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#Proffer Procedure in Legal Cases
sohanur24 · 7 months
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The reasons Joran van der Sloot is unlikely to face prosecution for Natalee Holloway's murder, even after confessing to the crime.
US Prosecutors’ Plea Agreement Prompts Joran van der Sloot’s Confession in Natalee Holloway Case In a pivotal development, US prosecutors extended a plea agreement to Joran van der Sloot on charges of extortion and wire fraud, leading to his confession in the 2005 Natalee Holloway case in Aruba. While the legal system may not hold him accountable for the tragic death of the Alabama teen, legal…
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raeshearn · 1 year
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Breaking a Nebbia Bond
It is critical to understand what is required if you want to lift a Nebbia bond or are in the process of securing a bond for a Nebbia case. There are several alternatives available, and the procedure is occasionally varied. Examining a few aspects can help you locate the finest option for your requirements.
During the bond hearing, a defendant must demonstrate that the monies used for bail were not acquired illegally. The Nebbia hearing is the name given to this procedure. To prove the monies were received legally, the defendant must submit proof such as tax returns, bank statements, mortgage documents, and other data.
The Nebbia condition is routinely attached to bonds as a condition of release in drug trafficking cases. However, the state is not always essential. It is sometimes imposed as a condition of release for other criminal offences. In Florida state courts, the Nebbia hold is a legal requirement. It is likewise included as a release requirement in other state courts. After the hearing is over, the Nebbia condition may be eliminated. A criminal defence counsel will often submit a request to release the defendant from the Nebbia hold, citing proof of the defendant's natural assets.
The Nebbia hold is often applied to drug trafficking bonds, although it may also be attached to bonds for other criminal offences. It is also typical in situations involving organized crime. The court system is more interested in the source of funds in such cases.
Whether you've been charged with a crime or are awaiting a bail hearing, you may do a few things to get out of prison as quickly as possible. One of the most typical methods is to file a motion to remove a Nebbia bond. Your bail may be reduced, or you may be released on your recognizance by the court.
The most apparent option to lift a Nebbia bond is hiring a qualified and experienced bail bond agent to guide you through the procedure. The agent may simplify the process as much as feasible. The agent can assist you in gathering the necessary papers for your Nebbia Hold hearing. A Nebbia Proffer might also be prepared for you by the agency. This poster displays a succession of documents demonstrating a genuine cash source. Examples include bank accounts, income statements, mortgage records, and real estate paperwork.
The Nebbia Hold is a bit more involved than a formal bail hearing. This is a standard requirement in Florida courts. A state court judge will usually add this condition to your bail.
Contact a Jacksonville Nebbia bail hearing lawyer if you need a Nebbia bond hearing. They can arrange a hearing for you swiftly and effectively.
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sentrient · 5 months
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5 Ways To Transform Compliance Into Competitive Advantage
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The side effects of non-compliance are widely known. Businesses can suffer penalties, reputational damages, and lost revenue-building opportunities.  
Many managers and business owners need to recognise the advantages of staying compliant with rules and regulations. Doing so doesn’t just reduce the cost of penalties, etc. It can also help businesses have a competitive advantage. This blog post explores how you can transform your compliance regime into a competitive edge. 
Five Ways To Transform Compliance into Competitive Advantage 
1. Foster The Right Culture 
Every cultural change must be committed to upper management and the board. Suppose upper management and board members are not committed to effective compliance management in gaining an advantage over business competition. In that case, generally, employees will also view compliance as a hindrance rather than an advantage. Changing this scenario needs involvement and cooperation from all levels of the organisation and the implementation of proper policies and procedures. Fostering a culture of prioritising compliance will be rewarding in the end. 
2. Proffer Appropriate Incentives 
Employees may not always be keen on paying attention to compliance requirements. They tend to focus more on individual tasks and progress rather than working on compliance management requirements. One way to encourage prioritising compliance amongst employees is to reward their efforts. Create measurable compliance goals and assign appropriate incentives. Employees who work towards achieving these goals rather than just focusing on their routine work and business must be rewarded. 
3. Leverage Technology 
Technology has transformed the way modern businesses operate. The function of compliance management is included in technological advancement, too. Automation in the form of compliance management software has changed the time and costs required to manage compliance and avoid risks. Investing in the right regulatory compliance management technology has become a critical decision for organisations globally. It can reduce efforts, time, and costs, along with providing better features to help achieve higher compliance. 
4. Impart Compliance Training 
Compliance training provides your employees with the ongoing support and resources they need to meet compliance standards. It helps convey the message of top management regarding the importance of compliance in business processes and workplaces. It communicates the compliance standards that are expected to be followed by all employees. Compliance training helps align employee efforts with the business compliance goals, resulting in low non-compliance risk. 
5. Conduct Effective Communication 
Becoming a compliance leader will make little difference if it’s not communicated correctly. Letting your customers and competition know about the standards of compliance management you have achieved can help enhance your market presence. This can be done using business communication, such as emails, newsletters, advertising, news releases, etc., to reach out to the public and present your brand as legally compliant.  
The Takeaway: 
Having well-designed compliance management software in place can help leverage the advantages of automation and rise above the competition. Sentrient’s compliance management system covers comprehensive features that not only automate compliance management tasks but also allow management more time to spend on decision-making and strategic planning. Contact us today for more information.
This blog post was originally published here.
