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Defensive Medicine: A Small Price for Quality Assurance
The Minnesota Supreme Court’s ruling in a recent malpractice case is a classic cough syrup remedy: it might taste a little bitter, but we’re better for it.
In late May, a 3-2 decision clarified its position on the “loss of chance” doctrine. The doctrine rules that doctors may now be charged for probabilistic harms rather than exclusively causal outcomes. For example, absent a “loss of chance” doctrine, doctors could not be penalized if a failure to expediently diagnose cancer lowered a patient’s chance of survival from 40% to 25%, given it was probable the patient would have died from the cancer regardless of the diagnosis timing.
In the dissent, Justice Dietzen warned that adopting a “loss of chance” doctrine would increase “defensive medicine,” or the over-treatment of patients to avoid a lawsuit. Research suggests Dietzen’s concern has merit. An established relationship exists where increases in liability raise doctors’ apprehension about lawsuits, leading to defensive practices with few discernible changes in quality.
However, it's important to put defensive medicine's cost in context. Tort reform groups trumpet these practices cost $46 billion annually. But with roughly $2.5 trillion in annual U.S. health expenditures, defensive medicine represents just 2% of cost, according to a Kaiser study. Furthermore, defensive practices' costs pale in comparison to the impact of fee-for-service payment schemes.
Defensive medicine is a minor expense in the grand scheme of things and something we must ultimately come to bear. When a patient goes in for a checkup, we expect a doctor will notice if the patient has an odd bump, a strange cough, or whatever it may be, and take thorough precautions to ensure it's nothing more serious. It would be unconscionable to think a doctor was not held responsible for negligence or inattentiveness toward patients when lives are at stake.
Some trade-offs in policy are inevitable, but the “loss of chance” doctrine has minimal impact on affordability in order to fulfill the basic assurance of quality treatment in health care.
Posted in Health Care | Related Topics: Health Care Professionals Medical Care
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SPPS Parent Academy Shows Progress
As schools continue to seek to engage parents in student learning, the most important barrier seems to be making information on how to get involved accessible to parents. As I’ve written about before, even for parents who want to get involved, the process toward that involvement can be daunting and alienating, particularly for parents whose own school experience was limited. In St. Paul, the Wilder foundation has published a report on their new SPPS Parent Academy program that supports this idea, and could provide a solid model for improving this accessibility.
With responses from 155 participants across four languages, data from Parent Academy show that parents already largely involve themselves at some level in their child’s education. 94% of parents reported asking their child about school at least once a week, and 91% reported helping their child with homework directly or finding help for their child.
These numbers, and others like them, show that even before this program, parents are taking a real interest in the education of their children. However, there was a significant drop-off when it came to parents actually knowing how to operate in the school system, with only 62% of participants as a whole, and only 51% of non-English speakers reporting that they understood how to navigate the school system. Numbers dropped even further when it came to specific services, indicating that parents felt alienated by the cumbersome process of engaging in the school system.
The Parent Academy made huge strides with parents in their ability to navigate the school system. After completing the six week program, parents reporting that they felt they could navigate the school system jumped to 83%, a 21 point spike after just one school year. Similar increases were found in areas like contacting educators, preparing for MCA tests and reviewing grades, empowering these parents to take control in all aspects of education. Considering that 100% of participants said they would recommend the program to other parents, it is clear that Parent Academy is making real progress in bridging the gap between schools and parents.
As St. Paul Public Schools expands Parent Academy district-wide, hopefully these kinds of increases can continue. Along with other strategies, efforts like these show real promise in getting all parents on equal footing. There are still questions, as Wilder points out, about long-term effectiveness and measurable effect on performance, but with a broader scale, and continued reviews, those questions may result in some real answers.
Posted in Education | Related Topics: K-12 education
Red States Giving Righties the Transit Blues
Pity the poor conservative rail transit basher. How can a right-wing, autocentric believer that light rail is the final step toward godless totalitarianism keep the faith when true-red places such as Salt Lake City and Dallas-Fort Worth are laying transit tracks lots faster than deep-blue enclaves like the Twin Cities?
