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PubMed2001

Louis H. Bauer, M.D., and the first civil U.S. aeromedical standards: his continuing legacy.

Louis Hopewell Bauer, M.D. (1888-1964) promulgated the first civil aviation medicine regulations for U.S. civil airmen on December 31, 1926. Major elements of these regulations are reflected in the current Federal Aviation Administration Civil Airman Medical Standards, these latter including modifications resulting from medical and aeronautical technical advances. Dr. Bauer's plans covering periodic examinations, waivers, and a system implemented through designated "Aviation Medical Examiners" are continued to this day. Dr. Bauer founded the progenitor of the present Aerospace Medical Association in 1929, the Aero Medical Association. Further, he founded the Journal of Aviation Medicine, the predecessor of the present Aviation, Space, and Environmental Medicine journal, the first issue published in March, 1930. Dr. Bauer's influence in medicine broadened to include the presidency of the American Medical Association (1952-3) and a long standing leadership role with the World Medical Association. His 1926 textbook, Aviation Medicine, stands as an historic centerpiece in the evolution of aviation medicine. Bauer's leadership and contributions to civil aviation medicine came at the right time to enhance the development of U.S. civil aviation and civil aviation safety.

Aerospace Medicine↗
PubMedDate not supplied

[The integral civil and military health care system].

The problem of the organization of the army health care system in the Republic of Croatia is very actual. At the beginning of the war, the all fighting formations were covered by the civil health organization. After the Croatian army was organized, the differentiation between civil and army health system has been established. The characteristic of that differentiation was integral system with primary health care and transporting of the wounded persons organized by the army, while the specialistic and hospital care were organized by the civil institutions. In the peaceful future the integral health system must be kept. There is no need for the army hospitals, because only one hundred beds for a year will be enough for the army consisted of about 50,000 persons. The civil hospitals can provide the high quality service with a short-term transporting of the patients. The Government of the Republic of Croatia has decided to establish such integral system which includes the civil hospital care and the civil specialistic out-patient care, while the primary and specific health care are in the organization of the army. This system is less expensive than the full army health system, but is of better quality and includes an easy approach to all health institutions.

Croatia↗
PubMed1992

Preventive outpatient civil commitment and the right to refuse treatment: can pragmatic realities and constitutional requirements be reconciled?

This article examines the concept of preventive outpatient civil commitment as a mechanism for controlling the behaviour of the chronically mentally ill. The goal of preventive outpatient civil commitment is to intervene at an early stage to prevent further deterioration of a mentally ill person's state. In the jurisdictions in the United States which have enacted preventive outpatient civil commitment statutes, there is a lesser standard required for outpatient commitment than for inpatient commitment. For outpatient commitment, there generally only needs to be a finding of mental illness and a conclusion that without treatment a person's mental illness will further deteriorate. This standard often clashes with the civil liberties of those being committed, particularly with the right to refuse treatment. This article explores preventive outpatient civil commitment in relation to the historic right to refuse treatment by examining the antithetical positions of the state's authority to treat and the mental health client's interest in liberty. The article concludes that both of these positions ignore the possibility that, through the development of an adequate community care service system, the reality of the mentally ill in the community may be reconciled with a civil liberties perspective. '[The] [c]onstitutional right to privacy...is an expression of the sanctity of individual free choice and self-determination as fundamental constituents of life. The value of life as so perceived is lessened not by a decision to refuse treatment, but by the failure to allow a competent human being the right of choice.'

Ambulatory Care↗
PubMed1997

[Social medicine evaluation of pre-employment medical screening of civil service candidates].

