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First Edition: May 22, 2017

Kaiser Health News - Mon, 05/22/2017 - 6:28am
Categories: Health Care

Who Will Care For Abril? Parents Fear For Their Disabled Child If They Are Deported

Kaiser Health News - Mon, 05/22/2017 - 5:00am

Every few minutes, Abril begins to choke. Diagnosed as a baby with severe cerebral palsy and epilepsy, the Santa Cruz, Calif., 8-year-old has never spoken, or walked or cleared her own throat.

This story also ran in The Atlantic. It can be republished for free (details).

Dozens of times a day, her parents, Rafael and Sonia, use a special machine to suction out saliva and phlegm from their oldest daughter’s mouth. Because choking and seizures can strike Abril anytime, a parent is always by her side.

Rafael and Sonia, both from Mexico, have lived in this country without permission for more than a decade. But only since the recent presidential election has a question haunted them: If they are deported, what will happen to Abril?

As the Trump administration promises to deport a broader range of people, parents like Rafael and Sonia increasingly are seeking help to stay in the country so they can tend to very sick children, according to interviews with doctors, lawyers and others who work with immigrants. And these professionals say they are struggling to come up with sound advice.

Rafael and Sonia know that many neighbors in their crowded mobile home park — along with millions of other immigrants living in the country without permission — are keeping to the shadows to avoid detection by federal authorities.

But Abril depends on her parents to stay alive.

Abril sits in the living room while her parents make breakfast. Sonia and Rafael say the family always eats breakfast together and that dealing with Abril’s medical issues has made their family stronger. (Heidi de Marco/KHN)

The couple, along with other families in this story, spoke to California Healthline on the condition that their surnames be withheld, because they fear deportation. Abril and her younger sister are U.S. citizens.

Dr. Salem Magarian, pediatric director of the Santa Cruz Community Health Centers, said immigrant parents of his sickest patients are asking for letters documenting their children’s health care requirements. Some parents say they hope such letters will help them stay in the country if they are picked up by authorities.

“Some people are freaked out,” Magarian said. “Most people are concerned. Almost no one says ‘it’s not a big deal.’”

One of Magarian’s patients, a toddler named Leonardo, has had multiple surgeries for serious heart defects. The boy’s mother, Karla, has been in the country without papers for 23 years, having been brought to the United States at age 5. Karla is terrified by the prospect of leaving her children and being sent back to Mexico, a country she doesn’t remember.

Another child suffers from a life-threatening genetic condition that leaves him unable to speak or eat, Magarian said. Richey, 8, lost his father to cancer four years ago. His mother, Sugay, has been in the country illegally for 16 years.

“I try not to go anywhere,” Sugay said. “If I go anywhere, I’m very afraid. … I know this is not my country, I know this is not my place, but I’ve never done anything bad and I have a special baby who needs his mother.”

Such fears are reinforced by news accounts. The Salt Lake Tribune recently reported that the single mother and sole caretaker of an 18-year-old with cerebral palsy and epilepsy was deported to Colombia.

In another case, an Ohio mother of four children — including one with a history of seizures — was deported to Mexico. A spokesman for Immigration and Customs Enforcement (ICE) told The Guardian that the woman’s case had been reviewed several times by the courts.

“For parents who are ordered removed, it is their decision whether or not to relocate their children with them,” the spokesman said.

Immigration officials say they continue, as under the previous administration, to target for deportation people who have committed crimes — but they also say the new administration has changed policies to no longer support the practice of selective enforcement.

“Basically, there’s no exempted class for arrest,” said James Schwab, spokesman for the ICE field office in San Francisco.

Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a pro-enforcement think tank that favors reduced immigration, says she sees plenty of benefits to enforcing immigration laws more rigorously — particularly increasing access to low-wage jobs for U.S. citizens and legal residents.

But she also says she “absolutely” believes exceptions should — and will — be made in cases where deporting parents would cause “undue hardship” for a young U.S. citizen.

“That’s why Congress created these forms of relief,” she said. “I think most Americans would support that.”

A Precarious Existence

Abril’s father, Rafael, arrived in Santa Cruz from Mexico as a teenager 19 years ago. His brothers are U.S. citizens and his mother is a legal permanent resident. In March 2001, before his 21st birthday, Rafael’s mother applied for a green card for him. He said he’s still waiting for the application to be processed.

