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The Palais Royal in Paris – Pics of the Week

In Custodia Legis - Fri, 09/25/2015 - 9:00am

This is a guest post by Nicolas Boring who has previously written for the blog on a variety of topics including FALQs: Freedom of Speech in FranceHow Sunday Came to be a Day of Rest in France, Napoleon Bonaparte and Mining Rights in FranceFrench Law – Global Legal Collection Highlights, and co-collaborated on the post, Does the Haitian Criminal Code Outlaw Making Zombies.

Last May, I shared some pictures of Paris’ Palais de Justice (Palace of Justice), which I took during a short vacation in France last winter. In a long-overdue follow-up to that blog post, I will now share pictures of the Palais-Royal (literally: Royal Palace) which I took during that same trip.

The Palais-Royal is among France’s most significant judicial buildings. Indeed, it is the site of both the Conseil d’Etat (Council of State) and the Conseil Constitutionnel (Constitutional Council). The Conseil d’Etat is France’s ultimate appellate jurisdiction for matters of administrative law, and also serves as an advisory body for the French government. The Conseil Constitutionnel is a court specifically set up to review the constitutionality of legislation, and is the only judicial body with the authority to invalidate a law as unconstitutional. In addition, the main office of the Ministry of Culture is located in the Palais-Royal, as are a famous theater, and a number of shops, restaurants, and cafés.

Situated just one block from the Louvre, the Palais-Royal has a rich history of its own. Before becoming a royal palace, it was the residence of Cardinal Richelieu, Louis XIII’s famous advisor whom novelist Alexandre Dumas later cast as the main villain in The Three Musketeers. The Palais-Royal subsequently became a royal possession under Louis XIV, and then was the home of the Dukes of Orléans (the hereditary title for the king’s oldest brother).

The French Revolution of 1789 saw the Duke of Orléans open the gardens of the Palais-Royal to the public, and construct the surrounding colonnade as a space for shops and cafés. The following decades were not kind to the palace, however: it was ransacked during the 1848 Revolution, and burned down during the 1871 Paris Commune. After the Commune was put down, the Palais-Royal was rebuilt and the Conseil d’Etat was moved onto its premises. The Conseil Constitutionnel was also installed there upon its creation in 1958.

This picture shows the main entrance to the Conseil d’Etat / Photo by Nicolas Boring

This is the entrance to the Conseil Constitutionnel, located in the same building as the Conseil d’Etat but accessible through a side-street instead of the grand façade / Photo by Nicolas Boring

The interior courtyard of the Palais-Royal, featuring a modern art installation called the Colonnes de Buren (Buren Columns), by Daniel Buren. Dating from the mid-1980s, this installation remains controversial / Photo by Nicolas Boring

The Palais-Royal as seen from its gardens / Photo by Nicolas Boring

Categories: Research & Litigation

First Edition: September 25, 2015

Kaiser Health News - Fri, 09/25/2015 - 6:47am
Categories: Health Care

After 7 Overdoses, Joey Searches For A Reason Why He’s Still Here

CommonHealth (WBUR) - Fri, 09/25/2015 - 5:52am

Joey, who recently started using methadone to try and kick his heroin addiction, feeds the birds in Bellingham Square in Chelsea. “People say that you OD two or three times, the third time you usually die. I OD’d seven times and I’m still here, so someone up there is watching me,” he says. “Someone has a purpose for me or a plan, but I keep waiting for that purpose of plan or purpose and I can’t find it.” (Jesse Costa/WBUR)

It’s the first few minutes of the early morning that are really hard for Joey. For about nine years, until just a few months ago, he’d wake up — in a bed or on a park bench or under the Tobin Bridge — and immediately put a needle in his arm.

“I would always save a shot of heroin for myself for the morning to get myself going,” Joey, 47 says — just enough to keep the vomiting and tremors of withdrawal at bay. (He asked that we only use his first name because he’s still using the drug, and dealing a little, and we agreed.)

Joey says he misses the whole morning routine in a small way — like how some people crave the smell, look and taste of coffee in the morning. His face softens as he describes “opening the bag, pouring [heroin] in the cooker, pouring the water in it, drawing it up, seeing the blood in the needle, that’s all a part of the high,” he said — all part of the anticipated euphoria, all part of the power of heroin.

Joey sleeps these days on a couch in a Chelsea apartment that’s become a sort of crash pad for a few current and former heroin users. To avoid the cravings, he’s up and out before 7 a.m., seven days a week. With his long, lanky stride, it takes Joey 15 minutes to reach a methadone clinic in a white concrete building with barred windows where he’s been a patient since late June.

