physician – PROJECT COPE: Coalition On Patient Empowerment:

College Bound Disabled Students Get Started Early Learning Rules For Seeking Accommodations

Finding reported in the new Mobile Health Applications for Self-Management of Diabetes Report from the Agency For Healthcare Research and Quality (AHRQ).

The findings raise questions about whether patient, health plan, employer or other amounts invested to acquire and use in these applications as tools to help diabetes patients better manage their disease provide sufficient return on investment.

College bound or enrolled students with disabilities and their families should get moving to become familiar with, request and arrange for any needed accommodations at their planned university, college or other post secondary education program.

Students with disabilities continue to enjoy many protections against discrimination and rights to accommodation when applying for admission and pursuing education or training in college or other post secondary education settings. However disabled students and their families generally should expect to need to learn about some differences in the federal rules as well as be prepared to deal with different procedures their post secondary educational institutions use to comply with these requirements in order to understand and utilize these rights effectively.

While completing their primary and secondary school education, many disabled students and their families probably relied heavily upon rules established and enforced by the Office of Special Education and Rehabilitative Services (OSERS), the Department of Education also administers the under the Individuals with Disabilities Education Act (IDEA), which provides funds to states to assist in making a free appropriate public education (FAPE) available to eligible children with disabilities. IDEA requirements apply to state education agencies, school districts and other public agencies that serve IDEA-eligible children. Institutions of postsecondary education have no legal obligations under IDEA.

While the IDEA no longer applies, qualifying disabled students attending colleges or other post secondary education continue to enjoy valuable rights and protections under Section 504 of the Rehabilitation Act of 1973 (Section 504) and Title II of the Americans with Disabilities Act of 1990 (Title II) interpreted and enforced by the Department of Education. Section 504 and Title II both generally prohibit disability discrimination by any colleges, universities and other postsecondary education institutions receiving federal funds in the United States. While these rules generally reach most institutions, private institutions of postsecondary education that do not receive federal financial assistance are not subject to Section 504 or Title II, these nonfederally funded private educational institutions are subject to the prohibitions of Title III of the Americans with Disabilities Act against discrimination on the basis of disability by private entities that are not private clubs or religious entities. Thus, these private, nonfederally funded entities covered by these civil rights laws also have an obligation to comply with legal requirements and to carry out their programs and activities in a manner that does not discriminate on the basis of disability, but the Department of Justice, rather than the Department of Education interprets and enforces those rules.

Section 504 and Title II may provide qualifying students with disabilities attending federally funded colleges, universities and other post secondary education institutions a wide range of disability discrimination protections and other rights.

For example, prior to admission:

Institutions of post secondary education may not make inquiries about prospective students’ disabilities prior to admitting them. Prospective students may choose to provide an institution with information about disabilities, but any disclosure of disability is voluntary.

Institutions of post secondary education may inquire about whether prospective students can meet the academic and technical standards that are required for admission, provided that such inquiries are not designed to reveal the existence of disabilities.

Prospective post secondary students may obtain changes in standardized testing conditions in the administration of entrance examinations if they can provide documentation from a qualified professional that supports the existence of a disability and the need for the specific change.

Following Admission:

Institutions of post secondary education do not have a legal duty to identify students with disabilities. These institutions’ obligations are different from those of school districts, which must identify elementary and secondary school students with disabilities. As a result, students generally will need to be prepared to demonstrate their disability and request accommodations.

After admission, institutions of postsecondary education may make confidential inquiries of students about disabilities that may require accommodation. A post secondary student does not have to disclose that he or she has a disability. To obtain academic adjustments, however, students must identify themselves to institutions of post secondary education as having disabilities and must make a request for an academic adjustment. A student may request an academic adjustment at any time, but advising the institution as soon as possible of the need for an academic adjustment can help to ensure that the institution has adequate time to review the request and provide an appropriate academic adjustment.

Section 504 and IDEA require school districts to conduct an evaluation of a student suspected of having a disability at no cost to the student or his or her parents to determine whether the student has a disability and, because of that disability, needs special education and-or related services. Institutions of postsecondary education, however, are not required to pay for such evaluations. Therefore, if funding from other sources, such as the state vocational rehabilitation (VR) agency, is not available to a post secondary student, the student may have to pay for the evaluation.

To comply with the requirements of IDEA, a school district or other public agency must have in effect an individualized education program (IEP) for children with disabilities. School districts may also create a plan or other document describing the evaluation and placement decisions they make for elementary and secondary school students pursuant to Section 504. Institutions of postsecondary education have no obligation to create these documents.

Institutions of post secondary education must provide appropriate academic adjustments based on students’ disabilities and individual needs when necessary to avoid discrimination. In providing an academic adjustment, a post secondary institution does not have to eliminate or lower essential requirements, or make modifications that would result in a fundamental alteration of the programs or activities being offered or impose an undue burden on the institution.

Institutions of postsecondary education may establish reasonable procedures for requesting academic adjustments, and students are responsible for knowing these procedures and following them. Postsecondary institutions may require students who request academic adjustments to provide documentation of their current disabilities and the need for academic adjustments. The institutions must inform students of the documentation they require. Elementary and secondary school IEPs generally will not be sufficient documentation, due to the different contexts and requirements of postsecondary education. However, existing assessment reports and a summary of the student’s academic achievement provided in compliance with IDEA may meet some documentation requirements.

Institutions of post secondary education may not require students with disabilities to pay part or all of the costs of academic adjustments. Post secondary institutions may not condition their provision of academic adjustments on the availability of funds, refuse to spend more than a certain amount to provide academic adjustments, or refuse to provide academic adjustments because they believe other providers of such services exist.

These are just a few examples of the changes students with disabilities may encounter as they make the transition from high school to post secondary education.

To start getting a better understanding of the rules applicable when a disabled student attends a federally funded college, university or other post secondary educational institution, students and their families should consider reading the he explanations of the legal requirements of Section 504 and Title II in the post secondary education context Students with Disabilities Preparing for Postsecondary Education: Know Your Rights and Responsibilities and a guide entitled Transition of Students with Disabilities to Postsecondary Education: A Guide for High School Educators.

Students and their families also are likely to benefit from reviewing the following questions and answers provided by the Department of Education to assist students with disabilities and their families and educational institutions to understand the disabled student’s rights while attending postsecondary institutions.

As a student with a disability leaving high school and entering postsecondary education, will I see differences in my rights and how they are addressed?

Yes. Section 504 and Title II protect elementary, secondary, and postsecondary students from discrimination. Nevertheless, several of the requirements that apply through high school are different from the requirements that apply beyond high school. For instance, Section 504 requires a school district to provide a free appropriate public education (FAPE) to each child with a disability in the district’s jurisdiction. Whatever the disability, a school district must identify an individual’s educational needs and provide any regular or special education and related aids and services necessary to meet those needs as well as it is meeting the needs of students without disabilities.

Unlike your high school, however, your postsecondary school is not required to provide FAPE. Rather, your postsecondary school is required to provide appropriate academic adjustments as necessary to ensure that it does not discriminate on the basis of disability. In addition, if your postsecondary school provides housing to nondisabled students, it must provide comparable, convenient, and accessible housing to students with disabilities at the same cost.

Other important differences that you need to know, even before you arrive at your postsecondary school, are addressed in the remaining questions.

May a postsecondary school deny my admission because I have a disability?

No. If you meet the essential requirements for admission, a postsecondary school may not deny your admission simply because you have a disability.

Do I have to inform a postsecondary school that I have a disability?

No. But if you want the school to provide an academic adjustment, you must identify yourself as having a disability. Likewise, you should let the school know about your disability if you want to ensure that you are assigned to accessible facilities. In any event, your disclosure of a disability is always voluntary.

What academic adjustments must a postsecondary school provide?

The appropriate academic adjustment must be determined based on your disability and individual needs. Academic adjustments may include auxiliary aids and services, as well as modifications to academic requirements as necessary to ensure equal educational opportunity. Examples of adjustments are: arranging for priority registration; reducing a course load; substituting one course for another; providing note takers, recording devices, sign language interpreters, extended time for testing, and, if telephones are provided in dorm rooms, a TTY in your dorm room; and equipping school computers with screen-reading, voice recognition, or other adaptive software or hardware.