After he’d been in California for nearly a decade, he fell in love with Sonia, who had arrived in the U.S. in 2006. She became pregnant. Everything seemed normal until she was 35 weeks along and stopped feeling the baby move. After an emergency cesarean section, Abril was rushed to Lucile Packard Children’s Hospital Stanford.

Magarian began caring for Abril when she came home at 6 weeks old. Given Abril’s serious brain damage and severe cerebral palsy, Magarian didn’t expect her to make it past six months.

Abril was in the hospital constantly at first. Her parents found great solace in their faith as they struggled to accept their new reality.

Over time, they learned the intricacies of caring for their daughter: how to suction her mouth, what to do if her gastrointestinal feeding tube gets blocked or she has a seizure, which of her grunts are normal and which require a call to 911.

Mostly because of her parents’ unwavering attention, Abril’s condition has stabilized over the years, Magarian said. Still, her health remains precarious, and she remains vulnerable to seizures and pneumonia. Many children in Abril’s situation end up hospitalized repeatedly, he said.

Sonia puts Abril down for a nap. (Heidi de Marco/KHN)

Even so, until recently, Rafael and Sonia had begun to feel they were living something of a normal life. Sonia watched their daughters. Rafael rode the bus each day to his job as a cook. A special-education teacher from the local school district came to the trailer twice a week to work with Abril.

Rafael and Sonia worried less about deportation during the Obama administration, which prioritized the removal of immigrants with criminal records. Donald Trump’s promises of a border wall and mass deportations made them nervous.

Their fear grew after helicopter flyovers in mid-February signaled federal immigration raids in Santa Cruz County.

Soon after, Rafael and Sonia hired an attorney to help them become legal residents.

Some advocates say they worry that desperate families with chronically ill or developmentally disabled children are unwittingly putting themselves at greater risk of deportation by seeking legal help.

Often the applicants get turned down, triggering deportation proceedings.

In the best-case scenario, a judge will cancel the parent’s removal because of the hardship it would cause for a medically dependent child. But judges don’t always do this. Barbara Pinto, a senior staff attorney at El Centro Legal de la Raza in Oakland, said more families have been asking her organization about this legal channel. She recommends against it.

“It’s seen as very irresponsible and unethical” for attorneys to suggest such a risky process, she said.

A Daunting Responsibility

Rafael and Sonia know they’re taking a risk. But they don’t know what else to do.

These days, they rarely venture out of their trailer. No more trips to the park. No more weekend strolls at the shopping mall.

Rafael spends time with his daughters. The fear of deportation has limited the family’s time outdoors. (Heidi de Marco/KHN)

In case they get picked up by immigration authorities, they have been writing down the details of Abril’s care. But those details could fill a book, they say, and they don’t even know who’d be willing to take her.

Her uncles feel so uncomfortable with her serious health problems they don’t visit anymore. Rafael’s mother is too frail to lift her 53-pound granddaughter. Certainly someone could care for Abril’s healthy younger sister. But Abril?

“Nobody wants that big a responsibility,” Sonia said.

They think their best option might be a couple whom they barely know, whose own disabled child passed away. If that doesn’t work out, Abril could end up in foster care.

Rafael and Sonia say they wouldn’t be able to get the same financial support for Abril’s care in Mexico. Medi-Cal and California Children’s Services pay for the expensive equipment and medication that keep Abril alive — but only here in the U.S. Together, Abril’s three seizure medications cost about $5,000 a month, an amount they say they cannot possibly afford on their own.

“If we go to Mexico and we have to bring her,” Sonia said, “it is certain she will not live much time.”

Priscila Rodríguez, associate director of Disability Rights International, said Sonia’s concerns are valid. Her organization has documented the condition of people with disabilities in Mexico, finding they often are segregated from society and abused.

Rafael and Sonia aren’t certain how much their daughter understands; her developmental delays are profound.

But, over time, they have learned to love things about her that other people don’t see: the peaceful expression that crosses her face when they hold her. The smile that started appearing much more often after her little sister was born. Her apparent affinity — shared with little girls the world over — for Anna and Elsa in the Disney movie “Frozen.”