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floridaprelaw-blog · 11 months
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The Utilization of Lyrics as Evidence
By Theodros Fekade, University of Miami Class of 2024
June 22, 2023
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With the judgment in West Virginia State Board of Education v. Barnette, the judiciary proves that it is not willing to enforce or conduct a standard of uniformity amongst citizens or encourage groupthink. (West Virginia State Board of Education v. Barnette) In Brandenburg v. Ohio, the Supreme Court used a two-pronged speech test where speech can be deemed illegal if the speech is "directed at inciting or producing imminent lawless action" and is "likely to incite or produce such action.” (Brandenburg v. Ohio) The Brandenburg v. Ohio case perfectly displays the extent to which the First Amendment is willing to cover and protect. Analogously, the founding fathers envisioned a country where you could say anything you wished through “Congress shall make no law prohibiting the free exercise of abridging the freedom of speech.” (Cornell Law School Legal Information Institute) The First Amendment has been raised in the West Virginia v. Barnette and Brandenburg v. Ohio cases as a way of protecting free speech, but free speech and the First Amendment cover a broader scope that encompasses artistic freedom. Many countries across the world significantly destroy art or persecute graffiti artists, musicians, and painters for engaging in art that oversteps the general limitations that the government sets forth. (Pecot) Fortunately, in the realm of American jurisprudence, the judicial branch makes a considerable effort to combat this by assuring the protected rights of artists through rulings in their favor and by issuing practical limitations on alterations proffered by legislatures. In American jurisprudence, substantive and procedural laws are prevalent in civil and criminal cases. Substantive law is associated with the specific definitions of the law and their implications for society. Procedural law refers to the proceedings of the case and how they are conducted to institute equitable due process. While society tends to be adamant over substantive issues, it should be infuriated over procedural law implications because one cannot expect any substantive law to be impartial when the procedural law is inherently corrupt. As hip-hop lyrics are being cultivated as evidence in court rooms, we are witnessing a society where procedural law is arguably contradicting the First Amendment. Legal scholars, professors, and proponents assert that the use of hip-hop lyrics in court is explicitly dismantling the First Amendment, stripping the First Amendment of its authority, and infringing on the freedom within the precious society of the United States.
Arguably, the scope of the First Amendment should never shrink because our society will only progress with the introduction of artificial intelligence technologies, Web3, and the metaverse. Our society will inquire about the methods by which people should limit their free speech regarding emerging technological innovations. The Supreme Court must inculcate society with a determined and objective standard to prevent the collapse of society, which is an original tenet of the U.S. Constitution. In Miller v. California, the Supreme Court’s now famous test was employed to determine something obscene by the complete and subsuming satisfaction of "(a) whether 'the average person, applying contemporary community standards," would find that the work, taken as a whole, appeals to the prurient interest; (b) whether the work depicts or describes, in a patently offensive way, sexual conduct specifically defined by the applicable state law; and finally (c) whether the work, taken as a whole, lacks serious literary, artistic, political, or scientific value." (Miller v. California) Although Miller v. California has been used in a multitude of cases to benefit an artist, there have also been nefarious and sinister ways that prosecutors, government officials, and authority figures have overtly employed to implement hip-hop lyrics in court as a mechanism of evidence. In American jurisprudence, society tends to be shocked or gasp when they hear a summary judgment or verdict in a case. Society, using that dumfounded or appalled feeling, should be perturbed by the process of gaining the summary judgment or verdict in the case. Society should be baffled by the proceedings of the case, which can involve everything from pretrial discovery to jury selection. The pretrial discovery in a case itself can allow evidence that can prove invaluable in the minds of a jury or judge to render a verdict.
In Atlanta, Jeffery Williams (nicknamed Young Thug), Sergio Kitchens (nicknamed Gunna), and other members of the YSL Enterprise were indicted on the R.I.C.O. (Racketeer Influenced and Corrupt Organization) Act. Through Young Thug’s lyrics of "I never killed anybody, but I got something to do with that body," the prosecutors built their case upon these lyrics as their smoking gun evidence. (Lang) Gunna, who was only indicted due to a speeding ticket, was included in the indictment due to his lyrics, "YSL slimy and shady, they ain't wavy like my clique." This indictment sets a dangerous precedent because rappers will be in constant fear of reprisals from prosecutors. Analogously, the fear of reprisals and the limitations on lyrics will discharge the alluring effect of hip-hop’s nature. Johnny Cash once made a song named "Folsom Prison Blues" that had the lyrics "but I shot a man in Reno just to watch him die." (Genius) The result of Johnny Cash singing the Folsom Prison Blues resulted in no indictment whatsoever and critical acclaim that amassed him 15 Grammy awards. (Pecot) Although the employment of lyrics in court is erratic, perhaps the most egregious use of lyrics in court belongs to the case involving Vonte Skinner. In New Jersey v. Skinner, Vonte Skinner was charged and convicted of attempted murder and other charges because a state witness was allowed to read hip-hop lyrics that were finally used as evidence against Vonte Skinner. (New Jersey v. Skinner) The prosecutor in the case ended up applying 13 pages of violent lyrics that did not include the victim or material aspects related to the crime Skinner was accused of. (Kubrin and Nielson) The Supreme Court, in their reasoning, ruled that the evidence of the lyrics constituted "highly prejudicial evidence against Skinner" and that the hip-hop lyrics could be used to besmirch the jury’s judgment. (New Jersey v. Skinner) Although iniquitous prosecutors believe in exploiting the lyrics as an "I caught them red-handed" moment, the Supreme Court does not agree and will reverse the decisions of inferior courts that deem such lyrics material to the case.