In providing an academic adjustment, your postsecondary school is not required to lower or substantially modify essential requirements. For example, although your school may be required to provide extended testing time, it is not required to change the substantive content of the test. In addition, your postsecondary school does not have to make adjustments that would fundamentally alter the nature of a service, program, or activity, or that would result in an undue financial or administrative burden. Finally, your postsecondary school does not have to provide personal attendants, individually prescribed devices, readers for personal use or study, or other devices or services of a personal nature, such as tutoring and typing.

If I want an academic adjustment, what must I do?

You must inform the school that you have a disability and need an academic adjustment. Unlike your school district, your postsecondary school is not required to identify you as having a disability or to assess your needs.

Your postsecondary school may require you to follow reasonable procedures to request an academic adjustment. You are responsible for knowing and following those procedures. In their publications providing general information, postsecondary schools usually include information on the procedures and contacts for requesting an academic adjustment. Such publications include recruitment materials, catalogs, and student handbooks, and are often available on school websites. Many schools also have staff whose purpose is to assist students with disabilities. If you are unable to locate the procedures, ask a school official, such as an admissions officer or counselor.

When should I request an academic adjustment?

Although you may request an academic adjustment from your postsecondary school at any time, you should request it as early as possible. Some academic adjustments may take more time to provide than others. You should follow your school’s procedures to ensure that the school has enough time to review your request and provide an appropriate academic adjustment.

Do I have to prove that I have a disability to obtain an academic adjustment?

Generally, yes. Your school will probably require you to provide documentation showing that you have a current disability and need an academic adjustment.

What documentation should I provide?

Schools may set reasonable standards for documentation. Some schools require more documentation than others. They may require you to provide documentation prepared by an appropriate professional, such as a medical doctor, psychologist, or other qualified diagnostician. The required documentation may include one or more of the following: a diagnosis of your current disability, as well as supporting information, such as the date of the diagnosis, how that diagnosis was reached, and the credentials of the diagnosing professional; information on how your disability affects a major life activity; and information on how the disability affects your academic performance. The documentation should provide enough information for you and your school to decide what is an appropriate academic adjustment.

An individualized education program (IEP) or Section 504 plan, if you have one, may help identify services that have been effective for you. This is generally not sufficient documentation, however, because of the differences between postsecondary education and high school education. What you need to meet the new demands of postsecondary education may be different from what worked for you in high school. Also, in some cases, the nature of a disability may change.

If the documentation that you have does not meet the postsecondary school’s requirements, a school official should tell you in a timely manner what additional documentation you need to provide. You may need a new evaluation in order to provide the required documentation.

Who has to pay for a new evaluation?

Neither your high school nor your postsecondary school is required to conduct or pay for a new evaluation to document your disability and need for an academic adjustment. You may, therefore, have to pay or find funding to pay an appropriate professional for an evaluation. If you are eligible for services through your state vocational rehabilitation agency, you may qualify for an evaluation at no cost to you. You may locate your state vocational rehabilitation agency at http://rsa.ed.gov by clicking on “Info about RSA,” then “People and Offices,” and then “State Agencies/ Contacts.”

Once the school has received the necessary documentation from me, what should I expect?

To determine an appropriate academic adjustment, the school will review your request in light of the essential requirements for the relevant program. It is important to remember that the school is not required to lower or waive essential requirements. If you have requested a specific academic adjustment, the school may offer that academic adjustment, or it may offer an effective alternative. The school may also conduct its own evaluation of your disability and needs at its own expense.

You should expect your school to work with you in an interactive process to identify an appropriate academic adjustment. Unlike the experience you may have had in high school, however, do not expect your postsecondary school to invite your parents to participate in the process or to develop an IEP for you.

What if the academic adjustment we identified is not working?

Let the school know as soon as you become aware that the results are not what you expected. It may be too late to correct the problem if you wait until the course or activity is completed. You and your school should work together to resolve the problem.

May a postsecondary school charge me for providing an academic adjustment?

No. Nor may it charge students with disabilities more for participating in its programs or activities than it charges students who do not have disabilities.

What can I do if I believe the school is discriminating against me?

Practically every postsecondary school must have a person—frequently called the Section 504 Coordinator, ADA Coordinator, or Disability Services Coordinator—who coordinates the school’s compliance with Section 504,Title II, or both laws. You may contact that person for information about how to address your concerns.

The school must also have grievance procedures. These procedures are not the same as the due process procedures with which you may be familiar from high school. But the postsecondary school’s grievance procedures must include steps to ensure that you may raise your concerns fully and fairly, and must provide for the prompt and equitable resolution of complaints.

School publications, such as student handbooks and catalogs, usually describe the steps that you must take to start the grievance process. Often, schools have both formal and informal processes. If you decide to use a grievance process, you should be prepared to present all the reasons that support your request.

If at student is dissatisfied with the outcome of the school’s grievance procedures or wish to pursue an alternative to using those procedures, the student may file a complaint against the school with OCR or in a court following the OCR complaint process explained in the brochure How to File a Discrimination Complaint with the Office for Civil Rights.

In addition to understanding their rights, including differences in the rules from those that applied before college, college students with disabilities and their families need to anticipate that the student will need to learn to negotiate new rules and procedures that work differently from what their experience was in primary or secondary school. Beyond the actual differences in the procedures, students generally can expect much more diversity in the procedures, as post secondary institutions tend to delegate significant authority and responsibility for design, implementation and application of these requirements to schools, departments and even individual professors. Students also should be prepared to take on much greater responsibility for advocating for his or her own rights and needs. For these reasons, most students and their families will want to start learning and pursuing the process early and well in advance of commencement of their initial semester of attendance as well as be proactive to communicate with instructional staff and others throughout the process leading up to and attending these institutions.

About The Author

Recognized by LexisNexis® Martindale-Hubbell® as a “AV-Preeminent” (Top 1%/ the highest) and “Top Rated Lawyer,” with special recognition as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Health Care,” “Labor & Employment,” “Tax: Erisa & Employee Benefits” and “Business and Commercial Law” by D Magazine, the author of this update is widely known for her 29 plus years’ of work in health care, health benefit, health policy and regulatory affairs and other health industry concerns as a practicing attorney and management consultant, thought leader, author, public policy advocate and lecturer.

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management, crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training ;board, medical staff and other governance; compliance and internal controls; strategic planning, process and quality improvement; change management; assess, deter, investigate and address staffing, quality, compliance and other performance; meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

The American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting, former Vice President of the North Texas Health Care Compliance Professionals Association, past Chair of the ABA Health Law Section Managed Care & Insurance Section, past ABA JCEB Council Representative, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance management; outsourcing; internal controls and regulatory compliance; billing and reimbursement; physician, employment, vendor, managed care, government and other contracting; business transactions; grants; tax-exemption and not-for-profit; licensure and accreditation; vendor selection and management; privacy and data security; training; risk and change management; regulatory affairs and public policy and other concerns.

As a core component of her work, Ms. Stamer has worked extensively throughout her career with health care providers, health plans and insurers, managed care organizations, health care clearinghouses, their business associates, employers, banks and other financial institutions, management services organizations, professional associations, medical staffs, accreditation agencies, auditors, technology and other vendors and service providers, and others on legal and operational compliance, risk management and compliance, public policies and regulatory affairs, contracting, payer-provider, provider-provider, vendor, patient, governmental and community relations and matters including extensive involvement advising, representing and defending public and private hospitals and health care systems; physicians, physician organizations and medical staffs; specialty clinics and pharmacies; skilled nursing, home health, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing and management services organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, insurers, self-insured health plans and other payers; and other health industry clients to establish and administer compliance and risk management policies; comply with requirements, investigate and respond to Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD, FTC, SEC, CDC and other public health, Department of Justice and state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry investigation, enforcement including insurance or other liability management and allocation; process and product development, contracting, deployment and defense; evaluation, commenting or seeking modification of regulatory guidance, and other regulatory and public policy advocacy; training and discipline; enforcement, and a host of other related concerns for public and private health care providers, health insurers, health plans, technology and other vendors, employers, and others.and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

Past Chair of the ABA Managed Care & Insurance Interest Group and, a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also has extensive health care reimbursement and insurance experience advising and defending health care providers, payers, and others about Medicare, Medicaid, Medicare and Medicaid Advantage, Tri-Care, self-insured group, association, individual and group and other health benefit programs and coverages including but not limited to advising public and private payers about coverage and program design and documentation, advising and defending providers, payers and systems and billing services entities about systems and process design, audits, and other processes; provider credentialing, and contracting; providers and payer billing, reimbursement, claims audits, denials and appeals, coverage coordination, reporting, direct contracting, False Claims Act, Medicare & Medicaid, ERISA, state Prompt Pay, out-of-network and other nonpar insured, and other health care claims, prepayment, post-payment and other coverage, claims denials, appeals, billing and fraud investigations and actions and other reimbursement and payment related investigation, enforcement, litigation and actions.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly-regarded works and training programs on HIPAA and other data security, privacy and use, Ms. Stamer also is widely recognized for her extensive work and leadership on leading edge health care and benefit policy and operational issues including meaningful use and EMR, billing and reimbursement, quality measurement and reimbursement, HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other concerns. Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting, risk assessments, audits and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, FTC, state attorneys’ general and other federal or state agencies, other business partners, patients and others.

Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers and other plan sponsors, banks and other financial institutions, and others on risk management and compliance with HIPAA, FACTA, trade secret and other information privacy and data security rules, including the establishment, documentation, implementation, audit and enforcement of policies, procedures, systems and safeguards, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns. Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others. In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans, as well as HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for Los Angeles County Health Department, MGMA, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others.

A former lead consultant to the Government of Bolivia on its Pension Privatization Project with extensive domestic and international public policy and governmental and regulatory affairs experience, Ms. Stamer also is widely recognized for regulatory and policy work, advocacy and outreach on healthcare, education, aging, disability, savings and retirement, workforce, ethics, and other policies. Throughout her adult life and career, Ms. Stamer has provided thought leadership; policy and program design, statutory and regulatory development design and analysis; drafted legislation, proposed regulations and other guidance, position statements and briefs, comments and other critical policy documents; advised, assisted and represented health care providers, health plans and insurers, employers, professional. and trade associations, community and government leaders and others on health care, health, pension and retirement, workers’ compensation, Social Security and other benefit, insurance and financial services, tax, workforce, aging and disability, immigration, privacy and data security and a host of other international and domestic federal, state and local public policy and regulatory reforms through her involvement and participation in numerous client engagements, founder and Executive Director of the Coalition for Responsible Health Policy and its PROJECT COPE: the Coalition on Patient Empowerment, adviser to the National Physicians Congress for Healthcare Policy, leadership involvement with the US-Mexico Chamber of Commerce, the Texas Association of Business, the ABA JCEB, Health Law, RPTE, Tax, Labor, TIPS, International Life Sciences, and other Sections and Committees, SHRM Governmental Affairs Committee and a host of other involvements and activities.

A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, privacy and data security, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her thought leadership, experience and advocacy on these and other related concerns by her service in the leadership of the Solutions Law Press, Inc. Coalition for Responsible Health Policy, its PROJECT COPE: Coalition on Patient Empowerment, and a broad range of other professional and civic organizations including North Texas Healthcare Compliance Association, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children (now Warren Center For Children); current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, past Representative and chair of various committees of ABA Joint Committee on Employee Benefits; a ABA Health Law Coordinating Council representative, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposium and chair, faculty member and author, who publishes and speaks extensively on health and managed care industry, human resources, employment and other privacy, data security and other technology, regulatory and operational risk management. Examples of her many highly regarded publications on these matters include “Protecting & Using Patient Data In Disease Management: Opportunities, Liabilities And Prescriptions,” “Privacy Invasions of Medical Care-An Emerging Perspective,” “Cybercrime and Identity Theft: Health Information Security: Beyond HIPAA,” as well as thousands of other publications, programs and workshops these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, Insurance Thought Leadership and many other prominent publications and speaks and conducts training for a broad range of professional organizations.

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

Call To Action: Become a Project COPE Healthcare Hero

Follow, like and share our articles and resources in this ProjectCOPE.blog, and follow, like, share your comments and ideas, and participate in our Facebook page @ProjectCOPECOALITION or on LinkedIn to

Learn and share tips, tools and other information on how you and your family can manage your health and wellness needs.
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Monitor health, wellness and other developments.
Help your providers, family, friends and community cope with health care, disability, aging and wellness challenges.
Get educated! Learn about what’s happening in Washington and communities across the country to help or hurt healthcare quality and access and how you can help make things better or influence how these developments affect people you care about.
Get involved and recruit others to join the cause!

Despite an endless stream of well-meaning market and governmental reforms over the past 25 years, the U.S. health care system is in crisis. American patients, their families and other caregivers, their employers, their health benefit programs, their health care providers, the communities and even our federal health care budget increasingly are burdened and overwhelmed by the mounting obstacles to caring for our ill, disabled, and aging citizens within our health care system and the extraordinary expense of maintaining and using that system.

As Congress takes up reform again, it is critical that Americans act to protect their own and their families’ health care and control the financial burdens of health care by getting informed, providing clear and consistent direction to Congress and other reformers and taking other actions to empower and care for themselves and their loved ones within our evolving health care system.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources here such as:

©2018 Cynthia Marcotte Stamer. Image credit to collegedirection.org. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ All other rights reserved. For information about republication or other use, please contact Ms. Stamer here.

Diabetes Management Apps: Tech Tools or Toys?

Finding reported in the new Mobile Health Applications for Self-Management of Diabetes Report from the Agency For Healthcare Research and Quality (AHRQ).

AHRQ Report Questions Diabetes Management Mobile Apps Effectiveness

Using current diabetes self-management mobile applications generally does not improve the life, blood pressure, weight, or body mass index outcomes of diabetes patients and the effect of the use of these applications is not demonstrated to work any better than health care provider support regardless of the app or type of diabetes. That’s a key finding reported in the new Mobile Health Applications for Self-Management of Diabetes Report (Report) of the Agency For Healthcare Research and Quality (AHRQ).

The findings raise questions about whether the time and Money patient, health plan, employer or others invest in to acquire and for patients to use these applications as tools to help diabetes patients better manage their disease provide sufficient return on investment are justified.

While hundreds of mobile applications currently are available that purport to help diabetes patients self manage their disease, AHRQ says “patients lack information on which apps are effective in improving diabetes-related outcomes.”

In an effort to address this concern, AHRQ commissioned a review of the efficacy, usability, and features of 11 of hundreds of the currently available commercial applications for diabetes self-management commercially available mobile applications (apps) for diabetes self-management. The Study evaluated the performance of the applications by reviewing 15 studies/analyses evaluating 11 unique apps: six apps for type 1 diabetes and five for type 2 diabetes. Two apps had multiple tiers of access (free and paid), which resulted in the evaluation of features of 13 apps. Common features of apps include the ability to track blood glucose, HbA1c, medications, physical activity, and weight. Studies were 2-12 months long.

In addition to the Report, findings from the study also are discussed the Rapid Evidence Review of Mobile Applications for Self-Management of Diabetes article published in the May 3, 2018 issue of the Journal of General Internal Medicine.

According to the Report, the findings from this review raise significant questions about the value and effectiveness of diabetes self-management mobile apps. Significantly, while AHRQ says the study raises significant questions about the efficacy of current diabetes self-management mobile applications, it concludes that the research showed “[p]atients did not experience improvements in quality of life, blood pressure, weight, or body mass index outcomes, regardless of the app or type of diabetes.

Other key findings shared in the report include:

Of the 11 apps, studies showed only 5 were associated with clinically significant improvements in HbA1c, an important clinical test for monitoring diabetes. (For Type 1 diabetes- Glucose Buddy, Diabeo Telesage; For Type 2 diabetes- Blue Star, WellTang, Gather Health);
For type 1 diabetes, patients had clinically significant improvement in HbA1c if they used either of two apps and statistically significant improvement using one additional app. For type 2 diabetes, patients using any of three apps experienced clinical and statistical improvement in HbA1c.
Patients using two apps for type 1 diabetes experienced improvements in hypoglycemic episodes.
The quality of studies was variable. Study design and presentation made it difficult to distinguish the effect of the app and the effect of additional interactions with study personnel or health care providers. Of the eight apps available for usability testing, three apps (two for type 1 and one for type 2 diabetes) were scored by researchers as “acceptable,” two apps (type 1 diabetes) as “marginal,” and three apps (one for type 1 and two for type 2 diabetes) as “not acceptable.”
More rigorous and longer-term research studies could determine whether apps help people manage their diabetes and reduce complications.
Studies had methodological issues: they were short (2-12 months); inconsistent in reporting of randomization, allocation, masking, and drop-out analysis; and often used co-interventions that hindered interpretation of results. None of the included studies are considered to be high quality.

