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Frostbite, Hypothermia And Other Fun Facts To Remember On Blizzard Day

CommonHealth (WBUR) - Tue, 01/27/2015 - 8:29am

When you’re done with all the movies, go outside — but be careful. (Photo: Julia Teller)

It’s going to be a long, long day. If you’re like us, you’ve already cooked some kind of elaborate breakfast, chosen the morning movie lineup and set up the Let’s Dance Wii. And it’s not even 8 am.

When you’re ready to venture outside and “play,” remember it’s freezing, with ferocious winds. No doubt you’re familiar with this kind of extreme weather, but there are a few health tips worth repeating. Here’s the Boston Public Health Commission with a cute video reminder:

[Watch on YouTube]
Categories: Health Care

Medicare Physician Payment Reform: Securing the Connection Between Value and Payment

Brookings Institute -- Medicare - Tue, 01/27/2015 - 12:00am

Last year, Congress reached agreement in principle on legislation that would move Medicare’s payment of physicians and other clinicians away from fee-for-service (FFS), which pays based on the volume and intensity of services they provide. Instead, Medicare would begin paying clinicians for providing better care, keeping patients healthy, and lowering overall costs – a “pay for value” approach. The bill also would end the sustainable growth rate (SGR) formula that has been ineffective in limiting physician spending growth or supporting better care. The proposed legislation represents a once-in-a-generation opportunity for Medicare to move away from volume-based payment to value-based payment and better support clinician-led efforts to improve care. At the same, we believe that some specific modifications to the legislation would enable it to do more to support better care and more value in Medicare. Our recommended modifications are in three major categories:

1. Encourage the movement to effective alternative payment models (APMs) by providing bigger rewards for APMs that are strongly related to value.

  • APMs that qualify for the bonus should require providers to make a meaningful shift from FFS payment, either by accepting “downside risk” or reduced FFS rates.
  • APMs should cover multiple services, ideally spanning sites of care and providers.
  • Qualifying APMs should be supported by evidence that they can reduce overall spending, including pilots.
  • Organizations that use APMs with more advanced measures of performance should receive additional bonus incentives.

2. Improve Medicare’s physician FFS payment system by instituting policies that will achieve a higher-value set of services for Medicare beneficiaries, reducing costs without harming the quality of care.

  • Medicare’s bonuses for care improvements and lower costs should not be multipliers on FFS payments.
  • Physicians who report on more meaningful, outcome-oriented performance measures in the new Merit-based Incentive Payment System (MIPS) should receive larger bonuses.
  • The payment differences for physician services provided in hospitals v. an office setting should be removed.
  • A test of utilization review tools for selected high-cost, discretionary procedures/ services should be implemented.
  • Revised documentation guidelines should be evaluated and considered as a replacement for the current rules governing billing for office visits.

3. Improve and simplify the quality measures used in MIPS and APMs, by implementing more meaningful performance measures and better support systems for clinicians to improve performance.

  • Initially, reporting and payment adjustments for physicians should be based on patient experience and engagement, as well as a limited number of core measures reflecting the patient conditions they treat. The measures should progress over time toward measures of appropriateness, clinical outcomes, patient-reported outcomes, and total patient cost/resource use.
  • In both MIPS and APM programs, physicians should be eligible for a higher bonus payment if they report on more meaningful measures.
  • Centers for Medicare & Medicaid Services (CMS) should provide additional support for developing and implementing better performance measures in APMs, including improved Medicare data sharing with physicians to enable them to take action to improve care.
  • The selection of core measures for use in payment and public reporting should be based on input from an independent, multi-stakeholder process.

These steps would not require major revisions in the bipartisan legislation, and in some cases could potentially be addressed through comments in the legislative history or CMS implementation. They would also help offset the costs of the legislation. Addressing these modifications now will enable Congress to achieves the goals of providing necessary support for clinicians to improve care, while avoiding excess Medicare costs and ineffective reforms

Downloads Authors
  • Mark B. McClellan
  • Robert Berenson
  • Michael Chernew
  • William Kramer
  • David Lansky
  • Arnold Milstein
Image Source: © Brian Snyder / Reuters         
Categories: Elder

Listen: How Health Care Facilities Are Preparing For The Blizzard

CommonHealth (WBUR) - Mon, 01/26/2015 - 6:07pm

Most of us will be hunkered down at home over the next 24 hours, as a blizzard bears down on the state. But police, firefighters, hospital staff and workers at hundreds of nursing homes will be working. Listen above to a report from WBUR’s Martha Bebinger about how hospitals and senior care facilities are preparing to ride out the storm.