One of the most prevalent arguments for utilizing rap lyrics in court is to combat crime. When one uses this argument, one must first understand who the lyrics are used against, how material the lyrics are to a case, and how often the lyrics are used as evidence. In the overwhelming majority of cases involving the use of lyrics as evidence, there tends to be a focus on the artistic genre of hip-hop. When Bob Marley sang of how "he shot the sheriff" or how Edgar Allan Poe composed of how he "buried a man beneath his floorboards," no reasonable prosecutor sought charges against these artists. (Manly) When lyrics that are emotionally jarring are used as sole or prolific evidence throughout the entirety of the case, the jury can only be "poisoned" and clouded in their judgment of the defendant. (Pecot) The Supreme Court agrees while also determining that the rap lyrics themselves are inherently protected by the First Amendment as the lyrics are considered artistic expression.
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Brandenburg v. Ohio. U.S. Supreme Court. 9 June 1969.
Cornell Law School Legal Information Institute. Cornell Law School Legal Information Institute. 1992. <https://www.law.cornell.edu/constitution/first_amendment>.
Genius. Genius. 15 December 1955. <https://genius.com/Johnny-cash-folsom-prison-blues-lyrics>.
Kubrin, Charis E and Erik Nielson. Rap Lyrics on Trial. 13 January 2014. <https://www.nytimes.com/2014/01/14/opinion/rap-lyrics-on-trial.html>.
Lang, Cady. What to Know About Young Thug’s Trial and the Controversial Use of Rap Lyrics in Criminal Cases. 29 June 2022. <https://time.com/6192371/young-thug-rap-lyrics-evidence-court/>.
Manly, Lorne. New Jersey High Court Rules Lyrics Inadmissible in Rapper’s Case. 4 August 2014. <https://www.nytimes.com/2014/08/05/arts/music/new-jersey-high-court-rules-lyrics-inadmissible-in-rappers-case.html>.
Miller v. California. U.S. Supreme Court. 21 June 1973.
New Jersey v. Skinner. No. A-5365-14T2. Superior Court of New Jersey. 29 November 2017.
Pecot, Emily. Using Rap Lyrics as Evidence in Court. 15 February 2023. <https://njsbf.org/2023/02/15/using-rap-lyrics-as-evidence-in-court/>.
West Virginia State Board of Education v. Barnette. U.S. Supreme Court. 14 June 1943.
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lailoken · 3 years
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The Witches' Supper
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“ The figure of the witch in the early modern era was an amalgam of religious typologies including blasphemer, heretic, spiritual malefactor, idolater, consort of fallen angels, and liege of the Devil. In parallel the witch accreted the substance of secular criminality: poisoner, thief, abortionist, grave-robber. These opprobrious brands were impressed on the accused by those whose written records survive, often in the form of legal tractates or penitentials. Yet as command of the printed word spread beyond legal and religious centers, other typologies emerged: healer, folk-charmer, superstitious rustic, impoverished wretch, and others. This procession of witch-guises has continued well into the present day, to include the glamorized images suffused in popular culture: the witch as diabolist caricature, illusion-maker, emanant of sexual allure, and repository of the unexamined ejecta of Christian orthodoxy.
An important and little-examined dimension of the witch-guise is that of the reveler at the Devil's Sabbath banquet. The imagery of this feast appears frequently in woodcuts and is occasionally innocuous, but at other times proffers the image of the witch as necrophage. The assembled coven is alternately portrayed as consuming unbaptized infants or the grisly products of desecrated graves; human bones are also included at the table, as they are in portrayals of the witches' Grand Rite. From the perspective of desecration taboo, the array of grim foodstuffs is no less appalling than the relics held in veneration by the Roman and Eastern Orthodox Churches: teeth, fingers, jawbones, foreskins and skulls, incorruptible corpses and vials of blood which liquefy and coagulate at auspicious moments. Yet, witches too have their saints and ossuaries, their hallowed relations to the Holy Dead. It is the passage from stewardship and veneration of remains to ritual consumption that triggers affront in the common mind, and has also contributed to the fear of witchcraft. Despite its abhorrent qualities, this forbidden lore persists and is known to some modern practitioners of folk magic as The Witches Supper' -a clandestine and disturbing meal which is, in some cases, a cipher for profound spiritual arcana, as well as the lore of poisons.
The process of bodily decomposition was a matter of fascinative obsession and repulsion to our ancient forbears, from both religious and magical perspectives. Upon death, the body naturally undergoes myriad biochemical changes bent toward the singular goal of material retrogression, the descent of the incarnative vessel to the mortified estate of the Profane Adam. Discoloration of tissue, stiffening of the body, abdominal bloating and pooling blood are mere precursors of the great corporeal tumult whose horrific imagery resembles the demonic horrors of the witches' cauldron. Bodily decay produces its own array of chemical poisons, many of which are responsible for the fetor so viscerally offensive to the living nose, but, also serving as inviting beacons to scavengers and detritivores. The fortress of primordial Adamas, once inviolable with God-given dominion over Nature, is rapidly transformed into a food source for a great variety of organisms, this status heralded by the production of corpse-poisons. Many of these putrefaction-derived compounds, in isolation, can be intoxicating or deadly to Homo sapiens"; some of them, in minute amounts, are also associated with pleasure or sexual allure, thereby recalling the ancient connubium between Eros and Thanatos. In some cases the corpse-poison also served a magical function before physical death: the power to cause flesh to rot on a living body, by forced infection and corrupt magical principles, was a known power of Zuñi medicine men and a documented procedure during the slow execution of witches. This odorous stew of nitrogenous cadaver-compounds falls into the ancient toxicological classification of ptomaines, from the Greck ptoma, indicating a corpse or provenance is the graveyard and charnel house, the crypt and plague-pit, and they are united in both science and magic as the vaporous effluent of the necropolis.
