, as it would ensure that all psychologists are held to the same standards.

Monday, November 6, 2023

Abuse Survivors ‘Disgusted’ by Southern Baptist Court Brief

Bob Smietana
Christianity Today
Originally published 26 OCT 23

Here is an excerpt:

Members of the Executive Committee, including Oklahoma pastor Mike Keahbone, expressed dismay at the brief, saying he and other members of the committee were blindsided by it. Keahbone, a member of a task force implementing abuse reforms in the SBC, said the brief undermined survivors such as Thigpen, Woodson, and Lively, who have supported the reforms.

“We’ve had survivors that have been faithful to give us a chance,” he told Religion News Service in a phone interview. “And we hurt them badly.”

The controversy over the amicus brief is the latest crisis for leaders of the nation’s largest Protestant denomination, which has dealt with a revolving door of leaders and rising legal costs in the aftermath of a sexual abuse crisis in recent years.

The denomination passed abuse reforms in 2022 but has been slow to implement them, relying mostly on a volunteer task force charged with convincing the SBC’s 47,000 congregations and a host of state and national entities to put those reforms into practice. Those delays have led survivors to be skeptical that things would actually change.

Earlier this week, ­the Louisville Courier Journal reported that lawyers for the Executive Committee, Southern Baptist Theological Seminary—the denomination’s flagship seminary in Louisville—and Lifeway had filed the amicus brief earlier this year in a case brought by abuse survivor Samantha Killary.


Here is my summary: 

In October 2023, the Southern Baptist Convention (SBC) filed an amicus curiae brief in the Kentucky Supreme Court arguing that a new law extending the statute of limitations for child sexual abuse claims should not apply retroactively. This filing sparked outrage among abuse survivors and some SBC leaders, who accused the denomination of prioritizing its own legal interests over the needs of victims.

The SBC's brief was filed in response to a lawsuit filed by a woman who was sexually abused as a child by a Louisville police officer. The woman is seeking to sue the city of Louisville and the police department, arguing that they should be held liable for her abuse because they failed to protect her.

The SBC's brief argues that the new statute of limitations should not apply retroactively because it would create a "windfall" for abuse survivors who would not have been able to sue under the previous law. The brief also argues that applying the new law retroactively would be unfair to institutions like the SBC, which could be faced with a flood of lawsuits.

Abuse survivors and some SBC leaders have criticized the brief as being insensitive to the needs of victims. They argue that the SBC is more interested in protecting itself from lawsuits than in ensuring that victims of abuse are able to seek justice.

In a joint statement, three abuse survivors said they were "sickened and saddened to be burned yet again by the actions of the SBC against survivors." They accused the SBC of "proactively choosing to side against a survivor and with an abuser and the institution that enabled his abuse."

Sunday, August 27, 2023

Ontario court rules against Jordan Peterson, upholds social media training order

Canadian Broadcasting Company
Originally posted 23 August 23

An Ontario court ruled against psychologist and media personality Jordan Peterson Wednesday, and upheld a regulatory body's order that he take social media training in the wake of complaints about his controversial online posts and statements.

Last November, Peterson, a professor emeritus with the University of Toronto psychology department who is also an author and media commentator, was ordered by the College of Psychologists of Ontario to undergo a coaching program on professionalism in public statements.

That followed numerous complaints to the governing body of Ontario psychologists, of which Peterson is a member, regarding his online commentary directed at politicians, a plus-sized model, and transgender actor Elliot Page, among other issues. You can read more about those social media posts here.

The college's complaints committee concluded his controversial public statements could amount to professional misconduct and ordered Peterson to pay for a media coaching program — noting failure to comply could mean the loss of his licence to practice psychology in the province.

Peterson filed for a judicial review, arguing his political commentary is not under the college's purview.

Three Ontario Divisional Court judges unanimously dismissed Peterson's application, ruling that the college's decision falls within its mandate to regulate the profession in the public interest and does not affect his freedom of expression.

"The order is not disciplinary and does not prevent Dr. Peterson from expressing himself on controversial topics; it has a minimal impact on his right to freedom of expression," the decision written by Justice Paul Schabas reads, in part.



My take:

Peterson has argued that the order violates his right to free speech. He has also said that the complaints against him were politically motivated. However, the court ruled that the college's order was justified in order to protect the public from harm.

The case of Jordan Peterson is a reminder that psychologists, like other human beings, are not infallible. They are capable of making mistakes and of expressing harmful views. It is important to hold psychologists accountable for their actions, and to ensure that they are held to the highest ethical standards.

In addition to the steps outlined above, there are a number of other things that can be done to mitigate bias in psychology. These include:
  • Increasing diversity in the field of psychology
  • Promoting critical thinking and self-reflection among psychologists
  • Developing more specific ethical guidelines for psychologists' use of social media
  • Holding psychologists accountable for their online behavior

Wednesday, August 16, 2023

A Federal Judge Asks: Does the Supreme Court Realize How Bad It Smells?