Sonia smooths Abril’s hair and places her daughter gently on a bed made up with “Frozen” sheets.

“She gives us love how she can,” she says.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: Health Care

New York State Wants Its Prescription Drug Money Back — Or Else

Kaiser Health News - Mon, 05/22/2017 - 5:00am

New York Medicaid regulators aim to use the threat of imposing increased scrutiny of prescription drugs — such as eyeing their relative effectiveness and their profit margins — to coax additional discounts from drugmakers.

The rules, signed into law in mid-April as part of the state’s budget, don’t go as far as the surcharge that Democratic Gov. Andrew Cuomo originally sought to control the “skyrocketing costs of prescription drugs,” but they retain elements guaranteed to get under a pharmaceutical executive’s skin.

For example, those who don’t agree to voluntarily rebate or pass money back to the state when Medicaid drug spending rises fast could face multiple layers of reviews regarding profit margins and how well their drugs work.

The rules are the latest response to growing dissatisfaction about drug costs from the public, lawmakers and those who run programs like Medicaid, the state-federal health insurance program for low-income people.

This KHN story also ran in USA Today. It can be republished for free (details).

“It clearly is going to put more pressure on manufacturers to address prices if they want to stay in business in New York,” said Jack Hoadley, a health policy analyst at Georgetown University who studies Medicaid.

The new law also is part of a growing inclination among states to take on prescription drug costs themselves rather than waiting for a response from Congress or the federal government.

New York’s rules are novel, though, because they are the first to set an annual cap on Medicaid prescription drug spending. The target aims to limit total payments to the sum of medical inflation plus 5 percent, a goal that would have been exceeded in recent years, state officials say.

The law also stands out because — if that target is likely to be exceeded — it explicitly allows regulators to pursue a type of review drugmakers dislike. Such reviews, which are more common in the private sector, use scientific studies and other information to evaluate whether specific medications are overpriced proportionate to their medical benefit.

Drugmakers generally object to such reviews and often dispute their results.

To avoid having their drugs sent for such a review under the law in New York, targeted manufacturers could agree to add additional discounts.

The law “creates an incentive to want to collaborate with us and give us rebates,” said New York State Medicaid Director Jason Helgerson.

Drugmakers had strong objections to the governor’s proposal since its earliest iterations, and Priscilla VanderVeer, a spokeswoman for the industry’s trade lobby, said the group still has “significant concerns” about the price cap and “the chilling effect it could have on New York’s economy,” which she said benefits from 240,000 industry-related jobs.

It’s Not Just New York

States, which pay health costs for millions of employees, prisoners and Medicaid beneficiaries, are particularly sensitive to recent increases in brand and generic drug prices, as well as the introduction of very expensive products, such as treatments for hepatitis C.

New York’s Medicaid program, for example, has seen its drug spending rise on average 8 percent each year over the past three years, after taking into account existing rebates. The program, which uses federal and state funds, serves more than 6 million people. Drugs represent about 5 percent of the cost of the program — with the state paying out $3 billion last year for prescriptions, Medicaid officials said.

Though its law is unique, New York’s efforts are “in keeping with the mood in a number of other states,” said Rachel Sachs, an associate professor at Washington University-St. Louis School of Law who studies intellectual property, health law and food and drug regulation.

For instance:

  • Vermont lawmakers last year adopted legislation that requires drugmakers to provide justification for price increases it determines are driving up spending in state programs, such as Medicaid.
  • Maryland lawmakers in March passed legislation, still awaiting the governor’s signature, that directs Medicaid to notify the attorney general when off-patent or generic drugs experience an “excessive price increase” — and sets financial penalties if the drugmaker can’t justify the hike.
  • In Louisiana, officials have asked whether a rarely used federal law could be tapped to sidestep patents and allow government programs to get lower-cost generic versions of pricey hepatitis C treatments.

A Trigger For Action

Under the New York law, everything plays off an annual spending growth cap.

The new rules are triggered if the combination of price increases and use of drugs is forecast to push spending to exceed that target. First, regulators will ask drugmakers seen as driving that spending to voluntarily offer rebates.

