All posts by Dr. M Blatstein

You’re the FBI Target

You’re the FBI Target

5 Areas You Must Advocate For Yourself

 

PREPARATION = SURVIVAL


If You Suspect You’re The Target of a Federal Investigation | Before The Presentence Interview (PSI) | After The PSI – But Before The Sentencing Hearing | After Sentencing or You’re Already Incarcerated | There Are Still Things We Can Do

For a No Obligation Free Consult Call Dr.Blatstein at: 240.888.7778, or by emailDr. Blatstein answers and personally returns all of his calls.


1st Start interviewing Attorneys

  • Ask for References
  • Ask to see “several Sentencing Memorandums”,
    • If they ask Why, or that is Confidential, politely respond with either.
    • I am sure that you have several “happy” clients that would be willing to speak for a minute or two

… I asked surgeons for references before I had my hip replacement

or

Regarding the Memorandums,

  • the attorney can “just” redact (black out) the person’s personal info.
  • (Here we want to see if they individually take the time to write each one separately, or are they Boilerplate?

 

2nd You and your attorney have a quick decision

  • YOU HAVE TO BE HONEST WITH THEM –
  • ABOUT EVERYTHING (again, here too I was not, Another Lesson Learned)
  • NEXT: Trial (98% of Federal Cases Loose), or Plea

 

3rd If you win at Trial: CONGRATS!!

 

4th You now only have 90 days to prepare for your Presentence Interview

  • (Unless you have extenuating circumstances, but eventually)
  • You and your attorney will be in Proactive mode

YOU

  • Collecting copies of your medical records – Everything
  • Hospital, laboratory, radiology, physician, surgical, prescription, and medical devices

Other: copies

  • You get the picture: educational, military, character, community service, work references, original birth certificates, social security cards, licenses, etc.

 

Your Attorney: Preparing their strategy for The Presentence Interview, then

ASAP they will contact The Probation Officer

  • To learn when their Final Dictation Date Is for Your PRESENTENCE REPORT
    • Why: because they want to get a feel for what they know – and
    • begin to get their “message on the record, “… AKA Bonding
  • To Set Up YOUR INTERVIEW

BE PREPARED because the P.O. will write your PRESENTENCE REPORT based on your INTERVIEW

  • YOU NEED TO KNOW – YOUR NARRATIVE COLD

 

Your PRESENTENCE REPORT IMPACTS

  1. Release Date
  2. Security Level Requirements
  3. Medical and Mental Healthcare Needs
  4. Psychology Programs – Limited Availability
  5. FSA Programming, and Criminogenic Needs, Risk AssessmentETC towards early release

 

MEANWHILE, for the last 3 months you have been writing, and rewriting your story YOUR PERSONAL NARRATIVE

Why?

5th YOUR PERSONAL NARRATIVE

This is your chance to speak directly to the Judge – and where he gets to know you

Done right it can lower your sentence, but no guarantees

 

Still not convinced – Listen to what these five Judges Say:

A Federal Judge’s Musings on Defendants’ Right and Rite of Allocution,

NACDL, The Champion, March 2011

Judge Mark Bennett, My basic principles of allocution include:

(1) be sincere.

(2) discuss what “taking full responsibility” means;

(3) acknowledge that there are victims (e.g., even when the PSR indicates “no identifiable victim,” as it does in most drug cases);

(4) an understanding of how the crime affected the victims;

(5) express genuine remorse;

(6) a plan to use prison or probation time in a productive manner;

(7) a discussion of why the defendant wants to change his or her criminal behavior; and, perhaps most importantly,

  • a true desire to learn a specific trade and a request to go to a specific Bureau of Prisons institution that offers that trade can sometimes be beneficial.

(8) information that helps humanize the defendant and the defendant’s role in the crime.

 

THE FEDERAL LAWYER • September/October 2019

VIEWS FROM THE BENCH, Own the Mistake – Demonstrate Sincere Remorse

Judge Richard G. Kopf of the District of Nebraska,

One of the best allocutions I have ever heard was:

“Judge, I want to atone for what I did to the victims and my family. I deserve some prison time. I hurt the victims, I hurt my family and I’ve hurt myself. When I get out, I am ready to take the following steps.”

 

Judge Jon D. Levy of the District of Maine in Portland, “Allocution matters,”

“I will never hold poor communication skills against a defendant. What’s important is whether I am persuaded that the defendant is sincere and demonstrates insight about the crime…”

 

Judge Cynthia A. Bashant of the Southern District of California

“I want him to apologize to the victim and his or her family, particularly if they are in the courtroom. Just like a parent with a child who has done wrong, I am looking for ‘insight’ from the defendant,”

 

Judge Marcia S. Krieger of the District of Colorado in Denver, has “seen allocutions where a defendant has shown that he is sincere and thoughtful about what he is saying.”