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Witches and diabolical consorts at the Sabbath-feast.
No less than the natural decomposition of the human body, foodborne illness is also caused by organic decom 'fallen body'. Their position, and has been colloquially referred to today as a kind of poisoning. Corrupted food been a perpetual fact of civilized existence and has required ingenious solutions to forestall the advance of decay. Transmitted by the noisome taint of worms and micro-organisms en masse, putrefaction was a philosophically confounding process both dead and alive; the stench and ugliness generated in contaminated victuals were likewise an offense to reason as well as the senses. Early technologies of food preservation included cooling, drying and salting to arrest decomposition, or, in some cases, to mask the objectionable flavors of rancidification. The ancient arts of meat preservation naturally share a kinship with embalming: the outrage of post-mortem decay was of prime importance to the Old Egyptians, whose methods of providing salvific respite for the corpse may rightly be considered a magico-religious art form. In Christianity, the processes of corporeal decay were assigned to the dominion of the Devil, likely one reason for the folklore that Satan cannot abide the presence of salt. Persons who claimed to have attended the medieval Witches Sabbat remarked on the absence of salt at the feast. Similarly, when salt was brought in, the spectral revelers of midnight's table suddenly vanished, leaving the guest alone. The power of salt for slowing or arresting decay also relates to its magical uses for exorcism, blessing and consecration. The magician's exorcised circle is thus both fortified and mummified, a perfectly-preserved moment in time and space.
Both the corrupted products of Death and the means of slowing or arresting them bear crucial relationships to the Witches' Supper, which in one interpretation (stripped of its heretical elements) can be seen as fostering a ritual intimacy with the deceased. That the witches' delectations should be portrayed in the first instance as necro- cannibalistic is consistent with the position of witchcraft as transgressive, and as operating in spheres roundly condemned by religious and social orthodoxy. The witches' relation to the dead vis-à-vis their atrocious meal is, on the surface, portrayed as a mock Christian communion, or as the vulgar tactic of demonizing enemies by implied cannibalism. On a different level, the Supper operates as a hieroglyph of specific witchcraft power, namely the unique magical relationship between witches and the so called 'Mighty Dead', the retinue of ancestral shades and fountain of pre-incarnate atavism. The art of necromancy, or magically calling forth the shades of the dead, has long been a vibrant strand of witchcraft and magic of many epochs, and in many recensions may be considered its driving engine. Linked with more ancient currents of shamanism, this art was known from the writings of ancient Sumer, Chaldaea, and Greece, the latter providing the prototypal witch-figure and poisoner Circe, the sorceress of Homer's Odyssey.
The materia of the Dead—flesh, blood, and bones—is the mumia of art, known well to witchcraft, alchemy, folk magic, and medicine. The act of its ritual consumption, presented in early modern Witches' Supper depictions as vulgar cannibalism, encodes a number of precise ritual formulae and powers in necromantic magic. The most important of these is the elevation of 'dead matter to a living state by its incorporation into the living body. This is the active principle underlying the Holy Eucharist, wherein, through divine transmutation of elements symbolizing the mumia, Christ's body and blood are come forth from the tomb, and commune with the Body of the Faithful. The potent necromantic implications of the Holy Communion, as a magical act, would have been instantly recognizable to practitioners of folk-sorcery, particularly in contexts where funerary rites maintained close communication with the departing spirit.
Present within the Feast of the Dead is also the Formula of Opposition, a precept which underlies many historical patternings of witchcraft. Named by Andrew D. Chumbley, who wrote about it extensivelys , the Formula is an operant dynamic between the sorcerer and the 'Other', that being the zones of spirit-alienation external to personal experience and containing ungathered seeds of occult numen. In the case of historical folk magic, Formulae of Opposition are often transgressive against law, religious orthodoxy, or social convention, but above all against Self; as exacted they often make use of inversion. In violation of strongly-held personal Tabu, the structure normally governing conception and use of magical power is overturned, resulting in a liberation of consciousness, and the acquisition of previously-forbidden realms of power. At the Feast of the Witches, a culinary encounter with dismembered limbs, organs, and heads serves as an oppositional force on a multitude of levels, from the basic violation of the senses, to affronts against personal and group morality. Whilst the actual consumption of decomposing human flesh by historical practitioners of Sabbatic rites is an open question, it is, perhaps, the wrong question. More relevant is the depictions of the moribund Feast as a symbol of initiatic power gained through the Formula of Opposition.
The Accursed Victual, as a component of the Feast, may also mask the presence of initiatic power, conveyed through mumia. A recurrent component of magical charms is the secretion of semen, menstrual blood, feces, or urine into food as a spell of control over one's victim. This action mimics the spoor secreted by many mammals for the 'marking'or'claiming’of territory and if correctly engaged draws upon a vast astral repository of atavism, and belongs to an ancient stratum of magic reaching into prehistory. Spells employing such secreted matter are transgressive of ancient dietary laws wherein food, and the feast itself, represents a sacrosanct compact between the dining parties. However, when the parties are wholly conscious of the nature of their food, and eat nonetheless as they are shown doing in portrayals of the Witches' Supper- it may be presumed that there are religious or magical reasons for doing so, namely reverence for the deceased, the acquisition of power, or both.