No specific drugs have yet been named, and it isn’t clear how they will be chosen.

“This policy will not affect the vast majority of drugs,” said Helgerson, adding that it will target “the manufacturers that attempt to use periods of patent protection to drive outrageous prices.”

Attorney John Shakow, who represents drug manufacturers, said his clients’ reaction is “mystification and concern,” in part because it is unclear how regulators will select which drugs or manufacturers to pursue for additional rebates.

“It seems prone to abuse, if they want to go after a manufacturer for political reasons or otherwise,” said Shakow, a partner at King & Spalding who specializes in drug price cases. “Laws that are this amorphous and nonspecific and vest so much discretion in regulatory authorities strike us as being ripe for challenge.”

Other laws already require drugmakers nationwide to give Medicaid programs their “best price” — equal to or less than what it is paid by private insurers. Most states, including New York, already seek supplemental rebates, often in exchange for priority placement on lists of which drugs can be dispensed.

But the new law goes further in seeking additional rebates on top of those.

If the targeted drugmakers balk at offering discounts, regulators are granted a range of options that ramp up pressure by requiring those uncomfortable reviews.

Regulators, for example, can refer specific drugs to an evaluation by the state’s Drug Utilization Review Board.

The board would recommend a target rebate. If the state could not get the drugmaker to agree to at least 75 percent of that rebate amount, other sanctions could apply. Prior authorization — meaning a doctor would have to get special permission to prescribe — could be placed on the drug. Advocates fear that could make access to needed medications more of a hurdle for patients.

The state could also require drugmakers to disclose how much was spent on research and marketing, what it charges for the drug in other countries and its average profit margin over a five-year period. Such “transparency” rules are strongly opposed by the drug industry, which says they don’t capture all the costs that go into drug development — and won’t help consumers. With a few exceptions, the industry has successfully fought efforts in various states to pass such legislation.

And, finally, the strongest enforcement mechanism would allow the state to bar some medications entirely, so long as they were not the only drug for a particular condition or treatment. It isn’t clear how that would square with other federal requirements.

If it all works according to plan, the state expects to save $55 million this fiscal year and $85 million the next under the law, Helgerson said.

Categories: Health Care

Republicans Race The Clock On Health Care — But The Calendar Is Not Helping

Kaiser Health News - Mon, 05/22/2017 - 5:00am

Back in January, Republicans boasted they would deliver a “repeal and replace” bill for the Affordable Care Act to President Donald Trump’s desk by the end of the month.

In the interim, that bravado has faded as their efforts stalled and they found out how complicated undoing a major law can be. With summer just around the corner, and most of official Washington swept up in scandals surrounding Trump, the health overhaul delays are starting to back up the rest of the 2018 agenda.

One of the immediate casualties is the renewal of the Children’s Health Insurance Program. CHIP covers just under 9 million children in low- and moderate-income families, at a cost of about $15 billion a year.

Funding for CHIP does not technically end until Sept. 30, but it is already too late for states to plan their budgets effectively. They needed to know about future funding while their legislatures were still in session, but, according to the National Conference of State Legislatures, the local lawmakers have already adjourned for the year in more than half of the states.

This KHN story also ran on NPR. It can be republished for free (details).

“If [Congress] had wanted to do what states needed with respect to CHIP, it would be done already,” said Joan Alker of the Georgetown Center for Children and Families.

“Certainty and predictability [are] important,” agreed Matt Salo, executive director of the National Association of Medicaid Directors. “If we don’t know that the money is going to be there, we have to start planning to dismantle things early, and that has a real human toll.”

In a March letter urging prompt action, the Medicaid directors noted that while the end of September might seem far off, “as the program nears the end of its congressional funding, states will be required to notify current CHIP beneficiaries of the termination of their coverage. This process may be required to begin as early as July in some states.”

CHIP has long been a bipartisan program — one of its original sponsors is Sen. Orrin Hatch (R-Utah), who chairs the Finance Committee that oversees it. It was created in 1997, and last reauthorized in 2015, for two years. But a Finance hearing that was intended to launch the effort to renew the program was abruptly canceled this month, amid suggestions that Republicans might want to hold the program’s renewal hostage to force Democrats and moderate Republicans to make concessions on the bill to replace the Affordable Care Act.