Michael Ponsor
The New York Times: Opinion
Originally posted 14 July 23

What has gone wrong with the Supreme Court’s sense of smell?

I joined the federal bench in 1984, some years before any of the justices currently on the Supreme Court. Throughout my career, I have been bound and guided by a written code of conduct, backed by a committee of colleagues I can call on for advice. In fact, I checked with a member of that committee before writing this essay.

A few times in my nearly 40 years on the bench, complaints have been filed against me. This is not uncommon for a federal judge. So far, none have been found to have merit, but all of these complaints have been processed with respect, and I have paid close attention to them.

The Supreme Court has avoided imposing a formal ethical apparatus on itself like the one that applies to all other federal judges. I understand the general concern, in part. A complaint mechanism could become a political tool to paralyze the court or a playground for gadflies. However, a skillfully drafted code could overcome this problem. Even a nonenforceable code that the justices formally pledged to respect would be an improvement on the current void.

Reasonable people may disagree on this. The more important, uncontroversial point is that if there will not be formal ethical constraints on our Supreme Court — or even if there will be — its justices must have functioning noses. They must keep themselves far from any conduct with a dubious aroma, even if it may not breach a formal rule.

The fact is, when you become a judge, stuff happens. Many years ago, as a fairly new federal magistrate judge, I was chatting about our kids with a local attorney I knew only slightly. As our conversation unfolded, he mentioned that he’d been planning to take his 10-year-old to a Red Sox game that weekend but their plan had fallen through. Would I like to use his tickets?

Monday, July 31, 2023

Top Arkansas psychiatrist accused of falsely imprisoning patients and Medicaid fraud

Laura Strickler & Stephanie Gosk
NBCnews.com
Originally posted July 23, 2023

Here is an excerpt:

The man who led the unit at the time, Dr. Brian Hyatt, was one of the most prominent psychiatrists in Arkansas and the chairman of the board that disciplines physicians. But he’s now under investigation by state and federal authorities who are probing allegations ranging from Medicaid fraud to false imprisonment.

VanWhy’s release marked the second time in two months that a patient was released from Hyatt’s unit only after a sheriff’s deputy showed up with a court order, according to court records.

“I think that they were running a scheme to hold people as long as possible, to bill their insurance as long as possible before kicking them out the door, and then filling the bed with someone else,” said Aaron Cash, a lawyer who represents VanWhy.

VanWhy and at least 25 other former patients have sued Hyatt, alleging that they were held against their will in his unit for days and sometimes weeks. And Arkansas Attorney General Tim Griffin’s office has accused Hyatt of running an insurance scam, claiming to treat patients he rarely saw and then billing Medicaid at “the highest severity code on every patient,” according to a search warrant affidavit.

As the lawsuits piled up, Hyatt remained chairman of the Arkansas State Medical Board. But he resigned from the board in late May after Drug Enforcement Administration agents executed a search warrant at his private practice. 

“I am not resigning because of any wrongdoing on my part but so that the Board may continue its important work without delay or distraction,” he wrote in a letter. “I will continue to defend myself in the proper forum against the false allegations being made against me.”

Northwest Medical Center in Springdale “abruptly terminated” Hyatt’s contract in May 2022, according to the attorney general’s search warrant affidavit. 

In April, the hospital agreed to pay $1.1 million in a settlement with the Arkansas Attorney General’s Office. Northwest Medical Center could not provide sufficient documentation that justified the hospitalization of 246 patients who were held in Hyatt’s unit, according to the attorney general’s office. 

As part of the settlement, the hospital denied any wrongdoing.

Tuesday, July 25, 2023

Inside the DeSantis Doc That Showtime Didn’t Want You to See

Roger Sollenberger
The Daily Beast
Originally posted 23 July 23

Here are two excerpts:

The documentary contrasts DeSantis’ account with those of two anonymous ex-prisoners, whom the transcript indicated were not represented in the flesh; their claims were delivered in “voice notes.”

“Officer DeSantis was one of the officers who oversaw the force-feeding and torture we were subjected to in 2006,” one former prisoner said. The second former detainee claimed that DeSantis was “one of the officers who mistreated us,” adding that DeSantis was “a bad person” and “a very bad officer.”

Over a view of “Camp X-Ray”—the now-abandoned section of Gitmo where DeSantis was stationed but has since fallen into disrepair—the narrator revealed that a VICE freedom of information request for the Florida governor’s active duty record returned “little about Guantanamo” outside of his arrival in March 2006.

But as the documentary noted, that period was “a brutal point in the prison’s history.”