The findings and resulting number of rejections from 9.043 medical examinations of candidates for posts as civil servants in 1994 in Bavaria and a retrospective evaluation of 500 examinations at two large public health departments in Bavaria were used to discuss the value of such examinations and present possible alternatives. The rate of rejections for medical reasons in the 9.043 examinations of civil servants starting new jobs in Bavaria was 0.57%. The most frequent reason for rejection was obesity. In the retrospective evaluation of 500 medical examinations of candidates starting new jobs there were no cases of final rejection for medical reasons. In 0.4% of cases (n = 2) the candidates were considered suitable for the probationary period before becoming a civil servant, but unsuitable for health reasons for a life-time post in the civil service. In 27% of cases the findings were normal without any diagnosis stated in the examination report. The most frequent diagnoses were refractive ametropia (55.8%) and changes in the locomotor system (22.2%), in particular deviation of the axis are vertebral column (17.6%). The results are comparable with those obtained in studies carried out in Europe, although the procedures and study designs differed. Even with a low number of rejections of around 0.5%, examinations of the candidates economically justified for the employer (the state). In view of the high number of civil servants taking early retirement, the sensitivity and specificity of the medical examinations before starting work are discussed, as well as possible and better alternatives to a single examination. One suggestion is continuous monitoring of all civil servants by a physician specialised in occupational medicine, although in particular for teachers and office workers no standards have been developed for the scope and frequency of occupational-medical health checks and consultation.

Adolescent↗
PubMed1987

A review of tort liability in involuntary civil commitment.

The grounds for liability in cases of involuntary civil commitment have been broadened in recent years. Psychiatrists and other mental health professionals have been found liable for infringement of civil rights under Section 1983 of the Civil Rights Act and for failure to commit an individual who is subsequently involved in a tragedy. This article reviews recent developments in tort liability in involuntary civil commitment as well as the traditional areas of tort liability, including malpractice, malicious prosecution, false imprisonment, and abuse of process. The authors believe that even in this climate of expanded liability, mental health professionals who follow the letter and spirit of civil commitment laws will continue to enjoy the broad protections from liability afforded them in the past.

Civil Rights↗
PubMedDate not supplied

Trouble in Vineville: church property and the civil courts.

During the past century the U.S. Supreme COurt has developed a "deference" approach to resolving church property disputes in civil courts. This approach requires a civil court to defer to the decisions of the appropriate superior body in a hierarchical church, absent allegations of fraud or collusion by the church. In the late 1970s, a parallel approach developed, whereby a civil court may resolve church property disputes by applying neutral principles of property law. Insofar as the property documents contain express assertions of church law to be applied in disputes, those laws will be followed. If the church documents are silent, the civil court will not have recourse to other church documents but will decide the matter for itself. This, of course, could result in the civil court deciding contrary to the church tribunal. Both the deference approach and the neutral-principles approach satisfy the demands of the First Amendment because neither, the Supreme Court has said, interferes with the free exercise of religion nor unduly establishes a religion. A strong four-justice dissent in a recent decision may, however, signal trouble ahead for the neutral-principles approach.

Civil Rights↗
PubMed2001

Civilization as a threat to human health?

Civilization can be defined as the distinctly human attributes and attainments of a particular society. In general, the development of civilization is viewed as a positive step for the well-being of the human species, leading to an increased duration and quality of human life. The accelerated progress of civilization (mainly industrialization, urbanization and nutrition) has lead to new possibilities for adverse effects on human health. A collection of problems referred to as 'civilization diseases' has become the subject of serious concern but review of available data indicates that this concept appears to add very little to our understanding of modern environmental influences on human health. Important limitations in the continued use of this term are its non-specificity, the lack of a unifying scientific foundation, and provision of virtually no direction for remediation of these diseases or for future research. In addition, the use of this term has been localized to primarily post-socialist European countries. In view of these limitations, it seems more productive for scientists, in all parts of the world, to embrace the discipline of environmental health science and to discontinue use of the term "civilization diseases".

Civilization↗
PubMed1999

MMPI-2 profiles of NGRI and civil patients.

Limited information is available comparing individuals found Not Guilty by Reason of Insanity (NGRI) to other psychiatric patients. This study examined the MMPI-2 profiles of 36 NGRIs and 35 civilly committed inpatients at 3 state psychiatric hospitals. The NGRI and civil patient groups differed in terms of race and gender with more minority individuals and fewer women in the NGRI group. Therefore, these demographic variables were used as covariates in a MANCOVA comparing the MMPI-2 validity and clinical scales for these 2 groups. NGRIs and civil inpatients produced significantly different mean MMPI-2 profiles, with NGRIs reporting less pathology overall compared to civil inpatients. Specifically, NGRIs had lower scores on scales F, 1, 2, 7, 8, and O and higher scores on scale K. Contrary to expectations, NGRIs and civil patients did not differ on scale 4, supplementary scale Re, and content scales ANG, CYN, and ASP, or Harris-Lingoes subscale Pd2. Overall, these results suggest that NGRI patients are functioning at a higher level than civil patients. These findings are considered in terms of previous results and potential selection bias. Implications for treatment and future research are also considered.

