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PubMed1991

Arrest and incarceration of civil commitment candidates.

To gauge whether more stringent civil commitment criteria have led to the criminalization of mentally ill persons, forcing them into jails and prisons instead of treating them, a statewide sample of 1,226 civil commitment candidates in North Carolina was tracked for six months after their commitment hearings. Only 72 sample members were arrested during the period, mostly for burglary or larceny (22 arrests), simple or aggravated assault (17 arrests), and minor offenses (40 arrests), including drunkenness, trespassing, and traffic violations. Fourteen sample members were jailed, and two were sent to prison. The mentally ill who were not involuntarily hospitalized or who were hospitalized for only short periods were seldom arrested; when they were arrested, the charges were generally for nondangerous offenses.

Adult↗
PubMed1990

[Sterilization of the mentally handicapped according to section 1905 of the German Civil Code in relation to developing a patient management regulation].

Discussions on the sterilization of the mentally handicapped are still overshadowed to a great extent by the dire consequences of National Socialist policies which were only poorly concealed in the legislation of the period. These laws have meanwhile been rescinded but that has not eradicated the phenomenon itself. In fact, in recent years about 1,000 mentally handicapped persons have been sterilized--without their consent and without any firm legal basis for such action--shortly before reaching the age of 18. In most cases, the parents and the physicians involved joined forces in taking the matter into their own hands. Against this background there is a clear need for legislative action. Virtual agreement has been reached on this between the political groupings represented in the Bundestag and the organizations working for the welfare of the handicapped. Nonetheless, the recently submitted draft of a new bill is for the most part unacceptable. It is an improvement of earlier drafts in asmuchas the attempt to establish a close and often inappropriate link with Sect.218 a of the Penal Code (concerning abortion) has at least partly been given up. But the fact remains that handicapped women are still subjected to greater burdens than their male counterparts. Under the planned amendment to Sect.1905 Para. 1 (4) of the Civil Code, the act itself will define the requirements for a sterilization to be carried out "for medical reasons" (i.e. if life or health of the expectant mother are in jeopardy). Sect.1905 of the Civil Code contains no specific regulations as to when a sterilization is permissible "for eugenic reasons," but the fact remains that it can still be quite easily carried out under the general grounds. Pursuant to Sect.218a of the Penal Code an abortion can be exempt from punishment under special circumstances (i.e. on "social grounds") if the mother is at the time in a desperate situation which cannot be rectified in any other way. It certainly reflects very poorly on us if we do not succeed in giving the handicapped the help and support they need in their life situations which are so completely different from ours.

Child↗
PubMed1989

Civil Monetary Penalties Law: mistakes could be (very) costly.

The Civil Money Penalties Law (CMPL) authorizes the Secretary of Health and Human Services to impose civil money penalties, an assessment, and program exclusion for various forms of fraud and abuse involving the Medicare and Medicaid programs. Penalties range from $2,000 to $100,000 for each violation, depending on the specific misconduct involved. The monetary sanctions imposed generally far exceed the damages actually sustained by the government. The Inspector General must only prove liability by a "preponderance of the evidence" rather than the more demanding "beyond a reasonable doubt" standard required in criminal actions. A health care provider can be held liable based on its own negligence and the negligence of its employees. There is no requirement that intent to defraud must be proved.

Crime↗
PubMed1989

Investigators' and judges' opinions about civil commitment.

As part of our work with the Oregon Task Force on Civil Commitment, we surveyed the judges and commitment investigators involved in the state's involuntary treatment program. In Oregon the investigators recommend whether or not a commitment hearing should be held. These mental health professionals indicated that current confidentiality laws restrict their access to important information. The investigators also expressed concern about the lack of resources with which to divert clients out of the commitment system. Judges too felt that relaxing the rules of evidence would improve the quality of commitment hearings. Regarding changes in the system, investigators and judges indicated that outpatient treatment (including compliance with medications) should be required of committed patients. These professionals noted that involuntary outpatient treatment could only be enforced if the system included a mechanism for hospitalizing patients who were noncompliant. Although the investigators believed commitment criteria should be broadened so that their clients could receive treatment before becoming dangerous, judges did not generally endorse this view. We discuss the implications of these findings for new civil commitment legislation.

Adult↗
PubMed1989

Does determining serum alcohol concentrations in emergency department patients influence physicians' civil suit liability?

Emergency physicians may incur liability when impaired patients who have been treated and released are subsequently involved in traffic crashes. We surveyed attorneys to assess their perception of how serum alcohol determinations might influence their liability in civil suits. Overall, 63.9% of the attorneys surveyed would advise patients that they received potentially negligent care if they were impaired following treatment in the emergency department and were involved in a traffic crashes. Perceived liability was altered by physician behavior as follows: 43.1% of attorneys would advise clients that they received potentially negligent care when impairment was documented by a test for serum alcohol concentration and no advice was given regarding drunk driving, and 17.3% of attorneys would give similar advice when impairment was not documented by a test for serum alcohol concentration and no advice was given regarding drunk driving. In contrast, only 3.5% of attorneys would suggest possible negligence when impairment was documented by a test for serum alcohol concentration and with advice subsequently given not to drive. The coupling of diagnosing impairment by the serum alcohol concentration and driving advice is medically sensible and might result in minimal civil liability.