Based on these and other findings from the Study, the Report concludes that while
some apps for diabetes self-management may improve outcomes in the short-term, the effect cannot be distinguished from the concomitant effect of additional support from a health care provider. AHRQ also says more rigorous and longer-term evaluations are needed to determine how these apps affect weight, blood pressure, quality of life, and complications of diabetes.

In light of these findings, patients and health plans, employer and other health plan sponsors, health care providers should weigh critically the value of investing in or relying upon diabetes mobile apps to help patients manage diabetes. While these apps offer shiny attractiveness as tools, the Report’s findings that evidence does not show these applications produce sustainable improvements in the status of diabetes patients using them suggests that expenditures of time and money to uses these applications may not be justified. Patients and their families and caregivers also should weigh whether patients relying on these applications may be foregoing seeking or using other measures for management that work more effectively.

About The Author

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

Call To Action: Become a Project COPE Healthcare Hero

Learn and share tips, tools and other information on how you and your family can manage your health and wellness needs.
Get and share ideas on how to understand, shape and use your healthcare and health coverage.
Share your ideas and input about health and health coverage issues and policies with elected leaders and regulators?
Monitor health, wellness and other developments.
Help your providers, family, friends and community cope with health care, disability, aging and wellness challenges.
Get educated! Learn about what’s happening in Washington and communities across the country to help or hurt healthcare quality and access and how you can help make things better or influence how these developments affect people you care about.
Get involved and recruit others to join the cause!

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©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ All other rights reserved. For information about republication or other use, please contact Ms. Stamer here.

Celebrating Mother’s Day & Nurses Week Acknowledging The Nurse/Mother & Other Health Care Professionals Whose Work Began & Inspire Project COPE: Coalition On Patient Empowerment

This week’s celebration of “National Nurses’ Week” and the impending celebration Sunday of Mother’s Day is a perfect time to celebrate the career of a nurse and mother whose common sense efforts to take care of her patients and others began and whose insights and example continue to guide and inspire the mission now carried on through PROJECT COPE: The Coalition on Patient Empowerment: my mother, Mary Kutina Marcotte Brazda.

Like me, my mother grew up surrounded by health care. Her father was a dentist who helped found and lead the local community hospital and many other health care services in the region. His sisters both were nurses with Masters Degrees. Several other family members were nursing nuns, including some who worked internationally in the efforts of the Catholic nun, Mother Teresa. Her brother, and subsequently my brother and cousin, became dentists. Many others on both sides of her, and ultimately my family tree followed family members in to the health care profession, becoming physicians, nurses, occupational therapists, physical therapists, or other health care professionals. In fact I, like one of my sister, was expected to follow in these footsteps and become a physician before my begrudging recognition that an average ability to master scientific book learning and understanding of the intricacies of health care administration and policy could not sufficiently overcome much less skilled practical anatomy abilities diverted me to my current course.

From my earliest memories, I was privileged to experience health care through the eyes of a talented health care provider who viewed herself blessed to work in a profession that she viewed as her vocation. While she lived, I constantly experienced and witnessed through her and the caregivers she teamed with recurrent and undeniable proof that a deep and abiding love for people and desire to care for patients motivated her and most other nurses, doctors and other health care professionals to join and remain in their professions despite long and often grueling, highly stressful and often underappreciated and under-compensated work.

While mom, like my grandfather and other health care providers I know, never sought accolades and always exhibited great modesty and humility about her contributions, during her life and since her death, patients and families whose lives she touched frequently share with me stories of her compassionate care and its meaning to their families. While I treasure each of these stories as valued reminders of the special woman I was blessed to call “Mom,” the following letter from Ralph Simonson that I received as I prepared to celebrate my first Mother’s Day without her two months after her death holds a special place in my heart. Ralph wrote:

“Subject: Your mother!

My name is Ralph Simonson and I just received a reply from my inquiry to find Mary Kutina! I knew of Loren, since he was somewhere behind me in Great Bend High School. Found him in the internet when looking for Mary. Wrote him a note and asked about her whereabouts and he replied to tell me about her life and your email addresses for me to write to you.

My story is unusual and I know you have never heard of me. In ones old age, you think about your youth and a lot about your life. The summer after I graduated from High School, I contracted polio, 1951. It was late August and of course there was an epidemic back then. I went to the hospital on a Saturday afternoon. Sunday I lost my voice and that is the last I remember for over a week. I had the bulbar type that usually killed you, but if you recovered, you did not usually suffer limb paralysis. The left side of my throat is paralyzed which makes me turn my head to swallow, cannot sing (loved singing in HS), cannot cough and cannot laugh. I have actually survived well and do not notice this much anymore. I just have to watch getting something caught in my throat and if I do, I panic a little since I cannot breathe. I am not complaining, just explaining the situation to you.

I left for college late and had to change schools to get in at the later date. Denver U, which was on the quarter system. Then I finished up at K State. My life proceeded and in the 80’s sometime, I started to hear about “out of body experiences”! I suddenly remembered when I had polio. I received cards from all my friends and after the first week, I read them and it was all news to me. I was in a coma all week and feed intravenously. Fortunately, my father was a business man and had some money. When the seriousness of my condition became known, he hired MARY for my “full time” nurse. He put an A/C in the window and she took care of me.

After 30 some years, I “suddenly” remembered that Wednesday night of the crisis. Believe it or not, the doctors were not on the scene because they did not know what to do and as far as everyone was concerned, it was over and I would not make it. I VIVIDLY REMEMBER BEING ON THE CEILING WATCHING MARY AND MY MOTHER AGGRESSIVELY TENDING TO ME. They were concentrating on getting lemon juice down my throat to keep it clear from the flem that would stop up my breathing. Mary told me later that I was not very nice to my mother by saying bad things about her panic at my condition. I am sure Mary calmed her and kept everything in perspective. She was cool, calm and had things under control. Outwardly at least. I just realized from Loren that she was not a full fledged nurse at that time, but certainly had the training to be an aide, or what ever. I never saw Mary after that. In the last few years, I have thought a lot about that for various reasons. The sad part about it, is that at this very late stage of my life, I realized Mary saved my life and I never thanked her. That thought will never leave me.

I liked your mother and know everyone I have ever talked to has spoken very highly of her. As we age, it is easy to say we all loved her. I hope I have added some good memories of your mom. We never forget our mothers and the older we get, it seems the hungrier we are to hear about their lives. No more words to add that describes my gratitude to Mary Kutina!!!!!

Fondly, Ralph Simonson, Leesburg, Fl. “

Ralph’s experience both beautifully captured the essence of my mother’s tremendous heart and lifelong commitment as a nurse and care provider,. It also documents the extraordinary power and commitment of the thousands of nurses, physicians and other health care providers that pour their hearts and souls into caring for patients and families in their time of a need that I witnessed across her life, experienced in the years, months, days and final hours before her death from lymphoma and leukemia, and continue to see since.

In a time when cost-motivated government and insurance bean counters constantly attack the professionalism and motives of these critical caregivers, my mother’s example and story reminds us to resist with skepticism those who seek to manage the care out of health care by slurring the motives and professionalism of the physicians, nurses and other health care professionals that work in the trenches to make it work.

A nurse for more than 55 years in the small rural community where she was born and lived most of her life, mom breathed caring whether working as a nurse or living her after hours life as mother, daughter, sister, and neighbor. Since she cared, she constantly cared for people.

People were mom’s thing. Her childhood friends remember her as the confident, friendly and fun-loving daughter of a prominent founding family and the local dentist. Known for her warm and genuine friendliness and special ability to empathize with and put almost anyone at ease, she was liked by, and liked everyone regardless of status or condition.

Highly popular, and blessed with an insatiable ability to see and find the good in every experience and every person, her friendly and confident smile allowed few to suspect that she suffered from such severe dyslexia that she didn’t master the alphabet until Fourth Grade. Her resulting empathy learned from her own learning difficulties invested her with a unique ability to recognize, empathize with and help others with learning or other disabilities throughout her life even after she overcame her learning challenges to earn her nursing degrees and other subsequently earned advanced education.