Joey has been a patient at a methadone clinic since June. He says it’s the first time he’s been almost off heroin or OxyContin in more than 20 years. (Jesse Costa/WBUR)

“I been trying to quit this s— for probably 16 years and nothing’s ever worked,” Joey says, in one of a series of recordings he made for this story. “I been in and out of detox, I can’t count how many times I’ve been to detox.” He estimates it’s probably more than 100. Sometimes he really wanted to quit; other times he just wanted a clean, dry, warm place to sleep.

He’s lost track of the number of programs he signed up for, the halfway houses or sober houses he moved in and out of, the 12-step programs he attended, leaving early to fulfill drug cravings.

“Nothing ever worked,” Joey says. “I went to detox this last time and the guy said, ‘Joey, just try the methadone clinic, give it a shot, if it don’t work you can always come off it.’ So I tried and guess what? It’s the best thing I ever did.”

Recent Coverage Of The Opioid Addiction Crisis In Mass. Complete Coverage

The daily clinic routine that Joey describes is strict, sometimes impersonal — though clinic management disagrees with his perception.

Joey says he approaches the clinic, looking for a signal from the building security guards.

“If there’s like 20 to 30 people already inside, we have to wait outside,” he explains. “So we look at the guards, if they put their hands up like a cross that means there’s a hold. We have to go to a back parking lot to form a line and they let us in like five to 10 at a time.”

Joey says the guards keep track of patients who misbehave, swear or violate any rules about the use of methadone, a synthetic opiate. (For treatment of opiate addiction, methadone is only available at clinics regulated by the federal government.)

“It’s a three-strike rule and then after three strikes [the security officers] throw you off the property,” Joey says. “They’re real serious, you know, they don’t fool around down there.”

Clinic management says they don’t have a three-strike policy and don’t kick patients out for bad behavior. They say a patient might confuse terms of a contract they sign before they begin methadone treatment with a three-strike rule. Doctors who work in methadone clinics say they try not to lose patients, giving warnings and offering appeals before stopping treatment.

Inside the clinic, Joey says he waits to be served at one of three windows, each staffed by a nurse. When it’s Joey’s turn, he steps to the window, presents a special methadone clinic ID and recites his numbers: 4/07/68 and 70 — his date of birth and his dosage, 70 milligrams of methadone.

A nurse hands Joey a plastic cup with about an inch and a half of thick pink liquid. Some patients dilute the medicine with water to help get it down while the nurse watches.

“You can’t leave the window.That’d be crazy if you left the window with the methadone,” Joey says, laughing. “You can’t even leave with the cup, you have to throw it out before you leave.”

Joey says he doesn’t mind the strict rules and impersonal treatment. He waves off the criticism that he’s still using a drug to treat his drug addiction or that methadone is like handcuffs because he must come to clinic every day to get it.

“It’s better than sticking a needle in my arm, that’s for sure,” he says.

If Joey follows the rules, and is stable, he will eventually be able to pick up and take home a small supply so he won’t have to come in every morning.

Joey plans to increase his daily dose of methadone. The more a patient takes, the longer it takes to come off the drug safely. But Joey says he needs more.

“I do have to go up another 10 to 15 more milligrams cause I, like I’m not using heroin on an everyday basis anymore but I still am chipping here and there,” Joey says.

Chipping, as in using once or twice a week. Still, Joey says that’s a big improvement. He tries to look forward, not back — tries not to get stuck in regret.

“I’m grateful to have a roof over my head, but it’s not where I want to be,” Joey says with a long sigh. “What I want is my own place, to be stable. I lost like 30 pounds since I got out of jail which is terrible, I look like a twig. My mom just died in March, I miss her terribly. Everything just builds up, and you get depressed. Especially when you had everything at one time and you lost everything.”

Joey’s mother died the day he got out of jail, his fourth time behind bars for possession, shoplifting — a string of charges tied to his addiction. The “lost everything” period Joey mentions was back in his 20s. He’d dropped out of high school but had a good job, working construction on the Tobin Bridge. He had an apartment, a girlfriend and he fathered a son who he talks to now once a month or so.

Joey visits his parents grave at Woodlawn Cemetery in Everett. His mother died earlier this year, the same day Joey got out of jail for the fourth time. “I miss her terribly,” he says. (Jesse Costa/WBUR)

At age 24, a blood vessel burst in Joey’s brain, he had a partial stroke and a doctor prescribed the painkiller OxyContin. He says he was on 80 milligrams, three times a day for 15 years. When Joey’s doctor tried to wean him off the pills, Joey switched to heroin and, he says, nearly nine years of feeling controlled by the tiny bags of tan powder.

“Same thing, every day,” Joey says, his voice monotone. “Going to Chelsea Square, copping, getting high, sitting there like a zombie. Who the hell wants to live that way?”

The nearly three months on methadone is the first time he’s been almost off heroin or OxyContin in more than 20 years.

“I shoulda did this years ago,” he says.