Big D has 85 miles of light rail and is still adding on, prompting Oregon editorial columnist John Laird, a Lone Star State native, to marvel that "tough, red-blooded, God-fearing Texans -- of all people -- are building and extending light rail lines at a furious pace ... They've traded their leather saddles for plastic transit seats, giggling in unmanly ways because they'll soon be able to ride light rail to the DFW airport for two and a half bucks."
Then there's the rock-ribbed capital of Utah, which is "No. 1 in the nation in per-capita transit spending [and] the only city in the country building light rail, bus rapid transit, streetcars and commuter rail at the same time," according to Angie Schmitt at dc.streetsblog.
How to explain that "the most conservative state is ... one of the most progressive in the country on transit?" Dee Allsop, who led a public outreach campaign to promote Salt Lake's transit system, told Schmitt. "It's because the case was made in a way that fit with people's values."
A survey of 20,000 residents of 10 Utah counties in and around Salt Lake in the late 1990s found that they valued a city that is "beautiful, prosperous and neighborly." Public officials and voters were swayed as well by $15 billion in public infrastructure savings from transit-enabled density as opposed to freeway-induced sprawl.
The region now has plans for more than 300 miles of rail transit, at least three times greater than that of the Twin Cities, which has more than double Salt Lake's metro population. Its current light rail system is three times larger than ours, and built more inexpensively because of early right-of-way planning and acquisition and aggressive construction during the low-bid, low-interest-bonding days of the Great Recession.
Our sprawling metro has a long way to go to catch up. Progressive Minnesota policymakers and business leaders offered strong plans to do so this year, but legislators ended up ignoring them. Maybe we need Texas- and Utah-style conservatives around here to get the job done.
Posted in Transportation | Related Topics: Public Transportation
Federal Conservatives Tie Up MN DREAM Act
Congress has yet to pass the DREAM Act, which is designed to enable students who are here illegally but through no action of their own, to find a pathway to citizenship. President Obama however, by executive Order, refused to deport those students who are otherwise eligible for proposed DREAM Act citizenship status. In 2011, following up on the President’s policy, Director of Immigration and Customs Enforcement (ICE) John Morton issued a series of memos, called the “Morton Memos,” which limited enforcement activity of deportation laws related to these students.
Chief among these memos was the June 15, 2012 directive which discontinued deportation of illegal aliens up to the age of 30 who meet DREAM Act criteria. These criteria apply to those who came to the United States before age 16, have lived here for at least five years, and are in school, are high school graduates or are military veterans in good standing. The immigrants must also be not more than 30 and have clean criminal records
Last week, the House of Representatives voted 224-201, to deny funding “to finalize, implement, administer or enforce the Morton Memos.” In other words, the House voted to stop paying for an action that was not going on. This meaningless, bizarre act by House conservatives, is nothing more than a politically explosive statement, alienating further those communities which already do not support the conservative agenda. Joining the conservatives were Minnesota's John Kline, Michelle Bachmann, and Erik Paulsen.
Progressives in Congress called this vote an effort to “restart deporting an estimated 800,000 DREAM Act eligible young people.” This House measure stands in contrast to recent Minnesota state legislative action, which allows undocumented students who have attended Minnesota high schools for at least three years and want to become citizens to get in-state tuition and be eligible for grants. About 750 Minnesota students are expected to be eligible for this program—if they do not jeopardize their ability to stay in this country by coming forward to seek these benefits.
Conservatives also filed a lawsuit in federal Court in Dallas, challenging the Morton Memos. The Court issued an Order on April 23, 2013, making some findings contrary to the Obama administration’s position, but declining at the time to prevent enforcement of the Memos, asking for more briefing on the question of whether the Court has jurisdiction to grant the relief sought. For now at least, the policy remains in effect.
Immigration reform is set for a vote in the Senate this week. According to CNN, Georgia Rep. Tom Price, a leading conservative, told reporters it was "highly unlikely" the majority of House Republicans would vote for a bill similar to the Senate deal that permits citizenship after a series of conditions are met. Price and his GOP colleagues apparently do not trust the Obama administration to enforce the laws currently on the books. Even the Gang of 8, including Senator Rubio of Florida, cannot rein in the conservatives in the House. It's time to make our voices heard on this issue. This gridlock just cannot be permitted to continue.
