Law Technology

swimming to shore

Posted on July 14, 2017
When I experienced an injury that was temporarily disabling, I had certain expectations of what was to come that I now realize were not helpful. I originally thought that my recovery would be like flying on a plane. Transportation (in other words, my progress back to health) would be essentially passive; the discovery several months in that my injury was more severe than originally thought would be merely a diversion to another airport en route for bad weather (round two of surgery); and it would be clear when I had reached my destination and would be able to disembark...

financially-driven medical decision-making

Posted on June 16, 2017
One of my assumptions about medicine is that continuity of care--that is, working with the same set of providers for a long time--has benefits. They flow mostly from the trust that is established with a primary provider, but can also come from information-sharing...

we must all cultivate our gardens

Posted on May 10, 2017
As it turns out, the federal government is heavily involved in managing/subsidizing crop insurance for producers. "Under the Federal crop insurance program, private-sector insurance companies sell and service the policies, and USDA?s Risk Management Agency develops and/or approves the premium rate, administers premium and expense subsidies, approves and supports products, and reinsures the companies...

suppose it's an obligation, and not a right?

Posted on May 08, 2017
Suppose we frame the current health insurance* debate in a different way?*It is about insurance. "Health insurance"=/="health care," although the former should lead to the latter.Rather than arguing whether American individuals have a right to health care (beyond what you can already find in EMTALA, and please God let's not consider repealing that), because people get very huffy about this concept, can we ask a different question?Should we Americans collectively assume an obligation to "promote the general Welfare" by providing everyone access to basic health services, in the way that we have obliged ourselves to provide all children with access to a free public education (largely from each state's constitution, with the exception of protections for disabled children)?Consider this: we have already agreed, by enacting EMTALA in 1986, that as a society we don't want to see people die because an ER turns them away if they can't pay...

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bite me

Posted on April 30, 2017
I had what should have been a routine dentist's appointment a few days ago that ... wasn't. It took me a while to figure out why this bothered me so.I live in an upscale suburb of a major metropolitan area. The area is rife with dentists, all of whom are trying to outdo each other in their luxe experience, starting with a fancy lobby with a nicely stocked refrigerator, continuing on to the offering of a wide array of cosmetic services (whitening, veneers, Invisalign) to creature comforts such as warm blankets and sedation...

on mandates, and mandates

Posted on March 22, 2017
Let me begin with a rant.Look, I know headline writers and Twitterers have to shorten stuff up.But let's keep in mind that reforming "health insurance" is not the same thing as reforming "health care." Because insurance for care is not the care itself...

the solution never works if you haven't identified the problem

Posted on March 06, 2017
I have a bias, I admit it. I am sensitive to studies with a subtext of "those stupid patients, what are we going to do about them?" Read the following rant with that in mind.A pharmacy benefits manager a/k/a PBM funds a study of patients nonadherent to chronic prescription medication...

when a provider gets it right

Posted on January 17, 2017
I sent a thank you note today (from time to time, I like to use my powers for good). Dear Doctor X [Chief of Anesthesia at Big Hospital]: I wanted to take this opportunity to commend your entire team for its thorough engagement with me after my inquiry about glucose control protocols while I prepared for my most recent surgery at Big Hospital at the end of last month...

more fun with PBM appeals

Posted on December 13, 2016
The PBM denied the first appeal (more on that later). The form called "Important Information about Your Appeal Rights" provides a number to call "for information on how to designate an authorized representative."I try looking on the PBM website first and cannot find an authorized representative form...

i don't know how other people do this

Posted on November 22, 2016
I submitted a claim last month on behalf of a family member for a compound prescription medication (eye drops with a higher percentage of active ingredient than readily available).The claim was denied by our PBM because, according to them, it "contains non-covered ingredient(s)...

the further adventures of radiology department a

Posted on November 11, 2016
Part One here.I was looking at my EHR with Radiology Department A two days ago, as one does, and I noticed that, despite my best efforts, an actual doctor there--let's call him Doctor X--took the time to reread my film a couple of days ago, and repeated his recommendation for followup testing...

possibly the most boring post i will ever write

Posted on November 09, 2016
Apparently, my health insurer Aetna, which is actually not an "insurer" at all but a TPA, is changing PBMs from Express Scripts to CVS Caremark.To decode that last sentence and its significance:A "TPA" is a third-party administrator of the health benefits that are being provided by a large company which is actually "self-insured...

i made a difference today

Posted on November 08, 2016
I found out this morning that my paralegal wasn't intending to vote today because she didn't think she was eligible for a replacement ballot. Based on her quick check of the King County website, she thought her voter registration was no longer valid (she is an intelligent person, just intimidated by the process)...

hello, my name is...