Adult↗
PubMed2001

Involuntary treatment of alcohol-dependent patients: a study of 17 consecutive cases of civil commitment.

AIM: To investigate the baseline and follow-up characteristics of a group of alcohol-dependent patients being treated under civil commitment. METHODS: This study involved a cross-sectional comparative analysis of baseline characteristics and a follow-up survey of a group of committed alcoholic patients. The study was undertaken in the Alcohol Unit of a 1,000-bed general and university hospital. The study included 17 consecutive cases of civil commitment (representing 15 patients, of whom 2 were committed twice) and a comparative group of 34 randomly selected age- and sex-matched patients. Baseline characteristics of the cases (at the time of commitment) and of patients from the comparative group were collected from medical records, including sociodemographic data, medical condition, patterns of drinking and number and dates of previous treatments for alcohol-related problems. A structured follow-up interview of the cases provided information on their medical condition, social status, patterns of alcohol use, type and duration of residential treatment as well as their perceptions of commitment. RESULTS: During a 4-year period, our Unit referred 23 cases of alcohol-dependent patients (out of 367) to the Guardianship Authority, requesting civil commitment. On 17 occasions, patients were committed to residential treatment, including 2 patients who underwent commitment on two separate occasions, thus representing a total of 15 different patients. In comparison with age- and sex-matched patients seen at the Unit, the cases were characterized by multiple medical, social and psychological alcohol-related impairments. At the time of follow-up, 14 out of 15 patients were alive, among whom 10 agreed to be interviewed. Eight of these reported complete abstinence, whereas 9 considered their alcohol problem as less severe than before. The average duration of commitment was 29 weeks. The majority of patients retrospectively considered the measure as having been justified and useful. The patients' satisfaction with the decision to commit was higher among women than among men. Health-related quality of life at the time of follow-up, as assessed by the MOS 36-Item Short Form Health Survey questionnaire, was good on average and better than that usually reported by other cohorts of alcoholics undergoing treatment. CONCLUSIONS: The usefulness of residential civil commitment of certain severely impaired alcohol-dependent patients is underscored. This study suggests that civil commitment not only may save the lives of endangered patients but could also be a health-promoting measure that may sometimes allow for recovery from dependence. Unexpectedly, this measure was retrospectively well accepted by many patients, who considered the commitment decision as having been justified and useful.

Alcoholism↗
PubMed1995

Who will pay for involuntary civil commitment under capitated managed care? An emerging dilemma.

Involuntary civil commitment in managed care settings may create conflicts between providers and payers. Providers may determine that a patient, particularly one who presents a risk to self or others, must be confined beyond the period reimbursed by the payer. Court decisions have upheld clinicians' ethical obligations to provide care in these situations. In addition, civil commitment may be used to shift costs of long-term care to another provider. The author explores these issues and suggests six strategies that providers can use to address them. They include avoiding negotiations with payers over individual patients' care by ensuring that contracts with payers address civil commitment and patients at risk of harming themselves or others, identifying and creating services and social supports to reduce the necessity for commitment and allowing creative use of benefits, adopting formal risk assessment protocols to standardize the process for all patients and and clinicians, conducting research on the use of civil commitment and coercion in managed care settings, ensuring that incentives do not exist in states' Medicaid managed care programs to use civil commitment to shift costs, and holding discussions with treatment staff about the growing encroachment of financial considerations into treatment decisions.

Adult↗
PubMed1988

[Importance of the initial examination after a rape in considering the criminal penalty and indemnification of the victim in a civil suit. Review of the documents from one Court of Assizes over 11 years].