Detainees had been on a prolonged hunger strike to call attention to their treatment, and the government’s solution was to force-feed prisoners Ensure dietary supplements through tubes placed in their noses. Detainees alleged the process caused excessive bleeding and was repeated “until they vomited and defecated on themselves.” (DeSantis, a legal adviser, would almost certainly have been aware that the UN concluded that force-feeding amounted to torture the month before he started working at Guantanamo.)

(cut)

The transcript then presented DeSantis’ own 2018 account of his role in the forced-feedings, when he told CBS News Miami that he had personally and professionally endorsed force-feeding as a legal way to break prisoner hunger strikes.

“The commander wants to know, well how do I combat this? So one of the jobs as a legal adviser will be like, ‘Hey, you actually can force feed, here’s what you can do, here’s kinda the rules of that,’” DeSantis said at the time.

DeSantis altered that language in a Piers Morgan interview this March, again invoking his junior rank as evidence that he would have lacked standing to order forced-feeding.

“There may have been a commander that would have done feeding if someone was going to die, but that was not something that I would have even had authority to do,” he said. However, DeSantis did not deny that he had provided that legal advice.


My thoughts:

I would like the see the documentary and make my own decision about its veracity.
  • The decision by Showtime to pull the episode is a significant one, as it suggests that the network is willing to censor its programming in order to avoid political controversy.
  • This is a worrying development, as it raises questions about the future of independent journalism in the United States.
  • If news organizations are afraid to air stories that are critical of powerful figures, then it will be much more difficult for the public to hold those figures accountable.
  • I hope that Showtime will reconsider its decision and allow the episode to air. The public has a right to know about the allegations against DeSantis, and it is important that these allegations be given a fair hearing.

Friday, June 23, 2023

In the US, patient data privacy is an illusion

Harlan M Krumholz
Opinion
BMJ 2023;381:p1225

Here is an excerpt:

The regulation allows anyone involved in a patient’s care to access health information about them. It is based on the paternalistic assumption that for any healthcare provider or related associate to be able to provide care for a patient, unfettered access to all of that individual’s health records is required, regardless of the patient’s preference. This provision removes control from the patient’s hands for choices that should be theirs alone to make. For example, the pop-up covid testing service you may have used can claim to be an entity involved in your care and gain access to your data. This access can be bought through many for-profit companies. The urgent care centre you visited for your bruised ankle can access all your data. The team conducting your prenatal testing is considered involved in your care and can access your records. Health insurance companies can obtain all the records. And these are just a few examples.

Moreover, health systems legally transmit sensitive information with partners, affiliates, and vendors through Business Associate Agreements. But patients may not want their sensitive information disseminated—they may not want all their identified data transmitted to a third party through contracts that enable those companies to sell their personal information if the data are de-identified. And importantly, with all the advances in data science, effectively de-identifying detailed health information is almost impossible.

HIPAA confers ample latitude to these third parties. As a result, companies make massive profits from the sale of data. Some companies claim to be able to provide comprehensive health information on more than 300 million Americans—most of the American public—for a price. These companies' business models are legal, yet most patients remain in the dark about what may be happening to their data.

However, massive accumulations of medical data do have the potential to produce insights into medical problems and accelerate progress towards better outcomes. And many uses of a patient’s data, despite moving throughout the healthcare ecosystem without their knowledge, may nevertheless help advance new diagnostics and therapeutics. The critical questions surround the assumptions people should have about their health data and the disclosures that should be made before a patient speaks with a health professional. Should each person be notified before interacting with a healthcare provider about what may happen with the information they share or the data their tests reveal? Are there new technologies that could help patients regain control over their data?

Although no one would relish a return to paper records, that cumbersome system at least made it difficult for patients’ data to be made into a commodity. The digital transformation of healthcare data has enabled wonderous breakthroughs—but at the cost of our privacy. And as computational power and more clever means of moving and organising data emerge, the likelihood of permission-based privacy will recede even further.

Monday, June 19, 2023

On the origin of laws by natural selection

DeScioli, P.
Evolution and Human Behavior
Volume 44, Issue 3, May 2023, Pages 195-209

Abstract

Humans are lawmakers like we are toolmakers. Why do humans make so many laws? Here we examine the structure of laws to look for clues about how humans use them in evolutionary competition. We will see that laws are messages with a distinct combination of ideas. Laws are similar to threats but critical differences show that they have a different function. Instead, the structure of laws matches moral rules, revealing that laws derive from moral judgment. Moral judgment evolved as a strategy for choosing sides in conflicts by impartial rules of action—rather than by hierarchy or faction. For this purpose, humans can create endless laws to govern nearly any action. However, as prolific lawmakers, humans produce a confusion of contradictory laws, giving rise to a perpetual battle to control the laws. To illustrate, we visit some of the major conflicts over laws of violence, property, sex, faction, and power.

