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PubMed1988

Clinical experience with civil commitment.

The unstable motivation of the addicted person has represented a major problem in the treatment of opioid dependence. Only a minority of voluntary patients remained in the two PHS hospitals for treatment beyond withdrawal. Early followup studies at the two hospitals indicated that treatment under legal coercion, especially when combined with compulsory posthospital care, had better outcomes, but not markedly better, than did voluntary treatment. A large proportion, one-third to one-half, of the patients admitted to the hospitals for examination prior to civil commitment were found not suitable for treatment, mainly due to their disruptive or dangerous behavior. Due to attrition after examination and during 6 months of hospital treatment under commitment, only about one-third of the civil commitment patients admitted were discharged to aftercare. The high attrition rate may have been partly due to intensive psychosocial treatment. Patients who absconded from treatment were not prosecuted; consequently, civil commitment provided only a weak coercion to treatment. Two followup studies suggested that the short-term outcomes of the civil commitment patients were somewhat better than those of voluntary patients. Limited and inconclusive research exists on the relation of coercion to long-term stable abstinence. Methadone maintenance is accompanied by improved social adjustment, but it retains in treatment only a minority of opioid drug users. One study suggests that 16 to 30 percent of the population of chronic opioid users in the community is not in treatment. Civil commitment, as one of an array of social and legal coercions, can probably bring some opioid users into treatment who would not voluntarily enter. It has several limitations. Civil commitment cannot overcome deficits in treatment services. Civil commitment, or any other kind of external coercion, can bring drug users into treatment but cannot assure that patients will participate in treatment. Finally, civil commitment is restricted by constitutional guarantees of individual liberty.

Commitment of Persons with Psychiatric Disorders↗
PubMed1984

The behavior of mentally disordered criminals in civil mental hospitals.

Because of changes in Ohio mental health legislation in 1978, mentally disordered criminal offenders can now be turned over to the civil probate court for civil commitment procedures. In part because many officials in the civil hospital system fear the admission of dangerous criminals into their hospitals, the authors conducted a statewide research project to compare civil and criminal patients on demographic, diagnostic, and behavioral variables. There were no differences between the two groups on some indices of dangerousness, but on other variables the two groups differed. Sometimes it was not the forensic but the civil patients who appeared more threatening. In all, the forensic patients did not constitute a unique class of patients who are clearly and categorically more dangerous than civil patients. The findings suggest a more open-door policy toward forensic clients in the civil mental health system.

Adult↗
PubMedDate not supplied

[Civil, criminal and ethical liability of medical doctors].

In the last years doctors have been the target of a growing number of civil, criminal law suits, as well as ethical procedures. Medicine is a widely targeted career, not only owing to its inherent risks, but also owing to a mistaken approach of the Judiciary Power about the obligations of medical doctors. Decisions of the Medical Board in ethical procedures have an impact in civil and criminal justice and therefore should be followed closely. The purpose of this review is to provide a wide view from a doctor-lawyer perspective of cases involving civil, criminal liability of anesthesiologists as well as ethical procedures against them, in an effort to make them comprehensible to doctors. After a brief historical introduction civil liability foundations and legal articles are examined. Responsibilities of doctors, hospitals and health insurance providers are discussed separately, as well as reparation mechanisms. Crimes possible to occur during medical practice and respective penalties are described; the direct relationship between crime and civil reparation is demonstrated. The administrative nature of ethical procedure is described, emphasizing that the legal character of its penalties often serve as grounds for civil and criminal justice decisions. Prevention is still the best medicine. Good medical practice and a good medical-patient relationship are still the best ways to minimize lawsuits and their repercussions. Doctors should have some knowledge of juridical mechanisms in lawsuits and ethical procedures, but should not take defense initiatives without prior consultation of an attorney. Civil, criminal and ethical liability of physicians.

Brazil↗
PubMed2005

Crash-resistant fuel system effectiveness in civil helicopter crashes.

