Back Injuries Take a Toll in Winter

Source

Online Medical Advice Can Be a Prescription for Fear

Source

A Struggle to Disarm People Without Gun Rights

Mr. Perez, who pleaded guilty to three counts of murder and was sentenced last year to life in prison, had a history ofmental healthissues. As a result, even though in 2004 he legally bought the 9-millimeter Glock 26 handgun he used, at the time of the shootings his name was in a statewide law enforcement database as someone whose gun should be taken away, according to the authorities.

The case highlights a serious vulnerability when it comes to keeping guns out of the hands of the mentally unstable and others, not just in California but across the country.

In the wake of the Tucson shootings, much attention has been paid to various categories of people who are legally barred from buying handguns— those who have been“adjudicated as a mental defective,” have felony convictions, have committed domestic violence misdemeanors and so on. The focus has almost entirely been on gaps in the federal background check system that is supposed to deny guns to these prohibited buyers.

There is, however, another major blind spot in the system.

Tens of thousands of gun owners, like Mr. Perez, bought their weapons legally but under the law should no longer have them because of subsequent mental health or criminal issues. In Mr. Perez’s case, he had been held involuntarily by the authorities several times for psychiatric evaluation, which in California bars a person from possessing a gun for five years.

Policing these prohibitions is difficult, however, in most states. The authorities usually have to stumble upon the weapon in, say, a traffic stop or some other encounter, and run the person’s name through various record checks.

California is unique in the country, gun control advocates say, because of its computerized database, the Armed Prohibited Persons System. It was created, in part, to enable law enforcement officials to handle the issue pre-emptively, actively identifying people who legally bought handguns, or registered assault weapons, but are now prohibited from having them.

The list had 18,374 names on it as of the beginning of this month— 15 to 20 are added a day— swamping law enforcement’s ability to keep up. Some police departments admitted that they had not even tried.

The people currently in the database are believed to be in possession of 34,101 handguns and 1,590 assault weapons, said Steven Lindley, acting chief of the firearms bureau in the state’s Department of Justice. He estimated that 30 percent to 35 percent of the people on the list were there for mental health reasons.

Despite the enforcement challenges, the state’s database offers a window into how extensive the problem is likely to be across the country. Concrete figures on the scope of the issue are difficult to come by because no other state matches gun purchase records after the fact with criminal and mental health files as California does.

“There are 18,000 people on California’s list,” said Dr. Garen J. Wintemute, director of the Violence Prevention Research Program at theUniversity of California, Davis, who helped law enforcement officials set up the system and is working on a proposal to evaluate its effectiveness.“So we can roughly extrapolate there are 180,000 such people across the country, just based on differences across populations.”

By way of context, Dr. Wintemute said that in 2009 only about 150,000 people were prevented from buying a gun because they failed background checks, out of about 10.8 million who applied.

Only a handful of states, however, even have the ability to keep track of handgun purchases the way California does, by either requiring a license or permit to own one or simply keeping records of such purchases. Even fewer require a license or permit for other types of firearms.

California’s system came about through a 2002 law that was even supported by theNational Rifle Association, in part because it was billed as a way to protect members of law enforcement. It finally got under way in earnest in 2007. But though gun control advocates consider it a model, it still has serious gaps.

• 1
• 2

Next Page»

Source

Cameras in the Delivery Room? - Room for Debate

Source

Va. to Ask Supreme Court to Rule on Health Law

Only rarely does theSupreme Courtgrant such hearings, and it has already rejected a similar request in another legal challenge to the health care act. But the commonwealth’s attorney general, Kenneth T. Cuccinelli II, said the legal and governmental confusion sown by conflicting lower-court opinions demanded a rapid resolution.

“Currently, state governments and private businesses are being forced to expend enormous amounts of resources to prepare to implement a law that in the end may be declared unconstitutional,” Mr. Cuccinelli said in astatement.

In December, Mr. Cuccinelli became the first plaintiff to win a challenge to the health care act, when Judge Henry E. Hudson of Federal District Court in Richmond, Va., struck down a provision that requires most Americans to obtain insurance. The judgeruledthat the insurance requirement exceeded Congress’s authority under the Constitution to regulate interstate commerce.

Two other federal judges, including another in Virginia, had previously upheld the law. Then on Monday, Judge Roger Vinson of Federal District Court in Pensacola, Fla., joined Judge Hudson in striking down the insurance mandate. But unlike Judge Hudson, Judge Vinsoninvalidatedthe entire law.

The law, enacted last year by a Democratic Congress and signed in March byPresident Obama, aims to cover 32 million uninsured Americans by ending insurer discrimination against those with pre-existing health conditions and by providing government subsidies to make coverage affordable.