(cut)

Moral rules are not for cooperation

We have briefly summarized the  major divisions and operations of moral judgment. Why then did humans evolve such elaborate powers of the mind devoted to moral rules? What is all this rule making for?

One common opinion is that moral rules are for cooperation. That is, we make and enforce a moral code in order to cooperate more effectively with other people. Indeed, traditional  theories beginning with Darwin assume that morality is  the  same  as cooperation. These theories  successfully explain many forms of cooperation, such as why humans and other  animals  care  for  offspring,  trade  favors,  respect  property, communicate  honestly,  and  work  together  in  groups.  For  instance, theories of reciprocity explain why humans keep records of other people’s deeds in the form of reputation, why we seek partners who are nice, kind, and generous, why we praise these virtues, and why we aspire to attain them.

However, if we look closely, these theories explain cooperation, not moral  judgment.  Cooperation pertains  to our decisions  to  benefit  or harm someone, whereas moral judgment pertains to  our judgments of someone’s action  as right or  wrong. The difference  is crucial because these  mental  faculties  operate  independently  and  they  evolved  separately. For  instance,  people can  use moral judgment  to cooperate but also to cheat, such as a thief who hides the theft because they judge it to be  wrong, or a corrupt leader who invents a  moral rule  that forbids criticism of the leader. Likewise, people use moral judgment to benefit others  but  also  to  harm  them, such  as falsely  accusing an enemy of murder to imprison them. 

Regarding  their  evolutionary  history, moral  judgment is  a  recent adaptation while cooperation is ancient and widespread, some forms as old  as  the origins  of  life and  multicellular  organisms.  Recalling our previous examples, social animals like gorillas, baboons, lions, and hyenas cooperate in numerous ways. They care for offspring, share food, respect property, work together in teams, form reputations,  and judge others’ characters as nice or nasty. But these species do not communicate rules of action, nor do they learn, invent, and debate the rules. Like language, moral judgment  most likely evolved  recently in the  human lineage, long after complex forms of cooperation. 

From the Conclusion

Having anchored ourselves to concrete laws, we next asked, What are laws for? This is the central question for  any mental power because it persists only  by aiding an animal in evolutionary competition.  In this search,  we  should  not  be  deterred  by  the  magnificent creativity  and variety of laws. Some people suppose that natural selection could impart no more than  a  few fixed laws in  the  human mind, but there  are  no grounds for this supposition. Natural selection designed all life on Earth and its creativity exceeds our own. The mental adaptations of animals outperform our best computer programs on routine tasks such as loco-motion and vision. Why suppose that human laws must be far simpler than, for instance, the flight controllers in the brain of a hummingbird? And there are obvious counterexamples. Language is a complex  adaptation but this does not mean that humans speak just a few sentences. Tool use comes from mental adaptations including an intuitive theory of physics, and again these abilities do not limit but enable the enormous variety of tools.

Tuesday, March 28, 2023

Medical assistance in dying (MAiD): Ethical considerations for psychologists

Koocher, G. P., Benjamin, G. A. H.,  et al. (2023). 
Professional Psychology: 
Research and Practice, 54(1), 2–13.

Abstract

Significant ethical challenges arise when mental health practitioners care for patients who seek to accelerate their own dying for rational medically valid reasons. Current and proposed laws provide for medical assistance in dying (MAiD) in several U.S. jurisdictions, all of Canada, and several other nations. Differing provisions of these laws complicate their utility for some patients who seek aid in dying. Some extant laws include roles that mental health professionals might play in assessing patients’ competence or capacity to consent, mental illness, or other cognitive and behavioral factors. Practitioners who choose to accept roles in the MAiD process must consider and resolve a number of ethical challenges including potential conflicts between and among laws, ethical standards, third-party requests, personal values, and patients’ wishes. These include becoming aware of patients who may wish to act independently to end their lives when MAiD laws might otherwise exclude them. Examples from actual cases and the resultant discussion will form a basis for exploration of the ethical and legal complexities confronted when psychologists become engaged in the process either intentionally or incidentally. The lead article (Koocher) is not intended to comprehensively address MAiD in all of its complexity but rather to trigger a thoughtful discussion among the accompanying commentaries.

Impact Statement

Public Significance Statement—Current and proposed laws provide for medical assistance in dying (MAiD), sometimes described as physician-assisted suicide, in several U.S. jurisdictions, all of Canada, and in several other nations. Some such laws require psychological input, usually from either a psychologist or a psychiatrist. The limited scope of existing laws may result in some patients suffering with debilitating, painful, chronic, and fatal illnesses to consider suicide without medical assistance. With or without MAiD legislation, mental health professionals will come in contact with such patients and must consider the potentially complex ethical ramifications of caring for such patients. 