Joey leaves the methadone clinic by 8 a.m. Now he’s got 10 or 12 hours to fill before he goes back to the couch in his friend’s apartment. Some days he finds the odd job, but nothing steady. Most days he stops by Chelsea City Hall three or four times to fish through the ashtrays.

“People go out from work and they take breaks and they take like two or three drags on their cigarette and put it out,” Joey says. “I fill up a box full of them cigarettes and use them to smoke. Pretty smart, huh?”

Just before 1 p.m., Joey heads for the Salvation Army and a free lunch, hoping for his favorite — stuffed shells.

“I come every day unless I am tied up or I have another appointment,” Joey says. “I don’t really miss it cause it’s my only source of food during the day for right now.”

Joey gets $194 a month for food stamps, which he says he spends on food for his apartment. He used to sell his food stamp ration half-price and buy heroin. His only other regular income is $724 he receives monthly from Social Security for his disability. He’s enrolled in both Medicare and Medicaid, for free.

After lunch, Joey brings stale bread back to Bellingham Square and Chelsea City Hall to feed the birds. He calls the square a trap, where heroin is always available. It was Joey’s home base when he was shooting four to six times a day and doing small deals to pay for the heroin. Sometimes he gets sucked back in.

Joey calls Bellingham Square in Chelsea a trap, where heroin is always available. It was his home base when he was shooting four to six times a day and doing small deals to pay for the heroin. Sometimes he still gets sucked back in. (Jesse Costa/WBUR)

“I middled a deal today, made a quick $10,” Joey says, describing his role as the middle guy, between a buyer he knows and a dealer. He could get several years in state prison for that. But says he really needed the money — for soda and toilet paper.

“I woke up this morning and there was no toilet paper and you gotta have toilet paper,” Joey says. “I don’t care where, if you have to rob a bank to get it. That’s one thing you need in the house is toilet paper.”

Back in his friend’s apartment, Joey boils a hot dog and sits down to watch “The Texas Chainsaw Massacre,” one of a few DVDs lying around. He can’t afford cable TV. But Joey made it through another day.

Joey walks up the stairs in the apartment building where he currently lives. (Jesse Costa/WBUR)

“People say that you OD two or three times, the third time you usually die. I OD’d seven times and I’m still here, so someone up there is watching me,” Joey says. “Someone has a purpose for me or a plan, but I keep waiting for that purpose of plan or purpose and I can’t find it.”

Joey says he prays and goes to church when he can, looking for guidance. He can’t see the plan yet, but he’s pretty sure it will include helping young people avoid or cope with the addiction that has already consumed half his life.

Categories: Health Care

Clinton Seeks To Build On Health Law, But Does She Have The Rx For Rising Health Costs?

Kaiser Health News - Fri, 09/25/2015 - 5:00am

While the Republicans running for president are united in their desire to repeal the federal health law, Democrat Hillary Rodham Clinton is fashioning her own health care agenda to tackle out-of-pocket costs – but industry experts question whether her proposals would solve the problem.

In addition to defending the  Affordable Care Act, Clinton released two separate proposals this week. One would seek to protect people with insurance from having to pay thousands of dollars in addition to their premiums for prescription drugs; the other would set overall limits on out-of-pocket health spending for those with insurance.

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

“When Americans get sick, high costs shouldn’t prevent them from getting better,” said Clinton in a statement provided by the campaign. “My plan would take a number of steps to ease the burden of medical expenses and protect health care consumers.”

The drug plan would, among other things, cap payments for covered prescriptions at $250 per month and let the government negotiate prices for the Medicare program. The overall health spending plan would let people see a doctor at least three times a year without having to first satisfy their deductible and create a new tax credit for those whose out-of-pocket spending is more than  5 percent of their annual income.

But while surveys show that health costs, and particularly drug costs, are a top concern for many voters, it’s not at all clear that Clinton’s proposals – some of which have been  mentioned for decades – would provide an actual cure.

“There’s no magic bullet here except getting health costs down,” said Len Nichols, a health economist at George Mason University and a longtime backer of the federal health law.

The fundamental problem, says Nichols, was built into the health law itself. By requiring many new benefits, such as maternity care and coverage for mental health and substance abuse,  insurers were left with few choices when trying to keep premiums from spiraling. Many insurers narrowed their provider networks and collected more from customers who use the system most.

“The degree to which these out-of-pocket realities hit those with chronic conditions harder, it means we’re not accomplishing the social objective of sharing the risk,” said Nichols.

But setting specific limits for those who are sick will simply drive up premiums for everyone, says the insurance industry. “When you look at mandating additional benefits, that has a huge impact on the cost of coverage,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans (AHIP), the industry trade group.

And even if that was a tradeoff the public – and policymakers – decide they are willing to make, there is a phalanx of lobbyists in Washington bent on making sure many of these changes never happen.