The gynaecologist-obstetrician may be the medical witness who has to give evidence about the extent of the initial trauma after the presumption of a sexual assault on a victim who comes to consult him, or as an expert witness. The certificate that he gives at the time of the first consultation is an essential document for the examining magistrates who have to decide whether there has been an offence. It is also a very great help to support the brief for the lawyers in a civil action taken by the victim, who is claiming damages as compensation for physical or psychological damage resulting from the sexual abuse. The authors reported it useful to look through 64 case documents that were considered in 11 years. They studied the differences in the penalties that were awarded for criminal offences and the sums of money for indemnity that were awarded in civil cases. These were before the new law concerning rape was passed on the 23rd December 1980, and after this law had been applied. It tends to improve the position for the victim in civil cases and increases the sentences that can be passed for aggravated rape (as on a minor by an adult, or in particular somebody who has a position of responsibility to the child). The authors point out especially how important it is to take note of sexual precocity and to have a detailed account of the first investigations carried out after the sexual assault. These can be used to make the sentences differ and to make it possible to increase and widen the awards given to compensate the victims. As far as civil action is concerned, as there is usually a fixed scale for every regional Court of Assizes according to a definite formula, it is advisable according to the authors that the initial expert assessment presented by the magistrates should establish in its conclusions the details of the indemnity to be considered by professional judges of the Assize juries. They should take particular notice of added injuries that are not physical and are often not considered, such as pain and suffering, loss of pleasure and the aesthetic, the sexual, the obstetrical and the moral as well as the juvenile points of view. In certain cases ad full medical assessment presented before the end of the case will help the professional judges of the jury of Assizes who have to give judgment in a civil action by giving them information that will support the true interests of the victim.

Expert Testimony↗
PubMed2000

What is the role of procedural justice in civil commitment?

OBJECTIVE: To determine best practice management strategies in the clinical application of civil commitment. METHOD: All relevant literature on the topics of 'civil commitment', 'coercion' and 'procedural justice' were located on MEDLINE and PsychLIT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. RESULTS: Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. CONCLUSIONS: Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.

Advance Directives↗
PubMed1995

Adolescents' and young adults' conceptions of civil liberties: freedom of speech and religion.

This study examined adolescents' and young adults' conceptions of freedom of speech and religion (civil liberties). 48 adolescents and young adults in 3 grade levels (mean ages 12-8, 16-10, and 19-6) were administered a structured interview containing assessments of civil liberties in general, in straightforward (unconflicted) applications, and in conflict with other social and moral concerns, including law, physical and psychological harm, and equality of opportunity. Freedom of speech and religion were conceptualized as universal rights and applied to social events in unconflicted contexts at all ages. A diverse array of rationales, differentiated according to type of freedom, were used at all ages to ground conceptions of universal freedoms. Judgments of civil liberties in conflicts exhibited several sources of variation, including developmental differences, situational or contextual variation determined by the particular types of issues in conflict, and individual differences. Results are consistent with the proposition that judgments of civil liberties reflect age-related patterns of coordination of delimited social and moral concepts rather than general orientations.

Adolescent↗
PubMed1990

A comparison of civil patients and incompetent defendants: pre and post deinstitutionalization.

There has been a great deal of speculation that deinstitutionalization has resulted in the criminalization of the mentally ill. Using two samples of defendants found incompetent to stand trial (IST) and two samples of civil patients randomly selected from five states, pre and post deinstitutionalization, this research compares changes in their mental health and arrest histories. After deinstitutionalization, fewer and less dramatic differences in the arrest and mental health histories were evident between ISTs and civil patients. Both patient samples displayed significant increases in prior hospitalization and arrest histories. Among the civil patients there was a significant increase in the frequency and seriousness of criminal activity. There was no evidence that IST commitments are being expanded to hospitalize the nondangerous mentally ill no longer subject to civil commitment.

Civil Rights↗
PubMed1995

A pay-for-performance system for civil service doctors: the Indonesian experiment.