Conclusion

The culture of dying in America too often involves end-of-life care provided by strangers in institutional settings. Government and professional regulators often assume a parentalistic stance that effectively diminishes personal control of the dying process. Legalized MAiD offers an important option to those suffer from an irremediable medical condition and desire access to medical procedures to hasten death in a peaceful and dignified manner. Patients confronting chronic terminal illness have legitimate interests in controlling their own dying with quality care and support. Perhaps the most valuable and meaningful aspect of dying would include the presence of a community of care that demonstrates to the dying person that they will not feel abandoned (Campbell, 2019). Psychologists can play a significant role in making this happen. Ethical, professional, and legal controversies will abound as MAiD becomes more socially prevalent, and it will.

Saturday, March 25, 2023

A Christian Health Nonprofit Saddled Thousands With Debt as It Built a Family Empire Including a Pot Farm, a Bank and an Airline

Ryan Gabrielson & J. David McSwane
ProPublic.org
Originally published 25 FEB 23

Here is an excerpt:

Four years after its launch in 2014, the ministry enrolled members in almost every state and collected $300 million in annual revenue. Liberty used the money to pay at least $140 million to businesses owned and operated by Beers family members and friends over a seven-year period, the investigation found. The family then funneled the money through a network of shell companies to buy a private airline in Ohio, more than $20 million in real estate holdings and scores of other businesses, including a winery in Oregon that they turned into a marijuana farm. The family calls this collection of enterprises “the conglomerate.”

Beers has disguised his involvement in Liberty. He has never been listed as a Liberty executive or board member, and none of the family’s 50-plus companies or assets are in his name, records show.

From the family’s 700-acre ranch north of Canton, however, Beers acts as the shadow lord of a financial empire. It was built from money that people paid to Liberty, Beers’ top lieutenant confirmed to ProPublica. He plays in high-stakes poker tournaments around the country, travels to the Caribbean and leads big-game hunts at a vast hunting property in Canada, which the family partly owns. He is a man, said one former Liberty executive, with all the “trappings of large money coming his way.”

Despite abundant evidence of fraud, much of it detailed in court records and law enforcement files obtained by ProPublica, members of the Beers family have flourished in the health care industry and have never been prevented from running a nonprofit. Instead, the family’s long and lucrative history illustrates how health care sharing ministries thrive in a regulatory no man’s land where state insurance commissioners are barred from investigating, federal agencies turn a blind eye and law enforcement settles for paltry civil settlements.

The Ohio attorney general has twice investigated Beers for activities that financial crimes investigators said were probable felonies. Instead, the office settled for civil fines, most recently in 2021. It also required Liberty to sever its ties to some Beers family members.

The IRS has pursued individual family members for underreporting their income and failing to pay million-dollar tax bills. But there’s no indication that the IRS has investigated how several members of one family amassed such substantial wealth in just seven years by running a Christian nonprofit.

The agencies’ failure to move decisively against the Beers family has left Liberty members struggling with millions of dollars in medical debt. Many have joined a class-action lawsuit accusing the nonprofit of fraud.

After years of complaints, health care sharing ministries are now attracting more scrutiny. Sharity Ministries, once among the largest organizations in the industry, filed for bankruptcy and then dissolved in 2021 as regulators in multiple states investigated its failure to pay members’ bills. In January, the Justice Department seized the assets of a small Missouri-based ministry, Medical Cost Sharing Inc., and those of its founders, accusing them of fraud and self-enrichment. The founders have denied the government’s allegations.

Tuesday, February 7, 2023

UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.

By D. Armstron, R. Rucker, & M. Miller
ProPublica.org
Originally published 2 FEB 23

Here is an excerpt:

Insurers have wide discretion in crafting what is covered by their policies, beyond some basic services mandated by federal and state law. They often deny claims for services that they deem not “medically necessary.”

When United refused to pay for McNaughton's treatment for that reason, his family did something unusual. They fought back with a lawsuit, which uncovered a trove of materials, including internal emails and tape-recorded exchanges among company employees. Those records offer an extraordinary behind-the-scenes look at how one of America's leading health care insurers relentlessly fought to reduce spending on care, even as its profits rose to record levels.

As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.

At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.

United declined to answer specific questions about the case, even after McNaughton signed a release provided by the insurer to allow it to discuss details of his interactions with the company. United noted that it ultimately paid for all of McNaughton’s treatments. In a written response, United spokesperson Maria Gordon Shydlo wrote that the company’s guiding concern was McNaughton’s well-being.

“Mr. McNaughton’s treatment involves medication dosages that far exceed FDA guidelines,” the statement said. “In cases like this, we review treatment plans based on current clinical guidelines to help ensure patient safety.”

But the records reviewed by ProPublica show that United had another, equally urgent goal in dealing with McNaughton. In emails, officials calculated what McNaughton was costing them to keep his crippling disease at bay and how much they would save if they forced him to undergo a cheaper treatment that had already failed him. As the family pressed the company to back down, first through Penn State and then through a lawsuit, the United officials handling the case bristled.