It is very important for the lawyer to prepare his client for allocution if allocution is to be made

It is essential for Judge Krieger that a defendant “publicly admit his shame,” which shows her that he has internalized his crime


If You Suspect You’re The Target of a Federal Investigation | Before The Presentence Interview (PSI) | After The PSI – But Before The Sentencing Hearing | After Sentencing or You’re Already Incarcerated | There Are Still Things We Can Do

For a No Obligation Free Consult Call Dr.Blatstein at: 240.888.7778, or by email. Dr. Blatstein answers and personally returns all of his calls.

First Step Act – Revised 2022

Reduction in Recidivism

Requires the Attorney General to develop a risk and needs assessment system

  • The BOP assess the recidivism risk and criminogenic needs of all federal prisoners
  • Place them in recidivism reducing programs
  • Including productive activities to address their needs and reduce this risk.
  •  Under the act, the system provides guidance on the:
    • type,
    • amount, and
    • the intensity of recidivism reduction programming and
    • productive activities to which each prisoner is assigned, including
    • information on which programs prisoners should participate in based on their criminogenic needs.
    • on how to group, to the extent practicable,
      • prisoners with similar risk levels together in recidivism reduction programming and
      • housing assignments.
  • The Act also amends 18 U.S.C. § 4042(a), requiring the BOP to assist inmates in:
    • applying for federal and state benefits and
    • obtain identification, including a
      • social security card,
      • driver’s license or
      • other official photo identification, and
      • birth certificate.
  • The First Step Act also expands the Second Chance Act to deliver recidivism reduction programming.

Incentives for Success

  • The Act amended 18 U.S.C. § 3624(b), so that federal inmate can earn:
    • up to 54 days of good time credit for every year of their imposed sentence
    • rather than, for every year of their sentence served.
    • For example, you’re sentenced to 10 years, your maximum good time credit = 540 days.
    • These good-time credits go towards pre-release custody.
    • Ineligible for good-time credit are generally categorized as:
      • violent, or involve
      • terrorism,
      • espionage,
      • human trafficking,
      • sex and sexual exploitation; additionally
      • excluded offenses are a repeat felon in possession of a firearm, or
      • high-level drug offenses
      • For a more complete list, see disqualifying offenses

Confinement

  • 18 U.S.C. § 3621(b) requires the BOP to house inmates in facilities within 500 driving miles of their primary residence.
  • The BOP variety of factors goes into placement, including:
    • bed space availability,
    • security designation,
    • programmatic needs,
    • mental and medical health needs,
    • any request made by the inmate related to faith-based needs,
    • recommendations of the sentencing court, and
    • other security concerns.
  • The FSA reauthorizes and modifies a pilot program that allows the BOP to place certain elderly and terminally ill prisoners on home confinement to serve the remainder of their sentences.

Correctional Reforms

  • Criminal justice-related provisions, including;
    • prohibition on the use of restraints on pregnant inmates in the custody of BOP and the U.S. Marshals Service.
    • requirement the BOP to provide tampons and sanitary napkins for free
    • The FSA requires BOP to provide training to correctional officers and other BOP employees:
      • on how to interact and de-escalate encounters with people who are diagnosed with mental illness or other cognitive deficits.
      • Also included is a prohibition against the use of solitary confinement for juvenile delinquents in federal custody.

Sentencing Reforms

  • Changes to Mandatory Minimums for Certain Drug Offenders for some drug traffickers with prior drug convictions
    • the threshold for prior convictions that count toward triggering higher mandatory minimums for repeat offenders,
      • is reduced from the 20-year to a 15-year mandatory minimum,
    • The life-in-prison mandatory minimum (where there are two or more prior qualifying convictions),
      • to a 25-year mandatory minimum.
  • Retroactivity of the Fair Sentencing Act (FSA)
    •  Those who received longer sentences for crack cocaine than if sentenced for possession of powder cocaine can submit a petition in federal court to have their sentences reduced.
  • Expanding the Safety Valve

FEMALE PATTERN RISK SCORING

MALE PATTERN RISK SCORING

Violent Offense Codes for PATTERN Risk Assessment *

Cut points used when calculating an inmate’s Risk of Recidivism

Ambridge Man Pleads Guilty to Possessing Fentanyl 12/2020

Possessing Fentanyl – DOJ

In early December 2020, Michael Gamble was paid a surprise visit by law enforcement. At the conclusion of their search, they found at least 90 G of Fentanyl along with a loaded handgun with an attached extended magazine. None of this looks good, and easily crosses an Offense Level of 34 (with its approximate base number of 28 or greater). Michael Gamble, age 37, pleaded guilty to one count before United States District Judge Christy Criswell Wiegand and is scheduled sentencing for Feb. 9, 2023.

The DOJ has a case, and while everyone deserves legal representation, in the federal system 98% plea as opposed to going to trial, but I get ahead of myself.

