Valid or voodoo? A qualitative study of attorney perceptions of risk assessment in sentencing and plea bargaining.

Prior research largely has explored judicial perceptions of risk assessment in sentencing. Little is known about how other court actors, specifically, prosecutors and defense attorneys, perceive risk assessments in the sentencing process. Here, we report a qualitative study on the use of risk assessment by prosecutors and defense attorneys in Virginia. A prior survey (n = 70) pointed to a statistically significant difference in how prosecutors and defense attorneys view the role of recidivism risk in sentencing. On the basis of the results of this quantitative study, we collected follow-up qualitative data via interview (n = 30) to explain this unexpected difference. Analysis confirmed the survey findings that prosecutors and defense attorneys differ in their perceptions of risk assessment in sentencing. Results suggest that court actor perceptions vary as a function of professional role in the service of the identified client (the community or the defendant) and their interests. Although perceptions diverged on utility risk assessment in sentencing, both prosecutors and defense attorneys were outspoken in their skepticism of the Nonviolent Risk Assessment instrument that is used to predict recidivism risk in Virginia. This latter finding identifies obstacles that may emerge as jurisdictions adopt a risk-based approach to sentencing. We conclude with recommendations for addressing these barriers that may provide useful guidance on the implementation process.

[Physicians and lawyers operate in different worlds when it comes to approaching regulatory issues]. / Artsen en juristen leven in gescheiden werelden.

Expert panel consultations are heavily regulated. To such an extent that they impede doctors from obtaining expert advice for their patients in practically feasible ways, i.e. by phone call. We argue that this is emblematic of the fact that the legal and the medical domain have increasingly become "non-overlapping magisteria"; two world views that each have their own - completely separate - dynamics and have very little in common. There was a time when intuitive moral ideas of doctors and patients about privacy and confidentiality, about responsibilities and expedience closely approximated the legal framework. Those days are over, and doctors have to ask themselves whether they want to be part of the legal or the medical magisterium. We choose the latter and are willing to face the consequences.

Abogacía de salud, la partaqe olvidada de la promoción de salud en medicina familiar / Health Advocacy, the forgotten part of health promotion in family medicine

Introducción: La abogacía de salud es una estrategia de la promoción de salud y un componente esencial y fundamental de ella, mas no siempre se ve así, a veces se confunde o se intercambia con la promoción de salud misma. Objetivo: Realizar una revisión bibliográfica sobre el término abogacía de salud y su relación con la promoción de salud y la medicina familiar. Métodos: Análisis documental de la literatura encontrada en bases de datos y análisis y síntesis de estos documentos desde un enfoque socio-histórico y lógico. Conclusiones: A pesar de que es un tema sugerido para su inclusión en los programas de formación de medicina familiar según los estándares globales de la Organización Mundial de Médicos de Familia y Generales (2013), existen muy escasas referencias en la literatura hispana y latinoamericana de medicina familiar. La abogacía de salud es habitualmente subestimada y obviada como parte de la promoción de salud en medicina familiar, es una actitud, una competencia y una responsabilidad social del médico en general(AU)

Introduction: Health advocacy is a health promotion strategy and an essential and fundamental component of it, but it does not always looks like this, sometimes it is confused or exchanged with the promotion of health itself. Objective: To carry out a bibliographical review on the term health advocacy and its relationship with the promotion of health and family medicine. Methods: Documentary analysis of the literature found in data and analysis bases, and summary of these documents from a socio-historical and logical approach. Conclusions: Although it is a suggested topic for inclusion in family medicine training programs according to global standards of the World Organization of Family and General Physicians (2013), there are very few references in the Hispanic and Latin American literature on Family Medicine. Health advocacy is usually underestimated and ignored as part of health promotion in family medicine, it is an attitude, a competence and a social responsibility of the general practitioners(AU)

Effect of Lawyer-Submitted Reports on Signals of Disproportional Reporting in the Food and Drug Administration's Adverse Event Reporting System.