Friday, February 3, 2023

Contraceptive Coverage Expanded: No More ‘Moral’ Exemptions for Employers

Ari Blaff
Yahoo News
Originally posted 30 JAN 23

Here is an excerpt:

The proposed new rule released today by the Departments of Health and Human Services (HHS), Labor, and Treasury would remove the ability of employers to opt out for “moral” reasons, but it would retain the existing protections on “religious” grounds.

For employees covered by insurers with religious exemptions, the new policy will create an “independent pathway” that permits them to access contraceptives through a third-party provider free of charge.

“We had to really think through how to do this in the right way to satisfy both sides, but we think we found that way,” a senior HHS official told CNN.

Planned Parenthood applauded the announcement. “Employers and universities should not be able to dictate personal health-care decisions and impose their views on their employees or students,” the organization’s chief, Alexis McGill Johnson, told CNN. “The ACA mandates that health insurance plans cover all forms of birth control without out-of-pocket costs. Now, more than ever, we must protect this fundamental freedom.”

In 2018, the Trump administration sought to carve out an exception, based on “sincerely held religious beliefs,” to the ACA’s contraceptive mandate. The move triggered a Pennsylvania district court judge to issue a nationwide injunction in 2019, blocking the implementation of the change. However, in 2020, in Little Sisters of the Poor v. Pennsylvania, the Supreme Court, in a 7–2 ruling, defended the legality of the original Trump policy.

The Supreme Court’s overturning of Roe v. Wade in June 2022, in its Dobbs ruling, played a role in HHS’s decision to release the new proposal. Guaranteeing access to contraceptions at no cost to the individual “is a national public health imperative,” HHS said in the proposal. And the Dobbs ruling “has placed a heightened importance on access to contraceptive services nationwide.”

Tuesday, January 10, 2023

San Francisco will allow police to deploy robots that kill

Janie Har
Associated Press
Originally posted 29 Nov 22

Supervisors in San Francisco voted Tuesday to give city police the ability to use potentially lethal, remote-controlled robots in emergency situations -- following an emotionally charged debate that reflected divisions on the politically liberal board over support for law enforcement.

The vote was 8-3, with the majority agreeing to grant police the option despite strong objections from civil liberties and other police oversight groups. Opponents said the authority would lead to the further militarization of a police force already too aggressive with poor and minority communities.

Supervisor Connie Chan, a member of the committee that forwarded the proposal to the full board, said she understood concerns over use of force but that “according to state law, we are required to approve the use of these equipments. So here we are, and it’s definitely not a easy discussion.”

The San Francisco Police Department said it does not have pre-armed robots and has no plans to arm robots with guns. But the department could deploy robots equipped with explosive charges “to contact, incapacitate, or disorient violent, armed, or dangerous suspect” when lives are at stake, SFPD spokesperson Allison Maxie said in a statement.

“Robots equipped in this manner would only be used in extreme circumstances to save or prevent further loss of innocent lives,” she said.

Supervisors amended the proposal Tuesday to specify that officers could use robots only after using alternative force or de-escalation tactics, or concluding they would not be able to subdue the suspect through those alternative means. Only a limited number of high-ranking officers could authorize use of robots as a deadly force option.

Wednesday, December 28, 2022

Physician-assisted suicide is not protected by Massachusetts Constitution, top state court rules

Chris Van Buskirk
masslive.com
Originally posted 6 Dec 22

The state’s highest court ruled Monday morning that the Massachusetts state constitution does not protect physician-assisted suicide and that laws around manslaughter may prohibit the practice.

The decision affects whether doctors can prescribe lethal amounts of medication to terminally ill patients that would end their life. The plaintiffs, a doctor looking to provide physician-assisted suicide and a patient with an incurable cancer, argued that patients with six months or less to live have a constitutional right to bring about their death on their own terms.

But defendants in the case have said that the decision to legalize or formalize the procedure here in Massachusetts is a question best left to state lawmakers, not the courts. And in an 89-page ruling, Associate Justice Frank Gaziano wrote that the Supreme Judicial Court agreed with that position.

The court, he wrote, recognized the “paramount importance and profound significance of all end-of-life decisions” but that the Massachusetts Declaration of Rights does not reach so far as to protect physician-assisted suicide.

“Our decision today does not diminish the critical nature of these interests, but rather recognizes the limits of our Constitution, and the proper role of the judiciary in a functioning democracy. The desirability and practicality of physician-assisted suicide raises not only weighty philosophical questions about the nature of life and death, but also difficult technical questions about the regulation of the medical field,” Gaziano wrote. “These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field.”

