Tag: politics

Abortion clinic regulation scandal in PA

Yesterday, I briefly posted a link to an article about Kermit Gosnell, a physician in Philadelphia who has been charged with the murder of a patient and sevenbabies. I knew I recognized the name but couldn’t place it at the time. After looking a bit more, I found several articles on the Gosnell’s background (e.g., this one from LifeNews).

Then I located the grand jury report on the case which included testimony of lawyers for the PA Dept of Health (beware – the report is not for the faint of heart). There is some confirmation of my suspicion that the reason abortion clinics had not been inspected related to policy. Here is a passage (pp. 161-164) where the report characterizes the testimony of attorneys for the DOH.

It was clear to us after hearing these witnesses testify that the decisions not to inspect abortion clinics or to license them as ASFs were not based on any serious interpretation of statutes or legal research. These lawyers were simply twisting and reinterpreting the law to explain policy decisions that changed with administrations, even though the laws did not. Dutton admitted in her testimony that the decision not to inspect was a policy decision, not one grounded in the law:

Q: Does it surprise you to know that some of the reasons cited for the failure to go out and do these inspections is that they believed that they didn’t have the legal authority to do so?

A: That would surprise me, yes. . . . To me, I would believe that they didn’t go out to do them because some policy had been set in the department at some point in time in the past that we were not going to do regular inspections of abortion facilities.

Dutton’s failure to recognize and treat abortion clinics as ASFs, and her silence as DOH shirked its duty to protect women and infants at abortion clinics, reflect a blatant refusal to enforce the law.

The DOH attorneys offered multiple explanations to attempt to justify why the department does not license abortion clinics in the same manner as any other ASF. None of their explanations comports with the law or with common sense.

Two of their “justifications” are barely worth comment. One lawyer told us that there is always “push-back” from doctors who do not want to be licensed as ASFs. Not only is this argument irrelevant to any legal analysis, it is unpersuasive. We learned that there are fewer than 30 abortion providers in the entire state. These doctors should not be able to exert that much push-back. Moreover, the legitimate abortion providers who testified before the Grand Jury told us that they already comply with standards as demanding as those for ASFs. Abortion rights advocates told us the same thing – that licensing abortion clinics as ASFs would not be burdensome because clinics that are members of NAF, or associated with Planned Parenthood, already comply with the highest standards of care.

A second reason proffered by DOH attorneys for not licensing abortion clinics – that abortion is “controversial” – is just insulting. Abortion is a legal medical procedure. Any controversy surrounding the issue should not affect how the law is enforced or whether the Department of Health protects the safety of women seeking health care.

The DOH lawyers offered up policy based reasons not to regulate abortion providers but the grand jury dismissed these excuses.

I am hoping an investigation of the DOH will now commence to discern who authorized the policy which illegally exempted abortion facilities from inspection. As the rest of the grand jury report makes clear abortion facilities are required to be inspected by state law regulating ambulatory surgical facilities (ASFs). However, apparently for decades, these facilities have not been treated as such and allowed to practice without oversight.

Situation worsens in Pakistan; security increased for Asia Bibi

The assasination of Punjab Governor Salman Taseer has made political instability even more likely in Pakistan. Never far from collapse, the current government is facing multiple challenges from ongoing flood cleanup and relief to survivors to threats of violence from emboldened Islamic extremists.

New developments include:

500 Islamic “scholars” lauded the murder of Salman Taseer and praise his killer.

ISLAMABAD, Pakistan — The increasing radicalization of Pakistani society was laid bare Wednesday when the nation’s mainstream religious organizations applauded the murder of provincial governor Salman Taseer earlier this week, while his killer was showered with rose petals as he appeared in court.

Taseer, 66, the governor of Punjab, the country’s most heavily populated province, was assassinated Tuesday by one of his police bodyguards after Taseer had campaigned to ease Pakistan’s blasphemy law. Religious groups threatened to kill others who questioned the blasphemy statute, which is designed to protect Islam and the Prophet Muhammad from “insult.”

Security around Asia Bibi has been increased due to fears that a suicide bomber will take out the prison.

The death of Taseer has not mobilized moderates and civil society. If anything, according to Pakistani observer Fareed Zakaria , the situation is worsening in the direction of the extremists and Taliban.

Zakaria: This is a huge event in Pakistan. First of all it’s important to understand what Punjab is in Pakistan. Punjab is the most populous part of Pakistan, it is the most prosperous part of Pakistan, it’s also the heart and soul of Pakistan’s governing class. The officer corps of Pakistan’s military is largely Punjabi, there are some accounts that suggest as much as 80% of the officers corps comes from Punjab.

This man, Salman Taseer, was probably the most prominent liberal or progressive politician in Pakistan today. He was a very close ally of Benazir Bhutto, the Pakistani politician who was assassinated three years ago. He was a very powerful man in his own right and was famous as a crusading liberal — in particular against the forces of extremism and militant Islam.

Zakaria sums up why this issue is critical to our mission in the region. 

CNN: Why is this of concern to the United States?