Categories: Health Care

An Uncertain Outlook for Medicare Spending

Brookings Institute -- Medicare - Mon, 01/26/2015 - 4:22pm

In its latest report on the budget outlook, the Congressional Budget Office projects that net Medicare expenditures will increase from 2.9 percent of GDP in 2015 to 3.6 percent of GDP by 2025—an almost 25 percent increase in the share of GDP allocated to Medicare.

But all of this increase can be accounted for by the aging of the baby boom generation: the total number of Medicare beneficiaries is projected to climb about 35 percent in the next 10 years, from 54 million in 2014 to 73 million in 2025.

CBO reports that, after adjusting for inflation, Medicare spending per beneficiary is projected to rise only 1.2 percent per year over the next ten years, well short of the 1.5 percent per year increase in real per capita GDP projected.   This remarkably slow growth in Medicare spending stems from a number of factors, including a reduction in the average age of the Medicare population (reflecting the influx of baby boomers) and payment cuts to providers--particularly physicians, who are slated to receive a 20 percent pay cut this April.

But another important factor is the phenomenally slow growth in Medicare spending in recent years, as shown below.  Although some of this slowdown is well understood—reflecting payment cuts under the Affordable Care Act and the expiration of patents of a number of blockbuster drugs—much of the slowdown in Medicare spending is not understood by analysts.  CBO’s research suggests that the Medicare slowdown does not appear to be attributable to the recession, and my work, using a variety of data sources, concurs.

Source: CMS/BEA. Note: The chart omits 2006, the year Medicare Part D was introduced.

CBO has made the not-unreasonable assumption that this slowdown will persist for some time.  But, because we don’t understand why Medicare spending has slowed, this assumption must be viewed as highly uncertain.  It is possible that, rather than persisting, the slowdown could reverse itself, and spending growth could surprise us on the upside in coming years.    

For a simple explanation of the implication of health spending growth for the sustainability of the federal budget, see my new, short video:

Categories: Elder

Enrollees In Pa.’s Medicaid Expansion Locked Out Of Substance Abuse Services

Kaiser Health News - Mon, 01/26/2015 - 3:10pm

A year before Healthy Pennsylvania’s rollout, Michael Harle, president and CEO of Gaudenzia, the drug and alcohol treatment center, was assured by top state Medicaid officials his clients would not see their health insurance change.

Harle has been around. So he asked for that guarantee in writing. He didn’t get it.

A high-placed executive “promised me that they would get it right,” he said.

But “they” didn’t.

After Medicaid recipients began shifting to the new program on Dec. 1, “all hell broke loose,” Harle said. A glitch in the system covered his clients and thousands of people across Pennsylvania in need of substance-abuse and mental-health services with private insurance instead of Healthy Plus, the new program for the medically frail.

The problem is most of those private plans don’t offer addiction and mental-health treatment, and those that do have less robust benefits than Healthy Plus.

The result is thousands of people have been locked out of treatment centers, risking their lives, said Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania, a statewide coalition of treatment programs.

“The problem with addiction is you can’t wait,” she said. “Alcohol and other addictions are progressive and are always fatal illnesses if they go untreated. You can’t wait.”

This copyrighted story comes from The Philadelphia Inquirer, produced in partnership with KHN. All rights reserved.

In a letter sent two weeks ago to behavioral health providers, the Department of Human Services said it was working with drug and alcohol and mental-health groups to prevent interruption of service.

People shut out of care often end up in emergency rooms, jail, or on the street, Harle said. Some die. In 2011, Pennsylvania recorded more than 2,000 drug overdose deaths, ranking it seventh nationally, according to the federal government.

The lockout is also a financial burden on providers, especially smaller ones. How much of a burden is still unknown since many providers bill Medicaid a month or two after services are given.