INTRODUCTION: Lawyer-submitted reports may have unintended consequences on safety signal detection in spontaneous adverse event reporting systems. OBJECTIVE: Our objective was to assess the impact of lawyer-submitted reports primarily for one adverse event (AE) on the ability to detect a signal of disproportional reporting for another AE for the same drug in the US FDA Adverse Event Reporting System (FAERS). METHODS: FAERS reports from January 2004 to September 2015 were used to estimate yearly cumulative proportional reporting ratios (PRRs) for three known drug-AE pairs-isotretinoin-birth defects, atorvastatin-rhabdomyolysis, and rosuvastatin-rhabdomyolysis-with and without lawyer-submitted reports. Isotretinoin and atorvastatin have been the subject of high-profile tort litigation regarding other AEs. A lower bound of the 95% confidence interval (CI) of one or more based on three or more reports defined a signal. RESULTS: Cumulative PRRs met signaling criteria in all analyses. For isotretinoin, lawyer-submitted reports increased PRRs for birth defects before 2008, with the largest increase in 2006 (2.9 [95% CI 2.4-3.5] to 3.3 [95% CI 2.8-3.9]); lawyer-submitted reports decreased PRRs for birth defects after 2011, with the largest decrease in 2013 (2.2 [95% CI 2.0-2.5] to 1.9 [95% CI 1.7-2.1]). For atorvastatin, lawyer-submitted reports reduced PRRs for rhabdomyolysis after 2013, with the largest decrease in 2015 (18.0 [95% CI 17.1-19.1] to 15.4 [95% CI 14.5-16.2]). Lawyer-submitted reports had little impact on PRRs for rosuvastatin and rhabdomyolysis. CONCLUSIONS: Inclusion of lawyer-submitted reports in FAERS did not meaningfully distort known safety signals for two drugs subject to high-profile tort litigation for other AEs.

Legal access to medications: a threat to Brazil's public health system?

BACKGROUND: In Brazil, health is fundamental human right guaranteed by the Constitution of 1988, which created the Brazilian Universal Health System (Sistema Único de Saúde - SUS). The SUS provides medications for outpatient care via policy of pharmaceutical assistance (PA) programmes. Despite the advances in PA policies which include the improvement in access to medications, there has been a significant increase in lawsuits related to health products and services. This study aimed to characterize the medication processes filed between 2010 and 2014 against the Secretary of State for Health of São Paulo (State Health Department of São Paulo - SES/SP), in Brazil, following PA policies. METHODS: This descriptive study used secondary data on medication lawsuits filed against the SES/SP between 2010 and 2014. The data source was the S-Codes computerized system. RESULTS: In the period evaluated, the number of lawsuits filed concerning health-related products increased approximately 63%; requests for medications were predominant. Approximately 30% of the medications involved in court proceedings were supplied via PA programmes. With regard to medications supplied via specialized component, 81.3% were prescribed in disagreement with the protocols published by the Ministry of Health. Insulin glargine was the most requested medication (6.3%), followed by insulin aspart (3.3%). Because there is no scientific evidence that either of these medicines is superior for the treatment of diabetes, neither of them has been incorporated into the SUS by the National Commission for Technology Incorporation. The judicial data showed that most of the lawsuits involved normal proceedings (i.e., individual demands), were filed by private lawyers, and named the State of São Paulo as the sole defendant, demonstrating the individual nature of these claims. The data indicate inequality in the distribution between the number of cases and lawyers and the number of lawsuits and prescribers, evidencing the concentration of lawyers and physicians in filing lawsuits. CONCLUSION: The judicialization of health in the State of São Paulo with the characteristics presented herein is a threat to the SUS.

Conclaves and concurrent expert evidence: a positive development in Australian legal practice?

Many Australian courts now prefer pre-hearing meetings of experts (conclaves) being convened to prepare joint reports to identify areas of agreement and disagreement, followed by concurrent expert evidence at trial. This contrasts to the traditional approach where experts did not meet before trial and did not give evidence together. Most judges, lawyers and expert witnesses favour this as a positive development in Australian legal practice, at least for civil disputes. This new approach affects medical practitioners who are called on to give expert evidence, or who are parties to disputes before the courts. Arguably, it is too soon to tell whether the relative lack of transparency at the conclave stage will give rise to difficulties in the coronial, disciplinary and criminal arenas.

Association of Attorney Advertising and FDA Action with Prescription Claims: A Time Series Segmented Regression Analysis.

INTRODUCTION: Attorneys sponsor television advertisements that include repeated warnings about adverse drug events to solicit consumers for lawsuits against drug manufacturers. The relationship between such advertising, safety actions by the US Food and Drug Administration (FDA), and healthcare use is unknown. OBJECTIVES: To investigate the relationship between attorney advertising, FDA actions, and prescription drug claims. METHODS: The study examined total users per month and prescription rates for seven drugs with substantial attorney advertising volume and FDA or other safety interventions during 2009. Segmented regression analysis was used to detect pre-intervention trends, post-intervention level changes, and changes in post-intervention trends relative to the pre-intervention trends in the use of these seven drugs, using advertising volume, media hits, and the number of Medicare enrollees as covariates. Data for these variables were obtained from the Center for Medicare and Medicaid Services, Kantar Media, and LexisNexis. RESULTS: Several types of safety actions were associated with reductions in drug users and/or prescription rates, particularly for fentanyl, varenicline, and paroxetine. In most cases, attorney advertising volume rose in conjunction with major safety actions. Attorney advertising volume was positively correlated with prescription rates in five of seven drugs, likely because advertising volume began rising before safety actions, when prescription rates were still increasing. On the other hand, attorney advertising had mixed associations with the number of users per month. CONCLUSION: Regulatory and safety actions likely reduced the number of users and/or prescription rates for some drugs. Attorneys may have strategically chosen to begin advertising adverse drug events prior to major safety actions, but we found little evidence that attorney advertising reduced drug use. Further research is needed to better understand how consumers and physicians respond to attorney advertising.