All such approaches to the Feast are essentially necromantic, and as a coercive approach to spirits, it is properly classed as sorcery. It is thus aligned with early modern witchcraft, but ritual communion with the dead using food and drink is also a feature of ancient religion." Roman cults of the dead persisted into the early centuries of Christianity, with night-long memorial feasts in honor of those whose bodies had passed, often in situ at the tombs themselves. Archaeological evidence, as well as the written record, reveals remains of ancient graveside banquets, including drinking and cooking vessels. Church prohibitions on pagan rites honoring the dead occurs in written form as late as the thirteenth century, indicating that such observances were still in practice. Feasts offered in honour of the dead persist into the modern era, even in exemplars largely bereft of religious trappings. Ritual consumption of the dead as part of a socially acceptable funerary practice, is also documented.
The abominable meats, bones, and sundered limbs often pictured at the Witches' Supper may be afforded an additional interpretation with regard to their magical rôle at the Witches Sabbath. In certain inquisitional records, an emergent pattern among some groups, which differed from the usual clerical projections, involved a banquet with archaic features which scholar Wolfgang Behringer has called "The Miracle of the Bones'." This features the restoration of life to a cow or other animal from a disjointed skeleton. The implicit power of this mystery as a magical practice is captured in a section of Robert Fitzgerald's Midnight's Table, a manual of witchcraft lore and spellcraft concerning the arcane power of the witches' banquet:
The Mind void yet the Thought fully formed.
The Body hungry yet the Spirit replenished.
The Wood unfinished yet the Table carved.
The Platter empty yet the Larder full.
Here the desolation of the witches' feast remains, as well as their potentiality as nutritive victuals or even as living beings, is invoked, the suggestion of Voidful Presence through the juxtaposition of emptiness and corporeal flesh. Extrapolated beyond the objects themselves, the table may be seen as the witches'altar or circle, the zeroth vessel of all-potentiality which, like a cornucopia, may contain a multitude of fruits by way of ritual power. This symbolic and emblematic patterning is completely consistent with the atavistic patterning evident in the orally-transmitted magical lore of the Sabbatic Cultus.
The natural transformative processes of rot and decay are crucial strands of the magical currents feeding folk magic and witchcraft. The alchemists of Europe explored putrefactive states thoroughly, borrowing the process from Nature, then emulating, calibrating, and magnifying it under precise fractionations in glass vessels. It is likely that, as with the Royal Art itself, a considerable 'portion of putrefactive magic in Europe was a direct inheritance of Arabic and Islamic magic; such texts as Ġäyat al-Hakim and Kitab al-Sumum employ numerous members of dead animals, some ritually killed, for cursing, poison, and magical power. These usages also occur in the later corpus of European grimoire formulae. However, the powers of putrefaction and decomposition had a far more ancient pedigree, one of which is of specific interest to the Sabbath banquet. Correctly harnessed, they give rise to both of the primary mysteries of the witch sacrament: the Bread and Wine.
In the Bread and Wine of the Witches Supper, some have seen the historical outlines of the ritual consumption of psychoactive substances at the Sabbath, specifically conveyed through food and drink, and indeed this interpretation is present in some modern-day witchcrafi practices. Historical references are uncommon, but suggestive. The Inquisitor Pierre DeLancre reported that the bread of the Basque witches' was black and revolting, its flour ground from black millet, and served with 'false meats'. Aside from its resemblance to cadaverous flesh, the "black bread' is of potential toxicological interest. In centuries past, white flour was a privilege of the wealthy, and poorer classes resorted to eating so-called 'black breads', made of rye and barley, and which also contained diverse adulterants from the harvest. Piero Camporesi in his Bread of Dreams has speculated that psychoactive contaminants of grain such as darnel (Lolium temulentum) and ergot (Claviceps purpurea) were so common in the flours of some regions and eras that the average peasant was in a constant state of intoxicatio as a consequence of poor diet. If true, the evidence cited suggests that the psychoactivity of such breads was an accidental by-product of a fouled food supply, but if the phenomenon was understood by herbalists and magical practitioners, there would be little to stop the cunning from crafting experimental loaves. Indeed, as with the Thelemic Cakes of Light', the Sabbath Bread has its own secret formulations.
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The Nocturnal Assembly gathering corpses for the Witches’ Supper. Compendium Maleficarum, 1608.
The old term "Crow's Bread" originates in the founding lineages of the witchcraft order Cultus Sabbati, and originally referred to the intoxicating mushroom Psilocybe semilanceata as a gift of the spirits for visionary ritual use. In the late 20th century, the term was applied within the group for broader use to refer to any psychoactive ritual substance gathered from Nature, but its nature as 'Bread is linked both with the Communion Host of Christ and the male generative power linked with the 'Lord of Light’, in some cases identified with Lucifer. In this latter association, the Bread's power as Revelator is especially notable. Covines and lodges of the Cultus have long made use of venefic gnosis in various forms; its oldest known recensions, dating from the second half of the nineteenth century, contain obscure charms against poison, as well as certain ritual transmissions of power using a prepared psychoactive sacrament. Oral teachings long pre-dating the Great War concern another poisonous species of note in Britain: Belladonna. There are also adjunctive practices concerning a multitude of other plants of power, specifically their Eucharistic power. My contacts with other Traditional Witchcraft groups outside of the Cultus have, on occasion, affirmed the presence of such sacraments elsewhere, some of which have themselves passed into a largely symbolic or chemically inert form.