Zakaria: For the United States, this issue is actually at the center of whether or not it will be able to succeed in Afghanistan. Let’s remember, the strategy in Afghanistan cannot succeed as long as there are sanctuaries for the Taliban and al Qaeda in neighboring Pakistan.

Right now what happens is the Taliban crosses the border from Afghanistan into Pakistan, regroups, gains support, logistics, resources in Pakistan, and then comes back to fight the U.S. forces or Afghan government forces. This has been the key to their ability to survive and thrive, so unless you can deal with the sanctuaries in Pakistan, you’re not going to make any headway in Afghanistan.

The entire leadership of al Qaeda and the leadership of the worst elements of the Taliban are all in Pakistan now. In order to deal with that, to destroy those terrorist groups, the Pakistani army has to be willing to go into the areas where these various groups have their strongholds, mostly in a part of Pakistan called North Waziristan.

So far, the Pakistani army has refused to do so. The most important reason is that they fear a backlash within Pakistan. They’re too nervous about the political consequences of having this frontal struggle against Islamic extremism. So if you can’t confront Islamic extremism with things like the blasphemy law, what hope is there that they actually go ahead and mount large-scale military operations in North Waziristan?

I suspect this line of thinking informs the Obama administration and may explain why the White House has made only general statements about blasphemy laws and to my knowledge not publicly condemned the plight of Asia Bibi. In some of the Pakistani rallies in favor of the blasphemy laws, “death to America” is also a rally cry.

We also have a multi-billion dollar investment in Pakistan but the elements which oppose us don’t care if we remove it – at least this is my take on it at this point. I suspect there are Islamic governments that would be happy to supply extremists with funds if they were in charge of the country. We have few carrots and seem reluctant to use our sticks.

And finally, here is an article with citations from my new British friend, Raza Anjum. Raza has been in Pakistan for weeks attempting to see Asia Bibi and win her release. I also provided his assessment of the situation with quotes from Taseer Salman just days before he was murdered.

The website that cried wolf: World Net Daily and death panels

Today, the far right website, World Net Daily, is accusing the President of using the Food & Drug Administration drug approval process as a way to ration health care via “death panels.”  As evidence for the claim, this front page story by Greg Koprowski states that “new drug approvals declined dramatically last year” citing a drop in such drug approvals from 25 in 2009 to 21 in 2010.

Although website claims the article is “breaking news,” the other evidence offered is a quote from a July 27, 2010 letter to FDA official Dr. Richard Pazdur from Senator David Vitter (R-LA) writing in support of the anti-cancer drug Avastin.  The FDA recently made a recommendation to remove the breast cancer indication from the Avastin drug label. In the letter, Senator Vitter worries that the approval process may signal the beginning of treatment rationing.

I spoke with Sandy Walsh at the FDA who called the claim that the FDA was using cost as a measure of approval “absurd.” She also noted that recent approvals are in line with past years.  As a review of FDA data demonstrates, she is correct.  For perspective, here are numbers of new medicines approved by the FDA from 2000 to the 2010 estimate.

2010 – 21 (estimated)

2009 – 25

2008 – 24

2007 – 18

2006 – 22

2005 – 20

2004 – 36

2003 – 21

2002 – 17

2001 – 24

2000 – 27

Mr. Koprowski called the drop from 25 new drugs in 2009 to a “mere 21 new drugs in 2010” a dramatic decline. Not at all. An examination of the approvals over time tells a different story. Clearly, Obama’s FDA is keeping pace with the record of the Bush administration.

Regarding Avastin, the maker of the cancer fighting drug is appealing the decision but it is simply wrong to assume that the FDA decision was based on cost considerations. The FDA panel that voted 12-to-1 to recommended the action consisted of physicians and patient advocates. FDA spokesperson Erica Jefferson told me that “no political appointees were involved in the decision-making” adding that “most of the reviewers have been with the agency close to 15 years.” Moreover, the decision was endorsed by the National Breast Cancer Coalition, which said about the action, “We applaud the FDA for responding to the scientific evidence in the face of significant political and public pressure.”

By reading WND, one would never know the rest of the story. Selective reporting is just one reason to question crying wolves at WND. Enter the Medicare death panel scare.

In late December, World Net Daily published an article that said the Obama Administration was slipping death panels back into Medicare via a regulation defining patient-physician discussions of advance directive planning. Yesterday, the Obama administration rescinded that rule, in part because of the misinformation campaign waged by social conservatives.

Judie Brown of the American Life League was quoted as saying:

Nothing good can come of this,” said Judie Brown, the president of American Life League. “This will affect everybody’s parents and grandparents and preborn babies, and it will not affect anybody for the good.

She added ominously:

Congress must step up to cancel the regulation, Brown added. “If not, a death certificate is written for an awful lot of elderly people.”

Ratcheting up the rhetoric, Liberty Counsel’s Mat Staver told WND that the Medicare regulation was not just a death panel, but a “super death panel,” saying

When you have the government mandating this end-of-life counseling, they’re conscripting doctors to do end-of-life counseling on a massive scale. It will be the equivalent of a super death panel. Elderly patients will get confused and will end up signing documents without having a clue what they’re signing, and they will sign away care they might really want.