“I suspect that, particularly for small outpatient programs that haven’t sent their bills in yet, it could be a shock,” Beck said.

Last year, Pennsylvania treated 162,000 people for substance-abuse disorders in a variety of settings. The larger programs appear to be continuing to treat patients without payments, Beck said. But the residential rehabilitation programs that serve the poor have been affected the most. They serve 25,000 people a year, and December admissions were down 10 percent to 25 percent, Beck said.

At Gaudenzia, which has 900 beds in Southeastern Pennsylvania, December admissions fell by 247.

“They really botched this up,” Harle said.

The program was a signature health effort of former Gov. Tom Corbett, who had long resisted Medicaid expansion because he deemed it unsustainable. After losing his re-election bid in November, Corbett pushed a narrower version of expansion, called Healthy Pennsylvania, which cut benefits for all Medicaid recipients beginning Jan 1.

Problems began surfacing in the second week of December. That’s when Beck started getting calls from programs about their Medicaid clients. She spoke to state officials who told her there was a glitch in the system they were trying to figure out.

“I’m guessing that whoever did the data entry didn’t understand the addiction-treatment system and how it related to Medicaid,” Beck said. “And the misunderstanding became practice.”

When treatment programs realized what was happening, they had a choice. They could stop treating patients who didn’t have Medicaid coverage or continuing helping their clients. Harle and Gaudenzia decided to keep treating people.

“We get them treated and fight about it another day,” Harle said. “What is most important to us is the client.”

Gov. Wolf, who was sworn in last week, has pledged to scrap Healthy Pennsylvania for a more traditional Medicaid expansion program.

Estelle Richman, head of Wolf’s special transition team focused on human services, said the first thing on Secretary of Human Services Theodore Dallas’ to-do list was to “fix the drug and alcohol problem.”

“At the same time, we have to make sure that the providers are going to be paid,” she said. “Forcing providers to eat large sums of money only weakens them and their ability to provide comprehensive services to their clients.”

Richman said she would be in Harrisburg this week to continue working on the transition of Medicaid expansion. And though she didn’t want to speak for Dallas, she expected he would announce a plan that would unknot the problem.

“I will tell you that within the next couple of days we will have a plan and we will be communicating back out to the counties and people like Mike [Harle] how we plan to remedy this very quickly,” Richman said.

From Harle’s vantage point, the fix is really pretty simple. “There is a system in Pennsylvania that works,” he says. “It’s called HealthChoices and has been in place since the ’90s. It has rules and a system and a common language that people understand.”

Categories: Health Care

HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments

Kaiser Health News - Mon, 01/26/2015 - 2:36pm

The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality.

The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare’s traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares. Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternate payment models.

Last year, 20 percent of traditional Medicare spending, about $72 billion, went to models such as accountable care organizations, or ACOs, where doctors and others band together to care for patients with the promise of getting a piece of any savings they bring to Medicare, administration officials said. There are now 424 ACOs, and 105 hospitals and other health care groups that accept bundled payments, where Medicare gives them a fixed sum for each patient, which is supposed to cover not only their initial treatment for a specific ailment but also all the follow-up care. Other Medicare-funded pilot projects give doctors extra money to coordinate patient care among specialists and seek to get Medicare to work more in harmony with Medicaid, the state-federal health insurer for low-income people.

Burwell’s targets are for 30 percent, or about $113 billion, of Medicare’s traditional spending to go to these kind of endeavors by the end of President Barack Obama’s term in 2016, and 50 percent — about $215 billion — to be spent by the end of 2018.

The administration also wants Medicare spending with any quality component, such as bonuses and penalties on top of traditional fee-for-service payments, to increase, so that by the end of 2018, 90 percent of Medicare spending has some sort of link to quality. These figures do not include the money that now goes to private insurers in the Medicare Advantage program, which enrolls about a third of all Medicare beneficiaries.

This KHN story can be republished for free (details).

Monday’s announcement did not include any new policies or funding to encourage providers, but Burwell said setting a concrete goal alone would prompt changes not only in Medicare but also by private insurers, which are also trying some of these alternative models. Leavitt Partners, a consulting firm, counts 317 commercial ACOs and 40 in the Medicaid program.