Within the Sabbatic Cultus, the Bread of the Sabbath Feast operates upon many magical levels, its essence is intimately tied to British agricultural cycle, the God of Harvest, Corn and Sheaf, sometimes manifest in the mythical divinity of John Barleycorn. The germ of this myth encloses the great mystery of ritual murder and resurrection embodied in the Holy Loaf, and the resulting sustenance of the kingdom. This quintessentially English expression of the Bread is thus seminal, nutritive, life- giving, and radiant, but also embracing the mysterium of Death and a patterning of seasonal time and tide. Here Barleycorn is sometimes identified as the Witch-Father Mahazhael. He is thus often depicted as a skeletal god with an erect phallus, bearing a scythe, sickle, and stalk of grain; his mystery is well encapsulated in his invocation from Chumbley's The Dragon-Book of Essex:
On the first day I awoke within the furrow.
On the second day I knelt in prayer 'neath the sun.
On the third day I stood in the long green robe.
On the fourth day my head was crowned with gold. 
On the fifth day the sickle laid me to rest.
On the sixth day my body was ground between stone.
On the seventh day I was raised anew
to feed the brethren at Midnight's table-
to serve at the Round Feast for both the Living and the Dead.
In addition to the process of ritual murder which births the Bread, the putrefactive processes used for its fermentation, via yeast or bacteria, are also reckoned as a part of the Corn-God's dominion. As a natural agent of corruption, yeasts are widespread and penetrate countless strata of the world, often contaminating foodstuffs, as well as the human organism. Even where fermentation conditions are controlled, the process of making bread and wine relies on the mass death of these microorganisms. This catastrophic loss of life, on the order of hundreds of millions of individuals per loaf, nonetheless provides a delectable crumb serving as both an holy sacrament and the common man's ‘Staff of Life'. A further relation between bread and the grave is its frequent off-white colour, recalling bone, and the hardness it attains when stale, sometimes petrifying, as a skeleton, over the course of centuries; and amongst some witchcraft practitioners, the churchly Communion Wafer is sometimes addressed within the circle simply as 'The Corpse' or ‘The Skeleton'.
The magical corollary to the Witches' Bread is the Vinum Sabbati, or Winecup of Midnight's Table. Its alignment is with the Moon and the Lunar emanation, the feminine principle, and the many humours of the body, primarily blood, but also the female sexual secretions, both gross and subtle. In witchcraft contexts, as well as other secret societies and magical orders, the Wine is of legendary status and a great deal of lore and doctrines have emerged concerning its generation and use. To some it is a cup producing fantastic visions, to others, an initiatic ordeal which serves as the most harrowing trial for the drinker. Certain teachings, through its association with both the Living Cup and its Wine as a single entity, have two essential natures which in combination, magically unify to create a Blessed Third, an apotheosis of both. Within the Cultus Sabbati, the 'Graal of Midnight' has precise formulations to empower and support the various pathways of Sabbatic Congressus: Thanatomantic, Atavistic, Sexual, and many others. By a metaphoric pathway, the Wine of the Sabbath is not only a fluidic medium, fermented and distilled within the Flesh of the Initiate, but also the entire process of corporeal transmutation during its imbibition at the High Sabbat.
As an actual drink conveying ritual power, a medieval prototype of the Wine of the Sabbath is to be found in Johannes Nider's Formicarius (1435), which alleged the witches of the Simmenthal region of Switzerland were initiated using a potion brewed from the ashes of infants. More important than the composition of the brew was its alleged effect: the beguiling draught conferred upon the initiate an instant knowledge of the Art Magical. Though described prior to the advent of the Sabbath as a major component of witchcraft, it is the ritual cup and its function as a bestower of witch-power which links it to the Witches' Supper.
The bridge between wine and the incorporeal host is also relevant to the nature of the witches' cup. Historically, the grape was considered divine not only by mankind but also by spirits of the Dead. In ancient Greece, the Vine-shoot was regarded as possessing strong properties of purification; wine was often poured there as a libation for the dead, as well as to chthonic deities. This custom of offering alcohol to the deceased resisted the strongest attempts at eradication; Theodoret, Bishop of Cyrrhus (427-449) reports with outrage pagans bringing wine to the deceased in evening rites. Cæsarius relays a legend in which two servants at the monastery of Laach, charged to guard the vineyard by night, bribed the devil to do their work with a cophinum full of grapes, a deal which was apparently kept. Amongst the nocturnal activities later alleged of the Vaudois witches was the invasion of wine cellars, led there in a troupe by the Devil. "Under lead of the demon they enter cellars and drink wine, all of them first urinating in the cask from which it is drawn." The threefold linkage of wine to the Dead, witches and the Devil draw additional lines of arcane association with the Sabbatic Grail, both as a form of communion with the Dead and with the Black Man of the Sabbath, the God of the Lamiae.