Posted on November 04, 2016
I competed for several years in extemporaneous speaking in high school.I took classes in college where the exams were 100% oral. And in Russian.I have been going to court since 1984. I make my living with my voice.I rarely use a word-for-word script any more...

the other side of defensive medicine

Posted on November 01, 2016
I wrote a stupid and annoying letter today.The letter itself was very polite. But I wrote it because I was afraid, and that is what is stupid and annoying.What was I afraid of? Being branded a "noncompliant" patient.Why am I afraid of this? It's like a stink you can never get off...

dear sergeant

Posted on October 20, 2016
I would like to express my appreciation to you and your marshal for meeting with me on Tuesday afternoon, October 18, 2016. We met to discuss the incident earlier that day in which my personal mobility aid was confiscated before my entry to the Maleng Regional Justice Center, and I was required to use a completely unsatisfactory, presumptively unsanitary, and stigmatizing substitute mobility aid in order to obtain access to the courthouse...

every cane is a "stick"

Posted on October 17, 2016
I went to the King County Courthouse this morning, and had my walking stick confiscated (I got it back eventually). The deputy handed me a nasty bogus cane that someone had abandoned there for my use in the courthouse.The rationale for this was that my walking stick could be "used as a weapon" against me, and that they had taken it away from me for my own protection...

dear director of patient relations

Posted on October 17, 2016
I am new to your organization, so I have been reviewing carefully all the forms that were mailed to me in advance of my first appointment.[Of course, this isn't because I'm new. I will review carefully every form you ever hand me. Fair warning.]I noted with interest the following language:[This me trying to be tactful...

don't judge a post by its title

Posted on October 11, 2016
So the article was called "Rethinking Automatic Insurance Coverage For Preventive Health Care" on the NPR website. Which sounds like a bad thing, right? Because of course it is good public policy (as opposed to a prudent business practice) to make preventive care "free" (that is, prepaid as part of health insurance premium) because it encourages more people to obtain the care...

when someone tells you who he is, believe him

Posted on August 03, 2016
The consort of the Dark Goddess has always provided health insurance coverage for the family. As the health insurance industry has changed over the years, so too has the packaging of our coverage.I recall a time in the late 1990's when HMOs were all the rage, so we dutifully signed up for one...

at least his partners know he has a blog

Posted on January 21, 2011
Akin Gump Chair Hits Partner?s Personal Blog Post on ?Ugly? Indian Prayer - News - ABA JournalHis post, however, was not a good idea.

brief means brief

Posted on October 19, 2010
Oh, come on now. 104 issues raised on appeal? If you can't win your case on the first 103 issues, why raise the 104th? Seriously, if you can't win on the first four issues, I don't think the additional hundred will help at all.

Service Snakes

Posted on March 17, 2010
This has to be one of the funniest opinions I have ever read. God bless him, the trial judge played it perfectly straight.The hapless plaintiffs had two problems: (1) they wanted to use medical marijuana in federally-subsidized housing. True, Washington has a law created by initiative that provides an affirmative defense to prosecution under state law, but use of marijuana is still illegal under federal law;(2) more entertaingly, they wanted to claim that their snakes were "service animals [sic]" under the ADA...

grandfathered in, or perhaps grandmothered

Posted on February 02, 2010
The Washington state legislature enacted HB 1592, effective last summer, ending the formation of new corporations sole. Existing corporations sole are--for now--continued to exist. HB 1592 also enacted an annual report requirement and imposed a $10 annual fee...

the gauntlet is thrown

Posted on December 18, 2009
This judge needs to Get Over It. Or perhaps Rise Above It.

"game of lighter fluid tag ends badly"

Posted on May 21, 2009
Really, the headline tells you all you need to know, but the rest of the article is here. How else could a game of lighter fluid tag possibly end?

OMG! WTF?

Posted on May 15, 2009
Miami-Dade Circuit Judge Scott Silverman declared a mistrial in a civil fraud case Wednesday after being informed a witness on the stand in his courtroom had engaged in text-messaging while the judge spoke with attorneys during a sidebar conference. The dispute is over the sale of condo tower in North Miami Beach...

link rot

Posted on May 07, 2009
It's a problem in this state.

never heard of this one!

Posted on April 30, 2009
New York preserves a "unique" cause of action for loss of right of sepulchre, or the immediate right to bury your own loved ones. It is a sad case, and one that I would have bet money would not succeed. The hospital, however, argued that the claim was time-barred, and the A...

why i think twitter is stupid

Posted on April 21, 2009
How to lose a job with one tweet. It's not even that I think the applicant is "stupid" (naive, unwise, yes). The very application lends itself to this kind of unguarded naivete.

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