The Justice Department, which is defending the Obama administration in the health litigation, has already filed a notice of appeal of Judge Hudson’s ruling in the Court of Appeals for the Fourth Circuit in Richmond. Because of the geographic distribution of the four lower court rulings, three different courts of appeal are likely to hear the cases on their way to the Supreme Court.

Tracy Schmaler, a spokeswoman for the Justice Department, said the agency continued“to believe this case should follow the ordinary course” so that legal arguments could be fully developed before being presented to the Supreme Court. She pointed out that the insurance mandate does not take effect until 2014 and that the Fourth Circuit has already expedited its schedule by setting oral arguments for May.

The Justice Department also is considering whether to seek a stay of the Florida decision in order to clarify confusion about whether the health care act remains in effect in the 26 states that are plaintiffs in the case.

Mr. Cuccinelli said he recognized that an expedited Supreme Court review would be exceptional. But he said that this case and the others challenging the constitutionality of the Patient Protection and Affordable Care Act, as the law is known, were“truly exceptional in their own right.”

In November, the Supreme Court refused to review another challenge to the health care act that had been dismissed by a California judge on grounds that the plaintiffs did not have standing to sue.

Source

Potato and Chard Stalk Gratin - Recipes for Health

1 pound small boiling potatoes, scrubbed

Salt to taste

1 pound wide Swiss chard stems (from 1 large or 2 smaller bunches), trimmed and cut crosswise into 1/2 inch thick slices

1 garlic clove, halved

2 tablespoons extra virgin olive oil

2 tablespoons finely chopped shallot or onion (optional)

2 tablespoons all-purpose flour

2 cups low-fat (1 percent or 2 percent) milk

Freshly ground white or black pepper

1 teaspoon thyme leaves

1 ounce Gruyère, grated (1/4 cup)

1.Place the potatoes in a saucepan, and cover with water. Add 1/2 teaspoon salt, and bring to a boil. Reduce the heat to medium, and boil gently until tender, 10 to 20 minutes, depending on the size of the potatoes. Add the chard stalks to the pot, and simmer for another five minutes until crisp-tender. Drain, and retain the cooking liquid if you prefer to use it instead of milk for the béchamel. Cut the potatoes into quarters or halves, depending on their size.

2.Preheat the oven to 425 degrees. Rub a 2-quart baking dish or gratin with the cut clove of garlic, and brush with olive oil.

3.Make the béchamel. Heat the oil over medium heat in a heavy medium saucepan. Add the shallot or onion, and cook, stirring, until softened, about three minutes. Stir in the flour, and cook, stirring, for about three minutes until smooth and bubbling but not browned. It should have the texture of wet sand. Whisk in the milk all at once, and bring to a simmer, whisking all the while, until the mixture begins to thicken. Turn the heat to very low and simmer, stirring often with a whisk and scraping the bottom and edges of the pan with a rubber spatula, for 10 to 15 minutes until the sauce is thick and has lost its raw flour taste. Season with salt and pepper. Strain while hot into a heatproof bowl or a Pyrex measuring cup.

4.Cut the potatoes into quarters or halves, depending on their size. Combine with the chard stalks and thyme in a large bowl, and season with salt and pepper. Add the béchamel, and stir until the vegetables are coated with sauce. Scrape into the gratin dish. Sprinkle the Gruyère on top.

5.Bake 20 to 25 minutes until bubbling and beginning to brown on the top. Serve hot.

Variation:Substitute the stock from the vegetables for some or all of the milk.

Yield:Serves four.

Advance preparation:You can make a béchamel up to a day ahead of using it; keep it in the refrigerator. If you lay a sheet of plastic or wax paper directly on top, there is less chance that a skin will form. Even if it does, you can get rid of it by whisking vigorously when you reheat the béchamel. Then the sauce should be as smooth as it was when you made it. Thin out if necessary with milk or stock. You can cook the potatoes and chard stalks several hours ahead of serving. Assemble the gratin just before you cook it.

Nutritional information per serving (four servings, using 1 percent milk):265calories; 11 grams fat (3 gramssaturated fat); 14 milligramscholesterol; 34 gramscarbohydrates; 5 gramsdietary fiber; 326 milligrams sodium (does not include salt to taste); 11 grams protein

Martha Rose Shulmanis the author of"The Very Best of Recipes for Health."

Source

States Diverge on How to Approach Health Care Ruling

The Senate’s Democratic leaders answered the Republican challenge by saying they would stage a vote on the repeal measure on Wednesday, when they were certain it would be defeated. The House, where Republicans won a majority in November’s elections, approved the repeal last month.

“We want to get this out of their system very quickly,” the Senate majority leader,Harry Reidof Nevada, said at a news conference in Washington.