For example, John Castellani, head of the Pharmaceutical Research and Manufacturers of America, said Clinton’s drug proposal “would restrict patients’ access to medicines, result in fewer new treatments for patients, cost countless jobs across the country and could end our nation’s standing as the world leader in biomedical innovation.”

Meanwhile, Clinton’s proposed limit on advertising to consumers for prescription drugs has drawn the ire of the advertising industry. The Association of National Advertisers  in a statement called the proposal “wrong and misguided.”

Even the insurance industry, which has been relentlessly campaigning against high drug prices, has come out against Clinton’s plan. Marilyn Tavenner, AHIP president and CEO, said in a statement that “proposals that would impose arbitrary caps on insurance coverage or force government negotiation on prescription drug prices will only add to the cost pressures facing individuals and families across the country.”

Still, the advent of both blockbuster new drugs that cost tens or sometimes even hundreds of thousands of dollars, plus sudden spikes in prices of even generic medications, may prove to be a tipping point.

More than a half dozen states have already imposed some sort of limits on out-of-pocket costs for drugs, either through law or regulation.

Republicans, meanwhile, have yet to settle on how they would replace the Affordable Care Act, concedes Chris Jacobs, a senior editor for the Conservative Review.

“Republicans need to have a better and more substantive alternative than health savings accounts, liability reform, and cross-state purchasing,” he said, referring to ways people can save tax-free for their own health bills, medical malpractice reform and allowing individuals to purchase insurance from states other than their own. All are Republican ideas dating back several campaigns.

But when it comes to cost, Republicans have a major case against the authors of the health law, Jacobs says.

“They were never honest with the American people about how much this was really going to cost and the tradeoffs needed to pass it,” he said. He likened President  Barack Obama, when he was lobbying for the bill, to Oprah Winfrey on her television show’s famous give-away episode  – “YOU get a car, and YOU get a car,” he said. Basically the backers were offering everything to everyone at the same time many of the costs were either hidden or pushed off to the future, he said.

Nichols agrees, at least to a point. “The (health) law did answer all questions, but now we’re ready to revisit because we didn’t like all the answers.”

Categories: Health Care

D.C. Women To Get Access To Full Year’s Worth Of Contraceptives

Kaiser Health News - Fri, 09/25/2015 - 5:00am

Under a new law, District of Columbia women will be able to scratch one item off their list of things to worry about: running out of birth control pills.

Under the law, which passed its congressional review period this month, women will be able to get a year’s supply of pills at once.

Prescriptions for birth control pills typically have to be renewed every 30 or 90 days, potentially resulting in women missing scheduled pills. The yearlong provision will begin in 2017.

Earlier this year, Oregon became the first state to pass a law allowing women to get a year’s supply of contraceptives at once. That law takes effect next year.

More from this series

Other states have considered similar measures, including New York, Rhode Island and Washington, says Elizabeth Nash, a state policy analyst at the Guttmacher Institute, a reproductive health research and education organization. In addition, a few state Medicaid programs currently allow women to receive 12 months of contraceptives, she says.

“It’s a bit of a no-brainer,” says Nash. “If you want to prevent pregnancy, you want to make accessible the methods to do that.”

Women who received a year’s supply of birth control pills were 30 percent less likely to have an unplanned pregnancy than those who received either a one-month or three-month supply of pills, according to a 2011 study published in Obstetrics and Gynecology. The study linked the number of packs of pills dispensed to 84,401 women in California’s Medi-Cal program in 2006 to the number of pregnancies and births.

Insurers have raised concerns about allowing the yearlong prescriptions. “Making sure women have access to the medications they need is critically important,” says Clare Krusing, a spokesperson for America’s Health Insurance Plans, a trade group. “But we do have concerns that an automatic one-year supply of these medications will pose safety and affordability issues for patients, particularly if a woman is picking a brand-name over a generic, for example, or chooses to stop using contraception and is left with potentially months-worth of treatments.”

The health law removed many of the barriers that women faced in their ability to afford birth control, says Gretchen Borchelt, vice president for health and reproductive rights at the National Women’s Law Center. The law requires most employers and insurers to cover all FDA-approved birth control methods without charging women anything out of pocket. Now legislators are trying to identify other gaps that need to be addressed.

“This law is going to make a difference for D.C.,” Borchelt says. “There’s a high teen pregnancy rate, and pharmacies that are not well located for low-income areas.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Health Care

Seniors Tell Medical Students What They Need From Doctors

Kaiser Health News - Fri, 09/25/2015 - 5:00am

CLEVELAND – When doctors told Robert Madison his wife had dementia, they didn’t explain very much. His successful career as an architect hardly prepared him for what came next.

“A week before she passed away her behavior was different, and I was angry because I thought she was deliberately not doing things,” Madison, now 92, told a group of nearly 200 students at Case Western Reserve School of Medicine here. “You are knowledgeable in treating patients, but I’m the patient, too, and if someone had said she can’t control anything, I would have been better able to understand what was taking place.”