How over the years did a medication initially develop in 1959 by Dr. Paul Janssen as an intravenous surgical anesthetic, wind up on our streets? Recalling my days as a surgical resident in the mid-1980s, this was on no one’s radar, except anesthesia. Interest came initially from large animal veterinarians, which morphed into skin patches for humans in the early 2000s to treat chronic pain. This was followed with user-friendly delivery options; a lollipop, tablet, and nasal spray.

Carfentanyl, a fentanyl analog is approximately 10,000 times more potent than morphine, 100 times more than fentanyl, and 50 times more than heroin. It is to be used as a general anesthetic for very large animals.

Fentanyl (Carfentanyl) analogs, including fentanyl-laced heroin, come in many flavors, with street names such as white heroin, Perc-O-Pops, Chiclets, Apache, China Girl, White China, Dance Fever, Jackpot, Murder 8, TNT, Tango and Cash, Friend, Goodfella, and Redrum (murder spelled backward). The sheer variety and combinations make toxicology testing and accurate death reporting extremely challenging.

Having a cogent defense, that includes sentence mitigation through presentence interview preparation is key. Should you have a question, contact us.

2nd Chance Federal Pell Grants For Incarcerated Individuals

Federal Pell Grant Program

Education For Those In Prison

First established in 2015 by the Obama-Biden Administration, the Initiative has expanded under the Biden Administration to 73 additional schools, providing access to education to thousands of additional students, reducing recidivism rates, and improving public safety.  This expansion should bring the total number of schools able to participate in the Second Chance Pell Experiment to 200.

The Department of Education also announced changes to policies to help incarcerated individuals with defaulted loans, allowing them to qualify for a “fresh start,” which returns borrowers with defaulted loans to repayment in good standing, and allows them to access programs like the Second Chance Pell Experiment. The Department will also allow incarcerated individuals to consolidate their loans to help them exit default in the long term”.

Multiple studies, some done by RAND.org and funded by the DOJ were shown to reduce recidivism rates and were associated with higher employment, which improved public safety and allow individuals to return home to their communities and contribute to society.

It also showed that they were 48% less likely to return to prison within three years, than those incarcerated individuals who did not participate.

The Department intends to then fully implement the legislative changes to allow eligible students in college-in-prison programs to access Federal Pell Grants beginning on July 1, 2023. To see a full experimental list of participating sites.

Launching Historic DOJ-DOL Partnership. The Department of Justice and the Department of Labor are investing:

  • $145 million over FY22-FY23 to provide job skills training and individualized employment and
  • reentry plans for people incarcerated in Bureau of Prisons (BOP) facilities and to provide
  • pathways for a seamless transition to employment and reentry support upon release.
  • $55 million for job training, pre-apprenticeship programs, digital literacy training, and pre-release and post-release career counseling for justice-involved adults.

All of this works together, hand in glove with your efforts to get out of prison the earliest you can, on the most successful path that you can. While you may not see it now, together with the BOP (and the monster organization that it is) programs, education is something that nobody can take away from you.

I’m serious, give me a call.

Former CEO of Health Clinic Convicted of Medicaid Fraud

Former CEO of Health Clinic Convicted of Medicaid Fraud

St. Gabriel Health Clinic Inc. (St. Gabriel), a Louisiana nonprofit was contracted with the Iberville Parish School Board to provide primary care services to students as well as services related to the diagnosis and treatment of mental illnesses.


Evidence showed that St. Gabriel practitioners provided character development and other educational programs to entire classrooms of students and followed by fraudulent billing to Medicaid, as group psychotherapy.

Victor Clark Kirk, 73, of Baton Rouge, Louisiana, was the CEO of St. Gabriel Health Clinic Inc. and is scheduled to be sentenced on Jan. 12, 2023, faces a maximum penalty of 10 years in prison per count.

When facing the Federal Bureau of Prisons, retaining an experienced federal criminal defense attorney, and someone experienced in guiding you through the sentencing process, following the guilty verdict is critical to your future. Should you have any questions, contact us. 

Former Missouri Health Care Charity Executives Plead Guilty to Multimillion-Dollar Bribery and Embezzlement Scheme

Preferred Family Healthcare Inc., was a charity that provided services across Missouri, Arkansas, Kansas, Oklahoma, and Illinois, including mental and behavioral health treatment and counseling, substance abuse treatment and counseling, employment assistance, aid to individuals with developmental disabilities, and medical services.

Conspiracy charges included embezzling funds, bribes, and kickbacks to elected public officials against Bontiea Bernedette Goss, 63, and her husband, Tommy “Tom” Ray Goss, 66.