Posted in Economic Development | Related Topics: Immigration Federal Government
Was 2013 the Year of the Organizer?
As TakeAction Minnesota's Dan McGrath observed, many of the bills passed in the 2013 legislative session represent the culmination of years of organizing on issues that inspired real grassroots passion. While the groups that built political will to pass bills like the MN Dream Act, Ban the Box, the Homeowner’s Bill of Rights, and the Health Insurance Exchange take a well-deserved rest to celebrate and regroup, now’s a great time to anticipate what could happen in next year’s session, and the potential for today’s grassroots organizing to grow into tomorrow’s legislation.
First, let’s think about the context in which this all happened. Just two years ago, Minnesota progressives looked across our eastern border and stared into the abyss as Wisconsin government devolved into Ayn Randian dystopia. Our own economy was shaken, and the Occupy movement added fuel and a focus on Wall Street’s excesses to an already energized activist base. Conservatives here made a miscalculation of historic proportions, putting two amendments on the ballot that motivated volunteers and donors to build grassroots power with unusual urgency and purpose. This perfect storm created a lot of pull to draw ordinary Minnesotans out into the streets, and eventually to the capitol.
Which raises the question: Will this be remembered as the “year of the organizer” or will this be remembered as the beginning of a long-term shift in the role of grassroots power in shaping Minnesota’s legislative agenda? There remains plenty of work to be done, where dedicated activists and emerging new contexts might make significant victories possible in the next session. For example:
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Low-wage worker issues. Recently, fast food workers in Seattle walked off the job. This follows similar actions among low-wage workers in New York City, Chicago, Detroit, Milwaukee, and elsewhere around the country. Here in Minnesota, Centro Trabajadores Unidos en Lucha (CTUL) overnight retail cleaning workers are on strike demanding better wages and working conditions. Could the momentum generated by CTUL and other low-wage worker organizing efforts spur a stronger push on minimum wage, paid sick days, or other worker protections?
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Voting Rights. Just as opposition to the marriage amendment assembled a grassroots base that could move an affirmative marriage agenda, the “No on Voter ID” campaign identified voting rights supporters who could be mobilized to move affirmative voting rights legislation, including early in-person voting and restoration of voting rights for individuals with criminal records. The activists who won “ban the box” have shown their power. Could this be their next move?
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Education. This year’s education bill had some great things, but more needs to be done before education policy truly addresses our state’s embarrassing equity gap in schools. Parents, students, and teachers, if they can work together, could bring energy to proposals for state-level policy changes (for example, bills to address bullying and racially disparate discipline policies) and targeted investments aimed at erasing the gap.
What could grassroots organizing win next? What are you working on? Will we see you at the capitol next year?
Posted in News & Notes | Related Topics: Economic Recovery Historical Lessons Progressive Community
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A Rail Line Gag Order: Bad Precedent, Bad Policy
One subject brought up during our recent transportation-centered Tuesday Talk was the Dan Patch Commuter Rail. The line, which would run from Northfield to Minneapolis with several stops along the way, received a legislative gag order in 2002 and attempts to repeal the statute since have failed. In short, this is both bad precedent and bad policy for Minnesota.
All policy issues aside, the 2002 ban on discussion is a direct affront to the way government should operate. The statute (scroll to Sec. 85) requires that the Metropolitan Council, Department of Transportation, or other regional rail authority not “expend any money for study, planning, preliminary engineering, final design, or construction for the Dan Patch commuter rail line.” Further, the Council and MNDoT were required to “remove all references ... to the Dan Patch commuter rail line from any future revisions to the state [or Council] transportation plan and commuter rail system plan.”
The 2002 legislature, and subsequent legislatures that have chosen not to repeal the measure, have established the precedent that they should choose what in-the-field experts can and cannot study. The reason we hire experts is to tell us what good policy would be in a given field. To prevent even the study and discussion of a topic for political reasons borders on negligent governance. In fact, a 2011 report from the Office of the Legislative Auditor calls for a full repeal of the ban, to allow for evaluation of all transit options.
