The Online Resource for Massachusetts Poverty Law Advocates

Feed aggregator

An Interview with Ammar Alsallumi, Foreign Law Intern

In Custodia Legis - 1 hour 13 min ago

Today’s interview is with Ammar Alsallumi, a foreign law intern working with George Sadek on research related to the laws of Arabic-speaking countries.

Describe your background. What is your academic/professional history?

I obtained my bachelor degree in law (LL.B) from the Islamic University of Medina located in al-Medina al-Mounaura, West of Saudi Arabia. During my undergraduate studies, I co-founded a small technology company in Saudi Arabia called Technology Solutions of MKAN. The experience of creating a small company furthered my interest in pursuing a career in business law. As soon as I graduated from law school, I began working as a legal assistant at Taiba Holding Company, a public corporation in Saudi Arabia. Through my time at Taiba, I acquired first-hand legal experience in the company’s business practices and legal needs. In 2013, I was promoted to the position of corporate legal counsel. I was involved in the liquidation process of one of Taiba’s affiliated companies and helped to establish a subsidiary. The experience was a major stepping stone for me in securities and financial regulation. It also enhanced my interest to seek a master of advanced legal studies in this field. Accordingly, I decided to pursue an L.L.M. degree in the United States.

Ammar Alsallumi, intern with the Law Library Global Legal Research directorate. Photo courtesy of Ammar Alsallumi.

Soon after my arrival in the U.S., I enrolled at Boston University Center for English Language, where I took intensive academic English and business classes until the end of 2015. After that, I moved to Los Angeles and attended the legal English summer program (pre-LL.M.) at the University of Southern California, School of Law. The program provided me with a general understanding of U.S. laws and essential English language legal vocabulary. I then moved to Washington, D.C. where I am now pursuing my LL.M. degree at Georgetown University Law Center, specializing in securities and financial regulation.

How would you describe your job to other people?

I work as a legal intern at the Law Library of Congress. I am specifically assigned to conduct legal research on the Gulf Cooperation Council Countries (GCC). Also, I have contributed articles regarding new legal developments in the Gulf countries to the Law Library’s Global Legal Monitor.

Why did you want to work at the Law Library of Congress?

The Law Library of Congress has unparalleled resources. I feel lucky to be working in this prestigious institution. I am able to utilize valuable resources that have helped me sharpen and strengthen my legal knowledge by enhancing my understanding of domestic and foreign laws.

What is the most interesting fact you have learned about the Law Library of Congress?

It is fascinating for me to see how the community relies on the legal knowledge provided by the Law Library. I found out that the Law Library provides legal studies and resources to all federal agencies as well as reference services to the public.

What’s something most of your co-workers do not know about you?

I am a web developer and a daily online chess player.

Categories: Research & Litigation

This Thanksgiving, Carve Out Time For Lively Discourse On End-Of-Life Wishes

Kaiser Health News - 5 hours 13 min ago

The roast turkey and pecan pie may be the same as always, but growing numbers of families plan to add a tradition to their Thanksgiving holiday this week: a frank talk about their wishes for end-of-life care.

Paul Malley, president of Aging with Dignity, the agency behind Five Wishes, a popular living will, says requests for the documents that guide decisions surrounding serious illness and death typically surge starting now.

“We see a bit of a Thanksgiving rush and a bit of a Christmas rush in December,” said Malley, who notes that 30 million copies of Five Wishes have been distributed since 1998.

Turkey dinner with a side dish of death isn’t everyone’s idea of a festive meal. But Malley and other experts in end-of-life talks say the holidays are an ideal time to have hard conversations about final preferences and plans.

“People come home for the holidays,” said Ellen Goodman, the longtime columnist and reporter who co-founded The Conversation Project, which provides kits to kick-start end-of-life discussions. “It’s one of those times when we’re together. It’s something that’s important to talk about.”

While many families will start such discussions for the first time this year, Dr. Patricia Bomba’s family has made the talks a tradition since 1992.

“After the dinner dishes are cleared, the adults in our family stay at the table and talk about what matters most in our lives,” said Bomba, vice president and medical director for geriatrics for Excellus BlueCross BlueShield in New York.

Her family joke is: “There’s no pumpkin pie until you tell me how you want to live until you die,” she added. But the holiday sessions helped guide serious decisions when Bomba’s mother died, she said.