Several former executives from the charity, former members of the Arkansas state legislature, and others have also pleaded guilty in federal court as part of the long-running, multi-jurisdiction, federal investigation including the following:

  • Former Chief Executive Officer, Marilyn Luann Nolan of Springfield, Missouri, pleaded guilty in November 2018 to her role in a conspiracy to embezzle and misapply the funds of a charitable organization that received federal funds.
  • Former Director of Operations and Executive Vice President Robin Raveendran, of Little Rock, Arkansas, pleaded guilty in June 2019 to conspiracy to commit bribery concerning programs receiving federal funds.
  • Former executive and head of clinical operations Keith Fraser Noble, of Rogersville, Missouri, pleaded guilty in September 2019 to concealment of a known felony.
  • Former employee and head of operations and lobbying in Arkansas, Milton Russell Cranford, aka Rusty, of Rogers, Arkansas, was sentenced to seven years in federal prison without parole after pleading guilty to one count of federal program bribery.
  • Political consultant Donald Andrew Jones, aka D.A. Jones, of Willingboro, New Jersey, pleaded guilty in December 2017 to his role in a conspiracy from April 2011 to January 2017 to steal from an organization that receives federal funds.
  • Former Arkansas State Senator Jeremy Hutchinson, of Little Rock, Arkansas, pleaded guilty in June 2019 to conspiracy to commit federal program bribery.
  • Former Arkansas State Representative Eddie Wayne Cooper, of Melbourne, Arkansas, pleaded guilty in February 2018 to conspiracy to embezzle more than $4 million from Preferred Family Healthcare.
  • Former Arkansas State Senator and State Representative Henry “Hank” Wilkins IV pleaded guilty to conspiracy to commit federal program bribery and devising a scheme and artifice to defraud and deprive the citizens of the state of Arkansas of their right to honest services.

When facing the Federal Bureau of Prisons, retaining an experienced federal criminal defense attorney, and someone experienced in guiding you through the sentencing process, following the guilty verdict is critical to your future. Should you have any questions, contact us. 

Your Personal Narrative | PSI Investigation Report

Your Personal Narrative

and

The Presentence Interview Investigation Report

I want to start by saying that I only wish that my attorney had the insight to impart to me all of the knowledge that I have picked up before, during, and after my time in the BOP.

So, let’s get started;

Your Personal Narrative is your chance to speak directly to the Judge. We will start this exercise in written format.  I’d like to suggest that when I write, it usually takes 3-4 drafts until I feel that it’s ready, and then I ask those close to me to proofread it. If they too agree that it’s ready, off it goes. The length is up to you, but approximately 2000 words, more or less, should be sufficient.

As this is Your Life – please take this seriously…

Each of these category questions is meant to be thought-provoking, and possibly painful – which is all good. Be introspective, confer with those close to you, and of course your attorney.

Everything you say must be true and from the heart, for a few reasons: a) You need to believe it, or doing this has no value, b) If the Judge believes you, and then starts a conversation with you – then, coming to the conclusion that someone else wrote this, well you now have a BIGGER problem, and c) last, Probation will be the first to see this, and as their job is to make recommendations to the Judge, if they don’t believe you, well… you guessed it! Topic Categories:

1st.Express remorse, while still understanding the victim’s pain, suffering, and how it has impacted them. 

2. Agree with the court as to the seriousness of the crime, without minimizing it. Expand on this topic

3. What in your life brought you to this moment, what happened that caused you to do this?
3a. You can expand on this, with salient points from your childhood, while,

  • getting feedback from a consultant, attorney, a friend who is a writer,
  • If there was a “trigger,” what was that trigger, and how do you remove it from your life?
  • And don’t hand in your 1st, 2nd, 3rd, 4th, or even 5th draft; really, 
  • it will be a slow start, but when complete, you will be a different person, with a unique Personal Narrative Story to tell directly to the Judge.
  • It is now First Class and Honest.

3b. The whole Narrative may be several thousand words when you are finished.

4. What has this experience taught you? Did it bring up moments from your past?

5. Explain to the Judge that you have a plan (ONLY IF YOU DO) to start making this right with those you have victimized – or if you have already started – what are they, no matter how small those efforts have been. 

6. What is your plan to never re-offend, and you will NEVER Be Back Again In Their Courtroom? 

7. Let the Judge know that you feel financially responsible and want to make amends. If you can, bring some money with you ($100 or $1000), and let the court know that:

  • I know this is not much, but here is $0.00 that I want to submit to the court.
  • I want the court to also know that I have a plan for a job when I get home, and then I will be able to start the Financial Responsibility Program
  • As I will have little to no income in prison, I understand that not participating in the Financial Responsibility Program (FRP) in prison, may keep me from participating in other programs – and could be held against me keeping me from returning home to begin to make amends to myself, family and to those, I have harmed.

Cases that judges find most challenging. If you fall into either of these two categories, the plan we have covered still applies, but with a caveat.
1. Predatory child sex offenders who have harmed children, If you fall into this category – You will be strictly monitored once released.

2. White-collar criminals who have harmed vulnerable people. If you fall into this category – once off supervised release, you are smart enough to know that, you do not want to go back.