BACKGROUND: Crash-resistant fuel systems (CRFS) have demonstrated close to 100% effectiveness in survivable crashes of Army helicopters, but the technology has been slow to transfer into the civil helicopter arena. Federal standards for civil helicopter CRFS are less stringent than those for military helicopters. A reduction in standards for CRFS in military helicopters is being considered. OBJECTIVE: The goal of this study was to determine whether crashes of civil helicopters with CRFS are less likely to result in post-crash fire than crashes of those without. METHOD: Crashes of civil helicopters during 1982-2004 were analyzed, comparing Bell 206 helicopters manufactured with CRFS with Aerospatial 350 helicopters manufactured during the same period (post-1981), but lacking CRFS. Bell 206 helicopters with CRFS were also compared with earlier models without CRFS. RESULTS: The highest proportion of crashes with post-crash fires (11.3%) was in AS-350s manufactured after 1981 (non-CRFS), and the lowest (3.7%) was in Bell 206s (with CRFS) [unadjusted risk ratio (RR) = 3.3, 95% confidence interval (CI) = 1.04, 10.50; adjusted for light and weather, RR = 2.81, Cl = 0.82, 9.69]. Earlier models of Bell 206s without CRFS had higher risk of post-crash fire than post-1981 models with CRFS (7.4% vs. 3.7%; adjusted RR = 2.11, Cl = 0.82, 5.45). CONCLUSIONS: The results of this study suggest a better performance, in terms of post-crash fire prevention, of CRFS-equipped civil helicopters as compared with those without CRFS. It is possible that CRFS in civil helicopters have not achieved the same degree of effectiveness as CRFS in military helicopters. CRFS should be used more widely in civil helicopters. The more stringent CRFS requirements for military helicopters should not be reduced without further research.

Accidents, Aviation↗
PubMed1998

Rehabilitation in complex political emergencies: is rebuilding civil society the answer?

The paper examines the challenge of rehabilitation from complex political emergencies (CPEs) and identifies a strategy that is characterized as a civil society rebuilding approach. It focuses on Somalia and a case study of CARE project that aims to build the capacity of local NGOs. The paper argues that civil society in CPEs is simultaneously being undermined and contested by warring parties and emerging after state collapse. The scope of the paper is limited to one case study and that case study examines only a single aspect of civil society: national and international NGOs The paper therefore presents tentative and preliminary results based on limited research. However, in reviewing the literature and presenting a way of approaching the subject, it aims to suggest a starting-point for developing a theoretical framework for such research. The paper finds that international agencies have tended to focus on civil society institutions simply as conduits for aid money and that this has tended to create organisations which lack downward accountability, are dependent on donors and are not addressing the wider roles for civil society envisaged in the approach. Rebuilding civil society does hold out the promise of giving non-military interests a stronger voice and starting a process of changing the aid delivery culture. Achieving these objectives, however, will be a slow and largely indigenous process and there is a need for lowered expectations about what outside assistance can achieve.

Civil Disorders↗
PubMed1993

Gender differences in occupational mobility and structure of employment in the British Civil Service.

In all industrialized societies health status in adults has been found to vary with social position. Attempts to explain this are usually grouped under headings of artefact, material, lifestyle and selective mobility of the healthiest. Such attempts have to date been unsuccessful in fully accounting for this relationship, and whilst they have merit have left unconsidered the effects of the process whereby social stratification occurs. The present study is a prelude to subsequent studies that will endeavour to distinguish between three separate influences on health--the effects of current social position, the long term effects stemming from one's initial class position, and the effects of the processes governing mobility. The purpose of our present investigation is to describe patterns of occupational mobility, that will enable us to identify possible predictors of subsequent mobility and therefore to indicate to what extent mobility might be a process governed by social rules. The work presented in this paper comprises part of the Whitehall II study of occupational, social and lifestyle influences upon health in a Civil Service population. Using multiple regression techniques almost half the variation in mobility is modelled in terms of educational level, fathers' social class, gender, marital status, age on entry into the Civil Service, length of time in Civil Service employment and grade of entry into the Civil Service. Using estimates derived from this model it is suggested that a number of sub-groups within the Civil Service suffer adverse mobility (mobility appears particularly restricted for women and for those entering the Civil Service above 30 years of age). The results obtained suggest that the issue of obstructed opportunity at the workplace could become a focus for fruitful investigation, linking issues of personal autonomy, expectations and control to health. A number of methodological problems in this kind of work are considered together with discussion of how the model can be used to increase our understanding of mobility.