Accidents, Traffic↗
PubMed1987

Methodology for the analysis of civil commitment detention times and costs.

The authors expand their methodology for quantifying and comparing civil commitment processes by developing new formulas for the determination of the average commitment detention time and cost. They also examine the effects of specific changes in commitment procedures on the average detention time and cost. Using data from Oregon's civil commitment process, the authors present several examples of the practical application of their methodology and conclude with a discussion of its major administrative and research implications.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

Public health and the civilizing process.

Since the Middle Ages, European society has passed through two successive stages in the "civilizing process." Each has been attended by profound changes in psychological and social codes. These are examined in relation to a greater concern with health and hygiene in response to four waves of epidemics: leprosy, plague, syphilis, and cholera. Speculations are offered about AIDS and the "civilizing process".

Acquired Immunodeficiency Syndrome↗
PubMed1986

A methodology for predicting the effects of changes in civil commitment decision making.

We review a three-step civil commitment model and formulas for calculating the probability of release from commitment and the relative importance of the three steps in determining the outcome. New formulas are developed which enable predictions to be made about the effects of changes on the outcome of the three steps on the release probability. With the use of data from Oregon's civil commitment process, we present an example of the application of the methodology and conclude with a discussion of its major administrative and research implications.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

"Insanity" in civil law.

The issue of "insanity" is rarely alluded to in the area of civil law. As a consequence, the legal standard for insanity is not clearly understood by many psychiatrists. The standard derives from case law and is based upon statutory law in the criminal sector. A civil case will be presented where the question of "insanity" was raised. In this case an individual committed suicide and his insurance company refused to pay the beneficiaries of his life insurance policy based upon a provision in his policy that excluded payment in situations of suicide. His beneficiaries sued, claiming that the deceased was insane at the time of his suicide and therefore not responsible for his actions. The standard for insanity in New Jersey and the reasoning of the psychiatrists will be presented.

Expert Testimony↗
PubMed1972

Medical journals in Louisiana before the Civil War.

This study, an historical survey of medical journals in Louisiana before the outbreak of the Civil War in 1861, revealed that nine journals made an appearance during the period covered-all of them published in New Orleans. Of these, two were French language journals published by a French medical society. The others were all published by individuals rather than by professional societies. Medical practices, interests, and problems of the times were clearly reflected on the pages of the journals. It is evident that medical journalism reached a high plane in the era before the Civil War. Of the nine periodicals, only one emerged as a permanent publication after the War.

Education, Medical↗
PubMed1981

The selection of air traffic control specialists: history and review of contributions by the Civil Aeromedical Institute, 1960-80.

For two decades, the FAA Civil Aeromedical Institute ((CAMI) has explored the problems of effectively selecting air traffic control specialists (ATCSs) for the FAA. The results of those efforts have contributed directly to the establishment of revised ATCS selection standards by the Civil Service Commission (CSC). Early studies on the validity of aptitude tests for predicting successful completion of Academy training led to a decision to use such tests for part of the CSC screening standard. Later studies led to the establishment of a maximum age standard of 30 years for entry into ATCS training. In addition, CAMI researchers have continuously evaluated the validity of existing standards, have examined numerous variables and alternative aptitude measures, and have provided a number of data-based recommendations in an effort to improve predicting of success in ATCS training. This paper reviews that research with emphasis on aptitude screening measures, attrition, age, prior experience, education, sex, military ATCS training, and the Uniform Guidelines on Employee Selection.

Adult↗
PubMedDate not supplied

[Between individual therapy and political intervention: campaigns against "diseases of civilization" between 1920 and 1960].

The concept of "disease of civilization" is commonly used for a variety of conditions. It implies a criticism of the "modern" way of life. This criticism and the strategies put forward to prevent diseases of civilization are correlated to the specific historical context in which they are formulated. The paper analyses three positions characterising different periods in 20th century German history: In the Weimar Republic, representatives of paediatrics and social hygiene asked for the expansion of public health care programmes according to the principles laid down by the Weimar constitution. During the time of National Socialism, more radical measures were propagated by exponents of hygiene and psychotherapy, aiming at a fundamental restructuration of society in accordance with the Nazi ideology. After 1945, strategies focused on the individual: Physical exercise, abstinence, and individual psychotherapy were propagated to prevent or treat the consequences of life in modern society.

Germany↗
PubMed1995

Interaction of the criminal justice system and psychiatric professionals in which civil commitment standards are prohibitive.