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up Please confirm your email address below: Sign Up

The conversations typically occur between middle-aged children and their elderly parents or grandparents, but they should include all of the adults in a family, Malley said.

“Don’t just put your grandparents in the hot seat,” he said. “It makes for a better and easier family conversation if everyone is in it together.”

The goal is to ensure that people’s preferences are honored. But the talks also can reduce the guilt and depression many family members feel after a loved one dies.

“You can talk about what your values are, who you want to make decisions for you, the care you want, the care you don’t want,” Goodman said.

Often, though, no one wants to broach the subject, even when they think they should. A 2013 Conversation Project survey found that while 90 percent of people said it’s important to have end-of-life discussions with their loved ones, fewer than 30 percent had done so.

Nationwide, about a third of adults in the U.S. have completed written advance directives that spell out wishes for care or designate the person they’d like to carry them out, according to a study in the journal Health Affairs.

Research shows that advance care planning, including the use of written documents, can increase the chances that people’s end-of-life wishes will be followed.

But conversations held over time are key, said Jeannette Koijane, executive director of Kokua Mau, the Hawaii Hospice and Palliative Care Organization in Honolulu.

“Just checking the boxes is not what makes the difference. It’s the conversation that makes the difference,” she said.

Having those conversations in person is important, too, said Malley, who plans to help his parents, who are in their 70s, update their documents over the holiday.

“It’s a natural time to discuss which one of us boys do you want to be your health care agent?” said Malley, the youngest of three brothers. “My parents are teaching us about advance-care planning by doing this together as a family.”

Still, starting such a conversation can be difficult, Goodman said.

“People think if I bring this up with my elderly parents, they’re going to think I want them dead. Or there’s something wrong,” she said.

But if family members can explain that the goal is to understand what matters most to the person at the end of life, the conversation changes. The agency has put together a video that uses humor to show how to break the ice.

“When you say how important it is to you, it’s truly a gift,” Goodman said.

She sees a shift in the culture surrounding end-of-life wishes, even in the five years since The Conversation Project started.

Back then, the specter of “death panels” nearly derailed Obamacare. Today, end-of-life conversations are being paid for by Medicare and books like Atul Gawande’s “Being Mortal” have topped the best-seller list.

“I’m convinced we’re at a tipping point,” Goodman said. “It’s so important to get it right. When you get it wrong, you get something big wrong.”

Categories: Health Care

Problems With Your Hospital Care? Speak Up!

Kaiser Health News - 6 hours 8 min ago

My dad was in excruciating pain over Labor Day weekend, so my mom rushed him to the emergency room of a renowned university hospital.

Doctors determined that he needed surgery that night, and luckily I was able to fly in and see him before he was wheeled away. “Take care of your mom if anything happens to me,” he said as my mom and I wept.

Thankfully, my dad made it through. But he had to spend 11 days recovering in the hospital, a place he now equates with prison.

One night, he suffered for five hours, desperately calling for help after his pain meds had run out. A nurse’s aide stationed in his room had fallen asleep.

“I called on the intercom so many times, and nobody showed up,” he recounts.

That was just one of the many failures in care that we encountered during my dad’s stay. Others included inconsistent nursing quality, waiting all day for doctors to respond to pages, insensitive communication of bad news, trying in vain to reduce noise levels so my dad could sleep, and so much more.

My job is to give you advice on health care and insurance issues. My mom is a registered nurse. Yet we both felt frustrated that we couldn’t make things better for my dad.

Unfortunately, this happens to a lot of people. “Everything you hear these days is about patient-centered care, this and that,” says Terry Bay, who owns a Casper, Wyo.-based business that provides advocacy services to older patients. But “we don’t live in a patient-centered health care environment.”

Today I’m going to offer advice for you in case you or a loved one lands in a hospital.

There are state and federal laws that cover, among other things, your rights to privacy, nondiscrimination, language interpretation and visitation, says Lois Richardson, vice president and legal counsel of the California Hospital Association.

But beyond legal protections, there are people you can talk to and steps you can take to improve your situation if you feel you’re not getting the care you deserve. And patients’ opinions do count.

“All hospitals increasingly are being scored and paid based on patient and family satisfaction scores,” says Rebecca Kirch, an executive vice president with the National Patient Advocate Foundation. “There is power in the people.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up Please confirm your email address below: Sign Up

That power starts with a few simple things.