 

 The Presentence Interview Investigation Report

can be aided by

Your Personal Narrative

While I previously mentioned that it could be started in written format, it could also be made available in

  • video MP4 format and placed in a flash drive so that the judge could easily see it the week before (optimal timing) sentencing.
  • This you could work out with your attorney, using either PowerPoint or simply using a smartphone.

This brings me to my last point, that being The Presentence Interview (PSI) – Investigation Report.

  • As early as possible after your conviction, your attorney should reach out to the Probation Officer assigned to your case. 
  • At this point they likely have not yet spoken with the prosecutor, therefore they still may have an open mind.
  • Without this call, the PO may have already spoken with the Prosecutor before they ever met/interviewed you – and they may have already been influenced, just not in your favor.
  • Once they are talking, the goal is to learn from her/him, the date that was most convenient for them to do the interview, and then learn when the “due date” was for the preliminary Presentence Report needed to be turned in.

With a personal meeting, your attorney can clearly make their case and position.

  • You can then use your personal narrative, making it available in writing, and/or video format for the PO and eventually the judge.

Generally speaking, when working with the probation officer, a little extra effort goes a long way.

  • Consider presenting your entire view of the case, clearly in a letter to the PO as soon as possible.
  • If you feel the PO is receptive to a variance, this may be key to convincing the court to consider a sentence below the guideline range.
  • Consider presenting your entire view of the case, clearly in a letter to the PO as soon as possible – getting your message “on the record”.
  • As Probation Officers are very busy, doing their best, and never have enough time, they may actually appreciate your efforts in easing a portion of their workload,
  • Remember, a little thoughtful effort does go a long way

 

Call Dr.Blatstein at: 240.888.7778, or by email for a No Obligation Free Consult, he answers and personally returns all of his calls.

Protecting Your Privacy and Personal Healthcare Information

Dobbs Protecting Your Privacy and Healthcare Information

The Dobbs decision opened the conversation to the security of your private privacy healthcare information that we all assumed was secure. We have all been made aware of securing our company’s web infrastructure and firming up its variabilities. The weak link that remains involves our personal lives.

Our family’s cell phones, computers, laptops, note pads, i-pads, gaming things if they’re web-connected, and Alexa, right? Then we have electric cars, and homes, you get the picture. Last, let’s not forget our healthcare privacy.

HIPPA – NATIONAL LAW REVIEW 7/2022

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone1 or Tablet

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care

HHS Issues Guidance to Protect Patient Privacy in Wake of Supreme Court Decision on Roe

1-Where a state law prohibits abortion but

  • does not expressly require that a hospital report an individual for terminating her pregnancy,
    • The Privacy Rule would not permit disclosure of the individual’s PHI to law enforcement under the “required by law” provision.

2-The Privacy Rule Permits Does Not Require the disclosure of PHI

PHI, for law enforcement purposes “pursuant to the process and as otherwise required by law.”

    • If a law enforcement official requests records of abortion, but
    • there is no Court Order or other Mandate Enforceable in the court of law,
    • the Privacy Rule would Not Permit the Disclosure.

3- For disclosures permitted “to avert a serious threat to the health or safety of the individual or the public,”

HHS guidance provides this example.

  • A woman informs her health care provider,
    • in a state that bans abortion,
    • about her intent to seek an abortion in another state where abortion is legal.
      • The Privacy Rule would not permit the disclosure of the woman’s PHI to law enforcement
      • “to avert a serious threat to the health or safety of the individual or the public,”
      • because the woman’s statement tied to pregnancy loss does not constitute such a threat.
  • The guidance observes, moreover, that
    • the disclosure of such PHI would generally
      • increase the risk of harm to the individual and
      • detrimentally affect the patient-physician relationship and
      • would therefore conflict with professional ethical standards.
  • Can technology platforms be prevented from scraping databases to find the patients who had abortions out of state?

4- Protect your medical information when using health information apps (e.g., period trackers, and others).

5- In summary, none of this looks promising, but here it is:

  • Patient Privacy and Reproductive Health Data in the Dobbs Aftermath
  • Second, the FTC warns companies
    • not to make misleading claims that they “anonymize” or “aggregate” sensitive data to try to placate customers who might otherwise have concerns about their privacy.
  • Finally, the Commission points to several recent cases it has brought against companies that misuse customers’ data, without parental consent,
  • What can you do to protect yourself, but will we?
    • data encryption,
    • username ID and
    • password, and
    • two-factor authentication,
    • together can be used to help ensure the confidentiality of information.
    • But nothing is perfect, so you must keep your passwords updated.
  • Personal Data Examples: Credit card or personnel number of a person, account data, number plate, appearance, customer number, or address.
  • Sensitive Information Examples: Social security number, Birthdate/place, Home/Mobile phone number, Home address, Medical Records, Bank Account Numbers, IP address, Passwords, Gender, and Ethnicity.

HIPAA: applies to Healthcare providers and Healthcare Plans.