As I noted in a previous post, claims that the just rescinded Medicare regulation required doctors to persuade senior citizens to refuse care are just false. The new regulation was an extension of a definition of advance care planning which remains a part of the initial Medicare visit, a provision that was added by Congress in 2008. That bill was passed via override of a President Bush veto. The veto however, had nothing to do with end-of-life counseling, but rather concerns over cost. As far as I can find via search engines, there was no outcry from conservatives then over the end-of-life provision. No one cried death panels then.

As an administration official told me yesterday, Medicare does not prescribe any conversation between patients and physicians about end-of-life issues. Patients are free to use pro-life resources and advance directives to plan their end-of-life care. The only reason the definition was included was to alert physicians that these conversations are important. There is neither a separate reimbursement for advanced care planning now nor would there have been if the rule, rescinded yesterday, would have remained viable.

In the case of the advance care planning regulation, the scare tactics worked. The Obama administration backed off of a reasonable definition of advanced care planning, a practice that pro-life groups actually recommend to their constituents. However, hysteria and spin won out over good policy. In the case of FDA approvals, it is clear that there is no trend specific to this administration. At what point, do readers realize that those crying death panels are crying wolf?

Administration reverses course on end-of-life care planning regulation

UPDATE: I just spoke with an Obama Administration official who said the new proposed rule would be published at 4:15pm today in the Federal Register. This will allow for comment. He also confirmed to me that the advance care planning provision remains in the initial Welcome to Medicare visit with a physician. That provision was included by via statute during the Bush Administration in 2008. In other words, all of the bluster from social conservatives is a bit late. The Administration official indicated that the rule had been removed in order to give the public opportunity to indicate their views on the issue. He noted the misrepresentation of the issue and the Administration did not want the political process to jeopardize the existing benefits.

….

Annual voluntary advance care planning, we hardly knew ya.

Last week, I defended a new Medicare regulation which would have added advance end-of-life care planning to the definition of what could take place during the new Annual Wellness Visits authorized by the Affordable Care Act (ACA), otherwise known as ObamaCare. Some conservatives demonized this rule as the return of “death panels” in an effort to frighten voters. I don’t know whether or not the public was frightened, but according to the New York Times, these false characterizations scared the administration so much that the rule is being deleted.

And this is sad because this is case where spin and misinformation won out over fact and good sense. The truth is the Medicare regulation did not create a new reimbursable benefit and did not bring back “death panels.” The regulation added one voluntary component to the annual wellness visit – a discussion of the patients’ wishes if they become unable to express themselves during illness or injury. Physicians were not going to be paid separately for this conversation; they will still do the annual wellness visit and focus on many other issues of prevention and health maintenance. And here is the kicker, physicians can still bring up advance care planning if they want to.

Social conservatives who ranted about government involvement in end-of-life decision either had not read the regulation or were  intentionally  misleading people. 

But now the administration without attribution has shifted course and it is quite unclear why. 

Since yesterday morning, I have been seeking answers from the HHS press office and will comment more  as I get more information.

Here is an AP piece on the matter…

Governor of Pakistan’s Punjab province killed by his own security guard

This is a shocking and ominous development in Pakistan. Increasing calls from outside Pakistan for reform of blasphemy laws and the release of Asia Bibi has been met with a rise in violence from far right Islamic forces.

Islamabad, Pakistan (CNN) — The governor of Pakistan’s Punjab province, Salman Taseer, was assassinated by his own security guard Tuesday, according to Interior Minister Rehman Malik, apparently because he spoke out against the country’s controversial blasphemy law.

The security guard was arrested, Malik said. The shooting occurred at Islamabad’s Kohsar Market, which is frequented by foreigners.

Taseer went into the market to make some purchases, and he was shot by his guard as he left, said Naeem Iqbal, spokesman for Islamabad police. He was taken to a hospital, where he died, apparently from blood loss.

Malik told Pakistan’s GEO TV that Taseer was assassinated because he spoke out against Pakistan’s blasphemy law.

A spotlight was put on the law in November when a Christian woman, Asia Bibi of Punjab province, was sentenced to death for blasphemy. A court found the 45-year-old woman guilty of defiling the name of the Prophet Mohammed during a 2009 argument with fellow Muslim field workers.

When I spoke recently with Raza Anjum, UK city official now in Pakistan trying to win the release of Asia Bibi, he told me that Taseer was a fair man who saw the injustice being done in the name of Islam. He spoke out in her favor and worked to get a fair hearing for her case. For that reason, he was under constant threat.

Pakistan is no stranger to such violence but the issues surrounding the blasphemy laws appear to be giving extremists a rallying cry for opposition to moderate elements. The government recently demonstrated weakness by backing away from a bill that would reform the blasphemy laws. It shows no signs of an effective response to the far right.

I will be adding updates and information as I get it. Here is an interview with Taseer about why he took up Asia Bibi’s cause. Note his confidence in the ruling party. This was before the party began to capitulate to extremists.