First, make sure a spouse, child, family member or friend — anyone concerned for your well-being — can spend time with you in the hospital and be your advocate. You cannot do it by yourself while you’re in pain, medicated and not thinking clearly.

“It’s having someone else in your court, someone who can check in and make sure your questions are being answered,” says Dr. Rebecca Sudore, a geriatrician and palliative care physician at the University of California-San Francisco.

Before you or your advocate speaks to your nurse or doctor, write down your questions. Keep track of your glasses, hearing aids and dentures — the personal belongings that most often go missing in hospitals, Sudore says.

“How can someone speak up for themselves if they can’t see someone? Or can’t hear?” she asks.

When the time comes to ask questions — or express frustration — don’t be afraid to speak up. You have every right, even though it can feel intimidating to question your doctors or complain about your nurses.

“You can say, ‘No, I don’t want to go for that test. I want to speak to my daughter first,’” Bay says.

If you’re getting jostled out of sleep for a blood draw or blood pressure check in the middle of the night, ask your doctor the next day if it’s really necessary. Often, it can wait till early morning, says Julianne Morath, president and CEO of the Hospital Quality Institute.

“It’s up to us to put our own humanity back into decisions,” Sudore says.

But here’s where speaking up can get thorny.

Let’s say you don’t feel you’re getting adequate care or you’re unhappy with how you’re being treated. You can start with your nurse, but if that’s uncomfortable — perhaps because that nurse is the source of the problem — approach the charge nurse, who manages the staff in your unit.

You can also ask to talk to a hospital-based social worker, who can intercede or help you figure out who to talk to, Kirch says.

If that doesn’t help, take your complaints to the next level.

Every hospital that participates in the Medicare program — which is most — must have an ombudsman or patient rights advocate, Richardson says. My mom and I eventually complained to the patient rights advocate. It helped, and we wish we had done it sooner.

If you can’t go to the patient rights advocate yourself, “you can call them or ask your nurse to call them and have them come up to your room,” Richardson says. Hospitals must acknowledge patient complaints immediately, she says, and must respond in writing once they are resolved.

As part of this process, no matter whom you talk to, there are some phrases that can spur quick action, Kirch explains. One is “This doesn’t feel like quality care to me.” Another is “I see my loved one suffering.”

If you have a serious illness and you’re suffering from symptoms that aren’t being managed correctly, you can also request a consultation with a palliative care team. Palliative care isn’t only about end-of-life issues, it’s about quality of life, Kirch says.

Most large hospitals have a multidisciplinary team of doctors, nurses, social workers, chaplains and others who can provide added support on top of the medical treatment you’re receiving, especially if you’re getting shuffled among medical specialties.

“They can help tremendously to fill in the blanks. … It can be pain management. It can be spiritual or psychological distress,” Kirch says. “The palliative care team treats the person beyond the disease.”

If you have done all that and still have concerns, Kirch’s organization has case managers who provide free, one-on-one support for patients. Call 800-532-5274 for more information or visit www.patientadvocate.org/help.php.

To be clear, I’m not suggesting you complain about every little thing. Be realistic. For instance, a hospital doctor may see up to 30 patients a day. So you might have to wait for your page to be answered unless you have a serious, potentially life-threatening problem, Sudore says.

“It may not be that you’re being ignored. It might be that someone has to figure out the competing priorities,” she says.

And don’t forget that your caregivers are human too, Morath advises. “They get tired, they get stressed,” she says. “Very often, just letting them know you’re not getting what you need and asking for their help … is a very powerful act.”

Categories: Health Care

Got Food Allergies? Add Milk To The Worries For Your Meal

Kaiser Health News - 6 hours 13 min ago

Since her son Matt was an infant, Lynda Mitchell knew he had a milk allergy.

She controlled the symptoms by switching his baby formula. But when he was 1, Halloween proved horrifying. While trick-or-treating in a pumpkin costume, Matt grabbed a chocolate bar and bit through the wrapper. Although he spit out the candy, his violent allergic reaction morphed into a mess of hives, swelling and labored breathing. He ended up in the emergency room.

That was 26 years ago, but Mitchell vividly recalls the fear of that night — and of raising a child with a condition for which there was little information.

“It was really a scary time to have a child with a food allergy,” she said.