Safeguard: “protects health Information” or “PHI.”

  • Steps you can take to decrease how your cell phone or tablet collects and shares your health and other personal information, such as where you go and what you do, without your knowledge.
    • Avoid, downloading unnecessary or random apps, especially those that are “free.”
    •  ” giving any app permission to access your device’s location data, other than (e.g., navigation and traffic apps).
    • turn off the location services on your personal cell phone or tablet.
    • consider using communication apps, mobile web browsers, and search engines that are recognized as supporting increased privacy and security.
    • https://consumer.ftc.gov/articles/how-protect-your-privacy-apps
    • https://www.consumerreports.org/issue/data-privacy

Additional Resources:

FCC’s Protecting Your Privacy: Phone and Cable Records

How To Protect Your Phone From Hackers | Consumer Advice

Protect Your Personal Information and Data

FTC’s What to Know About Medical Identity Theft

NSA’s Limiting Location Data Exposure

ONC’s How Can You Protect and Security Health Information When Using a Mobile Device

Electronic Frontier Foundation (EFF) Surveillance Security Scenarios

Consumer Reports website on consumer data privacy

New York Times 3 Steps to Protect Your Phone

 

If you believe that your (or someone else’s) health privacy rights have been violated, at

(800) 368-1019, TDD toll-free: (800) 537-7697, or by emailing:  OCRMail@hhs.gov   https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

Thomas Court Denies Women The Right To Choose…

Justice Thomas on Dobbs

Credit: REUTERS/Jonathan Ernst

The Thomas Court – Denying Women The ‘Freedom To Choose’ Their Medical Reproductive Healthcare

Justice Thomas’s Message, Next: contraception, same-sex marriage…

Inside the Court’s ruling, Justice Thomas wrote that

  • “in future cases, we should reconsider all of this Court’s substantive due process precedents.”
  • “Because any substantive due process decision is ‘demonstrably erroneous,’ we have a duty to ‘correct the error’ established in those precedents.”  Just food for thought…

The More Restrictive States

Louisiana.

Louisiana is an example of extreme regulations, which defines “a viable in vitro fertilized human ovum” as ajuridical person which shall not be intentionally destroyed,” along with at least five states, that have introduced bills establishing fetal personhood. Now,

  • the ’embryo’ may be considered an individual, and if a couple is undergoing IVF, your criminal liability implications have suddenly exploded.
  • Why, because all of the embryos will have to be used.

IVF – Fertility Treatments

IVF and in some cases, even genetic screening, is seeing extreme statements from extreme states;

Will patients have to use all the embryos they develop,

  • a) which forces an individual or couple to expand their family before they can afford to do so, or
  • b) forgo the opportunity to have children, or
  • c) suggests that the couple limit the number of embryos to one or two, and hope that they are chromosomally balanced and will result in a live birth, but if not…
  • d) putting them through IVF stimulation over and over again, associated with the financial, emotional, psychological, and physical implications.

For states that take abortion bans to the extreme, and specify that,

Life begins at fertilization,

  • a) each excess embryo would have the same rights as an embryo,
  • b) all the embryos would then have to be implanted (by law), and
  • c) which could lead to financial hardships for an unprepared family to have multiple children all at once, high-risk pregnancy, multiple babies, risking the life of the mother and/or the children,
  • d) or regarding the fear of prosecution, the couple would decide not to have any children or
  • e) they would elect to move to another state.
  • Added to all this; are threats of violence that extremists have targeted at our behavior and beliefs, while representatives have kept quiet, and made this acceptable behavior.

Pregnancy Loss or Miscarriage.

Pregnancy Loss (NIH) | Miscarriage (Cleveland Clinic).

  • Some miscarriages require immediate medical interventions to prevent life-threatening infections or tubal rupture. Every year between 10% and 20% of known pregnancies end in miscarriages, mostly because the fetus is not developing normally, according to the Mayo Clinic.
  • Post Dobb’s, providers may now fear that the ‘state’ may view their treatment – as if they are providing abortion services, even if they have the necessary training and clinical skills, albeit the services may be similar.
  • If there is a malpractice (or negligence) claim where the provider was handicapped by the laws of their state, how then will this be reflected in their malpractice and liability carriers’ representation(s) going forward?

But it is in those most restrictive states, that women of color (and not those of means) could see even higher maternal mortality rates, increased child poverty, and face a greater risk of prosecution for seeking illegal abortions.

Religion

Religious freedom in America should mean that we all have a right to our religious beliefs. But it should not give us the right to use religion and beliefs to discriminate against others who do not share them—especially when doing so risks lives.

Attorneys – You Can Hear The Dam Breaking

Bloomberg Law – “There is so much confusion”

Aiding and Abetting

Abortion bans before six weeks in some states can depend on enforcement through lawsuits filed by private citizens. Possible targets: abortion providers and anyone who aids and abets an abortion – after an assumed heartbeat is detected – which is aflutter (or the beginning of our pacemaker),” and not a heartbeat.

