Health Care – Should Your Doctor Decide?

In years past, a doctor had the authority and power to decide what treatment and/or modality was appropriate. Each health care provider chose the remedy, relief &/or intervention based upon the following: (1) a specific diagnosis; (2) a tentative diagnosis [provisional]; &/or (3) a differential diagnosis [generally, that which relates to multiple conditions or causes that are based upon probabilities].

As medical insurance, Medicare, Medicaid and now Obamacare (officially entitled the Affordable Care Act) have intervened, their coverage for treatment rendered by a physician has been strictly refined and restricted, as well as subject to interpretation more often than not by lay individuals. These current business and regulatory systems in place seek to justify their role by pointing to, among other things, the nature and amount of waste, and their goal to make our health care better. In doing so, they often perceive medical treatments as increasingly suspect. As such, the scope of coverage of the third party payer system has continued to place limits on physicians, hospitals and other health care providers, along with using monetary incentives to achieve their political and business goals.

 Clearly, there are many who support the current scheme and, therefore, contend it is designed to produce an effective health care system, albeit conceding it is far from an ideal one. The opponents assert this system will inevitably lead to the rationing of medical care with a much smaller group of health care providers who choose such a career and, therefore, less available to serve the public, fewer innovations, and eventually far less medical research. In addition, they cite other countries that have socialized medicine and the inherent problems therein, including but not limited to the increasing waiting time before one can obtain an examination or evaluation; the length of time until one can obtain certain procedures and treatment; the inability of the physician to choose the nature and extent of care deemed appropriate; and, the growing trend to depersonalize the health care system as a whole. The debate continues while the ability to produce a better result is limited as each side remains polarized, and at times vilifying the other.

Articles: Delinquency

LOS ANGELES DAILY JOURNAL
November 02, 2004
ROLE OF DELINQUENCY ATTORNEY WILL EXPAND
By Blair Clarkson
Daily Journal Staff Writer
——————————————-

LOS ANGELES – The juvenile-delinquency court has been called everything from a revolving door to the unwanted stepchild of the justice system. Critics lament a sloppy system that strands minors in youth camps for months or years without effective treatment, only to send them back to court soon after their release.

The new state Rule of Court Section 1479, unveiled in July and presented to lawyers, social workers, judges and child advocates at a family and children’s law conference on Friday, attacks the problem by expanding the delinquency attorney’s role to include advocacy after the court case is finished.

“It’s giving emphasis to a new and important way to start representing kids,” said Jo Kaplan, a prominent delinquency lawyer and juvenile-court commissioner. “This rule says that delinquency counsel have a responsibility to see that the delinquent gets treatment.”

“If you don’t advocate for them to get treatment and services, they’re never going to get better,” Kaplan told an audience at the 9th annual New Beginnings conference in Los Angeles. Objectors, however, said delinquency attorneys have full calendars and lack the time and money to act as social workers for each of their clients.

While Joan Croker, head deputy in the juvenile division of the Los Angeles County public defender’s office, supports post-disposition advocacy, she says financial realities make it impossible. “In a perfect world, we would do this for every single client,” Croker said. “But nobody can afford that. The system doesn’t have the time. We need more funding to do it the way it should be done.”

Delinquency attorney Pat Rice, who joined Kaplan on Friday, insisted the job can be done. “Scheduling will be a hassle with juggling new hearings and follow-ups, but you’ve just got to do it,” Rice said. “All we really have to do is think a little differently.” The new rule outlines a dual role for delinquency lawyers. In addition to learning everything possible about a client’s particular mental health and personal life, the advocate must review the client’s treatment plan continually, see that it is fully executed in rehabilitation camps and work with the child toward permanent solutions. The extra work will cut into the high recidivism that attorneys say is a product of lack of follow-up to ensure that the delinquent child receives the particular educational or psychological services he or she needs in youth camps and juvenile facilities.

An Orange County report cited by the League of Women Voters Juvenile Justice Commission found that 8 percent to 12 percent of juvenile offenders accounted for 60 percent of juvenile crimes. “Nobody ever checks up on these kids,” Kaplan said. “This is really an opportunity for lawyers to figure out a way to check on their clients to see that they’re getting the remedial help they need.” Recent scathing rebukes of the California Youth Authority and other juvenile camps have raised awareness among delinquency advocates about the dearth of services for children in the system. The state has the highest rate of youth incarceration in the country, and overcrowding has limited youth camps’ ability to provide help, according to the state legislative analyst’s office. A concerted effort to correct these problems is long overdue, said Sue Burrell, a staff attorney at the Youth Law Center. “This rule says very loudly that cases should be brought back to court if kids aren’t getting what they need at camps,” Burrell said. “One of the sad things is that everybody acts as though the case is over after disposition. “But that’s when the whole rehabilitation process is supposed to take place.” Yet Burrell, a former L.A. County public defender, acknowledges that more funding and staffing and lighter caseloads will be needed to offset the huge amount of additional work and investigation demanded from delinquency attorneys. “The system has to provide resources to make sure it can be done,” she said. “It’s hard to expect that public defenders can do all this without help.”

Sam Spital, a former deputy attorney general and probation officer now representing delinquents at Spital & Associates in San Diego, says he has little pity for critics of the rule change.

“If you don’t have the time to follow up with your clients, don’t take the case,” Spital said. “Is it about the money you get or about keeping them from coming back into the court system?”