“It’s a very difficult time with respect to children’s coverage,” said Alker. Not only is the future of CHIP in doubt, but also the House-passed health bill would make major cuts to the Medicaid program, and many states have chosen to roll CHIP into the Medicaid program.”

“We’ve just achieved a historic level in coverage of kids,” she said, referring to a new report finding that more than 93 percent of eligible U.S. children now have health insurance under CHIP. “Now all three legs of that coverage stool — CHIP, Medicaid and ACA — are up for grabs.”

But it’s not just CHIP at risk due to the congested congressional calendar. Congress also can’t do the tax bill Republicans badly want until lawmakers wrap up the health bill.

That is because Republicans want to use the same budget procedure, called reconciliation, for both bills. That procedure forbids a filibuster in the Senate and allows passage with a simple majority.

There’s a catch, though. The health bill’s reconciliation instructions were part of the fiscal 2017 budget resolution, which Congress passed in January. Lawmakers would need to adopt a fiscal 2018 budget resolution in order to use the same fast-track procedures for their tax changes.

And they cannot do both at the same time. “Once Congress adopts a new budget resolution for fiscal year 2018,” said Ed Lorenzen, a budget-process expert at the Committee for a Responsible Federal Budget, that new resolution “supplants the fiscal year 2017 resolution and the reconciliation instructions in the fiscal year 2017 budget are moot.”

That means if Congress wanted to continue with the health bill, it would need 60 votes in the Senate, not a simple majority.

There is, however, a loophole of sorts. Congress “can start the next budget resolution before they finish health care,” said Lorenzen. “They just can’t finish the new budget resolution until they finish health care.”

So the House and Senate could each pass its own separate budget blueprint, and even meet to come to a consensus on its final product. But they cannot take the last step of the process — with each approving a conference report or identical resolutions — until the health bill is done or given up for dead. They could also start work on a tax plan, although, again, they could not take the bill to the floor of the Senate until they finish health care and the new budget resolution.

At least that’s what most budget experts and lawmakers assume. “There’s no precedent to go on,” said Lorenzen, because no budget reconciliation bill has taken Congress this far into a fiscal year. “So nobody really knows.”

Categories: Health Care

UnitedHealth Overbilled Medicare by Billions, U.S. Says in Suit

Medicare -- New York Times - Fri, 05/19/2017 - 9:39pm
The Justice Department said adjustments to patients’ charts were made to reap greater payments, but the company said it broke no rules.
Categories: Elder, Medicare

In Case You Missed It…

Center on Budget and Policy Priorities - Fri, 05/19/2017 - 4:38pm

This week at CBPP, we focused on health care, the federal budget, federal taxes, housing, and state budgets and taxes.

Categories: Benefits, Poverty

U.S. $26 Billion Short of “Fair Share” for Development Aid Yet Trump Proposing Big Cuts

Center on Budget and Policy Priorities - Fri, 05/19/2017 - 2:15pm

To justify his proposed cuts to development and humanitarian aid, President Trump has implied that the United States now contributes more than its “fair share” of foreign aid. Yet the United States already falls far short of meeting the most commonly used fair-share standard, CBPP Senior Fellow Isaac Shapiro and the Center for Global Development’s Director of the US Development Policy Initiative, Scott Morris, document in a new analysis.

Here’s the opening:

Categories: Benefits, Poverty

Armed Forces Day–U.S. Military leaders who also were lawyers

In Custodia Legis - Fri, 05/19/2017 - 1:52pm

This Saturday is Armed Forces Day in the United States, a day set aside to recognize the men and women who serve in the active and reserve components of the armed forces of the United States.  The day has been observed since 1950.
This blog post is devoted to a few of the men who rose to leadership positions in the armed forces of the United States, and in one instance the Confederate States, who studied law or had professional backgrounds as lawyers. This is not a comprehensive list, it mostly includes individuals from the 19th century and it focuses exclusively on Americans.  Excluded are some prominent figures, such as Andrew Jackson, because their roles in the legal profession are well known.  Four of these individuals ended up commanding the United States Army.

Portrait of Alexander Hamilton as Secretary of the Treasury by John Trumbull.