Belle Likover recounted for the students how she insisted when her husband was dying of lymphoma that doctors in the hospital not make decisions without involving his oncologist. “When someone is in the hospital, they need an advocate with them at all times,” said Likover, who turns 96 next month. “But to expect that from families when they are in crisis is expecting too much. The medical profession has to address that.”

Madison and Likover were among six people all over the age of 90 invited to talk to the second-year medical students this month. The annual panel discussion, called “Life Over 90,” is aimed at nudging students toward choosing geriatric medicine, the primary care field that focuses on the elderly. It is among the lowest-paid specialties, and geriatricians must contend with complex cases that are time consuming and are often not reimbursed adequately by Medicare or private insurance. And their patients can have diseases that can only be managed but never cured.

Students often are attracted to more lucrative specialties such as orthopedics or cardiology, said Jeremy Hill, who was in the audience. One undeniable factor is money: the 35-year-old North Carolina native may owe as much as $300,000 when he graduates, enough – he is quick to point out – to buy “a nice-sized house.”

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

Yet Hill is one of the few Case students who say they are leaning toward choosing geriatrics.

The American Geriatrics Society estimates that the nation will require about 30,000 geriatricians by 2030 to serve the 30 percent of Americans over age 65 with the most complicated medical problems. Yet there are about 7,000 geriatricians currently practicing. To meet the needs, the society estimates medical schools would have to train at least 1,500 geriatricians annually between now and 2030, or five times as many as last year.

The low number of geriatricians is not surprising considering that their average salary was $184,000 in 2010, almost three times lower than what radiologists earned, the American Geriatrics Society has reported.

Elizabeth O’Toole, a geriatrician and med school professor who arranged the panel discussion, acknowledged in her introduction that most students were interested in other specialties. Yet she warned them not to overlook the needs and outlooks of older patients.

“No matter what you’ll be doing, you are going to be working with these folks,” she said. More than 400,000 people 80 years old and older receive knee replacements last year, 35 percent of men over 80 and 19 percent of women have coronary heart disease and the most common medical procedure among people over 65 is cataract surgery. Successful outcomes depend on the patient’s cooperation and that, she said, requires “an understanding of who the patient is.”

Students who braced themselves for a solemn litany of medical problems from the panel were in for a surprise. It wasn’t just what the visitors said that made an impression, but how they said it.

The group offered the students advice, telling the doctors-to-be to look at their patients instead of typing notes into a computer, take more time with older patients and answer their questions.

“Having to see so many patients a day is tragic,” said Simon Ostrach, 92, a professor emeritus of engineering at Case, who recalled being rushed through an appointment with an orthopedic surgeon who did little for “excruciating pain” after his hip replacement.

When it was her turn, Likover pushed back her chair, stood up and had no need for the microphone she was offered.

“Getting old is a question of being able to adapt to your changing life situation, having a little less energy, not being quite as healthy as were you were before,” said Likover, a retired social worker. Four years ago, she was hospitalized twice for congestive heart failure until she learned how to manage the disease through diet. She also has an occasional irregular heart beat and only recently began walking with a cane. She swims at least three times a week, serves on several committees addressing seniors’ issues, and is a Jon Stewart fan because “getting a laugh every day is very, very helpful.”

Likover swims at least three times a week, serves on several committees addressing seniors’ issues and calls herself a huge Jon Stewart fan. (Photo by Lynn Ischay for Kaiser Health News)

“I have lived a very good and hopefully useful life and death does not concern me. It is going to happen,” she told the students. “And I think that kind of outlook, not worrying about every little ache and pain makes a big difference and a very happy life.”

“That’s a perfect segue to my story,” said Ostrach. “I attribute my longevity to smoking, drinking and overeating,” he told the students. And doctors who tried to reform him “are all long dead and gone.” He was an athlete in college, wrestling and playing tennis, “but as I got past 60, I found that listening to opera, smoking good cigars and having a little cognac was much more pleasant.” All in moderation, he added.

Efforts to introduce relatively healthy older adults to medical students can “reduce the sense of futility and show [the students] that there are real people with real lives who can benefit from quality health care,” said Chris Langston, program director at the John A. Hartford Foundation, which focuses on aging and health who has been analyzing the trend for the past several years.

But Jeremy Hill and the roughly two dozen members of Case’s “geriatric interest group” are the exception. For them, the challenge of a complicated patient — “figuring out the puzzle” as one student put it — is what makes geriatric medicine worthwhile, even when a cure is out of reach.

“I have such respect and admiration for this population, and if I could somehow give them one extra good day they would not have had otherwise,” said Hill, who then paused for a moment, “I would be privileged to work with them.”