Since infancy, Matt Mitchell has lived with a milk allergy. He experienced his first severe allergic reaction after biting a candy bar while trick-or-treating as a pumpkin, according to his mother, Lynda. (Courtesy of Lynda Mitchell)

To this day, Matt is extremely careful about his diet. He carries an EpiPen to thwart a severe attack if he inadvertently eats a milk product.

New research on food allergies finds that milk allergies pose not only a medical, but also a financial burden for families.

In fact, the condition registered the highest average number of services per patient of any food allergy in 2016 — outpacing even the widely publicized allergies to peanuts and shellfish, according to the analysis by Fair Health, a nonprofit that manages a database of private insurance claims and provides cost information to the health care industry and consumers.

Still, the study found that peanuts outranked all other single food allergens in causing severe and sometimes fatal reactions known as anaphylaxis. Peanut allergies accounted for a quarter of medical services given to treat anaphylaxis from 2007 to 2016. Anaphylactic reactions to milk products represented just 5 percent.

The data add to the mounting evidence that the number of people living with a food allergy is on the rise. From 2007 to 2016, medical services related to food allergies listed on private health insurance claims increased by 76 percent, said Dean Sicoli, executive director of communications for Fair Health.

BJ Lanser, director of the pediatric food allergy program at National Jewish Health in Denver, said the causes of those allergies aren’t limited to certain headline-grabbing foods.

While peanuts pose a potentially life-threatening risk for some people, he said, other food allergies can also lead to a lifetime of physical and financial stress.

“We can’t just think about peanuts. We have to think about the other major food allergens,” he said. “This is a disease that carries a significant cost burden.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up Please confirm your email address below: Sign Up

Among the findings from the report:

  • The rise in food allergies varied by locale. From 2007 to 2016, the number of services and procedures for those allergies increased by 70 percent in urban settings and more than doubled in rural areas.
  • For children, food allergy claims were more common among boys than girls, but among adults the opposite was true.
  • The effects of allergens also varied by gender. Women and girls were most commonly treated for food additive allergies, but peanuts were the top category for men and boys.
  • Food allergies are typically associated with children, but 34 percent of procedures and services involved a patient older than 18 years.

The report also looked at the costs of treating anaphylactic reactions in food allergies. The number of treatments for these life-threatening occurrences rose 377 percent from 2007 to 2016. But surprisingly, 7 in 10 services were handled in physicians’ offices, while 13 percent were in outpatient facilities (which could include hospital emergency departments). Two percent were specifically labeled as emergency room treatment.

Today, Matt lives independently. He has learned to cook dairy-free dishes and carries an EpiPen with him at all times in case he ingests milk. (Courtesy of Lynda Mitchell)

According to the Food and Drug Administration, more than 90 percent of food allergies are linked to eight foods: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybeans. Milk sensitivities can vary, ranging from a severe allergy like Matt Mitchell’s to an intolerance that causes gastric distress but is not technically a medical allergy.

The Fair Health report found that a peanut allergy is less financially menacing than other foods. Services and treatments related to a peanut allergy averaged $236.73 per patient in 2016. That was a quarter of the cost for a milk product allergy, which averaged $1,043.89 per patient in the same year.

Lanser said the high cost of treating milk allergies is likely related to the high price of milk substitutes, particularly alternative baby formulas. Neither the researchers nor the experts, however, could explain the wide variation in the cost of treating anaphylaxis among food allergies.

Robin Gelburd, president of Fair Health, said the report aims to identify trends in food allergies that could inspire other studies and discoveries. “We never want our data study to be the end of a conversation,” Gelburd said. “Rather, we would want it to be the beginning of a conversation that adds greater understanding to an area.”

Today, Lynda Mitchell is acting chief executive officer of the Asthma and Allergy Foundation of America, a patient advocacy group for people with asthma and allergies. True to tradition, with her son in mind, she intends to prepare Thanksgiving dinner without milk. She will search for a turkey that has not been injected with a solution that could have a milk base. She will make mashed potatoes with chicken stock and margarine but no milk or cream. And she will make her dairy-free pumpkin pie.

“As a parent of a child with a food allergy — especially a young child — you just always have to be surveying the landscape and having that vision going in your head about whether this is going to be a high-risk situation or not,” she said. “And it’s worth it. But it’s just something that parents of children that have food allergies have to do every day.”

