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Hospital Billing

Medicare -- New York Times - Wed, 06/24/2015 - 12:00am
The president of the American Hospital Association responds to an editorial about high prices charged for many procedures at for-profit hospitals.
Categories: Elder, Medicare

House of Lords Case Records Become (Micro)Film Stars

In Custodia Legis - Tue, 06/23/2015 - 3:55pm

The following is a guest post by Agata Tajchert, one of the collections technicians in the Processing Section of the Law Library’s Collection Services Division.  Agata heads up our preservation efforts to microfilm material that is too fragile to remain in paper form.

A few years ago, after a major inventorying project, the Law Library’s collection of United States Court of Appeals Records and Briefs was sentto our state-of-the-art off-site storage at Fort Meade for safekeeping.  Last month we started a new project to preserve our collection of case materials submitted to the United Kingdom‘s House of Lords.

An unexpected opportunity enabled us to provide much needed reformatting for additional archival titles, such as: 19th century Malaysian Sarawak gazettes, German Bundesanzeiger (federal gazette) and lastly, the final cases handled by the House of Lords before its role as the final court of appeal was taken over by the Supreme Court of the United Kingdom, newly created in 2009.

Previously the Law Library’s collection of briefs for cases submitted to the House of Lords, containing briefs from 1925 to the 1970s, was preserved on microfilm in 1974. Since then hard copies were shelved in our closed stacks. We managed to gather a pretty complete collection of over 20 years’ worth of material (1986-2008). Its sheer volume was overwhelming.

Ken with trucks and piles full of the House of Lords cases

Most of the credit for tackling this project should go to Suneewan Creech and Ken Sigmund, who spent several weeks organizing and researching this title. Their job wasn’t easy as many cases, especially older ones, did not have docket numbers, which weren’t easy to find even in the House of Lords’ online archives. Also, very often individual files for the same case became separated and were mixed with others, so finding and gathering them all together was a long and tedious process. Frequently, units – which eventually become microfilm reels – had to be rearranged to incorporate newly discovered material and at the same time stay within the page limit allowed per unit (each page is a future microfilm image, and each reel fits only a certain number of pages).

Work on the House of Lords cases was not completely tedious though. We had some interesting cases, such as [Michael] Douglas and another and others v Hello! Ltd., [2007] UKHL 21 and Polanski v Conde Nast Publications, Ltd., [2005] UKHL 10, where celebrities sued paparazzi and Vanity Fair’s publisher for invading their privacy and making false claims (respectively).

We also had files with interesting supplementary materials. One example, a brief from Designer Guild Limited v. Russell Williams (Textiles) Limited (Trading As Washington Dc), [2000] UKHL 58, had ten samples of fabric included. Unfortunately colors are lost when microfilmed, so after the images are made, this particular brief will come back to the Law Library and will be kept in our collection to supplement the microfilmed material.

Designer Guild Limited design

Russell Williams Limited design









Similarly, the VHS tape, “Welfare Aspects of Shooting Foxes”, attached to the Scottish case of Whaley and another (Appellant) v Lord Advocate (Respondent), [2007] UKHL 53 will remain as a supplement to the microfilm.

“The House considered claims that the 2002 Act, which set out to make the hunting of wild mammals with dogs unlawful, infringed the claimants’ human rights, in that it contravened international treaties requiring the support for traditional practices and cultures.” (David Swarbrick on

The photographs below, however, will be preserved only on microfilm even though the color will be lost.

Jif Lemon Case Photos (from Reckitt and Colman Products Limited v Borden Inc. and others, [1990] UKHL 12).

Because of the huge amount of these House of Lords records and briefs, we will be sending them gradually for reformatting and preservation while staying up-to-date with the microfilming of our regular material as well.

Nonetheless, the House of Lords cases are becoming the Law Library’s newest (micro)film stars.

(All photographs taken by Agata Tajchert)

Categories: Research & Litigation

An Uptick In Non-Jews Choosing Jewish Circumcision? Maybe.