Alexander Hamilton was New York‘s most influential lawyer during the first twenty years of the new republic. His role in our understanding of the U.S. Constitution, through his essays in the Federalist Papers, and in George Washington‘s cabinet as Secretary of the Treasury is well known. The role of Hamilton in the formation of the U.S. Army is not as well known. During much of the War for Independence Hamilton had served on George Washington’s staff.  After the end of the war he resigned his commission and returned to civilian life.  However, when the possibility of land hostilities with France arose in the late 1790s, he was recalled to the army and appointed a major general by President John Adams.  Hamilton served as inspector general of the army and after Washington’s death in December 1799 he was the army’s senior general officer for another six months.  Hamilton returned to civilian life in June, 1800.

Genl. Winfield Scott., commander in chief of the United States Army c. 1847. Library of Congress Prints & Photographs Division //

Unlike Hamilton, Winfield Scott’s legal career was short and undistinguished.  Scott was born in Virginia, the son of an officer in the Continental Army.  After one year he left the College of William and Mary to pursue a course of law office study.  He spent much of that time in Richmond observing the proceedings surrounding Aaron Burr’s trial for treason, although he also rode the circuit conducting routine legal work.   In 1807 Scott joined a local militia company; he later  received a commission in the regular army as a captain in the light artillery.  Over the next two years Scott would spend time in the army and, during a suspension from active duty after a conviction for mishandling funds, in Virginia as an attorney.  In his autobiography he provides few details about his law practice except for an account of a trial of a slave who successfully sued for her freedom.  While Scott’s law practice was mediocre, his military career was stellar; he rose to the rank of commanding general of the Army, a post that he held for twenty years.  His victories in the field included the Battle of Chippawa during the War of 1812 and the successful seaborne invasion of Mexico during the Mexican-American War.  Scott was in command of the Union Army at the beginning of the Civil War; he formulated the Anaconda Plan, the Union’s strategy that crippled the Confederacy.

Many members of the bar played prominent roles in the Civil War.  Professor Bernard J. Hibbitts estimates that at least 20,000 lawyers served in the Union Army.  There is no credible estimate for the number of lawyers who served in the Confederate forces, but a number of individuals with legal training rose to high command in the Confederacy.  Both armies had over 100 generals who had professional backgrounds at the bar.

Title page for Halleck’s A Collection of Mining Laws of Spain and Mexico. San Francisco, O’Meara & Painter, printers, 1859. Photograph by Donna Sokol.

Like Winfield Scott, Henry Halleck held the rank of General-in-Chief of the Union Army during the conflict.  After graduating from the United States Military Academy at West Point in 1839, he accepted a positing in the Corps of Engineers.  Halleck saw active duty in California during the war with Mexico.  In 1849 he was the military secretary to the convention which drafted that state’s constitution; his work in this post was widely praised but it was not sufficient to advance a career in politics.  In the early 1850s he remained on active duty in the state as an engineering officer, but resigned his commission in 1854 to devote his full time to work as an attorney.  In 1851 Halleck had been admitted to practice in federal courts and had joined a law firm in San Francisco where he specialized in land titles.  Halleck’s knowledge of Spanish, and of the state’s geography and history soon advanced his career; one of his written works was a compilation of translated Spanish and Mexican mining laws.  At the beginning of the Civil War he also published a treatise on international law, which would be reissued in multiple editions during the next 50 years.  Recalled to federal service in 1861, Halleck proved to be a talented staff officer, but he was a disappointing leader of troops in the field and as a director of strategy.  In 1864 he became chief of staff when Grant was promoted to lieutenant general and became General-in-Chief.  He remained in the army until his death in 1872.

Majr. Genl. William T. Sherman: U.S. Army, Currier & Ives graphic. Library of Congress Prints & Photographs Div. //

William Tecumseh Sherman was the professional opposite of Halleck, a very unsuccessful lawyer but a brilliant field general.  Sherman’s legal career is hardly mentioned by his biographers; in fact he just barely mentions it in his memoirs.  After leaving the army in 1853 Sherman became a banker in San Francisco.  By 1859 he had relocated to Leavenworth, Kansas where in addition to working as a government contractor he was admitted to the territorial bar on the basis of his education and reading of the standard legal texts.  In his memoirs Sherman cheerfully admits that he was an incompetent lawyer.  A story exists about one court case which he lost for a client who owned a shack on a rented plot of land and was sued for back rent.  The solution for the client, suggested by one of the firm’s senior attorneys, was to move the shack, in the middle of the night, to another location! In 1861 Sherman rejoined the army where he proved to be an original and outstanding strategist. He remained on duty until 1884 and served as General of the Army, the commanding general, from 1869 until his retirement.