Perhaps the most disappointing part of the gag order on the Dan Patch line is the fact that it’s a good policy. Before being embargoed, the line was a Tier-One transit option for MNDoT, and studies estimated it would be one of the most ridden transit lines in the state. A completed rail would be an economic boon to the communities it stops in, which among others include Northfield, Lakeville, Savage, Bloomington, and Minneapolis. These types of transit projects create both immediate and lasting jobs, in addition to reducing strain on the environment. The economic benefits of commuter rail have been proven again and again, and concerns over potential decreases in residential property values are not only unfounded, but wrong.
Minnesota could gain these benefits too, and that process starts by eliminating bad precedents and bad policies like the Dan Patch gag order.
Posted in Transportation | Related Topics: Passenger Rail
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Help Plan Southwest LRT Stations
Residents along the route of the planned 15.8-mile Southwest light rail line from Eden Prairie to downtown Minneapolis will get a chance to weigh in on station locations and designs at six open house meetings this month. The free sessions are intended to identify 17 station plans that "would enhance connections to existing neighborhoods and promote future development opportunities," according to a project news release.
In addition to pinpointing sites for each station, participants will help determine roadway, pedestrian, bicycle and bus connections as well as drop-off and park-and-ride locations.
The schedule:
Minneapolis:
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8-9:30 a.m. June 17 at Metro Transit's Fred T. Heywood Office Building, 560 Sixth Av. N.
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4:30-7 p.m. June 17 at Harrison Recreation Center, 503 Irving Av. N.
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4:30-7 p.m. June 24 at Kenwood Community Center, 2101 Franklin Av. W.
St. Louis Park:
- 4:30-7 p.m. June 20 at Beth El Synagogue, 5224 W. 26th St.
Minnetonka/Hopkins:
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4:30-7 p.m. June 18 at Hopkins Center for the Arts, 1111 Main St.
Eden Prairie:
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4:30-7 p.m. June 26 at Eden Prairie City Center, 8080 Mitchell Rd.
People who need special assistance to participate should contact Daren Nyquist, the project community outreach coordinator, at least seven days in advance of a meeting at .(JavaScript must be enabled to view this email address) or 612-373-3894
Posted in Transportation | Related Topics: City Management Light Rail
Invisible Workers Take a Stand
In case you haven't lately, stop and think for a second about how the stores you shop in get so clean. The answer, of course, is that a few people work really hard late at night to make sure the rest of us never have to think about it. If you've ever worked one of those jobs, you know the hours and the work are very difficult. If it's been a few years since you worked one of those jobs, you'd be surprised to learn how much harder the work has become. Wages have been dropping and the number of workers hired to clean entire stores has gone down, forcing the remaining workers to work twice as hard.
While many major retailers pay their front-line customer service employees living wages, retailers have used the invisibility of overnight cleaning workers as a license to create radically unfair working conditions. To avoid getting their hands dirty, retailers hire a contracting company, who in turn hires cleaning workers. The retailers often misleadingly claim they don't know and don't control how much contractors are paying their staff. Those same retailers select contractors through competitive bidding wars that create a race to the bottom, and they surely understand that the bottom has fallen well below anything they would want their customers (and in some cases the government) to know about.
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That's why Centro de Trabajadores Unidos en Lucha (CTUL) has announced a strike deadline for 5:00 today, and why we should all be paying close attention.
A lot of courageous workers, many of them new immigrants to this country, are bravely stepping into the spotlight to tell their stories of wage theft, sexual harassment, unsafe work conditions, and wages well below the cost of living in the Twin Cities.
After years spent raising awareness of these issues only to have their complaints fall on deaf ears, CTUL workers will strike this evening for the right to organize without fear of harassment or retaliation. Their organizing campaign is already showing results: they announced on Saturday that Anisca cleaning had become the first cleaning contractor to sign an agreement not to interfere. "At times," Anisca's General Manager says, "the fair treatment of employees can only be accomplished through the use of third parties such as labor unions. Whether or not to use these mediums is a decision that the employees should take based on their own free will."
Other contracting firms like Carlson Building Maintenance, Prestige Building Maintenance, Eurest Services, and Prestige Maintenance USA should listen to their colleague's wisdom, and let their employees decide for themselves whether a union would improve their working conditions or not.