CommonHealth (WBUR) - Tue, 06/23/2015 - 1:08pm

Reporter Jessica Alpert may have stumbled on a trend: non-Jews choosing to have their infant sons circumcised by traditional mohels, Jews trained to perform the ritual procedure, rather than doctors.

Alpert, a frequent CommonHealth contributor, writes in the current Atlantic:

Finch isn’t the only non-Jew who has felt a connection to the religious elements of the procedure. Nationwide, circumcisions have decreased over the last few decades—from 64.5 percent of newborn boys in 1979 to 58.3 percent in 2010, according to Centers for Disease Control data—but among those opting to circumcise their sons, some non-Jews are forgoing the hospital or doctor’s office and requesting Jewish mohels for reasons both practical and religious. (Reliable statistics on religious circumcisions are hard to come by, but several mohels I talked to said they’ve noticed an uptick in their popularity in recent years.)

Preparing for a circumcision (Cheskel Dovid/Wikimedia Commons)

Whether or not the practice is taking off, Alpert suggests that this co-mingling of religious and non-religious realms may have “tricky implications for mohels performing non-Jewish circumcisions,” and raise thorny legal questions:

The right to perform brit milah is protected under the First Amendment, but when it’s no longer a religious ritual, mohels may run up against laws that forbid the practice of medicine without a license, explains Marci Hamilton, a church-state scholar and professor at the Cardozo School of Law at Yeshiva University. There is no legal gray area for mohels who are also health professionals—these mohels can perform the procedure on non-Jews as part of their medical practice, even if the primary purpose is religious rather than medical. But others, Hamilton says, may be subject to prosecution when they perform the procedure outside of its religious context.

When it’s a non-Jewish family using a mohel, “The mohel is not acting as a religious participant, and therefore his acts are not protected as free exercise,” she explains.

“This is really a medical business transaction, not a religious transaction.”

Last year, a study published in the Mayo Clinic Proceedings concluded that the health benefits of newborn male circumcision outweighed the risks. However, that data did little to sway critics of the practice who have called it “a disservice to American parents and children” (and worse) in remarks posted on the American Academy of Pediatrics web site after the group published a policy statement supporting insurance coverage for the procedure and also underscoring the health benefits.

Categories: Health Care

Dietland: A Fat Heroine, And The Politics Of Weight

CommonHealth (WBUR) - Tue, 06/23/2015 - 12:57pm

By Jean Fain

The heroine is the news in Dietland, the new novel by Sarai Walker. That’s because she’s got the rarest of qualities in a female protagonist: she’s fat.

Also, she has next to no sense of self, and expects to remain selfless until she can afford weight-loss surgery and find her true self as a thin person. In the meantime, Plum Kettle, our heroine, works as a ghostwriter for the slender, glamourous and self-absorbed editor of a teen magazine called Daisy Chain. In short, Plum’s got no life of her own.

Plum’s transformation from fat girl to full-bodied rebel with a cause is the narrative arc of Walker’s provocative and insightful book. Like Alice in Wonderland, Plum’s sense of self gets turned on its head by a cast of oddball characters, from the daughter of a famous diet guru and her feminist cohort to a murderous terrorist cell of women avenging crimes against women. When the daughter of the diet guru offers Plum $20,000 to postpone her surgery and confront the real costs of beauty, the plot and subplot blend and thicken.

Despite the rave reviews from my inner circle and the world at large, I didn’t expect to be drawn in by the writing. But, truth be told, it’s fresh, playful and sometimes hilarious: the parody of the diet industry is spot on. I also didn’t expect to be touched by the rejection and humiliation the 300+ pound Plum encounters along the way to finding herself.

Most unexpected of all: I kind of looked forward to spending my evenings with a fictional someone desperately seeking weight loss. Generally, if I’m desperate for anything at the end of the day with clients (I’m a therapist specializing in eating disorders and food issues), it’s non-diet-related downtime.

I can’t say I always loved reading Dietland. Violence, even when served as Walker serves it — with sarcasm and panache, isn’t my cup of tea. I also had trouble swallowing the meanness of the male characters, and the complete self-acceptance of the female ones. And yet, my curiosity kept me turning all 307 pages. I wanted to know if Plum would live more happily ever after. Plus, I wanted to discuss the book with members of my mindful eating support group. (Dietland is the group’s first unofficial book club selection.)