In 1980 the Government of Indonesia proposed the introduction of a pay-for-performance system, the Functional Position System (FPS), for certain occupational categories of civil servants to provide a career development path and stimulate productivity (Government of Indonesia. Government Ordinance No. 3, 1980 Concerning Appointment to Civil Service Rank. Jakarta, 1980). The FPS, a bold pay concept in the civil service, links pay to skills and performance. In 1987, instructions were issued for doctors to be included in the system (Government of Indonesia, Credit Scores for Doctors. Circular Issued by the Ministry of Health and the Agency for Administration of the Civil Service No. 614/MENKES/E/VIII/1987 and No. 16/SE/1987). In this paper we evaluate how well the system-which in principle could be applicable to both developed and developing economies--can meet its stated objectives for Indonesian doctors working in the community, and for Indonesian health policy objectives as stated in the country's last five-year development plan "Repelita V" (Government of Indonesia. The Fifth Five-year Development Plan (Repelita V) 1989-1994. Jakarta, Indonesia, 1989). The FPS is particularly innovative in the Indonesian environment where wages are low and comparatively uniform, reflecting a philosophy of 'shared poverty', and vary primarily by seniority. The FPS has, however, several conceptual and practical shortcomings. The design of the reward system disregards effort or time inputs, as well as other inputs needed per unit of reward. Consequently, the FPS can not be used as an effective incentive system promoting professional excellence and health policy objectives. Practically, the system hardly provides an effective alternative for career development among community physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Mobility↗
PubMed2001

The reliability of perinatal and neonatal mortality rates: differential under-reporting in linked professional registers vs. Dutch civil registers.

Official Dutch perinatal mortality rates are based on birth and death certificates. These civil registration data are not detailed enough for international comparisons or extensive epidemiological research. In this study, we linked and extrapolated three national, incomplete, professional registers from midwives, obstetricians and paediatricians, containing detailed perinatal information. This linkage and extrapolation resulted in one detailed professional database which is representative of all Dutch births and from which gestational age-specific perinatal mortality rates could be calculated. The reliability of these calculated mortality rates was established by comparing them with the rates derived from the national civil registers. The professional database reported more perinatal deaths and fewer late neonatal deaths than the civil registers. The under-reporting in the civil registers amounted to 1.2 fewer perinatal deaths per 1000 births and was most apparent in immature newborns. We concluded that under-reporting of perinatal and neonatal deaths depends on the data source used. Mortality rates for the purpose of national and international comparison should, therefore, be defined with caution. This study also demonstrated that combining different incomplete professional registers can result in a more reliable database containing detailed perinatal information. Such databases can be used as the basis for extensive perinatal epidemiological research.

Data Collection↗
PubMed2000

Pharmacy in the American Civil War.

The role of pharmacists and the process of military drug supply in the American Civil War are described. Most raw drugs used in the United States in the mid-1800s were imported. During the Civil War, imports into the North continued, but the Union blockade forced the Confederacy to obtain medicines through means such as smuggling, capture of enemy supplies, and processing of indigenous medicinal plants. Medical supplies for Civil War troops were typically purchased by military physicians called medical purveyors and sometimes by pharmacists serving as acting medical purveyors. In the latter half of the war, U.S. Army medical laboratories, in which many pharmacists were employed, inspected purchases, repackaged supplies bought in bulk, and manufactured medicines from raw materials. The Confederacy also had medical laboratories, which were primarily responsible for manufacturing medicines from indigenous plant material but also inspected drugs that had been smuggled into the South. At a few large Union medical depots, pharmacists called medical storekeepers assumed many of the responsibilities of medical purveyors by receiving, storing, issuing, and accounting for supplies. Noncommissioned officers called hospital stewards assumed diverse duties that included dispensing drugs prescribed by military physicians. Although many hospital stewards were pharmacists or physicians, others had no previous pharmaceutical experience. Civilian pharmacists were employed in the medical laboratories and in military general hospitals. Pharmacists participated in nearly every aspect of military drug supply during the Civil War.

History, 19th Century↗
PubMed1982

Short-term civil commitment and the violent patient.

To explore the specificity of criteria for civil commitment for dangerousness, the authors examined the relationship between civil commitment for dangerousness to others under the California Civil Commitment Statute (the Lanterman-Petris-Short Act) and violent acts and behavioral ratings made immediately after commitment. Using a prospective design they evaluated 84 subjects. The ratings of violent acts for subjects considered dangerous to others were no different than those of a nondangerous control group. The subjects considered dangerous to others, however, differed on several subscales of the Brief Psychiatric Rating Scale. The authors discuss the implications of these results for civil commitment proceedings.

Adult↗