In her youth and across her life, her lack of acknowledgement of the significance of her own challenges as compared to others that she knew meant they went unknown and unacknowledged by others. Instead, people saw her for what she was: a blessed and confident young woman from a good family who always embraced life and people with an unbridled enthusiasm whether playing sports and music, dancing, singing, organizing gatherings at the lake or volunteering on health, church and other community projects.

Her extraordinary people skills, bright mind, and can-do enthusiasm allowed her to excel at sports, music, and life throughout her youth and collegiate studies. Although initially drawn to teach physical education, she ultimately pursued a career that was her vocation in nursing. After fully enjoying several years of college, she returned home to attend attend nurses training.

For 60 plus years after she became an R.N, mom lived her nursing vocation by caring for patients in public health, hospital, home health and school nursing. While she loved caring for patients is all contexts, she was particularly passionate about public health and school nursing.

After graduating nursing training, she spent several years delivering basic health care, education and social services to underprivileged families as the county public health nurse. In the 1950’s when she began her career, the county nurse functioned as both health care provider and social worker. She and other county nurses spent a large portion of their time traveling throughout the county making “house calls” on rural residents. While closely coordinating with the area physician(s), county nurses like mom often provided the primary care if not the only health care many rural families received and coordinated the health care and social services that most of these families received from other caregivers. A big part of her work involved making house calls to rural families around the county. Many of the families she cared for were poor and possessed limited education. She quickly learned effectively delivering health care required a holistic understanding and care of the patient and his or her family and circumstances.

After working several years in the health department, mom reluctantly left her job at my father’s urging as the birth of her second child approached to a stay at home to mother her growing brood. During her time as away from her career, however, she was not the typical stay at home mother. Instead, she swept up and brought along her growing brood of five children as she continued to make volunteer house calls on many area families, and organized and volunteered her services for a multitude of health and other community projects and fund raisers in her church and the community.

By her mid-thirties, however, my father’s advancing terminal cancer prompted her to return to the regular workforce as a night nurse working in the intensive care unit of the local Catholic hospital where she completed her nurses training. Along with performing the technical aspects of hospital nursing, her patients and their families often share stories of her listening and helping to troubleshoot problems, bringing meals or treats for family members, fixing patients hair or makeup, sitting with frightened or lonely patients or family member and other acts of spiritual nurturing and compassion that made their hospital experiences more bearable. Because even in the 1960’s hospital administration often complained about nursing staff “wasting” time to perform these acts of special care or compassion for patients, many don’t realize mom often arrived early or stayed after her shift to fit in this compassionate care around her family responsibilities of caring for her dying husband and five children aged 2 months to 10 years of age and various elderly members of the community. More than once, she shared her confusion about hospital “Administration” questioning the necessity of her efforts and time spent comforting frightened or lonely patients during those long hospital nights commenting, “Listening to and calming the fears of a sick or dying patient is caring for the patient.”

Shortly following my father’s death in 1968 and while continuing to raise her five children as a single mother, mom had the opportunity to return to public health nursing. She rejoined the county health department where along with checking and delivering care through a stream of house calls, administering free health screening and immunizations, coordinating and responding to public health outbreaks, and other aspects of administering and running the health department, mom also expanded the department’s programs to meet new needs she identified in the course of her work. She was responsible for initiating and coordinating a wide range of preschool and other health screening, charity care, health education, nutrition, prevention and other programs.

A few years later, the local school board invited her to become the district’s school nurse. As her school nursing hours followed the school schedule of her children, the position offered her the opportunity to continue her public health work with a schedule more suited to her home duties as a single mom. The offer came with a key condition however. At the time of the offer, mom was a non-degreed “Registered Nurse” or “R.N.” Although she completed more than five years of college before attending nursing school, she had not earned a Bachelors Degree in Nursing at the time of the offer. The job technically required a Bachelors Degree in Nursing in addition to her R.N. credentials. Familiar with her personality and public health experience, the school board believed she nevertheless was the right woman for the job. Consequently, the board offered her the position subject to the contingency that she earn her Bachelors Degree in Nursing within two years.

Accordingly, during her initial two years at the school district, mom returned college to complete her Bachelors of Science in Nursing. Earning her degree at night in the rural community where we lived was no easy feat as the community college at the time did not offer a Bachelors Degree in Nursing. Consequently, along with the normal challenges of fitting in homework and classes around working full-time and caring for her five children, attending classes required that she commute more than an hour each way across dark, usually empty and often icy Kansas prairie highways to the closest university offering the requisite nursing degree.

To fit everything in and to accommodate her lifelong dyslexia challenges, she “let” my siblings and me read her assignments to her as she drove or performed household duties and took one of us along for the trip to each class. After finishing her B.S., she continued to take us along as she completed her Masters Degree in Counseling, her Emergency Medicine Technician (EMT) certification and a long list of advanced studies and certification in nutrition, development, diagnosis and assessment, learning disabilities, public health and a host other various other advanced degrees and certifications. The process infused us with both extraordinary reading skills, an acceptance of staying busy and juggling busy schedules as “normal,” a broad understanding of many aspects of nursing and other aspects of health care and a life long hunger for learning and education. Somehow, attending class, studying and volunteering with mom always seemed like a treat rather than an obligation.

Throughout it all, mom never stopped seeing or caring for people and never accepted a lack of district or county funding or other resources as an excuse for letting a need go unaddressed. “No” and “can’t”weren’t in her vocabulary when someone in her care needed care.

While pursuing her education and for the remainder of her life, mom continued to push to improve and expand school and community health programs along with continuing to perform her original school nursing responsibilities. She expanded the preschool screening program, founded and administered scoliosis, educational disabilities and other screening, school nutrition, pregnancy prevention and support, and other school health programs.

She also helped organize local doctors and other health care providers to run health fairs and provide free or reduced cost charity care for low income families. She recruited local community organizations to pay for food and other supplies, eyeglasses, hearing aids and other resources.

Horrified when a child she knew had to undergo surgery as a result of late-diagnosed scoliosis, she took training and founded one the first comprehensive school-based scoliosis screening programs in the nation. Across the years, she expanded her training, implemented screening and intervention programs, and developed and connected extensive people, knowledge and other resources to identify and mitigate nutrition and hunger, mental health, educational and development disorders and a multitude of other health challenges impacting her students and their families.

Across these years she also volunteered her services on community and public advocacy activities. Our social life usually involved participating in fun, but service directed church and community activities where having “fun” working for the cause was a way of life. She also involved us and hundreds of others in advocacy activities seeking to educate and encourage local, state and federal officials to understand and improve health and disability funding and services.

When the State’ Medicaid funding rules obstructed her ability to get children care or other services by failing to fund care or the cost of transportation of her kids the two hours to the big city where the specialists needed practiced, mom conceived, coordinated and initially self-funded, and then eventually convinced local community agencies, churches and business leaders to pay for the needed transportation and cost of care to get the children diagnosed or treated. She talked the Lions Club, ELKS Club, American Legion, Chamber of Commerce, local physicians and churches and anyone else she could think of to sponsor screenings and care for her kids and their families.

When community fear lead to community backlash and exclusion against a local child infected from a blood transfusion with the HIV virus and his family, mom joined others working with the Kansas legislature to enact legislation protecting students with HIV/AIDs from discrimination in school. Across the years, she also worked on school nursing delegation, home health, under served community and other health funding, and a host of other key community health reforms.

Through it all, mom always recognized the importance of nurturing the spirit as well as the physical body of those under her care. Beyond addressing the physical needs of these victims, she cared for people by welcoming them into her office, her home, and her life.

Patients and family that knew she dealt with all patients with judgment free kindness, trustworthiness and patience that acknowledged and preserved their dignity and trust. No matter how much she had on her plate, mom was never too busy to listen and observe. Patients, families and others rewarded these efforts by giving her their trust, often opening up to share concerns, fears and information they never would have considered discussing with others.

In the course of her 60 plus year career, mom reported, investigated and testified in thousands of bullying and spousal and child abuse and neglect cases. While some of the circumstances she reported resulted in criminal or child protective services actions, her action, understanding of the human challenges of poverty, ignorance and other contributing causes of these risks and her practical approach to working with families and community resources and counseling resulted in timely intervention that that prevented or resolved many more potential situations before a child could be harmed.

Across my lifetime, I have heard thousands of stories of how mom cured stress-induced stomach and headaches with a well-timed listening ear and hug, time out or nap in her office, snack, or confidence infusing invitation to participate.