“For the first time we’re actually going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system,” Burwell said at an announcement at the department’s headquarters, where she was joined by leaders from insurance, hospitals and doctors. “So today what we want to do is measure our progress and we want to hold ourselves in the federal government accountable.”

Some providers have eagerly embraced the new payment models, some with success. Roughly a quarter of ACOs saved Medicare enough money to win bonuses last year. Others are wary, particularly since they could lose money if they fall short on either saving Medicare money or achieving the dozens of quality benchmarks the government has established.

“ACOs are quite expensive to set up,” said Andrea Ducas, a program officer at the Robert Wood Johnson Foundation, a New Jersey philanthropy that is funding research into ACO performance. “There’s a significant upfront investment and if you’re not sure you’re going to make it back, there’s a pause.”

In the largest ACO experiment, the Medicare Shared Savings Program, 53 ACOs saved enough money in 2013 to get bonuses from the government, but 41 spent more than the government estimated they should have. Those ACOs did not have to repay any money, but in future years Medicare intends to require reimbursements from those who fall short. Providers have been pushing Medicare to increase the cut they get from these programs and lessen the financial risks in ACOs and the other programs.

“Government needs to do more to make sure there’s more shared savings going back to the providers,” said Blair Childs, an executive with Premier, a company that assists hospitals and providers in establishing ACOs and other models.

It is still too early to know whether these alternate payment models actually improve the health of patients and whether the savings that have been achieved so far — often by focusing on the most expensive patients — will plateau. Studies on the success of these programs have shown mixed results.

“We still have very little evidence about which payment methods are going to be successful in getting the results we want, which are better quality care and more affordable care,” said Suzanne Delbanco, executive director of Catalyst For Payment Reform, a California-based nonprofit that has been tracking the spread of alternative payment models in the private sector.  “We’re just wanting to avoid a situation where a few years from now, where we’ve completely gotten rid of fee-for-service, we don’t want to wake up and say, ‘Oh my gosh, we did it and we’re no better off.’”

Categories: Health Care

5 Reasons You Should Worry Way More About Flu Than Ebola

CommonHealth (WBUR) - Mon, 01/26/2015 - 2:33pm


By Veronica Thomas
Guest Contributor

A deadly virus is sweeping America, putting nearly 10,000 people in the hospital so far. No, it’s not Ebola. We’re talking about the common seasonal flu that shows up every fall and lingers on until spring.

Every year, 5 to 20 percent of Americans get the flu and, depending on the strain, anywhere from 4,000 to 49,000 people die from the virus or its complications, like pneumonia. And this season’s flu virus is shaping up to be pretty nasty — so nasty that the CDC declared a national flu epidemic at the end of December.

As a graduate student at the Harvard School of Public Health, I’m baffled by this: A couple months ago, I couldn’t step on a subway car or flip through Facebook without being bombarded by panicked comments about Ebola spreading to the U.S. But when it comes to the real and immediate threat of the flu: radio silence.

“Ebola is exotic. It has a very high mortality rate that people are very much aware of. It seems like you can be exposed to it without your control,” says Dr. Alfred DeMaria, medical director for the Bureau of Infectious Disease at the Massachusetts Department of Public Health. “All of those [factors] contribute to a higher perception of risk than the flu.”

In reality, far, far more people die from flu-related complications than from Ebola, but it’s a very small proportion of the millions who get sick each year. That’s one reason we should be more concerned about the flu than Ebola, Dr. DeMaria says. Here’s why else:

1) The flu is next door, not across the Atlantic.

Ebola has tragically claimed over 8,600 lives in West Africa, largely because many countries don’t have the capacity to contain the outbreak or treat infected patients. And though the news cycles have moved on, Ebola hasn’t. As the virus continues to spread, Ebola remains a real threat for some West African countries.

But for ordinary Americans: “The risk of getting Ebola is somewhere in the order of magnitude of getting personally hit by a meteorite,” Dr. DeMaria says. Just four people have been treated for Ebola in the U.S., and only one has died. No new cases have been reported since October.

Meanwhile, the seasonal flu has already reached widespread levels in 43 states, the CDC reports. And last week nearly one out of every ten deaths was due to the flu and pneumonia — more than expected based on past seasons.