The presence of Wine in historical English witchcraft and folk magic may indeed arise from its aspect as mock-sacrament, theʻpolluted bloodof Christ which featured in invertive and blasphemous sorceries. However, wine was present in England before the advent of Christianity; introduced by the Romans, there is evidence for viticulture among the Anglo-Saxons; one conservative estimate identifies at least 139 definite or possible vineyards in medieval Britain. Though climatological trends in past centuries have fluctuated, and viticulture has prospered or suffered accordingly, the Genius of the Vine has been present in England for millennia. This is certainly sửfficient time for a body of lore and rites to have accreted around the Grape and its divine expressions, drawing from numerous magico-religious currents, as well as the inevitable corpus of agrarian lore which accompanies so important and venerated a crop. This is to say nothing of England's great tradition of hedge wines, a testament both to the ingenuity of her vintners and the botanical diversity of her lands.
The Cup of Wine which features so prominently at the Feast of the Witches may be understood as the mechanism of sorcerous transmutation of the body, not only its vehicle, but its symbol, process, teaching, and legacy. This symbol in activated form unfolds, as an opening rose, the entire ecstatic algorithm of the Sabbat. Within the rites of Sabbatic Witchcraft, the Wine of the Devil's Graal appears in radiance at the confluence of sorcerous enchantment and spirit-veneration. Where the covenant of adepts is of sufficiently focused will, desire, and belief and of sincere devotion", the Cup is vinted, filled, mixed, and drunk. The motto ‘Ipse venena bibas’ or 'drink thou thine own poison' encodes the truth that the Grail of the Witch is both the cup from which it is drunk, and the initiate into whom the wine passes. The alpha-numeric essence of this matter is eloquently contained within the number 710, which corresponds both to the grail-poison (tar`elah) and the Sabbath itself.
The active magical nature of the Witching Graal, and its function as the intermediary in rites of 'Communion' naturally evokes the Body of the Goddess as the portal of mystery. In the Sabbatic traditions of witchcraft, the shade-mother Lilith or Liliya Devala is identified with the witches' cup in both its exalted and desecrated forms, aligned with sex-magical moduli of Void-mind (the empty cup) and the conjured circle of spirits (the full cup). Other permutations occur, especially those co-identified with the body of the Priestess or ritual adjuditrices. Each wine vinted within these cups is as much a product of the Vessel as the Vine.
Kenneth Grant has linked the Sabbatic Wine to the blood of Charis, wife of the smith-god Haephestos, and also known as the threefold goddess Charites, or the Graces. Expanding upon the writings of Massey, which quote the ancient writings of the Gnostic Marcus, Grant links the Vinum Sabbati with the blood of Charis, the 'original Eucharist'of the early Gnostic Christians. The vintage is the central component of the ancient magico-sexual rites of trance mediumship wherein the goddess spoke through a chosen medium. This bears certain similarities with kindred operations in the Order of Eastern Templars, as well as those of at least one Traditional Witchcraft lineage informing the Cultus Sabbati. Likewise, a cup-blessing used for the Wine connects its use to the forgotten intimacy of Samael and First Woman:
Bright Host of Saint Hawa, draw nigh unto this, my Cup.
Before mine eyes, the Well of Abomination,
Betwixt thy thighs, the Red Stream of Eternal Fire.
Behold thou the Good Companie assembled
To feast upon the grave-wandering corpse,
Draught of Manbane, and dew of the Forest grail,
The blood-fouling thorn, the Fang and Toad-froth,
Yea, All Delights of Resurrection's Vineyard:
O, Mercy of the Spirit I pray!
Here 'Communion' also relates in mystery both to the Witches' Agapae or love-feast as well as the coition of spirit transpiring within the circle of the High Sabbat itself. This resonates with the witches' Fortunum or Cup of Good Fortune, a specific preparation of male and female sexual secretions, ritually expressed in the correct lunar phase, and empowered through conjuration of precise spirit- presences. Withing these covines are preserved teachings concerning 'the vinting and pouring’ of the Agapae-wine, as well as its function at the Feast. It is impossible to pinpoint with certainty the origin of the oldest of these witch-rites, though their resemblance to some practices of South Asian Tantra is striking. This may be an occult adaptation of Tantric practice, as perpetuated through such magical orders as the Ordo Templi Orientis, with which some covines have had contact. However, the oldest witch- praxes of this type pre-date the Oriental Templars' contact with Tantra, and in fact retain elements marking their origin as specifically English and Northern European. Additionally, their foci incorporate atavistic formulae, placing them squarely within the precincts of an ancestral cult, as well as incorporating elements which would to many occult lodges, be considered "low magic".
Despite the linkage of these sexual witchcraft formulae with the Dead, their strata of magical expression very much concern the living, the present body of initiates, woven into the perpetuity of magical time. In addition to the powers of manifestation their perfected exaction radiates, they are capable of simultaneous intoxication, empowerment and nourishment -the great 'Transmutation of the Body' in which one becomes magic entire. Its linkage with the ghastly imagery of the demonologist lies in its formulation from the Corpus Humanis. Under correct conditions, the two give rise, like the antediluvian pillars, to the Great Temple of the New Flesh.
Returning to the concept of Crow's Bread, within the Sabbatic Cultus, the Liberty Cap mushroom (Psilocybe semilanceata), when encountered growing in the wild, is regarded as an omen of ancestral favor. A prime concentrator of atavistic force, it is a gateway to the dominion of Faerie and a guardian of the Way. It is never hunted, but when encountered must be acknowledged by certain ritual customs and sacrifices.