Her calendar was never too busy to listen and comfort a sick, embarrassed or anxious student, parent or staff member. They were all her people and she was theirs.

Mom’s seemingly bottomless, pocket-ridden purse was famous for its Mary Poppins’ like capacity to hold and subtly produce as needed a fig newton bar, cheese or raisin snack, bandages, soap and wash cloth, personal hygiene items or encouraging reward or sticker.

She once arranged for all seventh grade girls participate in a grooming class conducted by beauty contestant and receive soap and other beauty supplies donated by a local salon to address complaints about the unwashed smells of three class members from underprivileged families without singling them out.

Her office, car and our home always had a collection of new or nearly new clothing and personal care items she collected and kept available to use to rescue poor children from the stigma and bullying that they often experience because their circumstances leaves them poorly washed or dressed.

Her purse, desk and car always had a snack for a child who went without breakfast.

Fifty plus years later and diagnosed with leukemia and lymphoma, mom eventually retired from the school district. Around the age of 68, she started the next phase of her heath care career. While negotiating the remaining decade of her life as terminally ill, she enjoyed an amazingly productive “retirement” discretely making health care house calls on aging and disabled members of her community under the guise of applying her newly acquired Cosmetology, massage, nutrition and Reiki credentials alongside her advanced nursing, counseling, public health and psychology professional degrees and credentials.

At 76 and toting along her oxygen tank, she joyfully drove her van to do a haircut, massage and health check on the 80 year old neighbor with Parkinson’s Disease, the church member with dementia, and countless others between attending her own chemotherapy and doctors visits.

Like most of our nation’s hard-working physicians, nurses, physicians assistants, nurse practitioners, physical therapists, occupational therapists, and other health care providers, caring for people was not a job for my mother: it was a vocation chosen based on a genuine love of and desire to care for people.

Mom also knew that great health care requires teamwork. She was proud to be a nurse and respected the fellow nurses, physicians and other members of the health care team she worked with as indispensable and valued teammates. She viewed their roles as essentially synergistic rather than competitive. She understood that the effective delivery of quality health care generally requires the knowledge, teamwork and communication between physicians, nurses, and others on the treatment team, as well as the patient, their family and others within the community.

She never forgot that effective health care involves much more than the mere science and technical delivery of health care. She recognized that health care starts and ends with seeing, listening to and caring for the whole patient taking into account the situation where the patient is at the time without judging how they got there.

Most of all, however, she never forgot that health care starts and ends with caring for people.

While lacking the operational talents to carry on my mother’s work as a nurse, physician or other direct care provider, I am privileged to witness and support thousands of physicians, nurses, therapists and other caregivers in the course of my work every year. Physicians and nurses I know regularly provide free care and hunt resources for a multitude of uninsured or underinsured patients. Others advocate for patients and their families afflicted with confusing and intractable health conditions to find answers and solutions. All listen.

Just a few weeks ago, a physician visiting my family on vacation stepped in to counsel a stranger we encountered at church, who was worried about his uninsured grandmother’s unwillingness to seek medical care for her dangerously high blood pressure. A nurse and EMT attending a sporting event sprung without thought to action when a rider suffered a serious head injury in the course of the event.

While limited and overextended resources continue to challenge their efforts, my experience overwhelmingly affirms that virtually all of these health care professionals, like my mother, are highly skilled, trustworthy and caring professionals motivated by a genuine desire and commitment to caring for patients, rather than the greed or other unsavory motivations often unfairly attributed to them. They work long hours. They endure ever-increasing paperwork, regulation and constricted resources. They fight to care for patients at work, as well as often spend their “off” time helping patients or others in the community. They earn and deserve our respect, trust and support.

Today, cost-containment motivated and technology star-struck government and insurance leaders perpetually seek to diminish the need for patient care, dehumanize care, divide and destroy teamwork between caregivers, and vilify nurses, physicians, and other health care providers in the name of the all mighty dollar and self-aggrandizement of their own importance.

Amid these attacks, we all must heed the reminders that the experiences of Ralph and other patients who depend upon our nations’ health care providers like my mother provided to deliver care for their physical and other needs during the critical health care moments of their lives. We need to celebrate their work and defend their ability to deliver the caring health care we and our families need and should expect as we face our own health care crises ahead.

We all know nurses, physicians and other health care providers that go the extra mile to care for our families, often at the expense of time with their own. Who’s your health care hero? Help keep real health care alive by celebrating, thanking, encouraging and standing up for the caring nurses, physicians, therapists and other health care providers that keep the caring in health care. Stand up against those who unfairly besmirch them and their work. Celebrate them by sharing their story in the comments below. Support them in their efforts to preserve and protect their ability to care for patients and their families!

About The Author

Throughout her adult life and nearly 30-year legal career, Ms. Stamer’s legal, management and governmental affairs work has focused on helping health industry, health benefit and other organizations and their management use the law, performance and risk management tools and process to manage people, performance, quality, compliance, operations and risk. Highly valued for her rare ability to find pragmatic client-centric solutions by combining her detailed legal and operational knowledge and experience with her talent for creative problem-solving, Ms. Stamer supports these organizations and their leaders on both a real-time, “on demand” basis as well as outsourced operations or special counsel on an interim, special project, or ongoing basis with strategic planning and product and services development and innovation; workforce and operations management, crisis preparedness and response as well as to prevent, stabilize and cleanup legal and operational crises large and small that arise in the course of operations. Her experience encompasses helping health industry clients manage workforce, medical staff, vendors and suppliers, medical billing, reimbursement, claims and other provider-payer relations, business partners, and their recruitment, performance, discipline, compliance, safety, compensation, benefits, and training; board, medical staff and other governance; compliance and internal controls; strategic planning, process and quality improvement; change management; assess, deter, investigate and address staffing, quality, compliance and other performance; meaningful use, EMR, HIPAA and other data security and breach and other health IT and data; crisis preparedness and response; internal, government and third-party reporting, audits, investigations and enforcement; government affairs and public policy; and other compliance and risk management, government and regulatory affairs and operations concerns.

Heavily involved in health care and health information technology, data and related process and systems development, policy and operations innovation and a Scribe for ABA JCEB annual agency meeting with OCR for many years who has authored numerous highly regarded works and training programs on HIPAA and other data security, privacy and use, Ms. Stamer also is widely recognized for her extensive work and leadership on leading edge health care and benefit policy and operational issues including meaningful use and EMR, billing and reimbursement, quality measurement and reimbursement, HIPAA, FACTA, PCI, trade secret, physician and other medical confidentiality and privacy, federal and state data security and data breach and other information privacy and data security rules and many other concerns. Her work includes both regulatory and public policy advocacy and thought leadership, as well as advising and representing a broad range of health industry and other clients about policy design, drafting, administration, business associate and other contracting, risk assessments, audits and other risk prevention and mitigation, investigation, reporting, mitigation and resolution of known or suspected violations or other incidents and responding to and defending investigations or other actions by plaintiffs, DOJ, OCR, FTC, state attorneys’ general and other federal or state agencies, other business partners, patients and others.

Ms. Stamer also works extensively with health care providers and organizations, legislative and regulatory bodies, health plans, communities and others on health care access, quality, affordability and other process improvement and risk management, aging, disability, education and other related legal and operational concerns, management, and education. Her work includes the establishment and reform of standards, processes and procedures, documentation, implementation, audit and enforcement of policies, procedures, systems and safeguards, investigating, and addressing and responding to emerging and other crises and issues, training and enforcement, and a host of other related concerns. Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, government and community agencies and others.

For more information about Ms. Stamer or her health industry and other experience and invlvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

About Solutions Law Press, Inc.™

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©2018 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ All other rights reserved. For information about republication or other use, please contact Ms. Stamer here.

Becoming & Caring For Antique People: A Privilege We All Hope To Experience

Lucky people live long enough to experience caring for beloved aging family or friends, then living through old age.

It’s a privilege most people look fondly forward to and take for granted until something happens that causes them to realize the mixed truth:

Living a long life usually is a blessing that comes with some challenges and costs for those that survive to enjoy it and their caregivers.

Some are the natural consequences of aging, like those humorously shared by 72-year old Mary Maxwell in this video perspective on aging.