While the majority of flu-related hospitalizations and deaths are among the very sick, young and old, the virus can even kill perfectly healthy individuals, like 26-year-old Katie McQuestion, who died from flu-related sepsis a couple weeks ago.

In Massachusetts alone, there have been 8,659 laboratory-confirmed cases of the flu so far, compared to 2,338 cases last year.

2) The flu spreads through the air, not bodily fluids.

While Ebola is much more deadly, the flu is more contagious and way more people catch it, Dr. DeMaria says. When you’re infected with the flu, the virus is literally all around you. You can infect someone by coughing, sneezing or even talking. And you can catch the flu by merely touching an object contaminated by the virus, then touching your face. To be infected with Ebola, you must come in direct contact with the bodily fluids (like blood or urine) of a visibly ill person.

3) This year’s flu shot isn’t very effective.

Though the flu vaccine is the best line of defense against the flu, this year’s formula isn’t as effective as past years. According to the CDC, the vaccine only reduces risk by 23 percent, so there’s a chance you’ll still catch it even if you’ve done your due diligence. That’s because the vaccine isn’t a good match for this season’s predominant flu strain, H3N2, which is expected to account for at least two-thirds of infections this year, Dr. DeMaria says. But that doesn’t mean you shouldn’t get the shot if you haven’t already (see #1 below).

4) There is no reliable cure or treatment for the flu.

If you’re one of the millions of people who get the flu this year, there’s not much you can do to nip it in the bud. Though the CDC director is encouraging doctors to prescribe the antiviral medication Tamiflu, there are mixed reviews about its effectiveness, especially for young, healthy individuals. At best, it may shorten the infection by one day; worst-case scenario, it could cause nausea, vomiting and, rarely, psychiatric side effects, like delirium in children.

5) The flu’s not going away anytime soon. Unlike Ebola, the flu spreads exponentially, making it hard to contain.

On average, each person with Ebola infects one other person; that’s called a linear spread. Meanwhile, a person with the flu typically infects at least two people, causing it to spread much more quickly. We were able to contain the very few cases of Ebola in the U.S., but that’s simply not possible with the flu.

And though the flu is at its peak right now, don’t expect it to vanish any time soon. According to Dr. DeMaria, a second wave of a different strain will appear soon and likely last until late March or early April, maybe longer. Last year, the flu stuck around through May along with the frost.

Now, all of this doesn’t mean you should panic and hole up until spring, but there are precautions you can take to help protect yourself and others:

1) Get the flu shot — immediately.

This year’s flu shot may not protect you from the prominent strain going around, but it can lessen its severity and protect you from complications, Dr. DeMaria says. And since the vaccine is designed to target four different flu viruses, it may protect you from additional strains that crop up these next few months.

Getting the flu shot every year also helps build your immunity over time by boosting the production of antibodies that can resist and fight the virus. Think it’s too late for you to get this season’s vaccine? “It’s not too late until you have the flu,” Dr. DeMaria says. And for most people, it’s free from your doctor and many drug stores. I stopped by a local pharmacy to get mine, and it only took five minutes.

2) Keep your distance from infected people.

I spent an entire weekend in the same small graduate dorm with my flu-infected boyfriend and managed to come out unscathed. I partially chalk up my protection to the flu shot, but I also made sure to keep my distance.

People with the flu can infect others one day before symptoms develop and up to a week after becoming sick. The key is to stay more than three feet away from someone with a respiratory infection, since the virus spreads through air particles, Dr. DeMaria says.

If you do touch a person with the flu, wash your hands after and avoid touching your face. “If you’re just careful, you can prevent transmission,” Dr. DeMaria says, even if you live under the same roof.

3) See a doctor ASAP if you’re at risk for complications.

Most people can treat flu symptoms, like a fever, headaches, and cough, in the comfort of their homes with rest, fluids, and over-the-counter medications like Tylenol. If you’re otherwise healthy, you’ll typically feel better within one or two weeks. But if you’re at risk for complications, like people with heart disease or young children, you should see your doctor within 48 hours of symptoms. Your doctor may treat you with antiviral drugs, like Tamiflu, which can help reduce the severity and length of your illness.