Plaintiff Roger Kligler, a retired physician, was diagnosed with stage four metastatic prostate cancer, and in May 2018, a doctor told him that there was a fifty percent chance that he would die within five years.

Kligler, Gaziano wrote in the ruling, had not yet received a six-month prognosis, and his cancer “currently has been contained, and his physician asserts that it would not be surprising if Kligler were alive ten years from now.”

Thursday, December 15, 2022

Dozens of telehealth startups sent sensitive health information to big tech companies

Katie Palmer with
Todd Feathers & Simon Fondrie-Teitler 
STAT NEWS
Originally posted 13 DEC 22

Here is an excerpt:

Health privacy experts and former regulators said sharing such sensitive medical information with the world’s largest advertising platforms threatens patient privacy and trust and could run afoul of unfair business practices laws. They also emphasized that privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) were not built for telehealth. That leaves “ethical and moral gray areas” that allow for the legal sharing of health-related data, said Andrew Mahler, a former investigator at the U.S. Department of Health and Human Services’ Office for Civil Rights.

“I thought I was at this point hard to shock,” said Ari Friedman, an emergency medicine physician at the University of Pennsylvania who researches digital health privacy. “And I find this particularly shocking.”

In October and November, STAT and The Markup signed up for accounts and completed onboarding forms on 50 telehealth sites using a fictional identity with dummy email and social media accounts. To determine what data was being shared by the telehealth sites as users completed their forms, reporters examined the network traffic between trackers using Chrome DevTools, a tool built into Google’s Chrome browser.

On Workit’s site, for example, STAT and The Markup found that a piece of code Meta calls a pixel sent responses about self-harm, drug and alcohol use, and personal information — including first name, email address, and phone number — to Facebook.

The investigation found trackers collecting information on websites that sell everything from addiction treatments and antidepressants to pills for weight loss and migraines. Despite efforts to trace the data using the tech companies’ own transparency tools, STAT and The Markup couldn’t independently confirm how or whether Meta and the other tech companies used the data they collected.

After STAT and The Markup shared detailed findings with all 50 companies, Workit said it had changed its use of trackers. When reporters tested the website again on Dec. 7, they found no evidence of tech platform trackers during the company’s intake or checkout process.

“Workit Health takes the privacy of our members seriously,” Kali Lux, a spokesperson for the company, wrote in an email. “Out of an abundance of caution, we elected to adjust the usage of a number of pixels for now as we continue to evaluate the issue.”

Wednesday, November 30, 2022

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew Wynia
September 15, 2022
N Engl J Med 2022; 387:959-961
DOI: 10.1056/NEJMp2210192

Here is an excerpt:

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?

There are several arguments in favor of professional associations supporting civil disobedience by their members. First, collective civil disobedience by a professional group would avert the most common and powerful criticism leveled against civil disobedience, which is that it could lead to anarchy.

Civil disobedience is a “public, nonviolent, conscientious yet political act contrary to law,” carried out with the aim of bringing about a change in an unjust law.2 But respect for laws is necessary to maintain a civil society. Having each person choose which laws to obey and which to disobey is a recipe for chaos. The most well-known proponents of civil disobedience — Henry David Thoreau, Mahatma Gandhi, Martin Luther King, Jr. — all took seriously the threat of unrestrained disregard of laws under the guise of civil disobedience. In his 1963 Letter from Birmingham Jail, King argued that people must respect just laws, but he also wrote, “law and order exist for the purpose of establishing justice,” and he agreed with St. Augustine that “an unjust law is no law at all.” He described a “moral responsibility to disobey unjust laws” and laid out criteria to help people decide when laws, such as those upholding racial segregation, are sufficiently unjust as to warrant open disobedience. Gandhi was even more worried about chaos and launched hunger strikes to rein in his own supporters when he believed they had gone too far in their disobedience of laws.

But professional civil disobedience poses little threat of anarchy. Unlike a situation in which each person decides whether to obey or disobey a law, a professional group’s deciding together, after frank and rational debate, to support disobedience of an unjust law might eventually reinforce social cohesion, elevate trust in the profession, and help communities avoid tragic errors. Professions, after all, are expected to protect vulnerable people and core social values. Such a decision would still be contentious, however. Civil disobedience is nonviolent, but it elevates and highlights conflict and often leads to violence against people disobeying the law. Professional civil disobedience would undoubtedly require tremendous courage.

Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

Tuesday, November 29, 2022

The Supreme Court has lost its ethical compass. Can it find one fast?

Ruth Marcus
The Washington Post
Originally published 23 Nov 22

The Supreme Court must get its ethics act together, and Chief Justice John G. Roberts Jr. needs to take the lead. After a string of embarrassments, the justices should finally subject themselves to the kind of rules that govern other federal judges and establish a standard for when to step aside from cases — one that is more stringent than simply leaving it up to the individual justice to decide.