At the same time, I kept reading between the lines to learn the author’s story. From the book-jacket flap, I knew Walker writes from professional experience. Before she did her doctoral research on the feminist issue that is fat, she wrote about body image for Our Bodies, Ourselves, the feminist classic by the Boston Women’s Health Collective.

From the author photo, I also knew Walker is a fat woman. And yet, combing through the reviews and interviews, I could find very little about Walker’s personal experience with food and body image issues.

The therapist in me really wanted to know if Walker, like Plum, had tried and failed to lose weight over and again? If she’d been a victim of fat shaming and stigma? If she’d been discriminated against because of her appearance? What was Walker’s story?

My curiosity moved me to set up a Skype interview with the NYC-based author. What follows are questions and answers from that recent interview with Sarai (pronounced SUH-ray) Walker.

JF: You seem to know a lot about food and body image issues even though you’re not a medical person or scientist. What can you tell me about your personal experience in this arena?

SW: Well, I’m a fat woman, and so I think one of the reasons I wanted to write Dietland is I wanted to explore what it’s like to be a fat woman in our contemporary society because I think, while there are some novels with fat heroines, I feel like there aren’t any novels that explore the issue in a serious way.

Author Sarai Walker (Photo: Marion-Ettlinger)

Which is interesting because our society is so obsessed with “obesity.” There was actually an article in the Wall Street Journal a couple of years ago where they wrote about the fact that people are so obsessed with the fat body, but there really aren’t a lot of novels that deal with that subject. So that was kind of my motivation for writing the book, and I felt like I had the kind of personal experience to make it very authentic.

JF: So does that mean you were a dieter and had your own body image issues?

SW: Yeah, I would say that I started dieting as a teenager, so I kind of did all sorts of commercial diet programs, and then diet books, things in magazines, just sort of everything. And so I’m kind of well familiar with the dieting industry and, I think, how diets really don’t work for most people. I’m sure they do work for some people, but I think they’re largely ineffective as calorie-restrictive dieting.

So you’ve been through the diet mill. How about body image issues? What can you say about that?

So I was doing my Ph.D., and then I started to attend Fat Studies conferences, and that sort of introduced me to fat acceptance, health at every size, these different movements. And it was really just a radical transformation in my way of thinking. And as soon as I was exposed to these ideas, it just sort of clicked, that’s what I had been looking for but hadn’t been able to find. So it definitely changed the way I viewed my own body and made me realize that I don’t want to take what people project onto me and internalize it. I can’t help what people say about me or think about me, but I can help how I think about my own body, and that was really a radical shift for me.

That’s fantastic, because this is a really tough culture. It’s toxic. So how would you describe your body image at this point, because it sounds like it’s been kind of a long journey?

I would say that part of it is getting older; I’m not sure if that factors into it as well. Even though I know some great fat activists who are in their twenties or even teens, so who knows. I think for me getting older perhaps helps a bit. I feel more confident, I think. I hate to use the cliché, but knowledge is power. Really understanding the power dynamics of how all of these things work in terms of why fat women are marginalized, treated the way that we are. I think understanding the dynamics at play, at least for me, helps me deal with it. But it very much places the responsibility on the shoulders of individual person. Maybe everybody can’t deal with that; some people may be more susceptible to societal pressure. I don’t want to make it seem like it’s easy, because it’s not. Some people are perhaps more capable of it than others.

You’re not a therapist, and yet one of your characters prescribes a really unconventional therapy to help Plum face her worst fears. I’m curious how you came up with the therapeutic strategies, some of which are a little bit aversive, like getting a full body wax and dating jerky men.

So in the novel, there’s this diet plan called Baptist Weight Loss that Plum’s on when she’s a teenager. And then as an adult, she meets the daughter of the founder who is this activist who’s trying to undo the damage that her mother did with this weight-loss mega empire that she had. So basically Plum kind of goes through the reverse of a weight-loss program. So the woman in the novel calls it the New Baptist Plan, so it’s a new kind of diet plan. And instead of focusing on the body, making your body smaller, it’s focusing on the more underlying issues of our obsession with thinness. So part of it was trying to open Plum’s eyes and trying to make her angry about the treatment that fat women receive. So basically helping her turn her anger outward rather than at herself. But I’m not a therapist; I just kind of used my knowledge of dieting culture and my creativity to craft this plan.