Attorney work product privilege trumps mandated child abuse reporting law: The case of Elijah W. v. Superior Court.

Forensic psychologists and psychiatrists are licensed in their respective professions, but they perform most of their work with attorneys in the legal arena. Both attorneys and mental health professionals place high value on confidentiality of information, reflected in the ethics of their professions and codified into laws governing their work. In psychology and psychiatry, there are some well-known exceptions to confidentiality; two primary exceptions include the mandated reporting of suspected child abuse and various "Tarasoff" duty to warn or protect laws. Generally, however, the corresponding duty for attorneys to report suspected child abuse or to warn or protect intended victims of threatened harm is not as extensive. This difference in mandated reporting responsibilities can create significant difficulties when attorneys need to retain forensic psychologists and psychiatrists to evaluate their clients, especially in criminal contexts. If the retained psychologist or psychiatrist is required to report suspected abuse or threatened harm, the attorney may be harming his or her client's legal interests by using the forensic psychologist or psychiatrist to evaluate his or her client. This article will briefly review the development of mandated reporting laws for psychologists and psychiatrists and juxtapose those with the legal and ethical requirements of confidentiality for attorneys embodied in the attorney-client privilege and attorney work product privilege. The article will then discuss the California Court of Appeals case in Elijah W. v. Superior Court, where the court addressed the issue of whether retained mental health professionals must report suspected child abuse and threatened harm to others as required by law or if they do not need to report because they come under the umbrella of the attorney work product privilege. This California court ultimately concluded that retained psychologists and psychiatrists work under the attorney work product privilege and are not required to comply with mandated reporting laws and "Tarasoff" duties.

Medical Advice from Lawyers: A Content Analysis of Advertising for Drug Injury Lawsuits.

This study examined the medical information contained in a sample of television ads soliciting consumers for lawsuits against drug and medical device manufactures. Almost all such ads involved drugs or devices that have not been recalled and remain on the market. These ads raise important public health questions because they may influence the prospective medical decisions of viewers. The ads contained extensive descriptions of serious adverse events associated with the drugs or devices but almost uniformly failed to disclose information relating to the likelihood of such events. They also failed to effectively advise viewers to consult a doctor. Results also identified a subset of ads that mimicked public service announcements, claiming to be. a "medical alert" "consumer alert" or "FDA warning" at the start of the ad. Most such ads did not disclose the attorney source of the advertising until the final few seconds.

How good are future lawyers in judging the accuracy of reminiscent details? The estimation-observation gap in real eyewitness accounts / Habilidad de los futuros abogados para valorar la precisión de detalles evocados. La brecha entre estimación y observación en el relato real de testigos oculares

Research has shown a discrepancy between estimated and actually observed accuracy of reminiscent details in eyewitness accounts. This estimation-observation gap is of particular relevance with regard to the evaluation of eyewitnesses’ accounts in the legal context. To date it has only been demonstrated in non-naturalistic settings, however. In addition, it is not known whether this gap extends to other tasks routinely employed in real-world trials, for instance person-identification tasks. In this study, law students witnessed a staged event and were asked to either recall the event and perform a person identification task or estimate the accuracy of the others’ performance. Additionally, external estimations were obtained from students who had not witnessed the event, but received a written summary instead. The estimation-observation gap was replicated for reminiscent details under naturalistic encoding conditions. This gap was more pronounced when compared to forgotten details, but not significantly so when compared to consistent details. In contrast, accuracy on the person-identification task was not consistently underestimated. The results are discussed in light of their implications for real-world trials and future research (AU)

La investigación ha revelado que hay diferencias entre la precisión estimada y la observada realmente en los detalles evocados en los relatos de testigos oculares. La brecha entre estimación y observación es especialmente importante en la evaluación de los relatos de testigos oculares en el contexto legal. Sin embargo, hasta la fecha solo se ha demostrado en contextos no naturales. Además, no se sabe si esta brecha es extensible a otras tareas habituales en pruebas en el mundo real, como las de identificación de personas. En este estudio, estudiantes de Derecho presenciaron un montaje y se les pidió que lo recordaran y llevaran a cabo una tarea de identificación de personas o bien que estimaran la precisión de la actuación de los demás. Además se obtuvieron estimaciones externas de los estudiantes que no habían presenciado el montaje, recibiendo un resumen escrito en su lugar. La brecha entre estimación y observación se replicó para detalles evocados en condiciones de codificación naturales. La brecha era más pronunciada cuando se comparaban con detalles olvidados, aunque no significativa cuando se comparaban con detalles congruentes. Por el contrario, no fue infravalorada de un modo coherente la precisión de la tarea de identificación de personas. Se comentan los resultados desde el punto de vista de sus implicaciones para los ensayos en el mundo real y la investigación futura (AU)

Step up to the bar: avoiding discrimination in professional licensure.