After the session, Hill went up to Ostrach, who had said he’s been lonely since his wife died. After chatting for a few minutes, he told Ostrach, “If you’d like to have lunch sometime, please call me,” and handed him a scrap of paper with his phone number.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

Categories: Health Care

Prouty Garden, ‘The Soul’ Of Boston Children’s Hospital, Is Slated For Demolition

CommonHealth (WBUR) - Thu, 09/24/2015 - 4:06pm

The Prouty Garden, at Boston Children’s Hospital, is seen in June. The beloved space is slated for demolition, with a new clinical building set to go in its place. (Robin Lubbock/WBUR)

Boston Children’s Hospital is known as one of the top hospitals in the world. It’s an elite pediatric center that treats devious and complex medical disorders, researches cures, and saves children’s lives.

The hospital is in the Longwood Medical Area, and there’s not a lot of breathing room there. Children’s is cheek by jowl with its neighbors — Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital and Dana Farber Cancer Center. The property is pricey and open space is a rarity. So when a hospital needs to expand, as Children’s does, it’s hard pressed to find space.

But not far from the jam of traffic outside Children’s, tucked between the hospital’s main buildings, is a half-acre oasis called Prouty Garden.

It has fountains, pine trees and birches, and a 65-foot dawn redwood tree. There’s a gazebo in the corner, alcoves shrouded by shrubs for privacy, little squirrel and rabbit sculptures, and real rabbits, too. The garden has won national acclaim.

On one of our visits, a family picnicked under the redwood. A little girl sat on a bench with an oxygen tank. Parents pushed children in wheelchairs and with IV poles. Staff had lunch on the lawn and at tables on the terrace. Such has been life in Prouty Garden for almost 60 years.

A rendering of the planned Boston Children’s Clinical Building, to be built on the site of the Prouty Garden and Wolbach building (Courtesy of Children’s Hospital)

Now, Prouty is at the center of a piqued battle that’s pit some staff and families of patients against the hospital. That’s because next year, the garden is slated to be demolished. The hospital plans to build in its place an 11-story, $1.5 billion clinical building. It’ll feature a state-of-the art neonatal intensive care unit, a pediatric heart center with a cardiac clinic, operating rooms and enough space so the hospital can offer all patients private rooms.

Tami Rich, of Ashland, says it will save lives, and that’s what matters most to her.

“Garden spaces and healing spaces are incredibly important to me,” Rich says. “But saving the lives of kids, for me, it’s sort of an apples and oranges conversation.”

Children’s Hospital helped save her son Jameson’s life. He was born with complex heart defects. His mother spent hundreds of nights at Children’s with him — almost always in a room with another patient.

“You would finally get your really sick kid settled after being admitted, and it can take six hours to get everybody to see you once you get admitted,” she says. “And then at 3 [a.m.] someone else gets admitted into the room. That kid might be coughing or crying, and your kid just got to sleep. You need that space to heal and have your private time while you face these challenges.”

Rich’s son is now 22 and doing well.

Gus Murby, of Medfield, also had a son treated at Boston Children’s Hospital — Gus Junior. He had leukemia and endured two bone marrow transplants. Frequently, the family practically lived at the hospital with him. The best times they had together were outdoors in the Prouty Garden. They’d bring binoculars and watch hawks.

Gus died in 2007 when he was 17. His family brought him to the garden to take his final breath.

“We asked if we could go outside and if he would not have a tube in his throat,” Murby recalls. “He was intubated, so basically it was under the sky and without a tube. And he passed away quietly.”

On a recent visit to the garden, Murby pointed to the place where his son died. He says he wants the garden to remain for all the future families of Children’s Hospital.

“I can’t tell you how touching it is, I guess, to know that somebody 50 to 60 years ago did this and to understand — when you’re sitting there in the middle of it — why they did it. This is something that a small number of people intensely understand,” Murby says.

Olive Prouty (Courtesy of Mason Smith)

Prouty Garden exists because of Olive Prouty, a Brookline novelist and poet. She had two daughters who died as infants, and she funded two hospital wards in their memory. But when the hospital had to tear down that building, she agreed to fund the creation and upkeep of the garden, despite concern the hospital might one day tear it down. She bestowed it to the hospital in 1956.

“This is part of what makes Children’s Hospital so special,” reflects Elaine Meyer, a clinical psychologist and registered nurse who directs an institute on ethics at Children’s. She’s helping to lead the push to save Prouty Garden.

“This is part of the healing that we have to offer, part of the therapy that we have to offer. This is not just a nice little sentimental space,” she says.

The Prouty Garden has won national acclaim. It has fountains, pine trees and birches, and a 65-foot dawn redwood tree, pictured here. (Jesse Costa/WBUR)

The save Prouty campaign has included sidewalk gatherings outside the hospital. Among those rallying: landscape architect Tom Paine, who designed a corner of Prouty Garden. For him, this is partly a land-use issue.