But in a few states that are party to the litigation, Republican governors and attorneys general declared the expansive health care law effectively null as a result of the judge’s ruling. They suggested they would suspend planning and implementation until appeals courts could rule, although they did not provide details about what precisely might change or whether they would refund federal planning grants already awarded.

“We’re not going to spend a lot of time and money with regard to trying to get ready to implement that until we know exactly what is going to happen,” said Gov.Rick Scott, the new Republican leader of Florida, where the lawsuit was filed by elected officials from 26 states.“And I hope and I believe that either it will be declared unconstitutional or it will be repealed.”

In Wisconsin, the state’s attorney general, J. B. Van Hollen, a Republican, said he was advising Gov. Scott Walker that“the federal health care law is dead— unless and until it is revived by an appellate court.” He added,“Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law.”

Aides to Mr. Walker, a Republican, did not respond to a request for comment.

Jon Hanian, a spokesman for Idaho’s Republican governor, C. L. Otter, said that state now might cancel a meeting scheduled for March to study the establishment of ahealth insuranceexchange, which the law requires in 2014.

“I think it’s fair to say it’s an open question whether they’ll do that,” Mr. Hanian said.“We’ve had two rulings now that have struck this thing down.”

But Democratic governors tended to echo Gov. Peter Shumlin of Vermont, who said his state was“moving ahead at full speed” to carry out the law. And in many states, even Republican officials who are party to the lawsuit chose to tread cautiously.

“We’ll be required to move forward until such time relief is granted or an appellate decision is finalized,” said Gov.Nathan Dealof Georgia.“It’s a victory, but not a complete victory.”

Judge Roger Vinson of Federal District Court in Pensacola, Fla., ruled Monday that the health care act’s requirement that Americans obtain insurance exceeded Congress’ authority to regulate interstate commerce. Unlike a Virginia judge who invalidated that provision in December, Judge Vinson struck down the entire health care act. Two other federal judges have upheld the law.

Judge Vinson noted that Congress had failed to include language in the bill to legally sever portions found unconstitutional from the rest. That, the judge wrote, left him to determine whether other components could function independently of the insurance mandate and whether Congress would have approved the act without that provision.

Comparing the law to“a finely crafted watch,” Judge Vinson wrote that there were“too many moving parts” for him to“dissect out the proper from the improper, and the able-to-stand-alone from the unable-to-stand-alone.”

He issued a declaratory judgment against the entire law, and suggested that the Obama administration view it as the“functional equivalent” of an injunction to suspend its implementation.

The judge acknowledged in a footnote that his reasoning on the question borrowed heavily from a friend of the court brief submitted by theFamily Research Council, a conservative Christian advocacy group.

States run a significant risk in suspending planning for the law’s implementation while awaiting a final judgment, presumably from theSupreme Court, in a process that could take up to two years. Under several major provisions, the federal government can step in if a state defaults.

Most notably, the law says the federal government will take over the operation of health insurance exchanges, where people can compare and buy health plans, if states do not make adequate progress toward establishing them by Jan. 1, 2013.

The White House has tried to emphasize that Judge Vinson’s ruling will not affect the law’s implementation, at least in Washington, until appellate courts can clarify the confusion.

The Justice Department, which represents the administration in the case, is considering whether to request a stay of the ruling. Regardless, it plans to appeal to the Court of Appeals for the Eleventh Circuit, in Atlanta.

Among other tasks, federal health officials are working to define“essential benefits” to be provided by all insurers, writing regulations for a new long-term care insurance program and weighing dozens of requests from states, employers and labor unions for exemptions from various requirements.

“There has not been any effect on the work being done by this department,” said Richard Sorian, a spokesman for theDepartment of Health and Human Services.

In Congress, the Senate Republican leader,Mitch McConnellof Kentucky, put forward the repeal measure as an amendment to an aviation industry bill that is now on the Senate floor.

“For all those who supported the health care law, it’s an opportunity to re-evaluate your vote, to listen to your constituents,” Mr. McConnell said in a floor speech on Tuesday. He added,“You can say, perhaps:‘This was a mistake. We can do this better.’ Or you can continue to dismiss the majority of people in this country as not knowing what they’re talking about.”

Senate Democrats, however, dismissed the Republican repeal effort as futile and an unnecessary delay of work on the aviation bill. They said their willingness to consider the measure reflected both a recent agreement among Senate leaders to avoid procedural gridlock and their confidence that the health law would survive.

Democrats said they still intended to work with Republicans to repeal one provision of the law that officials in both parties say would create onerous paperwork requirements for small businesses.“No one is saying that the health care bill should not be fixed in any way,” said SenatorCharles E. Schumerof New York, the No. 3 Democrat.

Source