Three case studies are the basis for a discussion of the criminalization hypothesis as it may apply to psychiatric probationers and parolees in the criminal justice system. In each of these cases, the treating psychiatrist faced the problems of noncompliance with treatment and/or restrictive civil commitment standards. The patient's status as a probationer or parolee played a pivotal role in strategies for ensuring treatment through the criminal justice system as opposed to the mental health system or civil commitment process.

Adult↗
PubMed1994

The Munchausen syndrome in civil forensic psychiatry.

The diagnosis of Munchausen syndrome requires that a patient intentionally produce or feign physical symptoms with a psychological need to assume the sick role. To differentiate the disorder from malingering one must document the absence of an external incentive for the patient's behavior. Although malingering is a major topic of interest in forensic psychiatry, there has been no literature that looks at the Munchausen syndrome presenting in the civil forensic setting. This paper reports on two cases of the Munchausen syndrome that occurred in the areas of medical malpractice and workers' compensation. The cases highlight how the psychiatrist should approach these cases in the civil forensic setting. The malpractice case also illustrates how the disorder is viewed by an appellate court.

Adult↗
PubMed1994

[Cases of hydatidiform mole at the Nuevo Hospital Civil in Guadalajara].

Thirty nine patients with hydatiform mole with clinical, echosonographic and hormonal diagnosis, were analyzed, from March, 1991 to February 1993 at the Nuevo Hospital Civil de Guadalajara. Incidence was I out of 301 pregnancies; average age, 24.6 years; 35.8% were primigravidae; average amenorreha was 15.6 weeks and there were not complications in 84.6%. The most frequent symptoms were transvaginal bleeding, 92.3%; mole rests expulsion, 25.6% and hyperemesis, 23%. The uterine fundus was larger in 17 patients; smaller in 13; the same in 5 and there were no data for four cases. An uterine curettage was performed in 38 patients; there was hysterotomy performed also for important bleeding; and there were 11 patients transfused. The histopathologic results of hydatidiform mole were confirmed in 84.6%. Only 20% of the patients came back for a post-evacuation control treatment. These results suggest that the characteristics of mola pregnancy at the Nuevo Hospital Civil de Guadalajara are similar to what has been reported in the literature; with a delayed diagnosis and a poor follow up of cases.

Adult↗
PubMed1994

Civil aviation mortality, state differences, and the role of multi-fatality aircraft accidents.

Mortality due to transportation-related causes may differ by state of residence and state of occurrence. Aircraft accidents can cause multiple fatalities due to a single event. Population-based state-specific civil aviation accident mortality rates were calculated using National Center for Health Statistics data for the years 1980-89. Aircraft accident information for the same period was obtained from National Transportation Safety Board sources. The national 10-year mean mortality rate for civil aviation-related causes was 5.2 deaths/1,000,000 general population. State-specific mortality rates by state of residence varied between 2.1 and 79.9 deaths/1,000,000 general population. Rates by state of death occurrence varied between 1.5 and 98.0 deaths/1,000,000. Mortality rates, calculated by state of residence, differed from rates calculated by state of occurrence for most states. For some states the differences were considerable. Ten states experienced at least one aircraft accident between 1980 and 1989 which accounted for 20 or more fatalities. These multi-fatality events had a substantial effect on state-specific aviation-related mortality rates.

Accidents, Aviation↗
PubMed1993

Aphakia and artificial lens implants in the civil airman population.

The Federal Aviation Administration allows civilian airmen with aphakia to fly with waivered certificates. This study analyzes, in the civil airman population, the distribution of aphakia and intraocular lens (I.O.L.) implant by type (unilateral, bilateral), class of airman medical certificate, and gender, for a 4-year period (1982-85). Medical records were individually evaluated for all certified airmen who were carrying FAA-specific codes for the pathology categories during the study period. The prevalence of both aphakia and I.O.L. increased most for bilateral type and second-class certificate holders. During the study period, the prevalence of aphakia increased most for males and I.O.L. increased most for females. The incidence declined in both pathology categories during the later years of the study period. Implications for aeromedical certification of the increasing prevalence of aphakia and I.O.L. in the civil airman population are discussed. The modification of surgical procedures for cataract extraction and evolution of I.O.L. devices strongly suggests continued specialized aeromedical certification and clinical research review.

Aerospace Medicine↗
PubMed1993

Civil aeromedical standards: year 2000 plus.

Civil aviation medical standards are continuing to evolve from those established in the World War I era. For example, the whispered voice test standards, the uncorrected visual acuity standards, and other holdovers have been modified, and these and others are now undergoing further modification. U.S. civil pilot ECG's are all now being sent by telephone to the FAA, and, beginning in 1992, some Aviation Medical Examiners are sending the airman physical examinations to the FAA by telephone. By 1994, the vast majority of these examinations are to be sent electronically. As cognitive function is the primary factor in safe flight operations, computerized assessments of this aspect will be accomplished routinely in the next century, taking precedence over physical characteristics which in earlier times were given priority.

Aerospace Medicine↗