Categories: Health Care

Podcast: ‘What The Health?’ Meanwhile, In Other Health News…

Kaiser Health News - Tue, 11/21/2017 - 2:43pm

Most followers of health policy have been consumed lately by the potential repeal or alteration of the Affordable Care Act, as well as the ongoing open enrollment for individual insurance for 2018.

But that’s far from the only health news out there. In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Alice Ollstein of Talking Points Memo, and Sarah Jane Tribble of Kaiser Health News discuss some of the important but under-covered stories you might have missed this fall, including prescription drug price fights and women’s reproductive health.

Among the takeaways from this week’s podcast:

  • Lobbyists are coming out of the woodwork – spending more than $42 million over the last quarter — on a battle over whether Medicare should reduce what it pays for drugs at hospitals that primarily serve low-income patients.
  • Massachusetts has passed its own guarantee of no-cost contraceptives for women, after the Trump administration rolled back the federal health law provision.
  • The health law’s individual mandate is front and center in the tax debate, but it’s not clear how the Senate will come down on it. Some GOP moderates are suggesting that they might support the repeal if another bill to help stabilize the individual insurance market is approved. Yet at the same time, the White House is signaling that it might be fine dropping the mandate.
  • Of course, if Congress opts not to tackle the mandate, the White House could take some actions later to neutralize the provision. That could add another log on the fire as critics seek help through the courts to stop administration actions. Email Sign-Up

    Subscribe to KHN’s free Morning Briefing.

    Sign Up Please confirm your email address below: Sign Up

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: The Washington Post and Kaiser Health News’ “Ambulance trips can leave you with surprising – and very expensive – bills,” by Melissa Bailey.

Joanne Kenen: The New York Times’ “Skin Cancers Rise, Along With Questionable Treatments,” by  Katie Hafner and Griffin Palmer.

Alice Ollstein: The Washington Post’s “What the parasites in a defector’s stomach tell us about North Korea,” by Cleve R. Wootson Jr.

Sarah Jane Tribble: The Washington Post’s “How we got the story about monkeypox,” by Lena H. Sun.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Categories: Health Care

Spark a Lifelong Adventure of Learning: Your Gift Makes a Difference!

In Custodia Legis - Tue, 11/21/2017 - 11:48am

The following is reposted from the Library of Congress blog. This is a guest post by Sue Siegel, director of development for the Library.

The Library is one of the greatest gifts the United States Congress has given to the American people. Its support provides a foundation of excellence in collecting, preserving and providing access to knowledge. There is so much to discover, not only the nation’s memory, but the world’s—information from all corners of the earth, in more than 470 languages. With millions of items available online, you can access the Library’s treasures from anywhere.

The Library is strengthened by donations from people like you. Your gift supports free programs that enrich the lives of millions of people across the nation and around the world and continues a legacy of philanthropy.

Transformative gifts like those from Elizabeth Sprague Coolidge, Gertrude Clarke Whittall, John W. Kluge,  Jay I. Kislak and David Woodley Packard and gifts of all sizes bring the Library to life with music, dance, film, sound, culture, scholarship, research, discussions and ideas. Your gift, no matter the size, will support diverse programs that make the Library’s treasures and services more accessible.

Why Give to the Library?

Your gift can help

  • Acquire and preserve rare and unique items that are important to our history.
  • Make the unique and universal collections of the Library accessible to the public through exhibitions, digitization and other means.
  • Develop scholars and grow new scholars.
  • Spark the imagination of people of all ages with programs that open the Library’s doors wide to as many people as possible.

At this time of the year, we would especially like to thank our generous donors for support that inspires curiosity, ignites conversations and illuminates minds.

The Library of Congress is your library, your gateway, to understanding the world. Please make your gift to spark a lifelong adventure of learning.

Categories: Research & Litigation

Study: Medicaid for Parents Boosts Preventive Care for Children

Center on Budget and Policy Priorities - Tue, 11/21/2017 - 10:09am

Children are much likelier to receive preventive care when their parents enroll in health coverage, new research published in the American Academy of Pediatrics’ journal finds. Low-income children with parents enrolled in Medicaid are 29 percentage points likelier to get an annual well-child visit.

Categories: Benefits, Poverty

Pages

Subscribe to Mass Legal Services aggregator

Limit Offer