If you find yourself in downtown Minneapolis tomorrow morning, CTUL members will be picketing in front of the Target Headquarters at 9th and Nicollet starting at 6 am. Drop by and join them for a few laps around the picket line, and let them know they're not invisible to you any more. I'll see you there.
Join the discussion at Tuesday Talk, we'll have a labor expert standing by to discuss how we can raise living standards for the working poor and close the wage gap.
Posted in Economic Development | Related Topics: Union Working / Middle Class Issues
Feds Might Do what MN Couldn’t on School Bullying
Congress is currently rewriting and replacing the defunct No Child Left Behind law. This new bill, dubbed the Strengthening America's Schools Act, should focus on student learning and building thinking skills and limits inflexible test standards. However, buried in the 1,150-page bill is an act Minnesota Senator Al Franken introduced, called the Student Non-Discrimination Act (SNDA). Franken, along with others, is seeking to extend title IX style discrimination protection to the LGBT community by extending civil rights protections to students based on sexuality and gender identity.
This part of the bill has real resonance in Minnesota, where issues of sexuality and gender are on the forefront of policy debates. While Minnesota became the 12th state to legalize same sex marriage, our school anti-bullying policies to protecting LGBT students lag behind. Minnesota lawmakers had a chance to strengthen our anti-bullying law, and extend protections to LGBT students, but we balked.
Opponents complained about costs, and charge the initiative as an “Orwellian nightmare” of “re-education camps” that infringe on school and parent rights. While we can debate costs and exact bill language, the safety and mental well-being of students should not be up for discussion. We must do something about school bullying. Bullying of all sorts leads to decreased school performance, lawsuits against districts and has even driven children to take their own lives.
The issue of bullying in schools is a civil rights issue with serious consequences. Some would even argue the consequences are farther reaching than marriage equality, which we as a state took a firm stand on, because of the physical and mental health stresses inflicted on young people. It's good to see the push for stronger anti-bullying laws get new life in Congress. It's also important to note the bill is still alive in Minnesota's legislature and should be brought back up when the session resumes in February. It is not an overstatement to say that lives could be saved by measures like these, and it is time for Minnesota to take another stand for civil rights. The need for action far outweighs the concerns hampering it, and we cannot let stalled legislation make us forget that.
Posted in Education | Related Topics: K-12 education Education Administration
Summer Meals Narrow the Learning Gap
While the summer break from school is a welcome relief for most children, it can be stressful on parents--especially those struggling to make ends meet. Not only do these parents need to find childcare for the summer, but they also need to find food. 38.3 percent of Minnesota students (over 300,000 children) receive free or reduced-price school lunches, and a growing number of schools also operate food shelves or send home weekend meal supplies. When these services end in June, we shouldn’t be surprised that some families will have trouble keeping food on the table.
When children go hungry, they are at risk of falling further behind their peers and needing more catch-up help come September. They’re less likely to have the energy for healthful activities such as reading or playing outside. The negative health and educational outcomes associated with hunger are well-documented, whether for the children missing out on balanced meals or the parents who skip their own dinner to make sure their kids can eat tonight.
The Summer Food Service Program, sponsored by the USDA and the Minnesota Department of Education, reaches some of these hungry children. Through this initiative, nonprofit and government agencies can set up meal service sites at schools, community centers, housing developments, and other places where they can reach low-income children. Many of these sites serve daily free meals to anyone age 18 and under with no questions asked: no registration is required; no income or address limits apply. Children just have to show up at the appointed time to enjoy a healthy, balanced meal. Camps and youth programs can also access this funding to provide meals for their low-income participants.
Last year, the program provided over 2.2 million meals at nearly 600 sites in Minnesota, but it still only reached about 15 percent of children in need. Transportation is surely an issue, especially in suburban and rural areas where the nearest site might be miles away. Food shelves are likely filling in some of this gap, so they also need community support through the summer. Keeping our students healthy and well-fed is one more way to narrow the education gap come September.
To find the Summer Food Service site nearest you, visit Second Harvest Heartland’s website or call/text 612-516-3663.
Posted in Education | Related Topics: Children's Health Achievement Gap Poverty