Hospitals, Healthcare Systems, Telehealth providers, Pharmacists, Nurses, and Providers are all looking for answers (and to date, getting few). I am sure that most of you are getting calls (if not, you will), as confusion reigns, from Coast to Coast.

Regulations

The Emergency Medical Treatment and Labor Act obligates all Medicare-participating hospitals with emergency departments to furnish all medical conditions that pose serious jeopardy to health, bodily severe impairment, or serious organ damage. This duty extends to emergency care for pregnancy or pregnancy loss.

Medical Societies Speak Out

The American Psychiatric Association

By dismantling nearly 50 years of legal precedent, the Court has jeopardized millions of American women’s physical and mental health and undermined the physician-patient relationship’s privacy.

This move will disproportionately impact our most vulnerable populations, such as communities of color, people living in rural areas, and those with low incomes who may have to travel long distances to receive abortions.

Today’s ruling will put many pregnant women and their families into life-threatening and/or traumatic situations.

American Society and Association, of Clinical Oncology

Unfortunately, with the implementation of Dobbs, doctors have been handicapped in this critical patient-doctor decision-making process. Still, ASCO will work to help our members navigate this new situation and preserve their patients’ access to the highest quality care by providing evidence-based clinical guidance, including fertility preservation, and by advocating for access to all the components of high-quality care.

The American College of Obstetricians and Gynecologists (ACOG)

“We are treating this as a disaster response,” Verma said. “We are in an emergency, and this is a disaster.” Its impact on situations will include miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted by “by-laws not founded in science or based on evidence.” She wondered, “Are surgeons going to be afraid to intervene when a pregnant patient ruptures their appendix because they might inadvertently end the pregnancy?”

The American Academy of Pediatrics (AAP)

Today’s ruling means that in many places in the United States, this evidence-based care will be difficult or impossible to access, threatening the health and safety of our patients and jeopardizing the patient-physician relationship.

New England Journal of Medicine

The Supreme Court’s fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie this disingenuous rhetoric.1,2. In view of these predictable consequences, the editors of the New England Journal of Medicine strongly condemn the U.S. Supreme Court’s decision

AAMC (Association of American Medical Colleges)

These laws and policies that restrict or otherwise interfere with the patient-physician relationship put patients at risk by limiting access to quality, evidence-based care.

Dobbs Non Medical, Legislator – Directed Patient Care

Dobbs

Doctor, ‘Patient-Care’ – Out

Non-Medical, ‘Legislator-Care’ – In

 

Today Families and Their Physicians are faced with impossible choices.

Physicians.

Recently, some states have enacted Legislator Directed Patient Care, that conflict with the doctor-patient ethical relationship, and the oath, to do no harm.

Since forever, as part of that relationship, providers try to educate patients to make decisions for themselves, about what they feel is right for them, saysDr. Stephanie Mischell.”

  • For some doctors, the debate comes down to medical ethics.
  • But now, can providers (or anyone) even discuss, refer, or contact out-of-state providers to give them information about patients, regarding abortion services without the fear of litigation, or prosecution?

Prenatal Care.

Prenatal Care may also be affected, particularly if they allow prosecutions to go forward against women.

  • Healthcare providers might find themselves caught in the middle – being forced to make ethical choices when asking routine past history questions regarding past pregnancies, and their outcomes.
  • In doing so, they may place themselves and their patients in the position of being criminally prosecuted, for what otherwise would have been considered usual and customary medical care.

Heartbeat Detection.

Pediatric cardiologist and researcher, Colin Phoon of New York University Langone Health, shared that before the sixth week, “there is no heart; there’s nothing beating.”heartbeat detection

  • What they are hearing is “a little flutter in the area that will later become, the future heart“- but

It’s not the actual heartbeat, said another physician, Dr. Saima Aftab, medical director of the Fetal Care Center at Nicklaus Children’s Hospital in Miami.

  • This flutter happens because that group of cells
  • will become the futurepacemaker of the heart and gain the capacity to fire electrical signals, she said.

Erika Werner, a maternal-fetal medicine physician at Brown University, and a Society for Maternal-Fetal Medicine board member explained, “You can see a little flicker,” she said.” That’s it.

As a product manual (Huntleigh High Sensitivity Pocket Dopplers) for one such device explains, the sound is the amplified version of the difference between the transmitted and received signals.

  • “It is not the real sound made by blood rushing through an artery or vein, or movement of the fetal heart.”
  • It’s only been in the last few decades that doctors have been able to detect this “flutter” at six weeks, thanks to the use of more sophisticated ultrasound technologies.
  • …at around 21-23 days after conception, two groups of cells form a horseshoe – known as a heart tube,
  • with cells creating a sound that seems like the first heartbeat,
  • although it may not pump the blood for another day or two.