4) If you’re sick, stay home.

If you have the flu, you should stay home from work and school as soon as symptoms arise until 48 hours after the fever goes away, Dr. DeMaria says. But even then, you can still be infectious. If you aren’t careful about washing your hands and covering up your cough, you can spread the flu to family members or co-workers, which brings us to the next tip.

5) Cough into your sleeve.

If you have the flu or any other respiratory infection, you should cough into your sleeve, Dr. DeMaria says. If you cough into your hand, like many people do, you can transmit the virus to surfaces, where it can survive if damp. The sleeve catches those infectious particles and stops them in their tracks.

Readers, what’s your flu experience this year? Other tips to add?

Categories: Health Care

Healey Details Concerns With Partners Deal

CommonHealth (WBUR) - Mon, 01/26/2015 - 2:16pm

Attorney General Maura Healey, at WBUR (Robin Lubbock/WBUR)

There’s a dramatic twist in that deal between Partners HealthCare and former state Attorney General Martha Coakley — the one that’s been bouncing in and out of court and the news since it was filed in July of last year.

Attorney General Maura Healey, in her fourth day on the job, filed notice that she has concerns about the agreement and is ready to sue Partners if Judge Janet Sanders rejects the deal.

You’ll recall that Sanders suggested back in November that she might wait to hear from Healey before deciding whether to approve or reject the agreement.

The deal would let Partners acquire at least three hospitals in exchange for limits on how much the network could raise prices and how many doctors it could add.

Healey says that since the agreement was filed, she’s read and heard a lot about the health care market in Massachusetts. She explained her concerns in a brief filed earlier today:

If Sanders approves the deal, Healey says she will enforce it vigorously. If Sanders rejects the deal, Healey says she’ll sue to try to stop Partners’ proposed acquisition of South Shore Hospital.

Healey says she is still evaluating Partners’ proposal to add two Hallmark hospitals to its network.

This story will be updated.

Categories: Health Care

FALQs: Terrorism in France

In Custodia Legis - Mon, 01/26/2015 - 10:10am

Today we start a new series on In Custodia Legis!  “FALQs” are “Frequently Asked Legal Questions.”  We will briefly discuss interesting and useful information on laws and legal issues related to events from around the world.  Please feel free to let us know in the comments if there are particular global events or issues that you would be interested in learning about from a legal perspective (noting of course that we can’t provide legal advice on private matters).

Our first post is by Nicolas Boring, the French law specialist at the Law Library of Congress.  He has previously written posts for In Custodia Legis on “How Sunday Came to be a Day of Rest in France,” “Napoleon Bonaparte and Mining Rights in France,” and “French Law – Global Legal Collection Highlights.”

Photo by Flickr user Ma Rui, Jan. 27, 2007. Used under Creative Commons license,

In the wake of the tragic attacks on the satirical magazine Charlie Hebdo and on a kosher supermarket that occurred in Paris on January 7-9, we thought it would be useful to give a brief explanation of certain legal issues related to terrorism in France.  The attack on Charlie Hebdo has also put the spotlight on the issue of freedom of speech in France, an issue which will be the subject of a future blog post on my part.

1.  How does French law define terrorism?

The French Code pénal (Criminal Code) defines terrorism as a number of listed acts – including intentional homicide, assault, kidnapping, hijacking, theft, extortion, property destruction, membership in an illegal armed group, digital crimes, forgery, and more – carried out with the goal of “seriously disturbing public order through intimidation or terror.” Preparing to commit an act of terrorism, and seeking, obtaining, and keeping material to be used for an act of terrorism, is also considered an act of terrorism in and of itself. Intelligence gathering and training for the purpose of carrying out an act of terrorism also falls under that definition, as does the habitual access to websites that encourage or justify terrorism. (Code pénal, arts. 421-1 to 421-6.)

French law has long dealt with terrorism. Much of the current law on this issue is fairly recent, however, and stems from a 2012 law (Loi n° 2012-1432 du 21 décembre 2012 relative à la sécurité et à la lutte contre le terrorisme [Law No. 2012-1432 of December 21, 2012, Regarding Security and the Fight Against Terrorism], and an even more recent 2014 law (Loi n° 2014-1353 du 13 novembre 2014 renforçant les dispositions relatives à la lutte contre le terrorisme [Law No. 2014-1353 of November 13, 2014, Reinforcing Provisions Regarding the Fight Against Terrorism].