While keeping in mind the alternative can help those living through the process cope, the emotional, physical, financial and other wear and tear of being or caring for the elderly is often exhausting. The strain and stress often robs those living with the aging process of their opportunity to enjoy its privilege until too late.

For those of us around them, celebrate the aging experience by helping when you can.

Caring for or living with old age is not something government can handle. While money helps with somethings, the human reality is universal and transcends mere money. Mindless institutionalization of old people absent a purpose for them and the involvement of caring family, friends, caregivers and community wastes the value. The elderly become prisoners trapped in bodies tracked and administered as objects rather than enjoyed and protected as the priceless treasures they’ve become through their life experiences.

Family, friends and communities living and caring for the elderly should always strive to remember having and caring for elderly people is a privilege.

Never forget that getting or knowing someone old is a privilege only a select few enjoy for a limited time.

Celebrate, support and enjoy it by participating. Treat yourself by visiting with the elderly. You’ll be amazed the treasures of history, life wisdom and self discovery you’ll gain.

Volunteer to help with caregiving or help caregivers out by taking on other tasks to give them more time.

Advocate for policies and community efforts that understand, recognize the value of our aging community members.

Your efforts not only benefit the elderly and those caring for them today. They are the foundation for deciding how you and your loved ones will be supported when and if you sometime get to enjoy the privilege of being or caring for a loved one who lives to become old.

About The Author

For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (469) 767-8872 or via e-mail here.

About Solutions Law Press, Inc.™

©2017 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ All other rights reserved. For information about republication or other use, please contact Ms. Stamer here.

Making Real Change Happen Through Committed Action

As many students participate in the National School Walkout in protest that something be done following the tragic Parkland school shooting today, it’s a good time to focus on the best way to make needed community and government change happen.

Want to make real change happen? Stop Protesting. Start Doing.

Whether stopping school or community violence, fixing health care, ending discrimination or seeking government intervention to help accomplish any other change, the truth is that real change that works comes from thoughtful, meaningful, strategic, sustained action by individuals working together in their communities. Usually government intervention can do little to really accomplish anything that communities working together can’t accomplish without government regulation. When and if necessary, however, it helps if efforts to work with government Leaders are properly focused and executed.

Want to get government to help make real change happen? Stop Protesting. Start Doing. Decide what realistically can be done without government and what government realistically can and will do that can’t be better achieved without it.

Don’t wait for government to do anything. Start with you. Lead by example. Do what you can do personally to make things better. Lead by example, then recruit and motivate friends and others to join you.

When looking to motivate government, protest seldom motivates meaningful real change. Instead of venting, look at what government realistically could do, and what politically is possible to accomplish. Recognize that legislation and regulation almost always involves compromise and laws and regulations rarely happen quickly or the way initially proposed. All or nothing efforts usually get nothing. Take what you can get done and keep pushing toward the goal.

Too often, passing legislation primarily achieves only symbolic change. The enactment affirms and validates the concern. However, legislative enactment rarely solves anything. Change through legislation or regulation requires sustained action to get proper implementation and enforcement. Stay involved. Keep providing informed, measured, well-thought-out, specific oversight and input to government leaders through focused comment delivered through official comment channels. Otherwise, the legislation actually hurts progress by promoting the myth that the enactment solved the problem when the real work had just begun.

In all cases, keep your involvement and leadership going in the community. Even when government acts, this is where true change happens.

About The Author

Repeatedly recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: ERISA & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, a Fellow in the American College of Employee Benefit Council, the American Bar Foundation and the Texas Bar Foundation and board certified in labor and employment law by the Texas Board of Legal Specialization, Cynthia Marcotte Stamer is a practicing attorney, management consultant, author, public policy advocate and lecturer widely known for health and managed care, employee benefits, insurance and financial services, data and technology and other management work, public policy leadership and advocacy, coaching, teachings, and publications. For her profession practice and pro bono work with PROJECT COPE and others she is recognized for her work, experience, leadership and publications on veterans and other health and workforce policy and law and regulation for more than 30 years.

Ms. Stamer also has an extensive contributes her leadership and insights with other professionals, industry leaders and lawmakers. Her insights on health care, insurance, benefits and other risk management and compliance concerns often appear in medical privacy related publications of a broad range of health care, health plan and other industry publications Among others, she has conducted privacy training for the Association of State & Territorial Health Plans (ASTHO), the Los Angeles Health Department, SHRM, HIMMS, the American Bar Association, the Health Care Compliance Association, a multitude of health plan, insurance and financial services, education, employer employee benefit and other clients, trade and professional associations and others. You can get more information about her HIPAA and other experience here. For additional information about Ms. Stamer, see here, e-mail her here or telephone Ms. Stamer at (214) 452-8297.

About Solutions Law Press, Inc.™

Review Your Provider Performance Data

1/18 Comment Deadline on Office Of Child Care Guidance That Allows Background Check Requirement Delays

Bill Allowing FDA Emergency Use Authorizations To Protect Military From Biological Warfare Threats Sent to President

OIG Tells Texas Stop Paying Medicaid MCOs For Dead Patients

1/19 Deadline To Comment On Proposed FDA Premarket Notice Exemption For Over-The-Counter Dental Repair Kits

Michigan Doctor Pleads Guilty To Billing Medicare For Illegally Prescribed Drugs

Anesthesiology Practice Nailed For Improperly Billing For Moderate Sedation

Florida Doctor Sentenced For Multi-Million Dollar Drug & Alcohol Addiction Treatment Health Care Fraud, Money Laundering & Forced Prostitution Scheme

CMS Announces New Medicare Provider Ombudsman

Comment By 1/8 on Guidance for Industry on Expedited Programs for Serious Conditions– Drugs and Biologics

CMS Publishes 2018 Updates To Home Health Prospective Payment Rates & Rules

CMS Publishes 2018 Physician Fee Schedule Rule

Check Your Medicare/Medicaid Compliance Against Against Quarterly Guidance Changes List

CDC Proposed Changes To NIOSH Occupational Health Biological Monitoring Methods for Chemical Exposures

HHS Picks Hargan As Acting HHS Secretary

OCR Gives Health Care Providers, Other Covered Entities Post-Las Vegas Shooting HIPAA Medical Privacy Guidance On Disclosures To Family, Media & Others For Notification & Other Purposes

Novo Nordisk Pays $58M+ For Not Giving FDA-Required Warnings ABout Victoza Cancer Risks

Christus Pays $12.24M Settlement Resolves False Claims Act Charges From “Donations” To New Mexico

Oklahoma Nursing Home Settles HHS HIV Discrimination Charges

HHS Issues Hurricane Irma Relief For Puerto Rico, U.S. Virgin Islands & Florida

HHS Medical Clinic to Provide Healthcare to Hurricane Harvey Victims at Houston Convention Center Starting Wednesday

CMS Proposes Cutbacks To Medicare Bundled Payment Program

CMS Releases 2017 Provider Payment Program Hardship Exception Application

RAISE Act Immigration Visa, Visa Holder Public Benefit Limits Create Potential Health Industry Concerns

SCOTUS Bars State Law Restrictions On Health, Other Arbitration Agreement Enforceability

Health Care, Health Plan & Other Health IT Systems Warned of E-Mail Cyber Attack

$2.4M HIPAA Settlement Warns Providers About Media Disclosures Of PHI

CardioNet $2.5M HIPAA Resolution Agreement Schools HIPAA Entities To Clean Up Their Acts

Medical Clinic HIPAA Resolution Agreement Shows Need For Current Business Associate Agreements

NOTICE: These statements and materials are for general informational and purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstance at any particular time. No comment or statement in this publication is to be construed as legal advice or an admission. The author reserves the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules makes it highly likely that subsequent developments could impact the currency and completeness of this discussion. The presenter and the program sponsor disclaim, and have no responsibility to provide any update or otherwise notify any participant of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication.

Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.

©2018 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc.™ For information about republication, please contact the author directly. All other rights reserved.

Trump Executive Order Promises Better Care To Veterans

Trump Executive Order Promises Better Veteran Health Care

Veterans transitioning back to civilian life can look forward to expanded mental health services, more choices for accessing care under some circumstances and other expanded assistance and support transitioning to civilian life under the Presidential Executive Order on Supporting Our Veterans During Their Transition From Uniformed Service to Civilian Life President Donald J. Trump signed this morning (January 9, 2018) to ensure veterans have the resources they need as they transition back to civilian life..