In their efforts to protect the public from impaired professionals, licensure boards often have created special rules for applicants with mental disorders. The authorities in charge of admission to the Louisiana bar required extensive disclosure of mental health status, even if an applicant's professional functioning was not impaired. After the U.S. Department of Justice found that Louisiana's practices violated applicants' rights under the Americans with Disabilities Act, the state agreed to focus on applicants' functional impairment rather than on mental disorders. This settlement may provide a model for licensure boards in other states and for other professions, including the health professions.

Revisions to direct fee payment rules. Final rules.

We are adopting, with two revisions, our interim final rules that implemented amendments to the Social Security Act (Act) made by the Social Security Disability Applicants' Access to Professional Representation Act of 2010 (PRA). The interim final rules made permanent the direct fee payment rules for eligible non-attorney representatives under titles II and XVI of the Act and for attorney representatives under title XVI of the Act. They also revised some of our eligibility policies for non-attorney representatives under titles II and XVI of the Act. Based on public comment and subsequent inquiries, we are revising our rules to clarify that an eligible non-attorney representative's liability insurance policy must include malpractice coverage. We are also reaffirming that a business entity legally permitted to provide the required insurance in the States in which the non-attorney representative conducts business must underwrite the policies.

The influence of mitigation evidence, ethnicity, and SES on death penalty decisions by European American and Latino venire persons.

The purpose of the research was to determine whether European American and Latino mock jurors would demonstrate bias in death penalty decision making when mitigation evidence and defendant ethnicity and socioeconomic status (SES) were varied. A total of 561 actual venire persons acted as mock jurors and read a trial transcript that varied a defendant's case information (mitigating circumstances: strong/weak, defendant ethnicity: European American/Latino, and defendant SES: low/high). European American jurors recommended the death penalty significantly more often for the low SES Latino defendant when strength of mitigation evidence was weak. In addition, they also assigned this defendant higher culpability ratings and lower ratings on positive personality trait measures compared with all other conditions. Strong mitigation evidence contributed to lower guilt ratings by European American jurors for the high SES European American defendant. Latino jurors did not differ in their death penalty sentencing across defendant mitigation, ethnicity, or SES conditions. Discussion of in-group favoritism and out-group derogation, as well as suggestions for procedures to diminish juror bias in death penalty cases, is provided.

Addressing All Heads of the Hydra: Reframing Safeguards for Mentally Impaired Detainees in Immigration Removal Proceedings.

This article concerns the constitutional rights of detained, mentally impaired non-citizens in defending against deportation. Due process requires that such detainees receive a full and fair hearing. However, until recently, they were not provided an attorney to assist them in navigating our extremely complicated immigration system. Mentally impaired detainees were expected to proceed alone in proving the elements of their claims against skilled government attorneys--a daunting task even for those unencumbered by a mental disorder. On December 31, 2013, the Department of Justice ("DOJ") released guidelines detailing new procedures for how immigration courts should handle these cases, including the provision of counsel upon a finding of mental incompetence. The guidelines were issued as a direct response to Franco-Gonzales v. Holder, a class action lawsuit brought by the American Civil Liberties Union in federal district court in California seeking appointed counsel for detained, unrepresented, mentally impaired non-citizens. The guidelines created a three-stage process for assessing competency. Only at the end of this process--and after an individual is declared incompetent--is counsel appointed. This article argues that the DOJ guidelines fall far short of Franco's promise of due process for this particularly vulnerable population. It proposes an alternative model wherein counsel is appointed the moment the court is presented with "indicia" of incompetence, rather than after an adjudication of incompetence. "Indicia" should create a presumption of incompetency that can be rebutted only after a forensic evaluation is conducted and the court holds a robust hearing into the matter. This article reveals, through empirical evidence, the critical role that counsel plays in the investigation of a respondent's ability to participate in the proceedings, and how an attorney is often the only party positioned to marshal all the evidence relevant to the question of competency. Additionally, where a lack of competence is found, the court should appoint a guardian ad litem ("GAL") to assist the attorney in the individual's defense. Counsel and the GAL should work in tandem to achieve the outcome most favorable to the individual, which could be termination, the pursuit of relief, or even deportation in some instances. The expanded use of existing "Deferred Action" categories offers an additional remedy when none of the above proposed options are adequate. The article concludes that the DOJ guidance must be amended in accordance with these recommendations. This proposal best ensures vigorous and informed examination of an individual's competency, while safeguarding the individual against the inherent limits of immigration courts, conflicts of interest, and undue harm.