Raphael Semmes, rear admiral and brig. genl., C.S.A. , Lee Gallery, Richmond, VA. [between 1861 and 1865(?)] Library of Congress Prints and Photographs Division. //

Raphael Semmes found that the antebellum United States Navy provided great flexibility in pursuing non-nautical pursuits.  Semmes was born in Maryland in 1809.  He was appointed a midshipman in the navy in 1826; in 1832, after passing the examination, he was commissioned a midshipman.  Not having immediate sea duty, he spent the next few years studying law in his brother’s office in Cumberland, Maryland and was admitted to practice in 1835.  Although recalled to active duty in 1835, Semmes’ career until the Mexican-American war would often be interrupted with long periods of leave.  During one such period he relocated his law practice to Cincinnati.  Afterwards while posted to the Pensacola Naval Base he moved his family to Alabama, which became his permanent home.  Semmes served on active duty during the Mexican-American War, and later published his observations in 1851 as Service afloat and ashore during the Mexican War.  His law practice in Mobile in the period after the war was mainly devoted to civil work, although as a naval officer he sometimes acted as a defense attorney in court-martial cases.  One such case involved one of his future lieutenants on the CSS Alabama, John McIntosh Kell.  Semmes returned to active duty in the mid-1850s and after Alabama seceded from the Union he resigned his commission to accept a commission in the Confederate Navy.  During the Civil War Semmes was assigned to command two commerce raiders, the CSS Sumter, and later the CSS Alabama.  His success was responsible for drastic increases in marine insurance rates for Union flagged vessels.  Alabama would spend almost two years at sea sinking over 60 vessels before finally being destroyed in combat by the USS Kearsarge off the coast of France in 1864.  Semmes returned to the Confederacy, and promotion to the rank of rear admiral,  in the last months of the war.  After the war he faced charges arising out of his conduct as the captain of the Alabama, but the prosecution was dropped. Unable to return immediately to the practice of law, he spent sometime after the war as a college professor and newspaper editor.  He resumed the practice of law in Mobile in 1869 concentrating on maritime law.  He also served as that city’s attorney.  Semmes died in 1877.

Bronze bust of Holland M. Smith, photograph by David Durham, Bounds Law Library, University of Alabama School of Law Used with permission.

Holland McTyerie Smith was born in a small Alabama town in 1882.  A precocious student, he entered Auburn University at the age of 16, which at that time operated as a military academy.  Smith did not like the regimented environment, but  he mentions in his autobiography that he read everything he could find in the college library on the campaigns of Napoleon.  Smith’s father was a lawyer and it was his hope that his son would follow in his footsteps.  In 1901 Holland entered the law program at the University of Alabama, graduating with the class of 1903.   He briefly practiced law, but found the profession to be boring and his skills not equal to the task.  His memoirs relates one trial where when acting as an assistant to the local prosecutor, he presented such a weak case that the quick acquittal of the defendant resulted in his resolve to leave the profession.  Smith applied to become a military officer and successfully passed the examination for the Marines  school for candidates for second lieutenant.  Smith’s career spanned over 40 years with service on three continents and in two major wars.   He is perhaps most remembered for his leadership in preparing and leading the Marine Corps amphibious campaigns in the Pacific Theater.  He retired in 1946, and died in 1967.

Further Reading

General biographies and autobiographies are good sources for finding basic information about the professional backgrounds of these individuals.  A select list includes


Categories: Research & Litigation

Congrats, Med School Grad! Now It's Time To Find A Therapist.

CommonHealth (WBUR) - Fri, 05/19/2017 - 1:00pm
Amid overwork and sleepless stress, roughly half of doctors-in-training experience depression, so it's best to be prepared.
Categories: Health Care


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