Recent episodes are alarming and underscore the need for quick action to help restore confidence in the institution.

Last week, the Supreme Court wisely rebuffed an effort by Arizona GOP chair Kelli Ward to prevent the House Jan. 6 committee — the party in this case — from obtaining her phone records. The court’s brief order noted that Justice Clarence Thomas, along with Justice Samuel A. Alito Jr., would have sided with Ward.

Thomas’s involvement, though it didn’t affect the outcome of the dispute, is nothing short of outrageous. Federal law already requires judges, including Supreme Court justices, to step aside from involvement in any case in which their impartiality “might reasonably be questioned.”

Perhaps back in January, when he was the only justice to disagree when the court refused to grant former president Donald Trump’s bid to stop his records from being turned over to the Jan. 6 committee, Thomas didn’t realize the extent of his wife’s involvement with disputing the election results. (I’m being kind here: Ginni Thomas had signed a letter the previous month calling on House Republicans to expel Reps. Liz Cheney of Wyoming and Adam Kinzinger of Illinois from the House Republican Conference for participating in an “overtly partisan political persecution.”)

But here’s what we know now, and Justice Thomas does, too: The Jan 6. committee has subpoenaed and interviewed his wife. We — and he — know that she contacted 29 Arizona lawmakers, urging them to “fight back against fraud” and choose a “clean slate of electors” after the 2020 election.

Some recusal questions are close. Not this one. Did the chief justice urge Thomas to recuse? He should have. This will sound unthinkable, but if Roberts asked and Thomas refused, maybe it’s time the chief, or other justices, to publicly note their disagreement.

(cut)

One obvious step is to follow the ethics rules that apply to other federal judges, perhaps adapting them to the particular needs of the high court. That would send an important — and overdue — message that the justices are not a law unto themselves. It’s symbolic, but symbolism matters.

Friday, November 4, 2022

Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations

Ogbu-Nwobodo, L., Shim, R.S., et al.
October 27, 2022
N Engl J Med 2022; 387:1613-1617
DOI: 10.1056/NEJMms2211124

Here is an excerpt:

Abortion and Mental Health

To begin with, abortion does not lead to mental health harm — a fact that has been established by data and recognized by the National Academies of Sciences, Engineering, and Medicine and the American Psychological Association The Turnaway Study, a longitudinal study that compared mental health outcomes among people who obtained an abortion with those among people denied abortion care, found that abortion denial was associated with initially higher levels of stress, anxiety, and low self-esteem than was obtaining of wanted abortion care. People who had an abortion did not have an increased risk of any mental health disorder, including depression, anxiety, suicidal ideation, post-traumatic stress disorder, or substance use disorders. Whether people obtained or were denied an abortion, those at greatest risk for adverse psychological outcomes after seeking an abortion were those with a history of mental health conditions or of child abuse or neglect and those who perceived abortion stigma (i.e., they felt others would look down on them for seeking an abortion). Furthermore, people who are highly oppressed and marginalized by society are more vulnerable to psychological distress.

There is evidence that people seeking abortion have poorer baseline mental health, on average, than people who are not seeking an abortion. However, this poorer mental health results in part from structural inequities that disproportionately expose some populations to poverty, trauma, adverse childhood experiences (including physical and sexual abuse), and intimate partner violence. People seek abortion for many reasons, including (but not limited to) timing issues, the need to focus on their other children, concern for their own physical or mental health, the desire to avoid exposing a child to a violent or abusive partner, and the lack of financial security to raise a child.

In addition, for people with a history of mental illness, pregnancy and the postpartum period are a time of high risk, with increased rates of recurrence of psychiatric symptoms and of adverse pregnancy and birth outcomes. Because of stigma and discrimination, birthing or pregnant people with serious mental illnesses or substance use disorders are more likely to be counseled by health professionals to avoid or terminate pregnancies, as highlighted by a small study of women with bipolar disorder. One study found that among women with mental health conditions, the rate of readmission to a psychiatric hospital was not elevated around the time of abortion, but there was an increased rate of hospitalization in psychiatric facilities at the time of childbirth. Data also indicate that for people with preexisting mental health conditions, mental health outcomes are poor whether they obtain an abortion or give birth.

The Role of Structural Racism

Structural racism — defined as ongoing interactions between macro-level systems and institutions that constrain the resources, opportunities, and power of marginalized racial and ethnic groups — is widely considered a fundamental cause of poor health and racial inequities, including adverse maternal health outcomes. Structural racism ensures the inequitable distribution of a broad range of health-promoting resources and opportunities that unfairly advantage White people and unfairly disadvantage historically marginalized racial and ethnic groups (e.g., education, paid leave from work, access to high-quality health care, safe neighborhoods, and affordable housing). In addition, structural racism is responsible for inequities and poor mental health outcomes among many diverse populations.