It’s hard because when you’re a fiction writer you have to be concerned with the story as well. An interesting story, having the readers turn the page. So it’s a lot different than nonfiction, even though it might deal with some of the same issues, where there are a lot of different factors at play. I just made it up myself based on what I thought would be useful.

Over the course of the novel, Plum learns to accept her body without losing weight, which as we’re saying is no small task, especially in this fat-phobic society. How about you? What can you tell me about accepting your body just as it is right now?

I think it’s not like where you get to a place where you say, “Ok, as of today I just accept my body and that’s it.” It’s something that I wouldn’t say is a constant struggle, but it’s a constant issue, something you have to work on a lot. It’s never just one moment where you’re perfect and everything’s fine. Again, having access to fat acceptance, body positivity, health at every size, these different movements I think just are very empowering. And I think it helps a lot to have a community of other people as well, which is essential to Plum in the novel, finding other like-minded women. So if you can find a group of women, or people online, that’s been very helpful to ne, to know that I’m not alone and other people are going through the same thing.

My favorite quote is when one character tells Plum: “There comes a moment when you realize you’ve changed in some irrevocable way, and you’ll never go back to the way you were. Think of it as crossing over to a new place.” Do you have such a moment in your own life?

When I started attending these fat study conferences, it just kind of clicked for me; all of a sudden it made sense. And I knew that while it’s always a process – as I said before, it’s never just one moment where everything’s perfect, it’s a continuing process – there was a point where something inside me, a kind of consciousness raising, and once that happened, something shifted in me, and I knew that I would never go back to the way I was before. So not that everything was going to be perfect, but it was a before and after kind of moment. I wouldn’t say that it was one instant, but it was a period of time when I became exposed to these ideas and it shifted my way of thinking.

Tell me how working on Our Bodies, Ourselves influenced the writing of Dietland, because I could swear I could see little instructional moments that might have ben straight out of that book.

That’s funny because that was about 10 years ago I worked there. For one thing, I wrote the chapter on body image, so that was my first experience writing about the body from a feminist perspective, because before that I had worked at women’s magazines, so that was a big shift for me. But I also think working on Our Bodies, Ourselves made me very comfortable talking about the body in more explicit ways. All day we would deal with all sorts of issues, childbirth, everything, whatever it was, we would have graphic photos and illustrations surrounding us all day long. It made me lose some of the shame I had perhaps when thinking about the body, because I think that’s quite common in our culture, to be raised with this kind of embarrassment or shame about the body.

And after I worked there I lost that, just thinking about the body, talking about those sorts of issues in general. So that’s one of the things I think really helped me with the novel, kind of liberated me in that sense. But I also think Dietland kind of has that spirit of the 70s feminism in it. So of course, Our Bodies, Ourselves was such an integral part of 70s feminism, so I really value that experience. Getting to experience a kind of feminist collective – it’s not really a collective I guess in the traditional sense anymore – definitely influenced me in all sorts of ways I would think.

Anything else you want to tell me about?

The thing about the difference between a novel and nonfiction, for example, because I think most books on this topic are nonfiction, and a novel just functions differently on a more emotional level, a gut level. So I think it’s interesting for me to see how people respond to – particularly people who’ve never been exposed to these ideas before. It’s been fun to see some people are sort of like “Oh, I never thought of that before; you changed my way of thinking.” That kind of shift we were talking about; I love when people experience that after reading the book. So that’s been one of my favorite things so far.


Jean Fain, LICSW, MSW, is a Harvard Medical School-affiliated psychotherapist and the author of “The Self-Compassion Diet.”