Adult↗
PubMed2000

On the justification for civil commitment.

This paper explores some of the controversies in the debate regarding the justification of civil commitment. The sometimes conflicting values reflected in the mental health legislation, human rights principles, moral philosophy and psychiatric professional standards are discussed. In spite of the often substantial use of civil commitment in many countries, there are almost no scientifically sound studies addressing the outcome of coercive treatment. The paper establishes that the traditional arguments in favour of civil commitment, like lack of insight and competence as well as the effectiveness of civil commitment, are poorly founded. The paper concludes that there seems to be a general agreement that civil commitment of patients who are dangerous to themselves or others should be the responsibility of the mental health care system, while civil commitment for treatment purposes is more controversial and hard to justify.

Commitment of Persons with Psychiatric Disorders↗
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↗
PubMedDate not supplied

The involuntary civil commitment of mentally ill persons in the United States and Romania: a comparative analysis.

The law and policy relating to the civil commitment of mentally ill persons in the United States and Romania are currently undergoing significant changes. While many jurisdictions in the United States are moving towards increasing emphasis on various forms of outpatient civil commitment, Romania is contemplating a restructuring of its commitment procedures to conform to international principles of human rights and to resemble more closely the United States model of commitment and care. A comparison of the procedures and standards for the involuntary civil commitment of mentally ill persons under each system is, consequently, timely. This article begins with a discussion of how mental illness is defined and identified clinically in a cross-cultural context. The article then examines the legal meaning of mental illness in the civil context in the United States and Romania, focusing on the implications of these meanings for the civil commitment of persons deemed to be mentally ill. Current models, standards, and procedures for the civil commitment of persons deemed to be mentally ill are described, using schizophrenia as a case example. The article concludes with an analysis of the strengths and weaknesses of each system and the arguments that provide the basis for the current reform efforts.

Advance Directives↗
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↗
PubMed2006

Physical and mental health costs of traumatic war experiences among Civil War veterans.

BACKGROUND: Hundreds of thousands of soldiers face exposure to combat during wars across the globe. The health effects of traumatic war experiences have not been adequately assessed across the lifetime of these veterans. OBJECTIVE: To identify the role of traumatic war experiences in predicting postwar nervous and physical disease and mortality using archival data from military and medical records of veterans from the Civil War. DESIGN: An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded. SETTING AND PARTICIPANTS: The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records. MAIN OUTCOME MEASURES: Signs of physician-diagnosed disease, including cardiac, gastrointestinal, and nervous disease; number of unique ailments within each disease; and mortality. RESULTS: Military trauma was related to signs of disease and mortality. A greater percentage of company killed was associated with signs of postwar cardiac and gastrointestinal disease (incidence risk ratio [IRR], 1.34; P < .02), comorbid nervous and physical disease (IRR, 1.51; P < .005), and more unique ailments within each disease (IRR, 1.14; P < .005). Younger soldiers (<18 years), compared with older enlistees (>30 years), showed a higher mortality risk (hazard ratio, 1.52), signs of comorbid nervous and physical disease (IRR, 1.93), and more unique ailments within each disease (IRR, 1.32) (P < .005 for all), controlling for time lived and other covariates. CONCLUSIONS: Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War veterans. Physiological mechanisms by which trauma might result in disease are discussed.

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↗
PubMed2004

Thirty-five years of working with civil commitment statutes.

This commentary reflects my 35 years of working with civil commitment statutes, first in Alaska, then in Oregon, and on various committees on the national level. Coming from a background in community and public psychiatry, I have always considered civil commitment to be the most important forensic mental health statute, as the commitment process in any state greatly influences the lives of many severely mentally ill individuals. Over the course of the past 35 years, many changes have occurred in civil commitment law, resulting in the gradual de-emphasis of the importance of these statutes. The ability of clinicians to use these statutes effectively has diminished. Herein, I review some of the areas of conceptual and practical problems related to the use of these statutes and, in effect, make a plea for a re-examination of the importance of civil commitment and for an attempt to fix some of the problems that have led to the loss of effective and rational civil commitment laws.

Civil Rights↗
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↗