Monday, September 29, 2008

On The Issues

Here is the website of one of the most progressive magazines on women's issues (and thus, imho, human issues):

Sunday, September 28, 2008

In support of Good Medical Practices

On behalf of Governor Paterson and the State of New York, Health Commissioner Richard F. Daines, M.D. this week submitted comments to HHS Secretary Michael O. Leavitt urging the immediate withdrawal of these proposed regulations.

Commissioner Daines said: “Professional standards of medical practice recognize the right of providers to refuse to provide abortion or sterilization services on religious or moral grounds, but they also require providers to assume the responsibility to assure patients access to information and services. The regulations proposed by HHS will disrupt that balance and deprive women of medically necessary health care. In an emergency situation, the consequences could be devastating.”

The proposed regulations were published on Aug. 26.

From: Richard F. Daines, M.D.
Commissioner of Health 9-26-08

Hon. Michael O. Leavitt Secretary United States Department of Health and Human Services Office of Global Health Affairs 200 Independence Avenue, SW, Room 639H Washington, DC 20201

Re: Provider Conscience Regulation
Comments on Proposed Federal Rule: 45 C.F.R. Part 88 73 Federal Register Aug. 26, 2008

Dear Secretary Leavitt:

This is in response to the request for public comment on proposed
45 C.F.R. Part 88, which seeks to implement and clarify the provider conscience provisions of the Church Amendments, the Public Health Service Act, and the Weldon Amendment. After review of the proposal and its likely impact on women’s health care services and their costs, we conclude that implementation of the rule will impede access to quality care and create unnecessary and costly paperwork.

The proposed regulations do not clarify the federal statutes. Rather, they create confusion and leave critical elements open to broad misinterpretation, while providing no protections to ensure that consumers have adequate access to needed health care. They would disrupt access to legal health services, deny timely lifesaving measures and critical care, impede the ability of practitioners and health care entities to comply with current standards of medical practice, and create unnecessary administrative burdens. For these reasons, New York State respectfully requests withdrawal of the proposed rule.

The proposed rule is overbroad, ambiguous and upsets the balance between the rights of providers and the rights of patients.

The proposed rule goes far beyond the federal statutes by expanding its application in two critical ways. First, it appears to permit individuals to refuse to provide care because of personal objections of any nature; and second, it expands the group of employees who may exercise the right to refuse.

In Section 88.1, the regulations outline the proposed rule’s purpose in a manner that expands protection for religious and moral convictions to include the “rights to refuse to perform health care services to which [employees] may object for religious, moral, ethical, or other reasons.” (Emphasis added). The proposed regulation would allow employees and volunteers in federally funded health care settings to refuse to participate in “any part of a health service or research activity,” including providing treatment, information or even referral services, if participating would violate their beliefs.

As a result of this expansion, employers will feel compelled to acquiesce to a wide range of objections or risk legal action or loss of federal funding. Such objections could include participation in implementing end-of-life decisions made by patients and families, aggressive pain management, transfusions, vaccination, HIV/AIDS treatment, infertility treatment, treatment of sexually transmitted diseases and stem cell research. Moreover, the regulation is broad enough to allow workers to refuse services to individual patients or groups of patients whose lifestyles they consider objectionable, such as illegal immigrants, drug and alcohol users, and gay and transgendered individuals. In seeking to prevent discrimination against objecting providers, this rule may inadvertently encourage discrimination against broad classes of health care consumers.

The most likely impact of the rule’s apparent overbreadth is on the provision of women’s reproductive services. While the Health and Human Services Administration has appropriately removed the previous objectionable abortion definition in Section 88.2, the absence of a medically acceptable definition for abortion and sterilization creates ambiguity as to which additional family planning or reproductive health care services are covered. For example, it remains unclear whether providers will be able to refuse to prescribe contraception.

Of additional concern are the new categories of workers who will be able to refuse to participate in practices to which their connection is remote. Section 88.1 and the corresponding supplemental information newly defines “assist in performance” and “workforce” to include anyone connected in any capacity to the health care practice at issue, including, for example, individuals who clean instruments. It will be costly and difficult for hospitals, clinics and private practices to determine whether any particular objecting worker is entitled to the accommodations this rule requires.

Current medical practice standards strive to strike a balance between the rights of the provider and the patient. The ambiguity of this rule will tip the balance away from the needs of the patient. While professional standards of practice support a provider’s right to refuse to provide abortion or sterilization when those services violate moral or religious beliefs, they also require that a provider assume the responsibility to assure patients access to information and services. This balance is widely recognized in the modern American medical community and is a fundamental component of professional practice standards of provider organizations across the country. See, e.g., the American College of Obstetrics and Gynecology Committee Opinion Number 385, November 2007. See also American Medical Association Code of Medical Ethics: Opinions on Practice Matters, E-8.08 Informed Consent.