All of the major structures appear mostly intact after nine weeks and one day of pregnancy when the entire process is largely complete.

Lupus.

In patients with Lupus (an autoimmune disease), should an inflammatory response flare during their pregnancy, this could then rise to the level of being consideredhigh risk“.

  • In this case, trained medical providers’ treatment plans may be interrupted by Legislator Directed Patient Care, without medical training, forcing themselves into the doctor-patient relationship, which may result in the loss of life. A scary result when considering Dobb’s.

Should the physician decide to ignore Dobbs, and provide what is the standard of care in the medical community, that would likely result in pregnancy loss or miscarriage, they and possibly their patients could expect to be criminally prosecuted – as you see, these are not easy decisions.

  • If the moral code of the provider is such that they go ahead and, provide what is considered usual and customary care, that is in line with their medical board code of ethics, and is the standard of care in the community, how will this impact their future should prosecution proceed?
  • Will some providers, depending on the severity of the state’s laws, begin to avoid practicing in those states altogether?
  • Could they face incarceration as an example to other providers?
  • Where does it end?

The Loss of an Experienced Medical Specialty – Who Suffers?

As state Legislator Directed Patient Care laws insert themselves into the physician-patient care model, this may create ethical issues for the provider, and malpractice liabilities for the doctor, hospital, and their associated healthcare systems.

The result of having no contingency plans for the “dead space” that immediately followed Dobbs, created this cascading series of events that result in

  • reduced access to specialists – in states where certain procedures are not permitted.
  • ultimately to be mostly felt by minority populations,
  • with a decrease in new resident training,
  • leads to a generation of fewer and “less qualified physicians in this niche specialty,” which makes up Obstetrics and Gynecology.

This new wave of disillusioned providers will not be used to being,

  • dictated to by non-medically trained legislators who
  • do not have their patient’s best healthcare interests at heart, or based on science, and then
  • tell them how to practice medicine.

Some may even face incarceration in some of the more extreme states, and if so – is practicing in those states even worth it?

  • Will their colleagues look the other way – or be concerned?
  • Likely, as we all have gone to school, before books started being banned, of course, we will be concerned.

Attorneys | You Can Help The Dam From Breaking | Bloomberg Law |“There is so much confusion”

Aiding and Abetting’.

Abortion bans before six weeks in some states depend on enforcement through lawsuits filed by private citizens.

Possible targets: abortion providers and anyone who aids and abets an abortion – after an assumed heartbeat is detected – but which is a “flutter,” only.

Hospitals, Healthcare Systems, Telehealth providers, Pharmacists, Nurses, and Providers are all looking to the legal community for guidance, as confusion reigns from Coast to Coast.

Regulations

The Emergency Medical Treatment and Labor Act obligates all Medicare-participating hospitals with emergency departments to furnish all medical conditions that pose serious jeopardy to health, bodily severe impairment, or serious organ damage.

This duty extends to emergency care for pregnancy or pregnancy loss.

Regarding Catholic Hospitals, the ACLU has collected numerous stories of women being denied emergency care at Catholic hospitals, with more emerging all the time.

Medical Societies Speak Out

The American Psychiatric Association

By dismantling nearly 50 years of legal precedent, the Court has jeopardized millions of American women’s physical and mental health and undermined the physician-patient relationship’s privacy.

This move will disproportionately impact our most vulnerable populations, such as communities of color, people living in rural areas, and those with low incomes who may have to travel long distances to receive abortions.

Today’s ruling will put many pregnant women and their families into life-threatening and/or traumatic situations.

American Society and Association, of Clinical Oncology

Unfortunately, with the implementation of Dobbs, doctors have been handicapped in this critical patient-doctor decision-making process. Still, ASCO will work to help our members navigate this new situation and preserve their patients’ access to the highest quality care by providing evidence-based clinical guidance, including fertility preservation, and by advocating for access to all the components of high-quality care.

The American College of Obstetricians and Gynecologists (ACOG)

“We are treating this as a disaster response,” Verma said. “We are in an emergency, and this is a disaster.” Its impact on situations will include miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted by “by-laws not founded in science or based on evidence.” She wondered, “Are surgeons going to be afraid to intervene when a pregnant patient ruptures their appendix because they might inadvertently end the pregnancy?”

The American Academy of Pediatrics (AAP)

Today’s ruling means that in many places in the United States, this evidence-based care will be difficult or impossible to access, threatening the health and safety of our patients and jeopardizing the patient-physician relationship.

New England Journal of Medicine

The Supreme Court’s fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie this disingenuous rhetoric.1,2. In view of these predictable consequences, the editors of the New England Journal of Medicine strongly condemn the U.S. Supreme Court’s decision

AAMC (Association of American Medical Colleges)

These laws and policies that restrict or otherwise interfere with the patient-physician relationship put patients at risk by limiting access to quality, evidence-based care.