“Open space is not just a building site waiting to happen, which is how we too often look at open space,” Paine says. “We consider it just simply tomorrow’s building site, when it’s not that.”

But hospital executives say they’re dedicated to developing new green space. And they emphasize that with the new building, they’ll end up with about 9,000 more square feet of green space than they have now. It won’t be in one place, but many — some of which already exist and will be expanded, and several that will be new.

“I think we have a great opportunity to not just replicate but evolve those types of spaces,” says Dr. Kevin Churchwell, the executive vice president of health affairs and chief operating officer at Boston Children’s Hospital, who also worked for many years as a critical care pediatrician.

Churchwell says landscape architects hired by the hospital are designing an indoor winter garden, an outdoor roof garden on the hospital’s main building, and other spaces, including an earth-level exterior garden about half the size of Prouty.

A rendering of the rooftop garden planned for Boston Children’s Hospital’s existing main building. Hospital executives say they expect the garden to be completed in the next two years. (Courtesy of Children’s Hospital)

But some opponents say those spaces won’t come close to replicating Prouty Garden.

“They’re manufactured. They’re not authentic. They’re kind of put-in green. Fake green. Cheese Whiz,” says Episcopal priest Joel Ives, from Brookline, who has prayed with patients in Prouty Garden. He’s one of 12,000 people who’ve signed a petition to preserve the space.

Children’s Churchwell says the garden has a great history with the hospital. But, he says, times have changed and the needs are dire.

“Our major discussion is around census management — trying to figure out, given our number of beds and number of children who want or need our care, how do we manage that? It’s not a match right now,” Churchwell explains.

He says the hospital looked seriously at alternative sites for the new clinical building.

“And looking at the other sites within this area, we sort of ruled out what didn’t work and came up that the building that we’re going to build made the most sense from a cost standpoint, a time standpoint and a feasibility standpoint,” he explains

Opponents say they asked to see detailed analyses of the sites but the hospital never provided them. In filings with the Boston Redevelopment Authority, Children’s said the other sites didn’t offer a big enough space or were too far from the main buildings to provide optimal medical care.

The hospital’s head of real estate, Charles Weinstein, said in a 2103 interview with WBUR that those issues were “fatal flaws.”

We asked Churchwell why hospital executives didn’t consider Prouty Garden a deal breaker for the new building. “Priority,” he replies. “What’s the most important thing that we do here? The most important thing that we do here is to take care of children who need us desperately. And that care is provided by our caregivers and by the space. And if the space is not where it needs to be, that’s an important issue that we have to deal with.”

Gus Murby, who brought his son to Prouty Garden to die, calls it the “soul” of the hospital. (Robin Lubbock/WBUR)

Murby, who brought his son to Prouty Garden to die, calls it the “soul” of the hospital.

“It really boils down to what you’re in the business of doing. If you’re in the business of clinically treating patients, end of story, you’re absolutely right,” he says. “If you’re in the business of healing patients, and within your medical knowledge you can treat them but you realize they’re more than just that; if you’re running a hospital and you want staff to care the way I believe this Children’s staff cares, you need a place they can come. This is not just a garden for the kids.”

Prouty supporters are now pursuing legal action, hoping for an 11th hour reprieve. They’ve asked Attorney General Maura Healey to block the hospital from building on Prouty Garden. To bolster their case, they point to letters between Prouty and hospital officials about the garden’s future, and a plaque the hospital erected and still stands in the garden. It reads, in part:

“Mrs. Prouty insisted on perpetually maintaining this location as a haven…” and, “Because of Mrs. Prouty’s vision, this garden will exist as long as Children’s Hospital has patients, families, and staff to enjoy it.”

Attorney Greg McGregor, of McGregor and Legere, says a state law pertaining to charitable gifts could be the basis for action by the attorney general.

“If necessary, [we’ll seek] a lawsuit to see to it that the garden is saved in perpetuity, as the original gift contemplated, which the hospital asked Mrs. Prouty for, and which her will specifies in endowing the garden,” McGregor says.

Mason Smith is resigned to Children’s building on the garden his grandmother created. In fact, he’s on the hospital committee that’s helping to develop the new green spaces. (Robin Lubbock/WBUR)

But the hospital has a surprising ally. Mason Smith is Olive Prouty’s grandson, and he heads the Olive Higgins Prouty Foundation, which his grandmother set up to endow the garden.

Smith is also a retired architect who worked for Shepley Bulfinch, the firm that designed the hospital’s Berthiaume building and is designing the new clinical building. Smith is resigned to Children’s Hospital building on the garden his grandmother created. In fact, he’s on the hospital committee that’s helping to develop the new green spaces.