The rule makes no provisions for emergencies.

We are particularly concerned that the regulations do not include exceptions or accommodations for emergency medical procedures, such as those recognized by the federal Medicaid program. For example, Medicaid will cover the costs of an abortion when “on the basis of [the physician’s] professional judgment, the life of the mother would be endangered if the fetus were carried to term.” 45 C.F.R. § 441.203. No such protection exists here. We believe that without including explicit exceptions, women’s lives could be jeopardized by promulgation of these regulations in their current form. We are concerned and troubled that a woman with an ectopic pregnancy may have to track down a willing provider so that she can get appropriate treatment before it is too late. Similarly disturbing is the prospect that a woman who has been raped may be refused emergency contraception and turned away without assistance to find and obtain it.

Implementation will be administratively burdensome and expensive.

The proposed certification process will create an administrative burden for providers, grant awardees and other sub-recipients receiving federal funds. Recipients of federal funds will find it difficult to certify compliance for themselves and for their sub-recipients, given the rule’s ambiguities. Moreover, the paperwork involved is unnecessary and costly. The certification requirement will make health care more expensive at a time when government should be directing scarce health care dollars to improving health care quality and access.

The cost-benefit analysis performed by the Department of Health and Human Services is inadequate. While it has estimated a cost of $44.5 million for the certification program, this amount represents only part of the picture. The scrupulous provider, attempting to comply with this ambiguous rule, will need legal counsel to determine its application. Employers will have to apply the provisions broadly and engage additional staff in close cases. There will be costly litigation. None of these expenses will improve the quality of health care. The American people have made clear that improved health care and broader access are goals of paramount importance. The wastefulness that will be caused by implementation of this rule is a step in the wrong direction.

In conclusion, the proposed rule is likely to cause irreparable harm to women, ignores current standards of good practice, is unnecessary and costly and creates confusion in the health care system. As indicated above, New York requests that the Secretary withdraw the proposed rule.

Very truly yours,

Richard F. Daines, M.D.
Commissioner of Health 9-26-08

Saturday, September 13, 2008

Blink, blink, Do not Think

That seems to be Palin's motto if we listened/watched her interview with Charlie Gibson this week:, and

And, today's NYT editorial summed it up well--we need a leader who can think, who has experience in this w world

Tuesday, September 9, 2008

Palin:Not good for our children and other living things

Sarah Palin might not be healthy for our children and other living things:
Sarah Palin does not believe in sex education. "Explicit sex-ed programs will not find my support" This is NOT about Bristol Palin's pregnancy, but about the HEALTH of teens having unprotected sex: 1 in 4 American Girls (and the studies only studied girls, not the boys) have an STD.
This goes hand in hand with her stand on NO abortion EXCEPT if the mother's life is in danger. Thus, (young) females who are impregnated by family or stranger rapes will carry the pregnancy to term according to Palin's beliefs: punish the victim! 25%of rapes result in pregnancy,btw.
She is also not for giving our children a good education--she believes that creationism is a valid theory and should be taught in our public schools; and that books banning books is an okay practice in a democracy.

Palin's environmental creds are very questionable: not only does she NOT believe in the human cause of global warming, she advocated voting down a state proposition that would have banned metal mines from discharging pollution into salmon streams; she signed into being laws that let oil and gas companies nearly triple the amount of toxic waste they can dump into Cook Inlet (an important fishery). So, along with her "drill, baby, drill" energy policy ( and tho' she mouthed the words alternative energy at the convention, as governor she actually vetoed a wind energy project's funding).

Monday, September 1, 2008

A lag of ONLY 24 years

Saturday morning I was on the Cape. My cell phone rang; it was a reporter from the Poughkeepsie Journal wanting my reaction to McCain's announcement of Sarah Palin as his running mate.
I told the reporter that i did not know here,BUT vice presidential candidates in the past have only had at most a plus or minus 2% impact--the minus 2% was for Nixon's choice of Spiro Agnew,the plus 2% was for the FIRST major party choice of Geraldine Ferraro to run on Mondale's ticket in 1984.
And, as of today, news surveys have shown NO significant movement of voters towards the McCain camp.
While we may may more attention to who the vice presidential candidate is, credit Cheney for this, I do not believe that Palin will have the desired affect.
Palin will not attract women voters--she is NOT a feminist by any stretch of the imagination. Just because she is a woman,does not mean women will vote for her. Women are not monoliths that McCain, and other men, think we are.
She does solidify McCain's conservative religious right camp more than he does. The Evangelicals are ecstatic!

Here is NOW's statement re:Palin