Categories: Health Care

Baker Announces Plan To Combat Opioid Addiction Epidemic

CommonHealth (WBUR) - Mon, 06/22/2015 - 6:14pm

One person living in Plymouth County will die today from an overdose of heroin or another opiate. Gov. Charlie Baker says that sobering average, from just one county, offers a glimpse into the opioid epidemic that rages through every community in Massachusetts.

To combat this epidemic, Baker released a plan of attack. It includes 65 recommendations, drawn from a task force of experts who heard from 1,100 people this winter and spring, many of whom crowded into public hearings to tell their stories.

Massachusetts Gov. Charlie Baker announces his recommendations of his Opioid Working Group along with Attorney General Maura Healey and Health and Human Services Secretary Marylou Sudders at the State House. (Jesse Costa/WBUR)

“Opioid addiction is a health care issue that knows no boundaries across age, race, class or demographics,” Baker said during a press conference Monday. “From the Berkshires, to Boston, to Cape Cod, too many people have heart-wrenching stories of loved ones or friends who have battled with addiction and in some cases lost their lives. Opioid abuse is stealing the livelihood of our children, our siblings, relatives and friends, one person at a time.”

The recommendations include more education for doctors, young people, those at risk for addiction and their family members about the dangers of pain killers. The state will look to add 100 treatment and recovery beds by this time next year. Pharmacists will be required to add pain prescriptions to a statewide database within 24 hours, much more quickly than the current seven days, which Massachusetts is working to connect to databases in other states.

“This is a complicated issue so there’s not going to be a simple fix,” said Health and Human Services Secretary Marylou Sudders.

The Baker administration will rely on partnerships at the federal, state and local level to make many needed changes. One recommendation is to let medical residents prescribe a federally controlled treatment drug; another would increase or eliminate a cap on the number of patients to whom a doctor can prescribe the same drug, buprenorphine.

HHS secretary Marylou Sudders speaks to the press during a press conference at the State House to announce recommendations from the Governor’s Opioid Working Group. (Jesse Costa/WBUR)

The state does not have, but will try to establish timely statewide reports on overdoses and deaths. Right now, Sudders says, the state has a general sense of so-called hot spots, areas with the highest number of deaths.

“Hot spots are in Fall River, New Bedford, Middlesex County has a very high rate of opioid deaths, Plymouth, Brockton,” Sudders said. “The difference here is instead of using anecdotes, really use data to [identify] where we need to intervene.”

Close to real-time data will help the state determine which towns need more Naloxone, the drug that temporarily reverses an overdose, or, which cities and towns need more treatment programs, beds and coaches to help substance abuse patients with recovery.

An underlying theme in the report is that substance abuse is a health care, not criminal, issue.

“We are not going to arrest or incarcerate our way out of this,” said Attorney General Maura Healey. “This is a disease, a public health crisis and we must treat it as such.”

Healey says she’ll focus on making sure doctors are prescribing pain killers responsibly and that insurers are covering addiction as they would diabetes or asthma or any other chronic illness.

The Baker administration plans to spend $34.5 million to implement these recommendations, $27.8 million of which is new spending. The sum includes:

  • $5.8 million to move substance abuse disorder out of prison and into Taunton State Hospital
  • $14 million for recovery beds
  • $5 million for school-based education
  • $3 million for case managers and coordinators at MassHealth

The spending started last week with an $800,000 public service campaign.

[Watch on YouTube]

In this video, Janis McGrory and her daughter Amy LeFort from Harwich tell the story of Liz, the daughter and sister who died from an accidental heroin overdose four years ago. McGory says Liz switched to heroin after taking a pain medication.

“Prescription drugs are dangerous. Parents be vigilant. Addiction is a disease and don’t be fooled, it can happen to anyone,” McGrory said.

Baker’s report is, in part, a commitment to Liz and 6,600 Massachusetts residents killed by opioids in the last decade — a commitment to slow or stop the epidemic.

“All of those with this disease matter. My daughter Liz still matters. And all who have died still matter,” McGrory said.

Baker says he’ll issue updates on the results of his plan on a regular basis. Four of his proposals cannot take effect without approval from the state legislature. Baker and his aides say they are hopeful that working with partners, opioids will stop stealing so many lives.

Categories: Health Care


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