“I guess I saw this as where the hospital was headed, and then my interest was, ‘Well, let’s do the best of it that we can,’ ” Smith explains. “I was asked continually by the people that are very sad about the garden’s going, did my grandmother say the garden should never be changed or removed? And I said, ‘No, my grandmother was a smart woman. She knew things were temporal and didn’t last forever.’ ”

Smith says he takes hospital executives at their word that they fully explored alternatives. The foundation gives between $40,000 and $50,000 a year for the garden’s upkeep — not enough, he says, to give him any pull over the hospital’s decision.

But for Elizabeth Richter of Canton, Connecticut, the plans to demolish Prouty are a betrayal.

When her brother was treated at Children’s for multiple brain tumors, he loved being outside in the garden and watching the squirrels, Richter says. He died at the age of 12 in 1973. The family scattered his ashes in Prouty Garden.

“I have always felt a tremendous commitment to Boston Children’s Hospital. And every year since my brother’s death I have come here, to celebrate my brother, to walk through the garden, to remember him,” she says. “And for the administrators of this hospital to betray the people of Boston, to betray their patients and the parents and the families like this is, it’s just, I can’t even speak.”

As of now, the hospital plans to begin construction on the new clinical building next year. And, administrators say, they will hold multiple ceremonies to honor Prouty Garden and say goodbye.

Earlier Coverage:
Categories: Health Care

On the Shelf: Hispanic Heritage Month at the Law Library

In Custodia Legis - Thu, 09/24/2015 - 11:36am

Seminario Judicial de la Federacion (photo by Betty Lupinacci)

The following post is a joint effort by Betty Lupinacci (intro, photos) and Jennifer Davis (main text), both staff members in the Collection Services Division.

Earlier this month Jennifer wrote about some of our newest acquisitions on piracy law.  Following that post, the Global Legal Collection Directorate decided that we would regularly highlight not only new acquisitions, but interesting items in our collection that we run across in our day-to-day duties.  With this post, we are inaugurating a new series titled On the Shelf.

Much like the Global Legal Collection Highlights series our goal is not to endorse any particular titles, but merely to inform readers about the vast array of legal material we hold in our collection.

Unlike the Global Legal Collection Highlights series, these posts will not necessarily focus on content.  Sometimes we may stop to admire books based on their aesthetic qualities, or their sheer size, or maybe it will be a long-standing title that has moved into a new series (say for example, one of the National Reporter System titles).  We might also highlight newly digitized titles that we are working to preserve.  (So bear in mind that at times we may use the word “Shelf” a bit loosely here.)

The Mexican writer Carlos Fuentes said, “We have to assimilate the enormous weight of our past so we will not forget what gives us life. If you forget your past, you die.” Celebrating our heritage—our past, and the past of our families—is our chance to remember what gives us life. In the United States, we commemorate the heritage of Hispanic people during Hispanic Heritage Month.

The observation started in 1968 as Hispanic Heritage Week under President Lyndon Johnson and was expanded by President Ronald Reagan in 1988 to cover a 30-day period starting on September 15 and ending on October 15. The date was chosen because September 15 is the anniversary of the independence of Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua. Mexico, Chile and Belize also have independence days during the celebration period. The commemoration was enacted into law on August 17, 1988, on the approval of Public Law 100-402. These laws are codified in the United States Code at 36 U.S.C. 126. You can find the public laws that designated a week, and then a month, for National Hispanic Heritage in the United States Statutes at Large which is widely available through federal depository libraries.

Another way legal researchers can celebrate Hispanic Heritage Month is to look over the resources available on the Law Library’s National Hispanic Heritage Month research page. Back in the Collection Services Division, Betty and I were talking about the best way we could celebrate the month. Although we could have picked any number of Hispanic heritage jurisdictions or majority Latino populations, we wanted to highlight some of our Mexican titles because we are excited about the recent arrival of a large number of official gazettes of the state of Coahuila.

Gazettes of the states of Coahuila, Baja California, Jalisco, Guanajuato, Sonora and Yucatan (photo by Betty Lupinacci)

We decided to show off some of our Mexican state gazette resources as well, calling attention in particular to Baja California, Guanajuato, Jalisco, Sonora and Yucatán, among our copies of gazettes for the rest of the 31 states, the Distrito Federal and the entire nation. Regular users of Mexican gazettes know that although all of them are available online, most of them are not official unless they’re in paper, and the online versions will print out with a watermark stating that it’s the unofficial version. We had also noted that the covers of the reports of the Suprema Corte de Justicia de la Nación have gotten brighter—formerly a muddy light green, they’re now very shiny and sporting the colors of the Mexican flag, and you can see the results here:

Cover of the report of the Suprema Corte de Justicia de la Nacion (photo by Betty Lupinacci)

Enjoy these shelfies of just a few of our rich holdings on the shelf here at the Law Library of Congress, and have a lovely Hispanic Heritage month!

Categories: Research & Litigation

First Edition: September 24, 2015

Kaiser Health News - Thu, 09/24/2015 - 6:52am
Categories: Health Care


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