2.  What is the penalty for acts of terrorism under French law?

Terrorism appears to be generally considered an aggravating circumstance to the underlying offense. For example, money laundering is ordinarily punishable by up to five years of imprisonment (Code pénal, art. 324-1), but this is increased to seven years if the money laundering was related to terrorism (id., art. 421-3). Absent any aggravating circumstance, murder is punishable by thirty years of imprisonment (id., art. 221-1), but if the murder was committed as an act of terrorism, the punishment is increased to life imprisonment (id., art. 421-3).

3.  What law enforcement agencies are involved in the fight against terrorism in France?

All French law enforcement agencies are involved, to some degree or another, in the fight against terrorism. One of the most important agencies in that fight, however, is probably the Direction générale de la sécurité intérieure (General Directorate for Internal Security, or DGSI), which is essentially a domestic intelligence agency.  The Direction générale de la sécurité extérieure (General Directorate for External Security, or DGSE), France’s external intelligence agency, has a strong role in fighting terrorism on an international level.

France’s two “generalist” law enforcement agencies, the National Police and the Gendarmerie, also have an important role in the fight against terrorism. In particular, both of these agencies have SWAT units that are specialized in dealing with hostage situations and other terrorist attacks: the RAID (which is a unit of the National Police), and the GIGN (which belongs to the Gendarmerie). Both of these groups intervened on January 9. The GIGN led the assault against the Kouachi brothers, who had attacked Charlie Hebdo two days earlier. Simultaneously, the RAID led the assault against Amedy Coulibaly, who had attacked the kosher supermarket in which he was holding hostages.

Categories: Research & Litigation

Hundreds Mourn Surgeon Fatally Shot At Brigham And Women’s Hospital

CommonHealth (WBUR) - Fri, 01/23/2015 - 5:08pm

A woman wears a button honoring Michael Davidson at his funeral service Friday. (Jesse Costa/WBUR)

The cardiac surgeon killed inside Brigham and Women’s Hospital this week was laid to rest on Friday.

More than a thousand people gathered at Temple Beth Elohim in Wellesley Friday to pay their respects to Dr. Michael Davidson, who was fatally shot by a patient’s son on Tuesday.

Some wore buttons with Davidson’s initials, MJD, in a heart. Six buses brought people from Brigham and Women’s, and when Rabbi Joel Sisenwine asked all the doctors and caregivers to rise, at least half the room stood.

Several colleagues and friends of Davidson’s spoke, as did Davidson’s father, Robert, a well-known cardiologist at Cedars-Sinai Medical Center in Los Angeles. He spoke of the hopeful flight he and his wife took to Boston Tuesday after they received news that their son had been shot — hopeful because Davidson’s parents thought when they boarded the plane that he would live.

“When he was young, he said he wanted to follow in my footsteps,” Robert Davidson said. “But wherever I walked, he ran.”

Davidson’s mother, Susan, made a poignant reference to her son’s chosen profession as a cardiac surgeon. “My heart is broken, and only Michael can fix it,” she said.

Davidson’s widow, Terri Halperin, is a plastic surgeon. She expressed her shock at Davidson’s death coming at the hands of a patient’s son.

“Surgeons are not known for their bedside manner, but Michael had it in spades,” Halperin said. “That’s why the fact that a patient’s family member would take Michael away from us makes it all the more devastating.”

Halperin and Davidson had an unusual love story. Halperin revealed that, as many people do, she and Davidson faced rough times in their marriage.

“We actually took it one step further and got divorced,” Halperin said. “Two years later, we realized the mistake we had made.”

The couple remarried five years ago in the same sanctuary where Davidson’s funeral was held Friday. Halperin said Davidson was looking forward to the birth of their fourth child, a baby girl, due in April.

“He would have said that his children were the greatest gifts he’s leaving on this earth,” she said.

“He lives on in the smiles” of their children, Halperin added.

As the simple pine casket was carried out of the temple, Halperin placed her hand on it, walking by its side.

Categories: Health Care


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