The Executive Order declares, “t is the policy of the United States to support the health and well-being of uniformed service members and veterans. After serving our Nation, veterans deserve long, fulfilling civilian lives. Accordingly, our Government must improve mental healthcare and access to suicide prevention resources available to veterans, particularly during the critical 1-year period following the transition from uniformed service to civilian life,

The Executive Order acknowledges the current system fails adequately to care for veterans transitioning to civilian life. It states, “Unfortunately, in some cases within the first year following transition, some veterans can have difficulties reintegrating into civilian life after their military experiences and some tragically take their own lives. Veterans, in their first year of separation from uniformed service, experience suicide rates approximately two times higher than the overall veteran suicide rate.” To help prevent these tragedies, the Executive Order states all veterans should have seamless access to high-quality mental healthcare and suicide prevention resources as they transition, with an emphasis on the 1-year period following separation.”

In announcing the Executive Order, President Trump said caring for veterans is a “top priority.”

“We want them to get the highest care and the care that they so richly deserve,” he said.

To implement the necessary improvements to improve veterans care, the Executive Order direct the Secretary of Defense, the Secretary of Veterans Affairs, and the Secretary of Homeland Security to collaborate to address the complex challenges faced by our transitioning uniformed service members and veterans to accomplish the following:

Within 60 days, the Secretary of Defense, the Secretary of Veterans Affairs, and the Secretary of Homeland Security must submit to the President, through the Assistant to the President for Domestic Policy, a Joint Action Plan that describes concrete actions to provide, to the extent consistent with law, seamless access to mental health treatment and suicide prevention resources for transitioning uniformed service members in the year following discharge, separation, or retirement.

Within 180 days, the Secretary of Defense, the Secretary of Veterans Affairs, and the Secretary of Homeland Security shall submit to the President, through the Assistant to the President for Domestic Policy, a status report on the implementation of the Joint Action Plan and how the proposed reforms have been effective in improving mental health treatment for all transitioning uniformed service members and veterans that addresses progress on certain specific reforms and any additional reforms that could help further address the problems that obstruct veterans’ access to resources and continuous mental healthcare treatment, including any suggestions for legislative and regulatory reforms; and

A timeline describing next steps and the results anticipated from continued and additional reforms.

The actual Executive Order tells little about how the Trump Administration intends to implement these directives. The White House press release about the Executive Order states President Trump believes that our veterans deserve the best healthcare in the world, and is working with the Department of Veterans Affairs (VA) to expand and modernize their care including through four already announced initiatives to expand healthcare access for our veterans through technological innovation:

An expansion of the VA’s “Anywhere to Anywhere” healthcare, which allows VA providers to use tele-health technology to remotely treat veterans regardless of geographic location.

A greater adoption of VA Video Connect, an application for mobile phones and computers, which directly connects veterans and healthcare providers from anywhere in the country.

At over 100 VA sites across the nation, a rollout of the new Online Scheduling Tool, which enables veterans to schedule appointments from their mobile devices or computers.

A launch of the VA’s “Access and Quality Tool,” which allows veterans to view online both wait times at VA locations and important quality-of-care data.

The press release also states President Trump has ensured continued access to care in the Veterans Choice Program by signing the VA Choice and Quality Employment Act, authorizing $2.1 billion in additional funds for the Veterans Choice Program (VCP).

The VCP gives eligible veterans their choice of private care if they live more than 40 miles from the closest eligible VA facility, experience wait times over 30 days from the clinically indicated date, or face an excessive burden in accessing VA care.

On addition, the press release states the Department of Veterans Affairs will adopt the same Electronic Health Record (EHR) as the Department of Defense (DOD) so all patient data will reside in one common system, enabling the immediate availability of service member’s medical records and seamless care between the departments.

Concerning veterans mental health, President Trump notes that Secretary Shulkin already expanded access to urgent mental healthcare to former service members with other-than-honorable (OTH) discharges.

As in the past, the effect of these promises remains to be seen. The announced changes only provide a portion of the reforms needed and past reform programs have promised much but have failed to resolve access issues and failed to address notorious neglect and abuse recurrently uncovered in many veterans hospitals and other care facilities across the nation. Veterans, their families and treating physicians and others concerned with veterans health issues should monitor proposed changes and provide input as needed to ensure these reforms are properly designed and implemented as well as recommend other improvements.

About The Author

About Solutions Law Press, Inc.™

Review Your Provider Performance Data

1/18 Comment Deadline on Office Of Child Care Guidance That Allows Background Check Requirement Delays

Bill Allowing FDA Emergency Use Authorizations To Protect Military From Biological Warfare Threats Sent to President

OIG Tells Texas Stop Paying Medicaid MCOs For Dead Patients

1/19 Deadline To Comment On Proposed FDA Premarket Notice Exemption For Over-The-Counter Dental Repair Kits

Michigan Doctor Pleads Guilty To Billing Medicare For Illegally Prescribed Drugs

Anesthesiology Practice Nailed For Improperly Billing For Moderate Sedation

Florida Doctor Sentenced For Multi-Million Dollar Drug & Alcohol Addiction Treatment Health Care Fraud, Money Laundering & Forced Prostitution Scheme

CMS Announces New Medicare Provider Ombudsman

Comment By 1/8 on Guidance for Industry on Expedited Programs for Serious Conditions– Drugs and Biologics

CMS Publishes 2018 Updates To Home Health Prospective Payment Rates & Rules

CMS Publishes 2018 Physician Fee Schedule Rule

Check Your Medicare/Medicaid Compliance Against Against Quarterly Guidance Changes List

CDC Proposed Changes To NIOSH Occupational Health Biological Monitoring Methods for Chemical Exposures

HHS Picks Hargan As Acting HHS Secretary

OCR Gives Health Care Providers, Other Covered Entities Post-Las Vegas Shooting HIPAA Medical Privacy Guidance On Disclosures To Family, Media & Others For Notification & Other Purposes

Novo Nordisk Pays $58M+ For Not Giving FDA-Required Warnings ABout Victoza Cancer Risks

Christus Pays $12.24M Settlement Resolves False Claims Act Charges From “Donations” To New Mexico

Oklahoma Nursing Home Settles HHS HIV Discrimination Charges

HHS Issues Hurricane Irma Relief For Puerto Rico, U.S. Virgin Islands & Florida

HHS Medical Clinic to Provide Healthcare to Hurricane Harvey Victims at Houston Convention Center Starting Wednesday

CMS Proposes Cutbacks To Medicare Bundled Payment Program

CMS Releases 2017 Provider Payment Program Hardship Exception Application

RAISE Act Immigration Visa, Visa Holder Public Benefit Limits Create Potential Health Industry Concerns

SCOTUS Bars State Law Restrictions On Health, Other Arbitration Agreement Enforceability

Health Care, Health Plan & Other Health IT Systems Warned of E-Mail Cyber Attack

$2.4M HIPAA Settlement Warns Providers About Media Disclosures Of P HI

CardioNet $2.5M HIPAA Resolution Agreement Schools HIPAA Entities To Clean Up Their Acts

Medical Clinic HIPAA Resolution Agreement Shows Need For Current Business Associate Agreements

Back To School Bullying Reminder

New and resumed interactions that accompany the start of a new school year create new bullying risks.

The federal government and many states have laws and other rules that make bullying illegal or civilly actionable in schools and other locations in the number of circumstances. See e.g Texas Anti-Bullying Laws. While these laws may help deter or partially redress the effects of some bullying under some circumstances, victims of bullying and family, friends, school, business, community and government leaders trying to prevent an address it know it the law rarely provides an adequate tool to stop all bullying, much less provide quick or reliable protection or relief for those targeted by bullies.

Help protect your child and others by educating yourself, your child and family, your teachers and school leaders, and friends that bullying is wrong, how to recognize it and what to do to prevent and remedy it.

STOPBULLYING.gov is one of many free websites that provides valuable resources about bullying, why it’s wrong and harmful, laws and other rules that help to prohibit and regress it and a host of other helpful resources to prevent and help people cope with bullying problems.

The best way to prevent or stop bullying is for everyone to step up and fight it. Step up to stomp out bullying. Teach and require your children and others to treat others with respect and to expect and require those around them to do the same. When someone is being bullied, use the tools from these resources to defend yourself or the other victims in a constructive way. Uniform zero intolerance is the best and most reliable redress and cure for bad behavior.

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