Importantly, it eschews dung, unlike other visionary mushrooms of its genus, and thus in mystical terms is separated from Abel, the unrefined or 'profane' nature of flesh prefiguring the sorcerer Cain. Proceeding as it does from the soil and thus the subterranean vaults of the Mighty Dead, its fruiting body is the brief apotheosis of those fallen and yet come again: the ephemeral Risen Phallus of the Spirit-Meadow. The mushroom thus subsumes three important mysteries of the Witches' Supper in one body: the Corpse, the Phallus, and the Visionary Sacrament. From a devotional entry in Hypnotikon:
Amongst the true-born of its flesh, it is known as ‘The Watcher on the Moor' and this is precisely where I was introduced to this Friend. It speaks of many things: great spectral mists uncurling before the moon; of time and the procession of bodies upon bodies; of hedge-haunting devils; of the deeds of the Saints' bones, resonant and deep in the earth; of the Immovable Stone and its wisdsom; of symmetries and arrangements of things - trees, plants, beasts; of holy books writ in ossuary dust; of the delectations and radiances of the flesh; of the Round Dance and the Fallen Star; of the Sovereign and Horn'd Head detached from the body, ruling over the Land; of the telescoping of the soul into indescribable abysses. When it has spoken its final word, and revealed its last vision, what then remains? The accumulated counsel of every incarnation as I'.
In the abyssal heart of ancestral shadow, the 'Bread' of Midnight's Table is served both for the Living and Dead. For those who sup in flesh, and walk in the world of men, it is a sacred loaf broken for remembrance: to honor the Dead with sensation and savor, and to call forth into the body, through the rite of necrodeipnon, what has gone before. For them who abide in shade, the Bread is the Lantern of the World, shone as a beacon for return to the flesh, if ever briefly. Through the medium of poison, and its child ecstasy, the decay and annihilation of Death is cast aside, the spirit clothed anew in the radiance of corporeal transfuguration. ”
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Veneficium:
Magic, Witchcraft and the Poison Path
by Daniel A. Schulke
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cookfinders · 3 years
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Indian Chef Recruitment in the USA
Apart from growing demand for Indian IT skills, Indian cuisine and Indian chef required in USAare gaining worldwide popularity. Owing to the increasing numbers of expats in India and Indian immigrants in every corner of the world, a plethora of opportunity has developed for Indian chefs and cooks in abroad countries. From 5-star restaurants to wide chains of multinational hotels and commercial kitchens, Indian chefs and cooks have a global promising career, especially for a chef looking for work in USA.
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price-law-firms · 3 years
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Where to get local expert attorneys?
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tallanssolicitor · 3 years
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The Most ideal Approach to Claim after an Auto Accident with best accident solicitors
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gordonwilliamsweb · 3 years
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Device Makers Have Funneled Billions to Orthopedic Surgeons Who Use Their Products
Dr. Kingsley R. Chin was little more than a decade out of Harvard Medical School when sales of his spine surgical implants took off.
Chin has patented more than 40 pieces of such hardware, including doughnut-shaped plastic cages, titanium screws and other products used to repair spines — generating $100 million for his company SpineFrontier, according to government officials.
Yet SpineFrontier’s success arose not from the quality of its goods, these officials say, but because it paid kickbacks to surgeons who agreed to implant the highly profitable devices in hundreds of patients.
In March 2020, the Department of Justice accused Chin and SpineFrontier of illegally funneling more than $8 million to nearly three dozen spine surgeons through “sham consulting fees” that paid them handsomely for doing little or no work. Chin had no comment on the civil suit, one of more than a dozen he has faced as a spine surgeon and businessman. Chin and SpineFrontier have yet to file a response in court.
Medical industry payments to orthopedists and neurosurgeons who operate on the spine have risen sharply, despite government accusations that some of these transactions may violate federal anti-kickback laws, drive up health care spending and put patients at risk of serious harm, a KHN investigation has found. These payments come in various forms, from royalties for helping to design implants to speakers’ fees for promoting devices at medical meetings to stock holdings in exchange for consulting work, according to government data.
Health policy experts and regulators have focused for decades on pharmaceutical companies’ payments to doctors — which research has shown can influence which drugs they prescribe. But far less is known about the impact of similar payments from device companies to surgeons. A drug can readily be stopped if deemed harmful, while surgical devices are permanently implanted in the body and often replace native bone that has been removed.
Every year, a torrent of cash and other compensation flows to these surgeons from manufacturers of hardware for spinal implants, artificial knees and hip joints — totaling more than $3.1 billion from August 2013 through the end of 2019, a KHN analysis of government data found. These bone specialists make up a quarter of U.S. doctors who have accepted at least $100,000 or more, and two-thirds of those who raked in $1 million or more, from the medical device and drug industries last year, the data shows.
“It is simply so much money that it is staggering,” said Dr. Eugene Carragee, a professor of orthopedic surgery at the Stanford University Medical Center and critic of the medical device industry’s influence. Much of the money is deemed to be compensation for consulting duties or medical research, or royalties for inventing, or fine-tuning, new surgical tools and techniques. In some cases, it pays for trips or splashy junkets or rewards surgeons for promoting products to their peers.
Device makers say the long-established practice leads to higher-quality, safer products. “Doctors help develop and refine medical devices, and they even create new devices themselves, sharing their intellectual property with companies to help save and improve patients’ lives,” said Scott Whitaker, president and CEO of AdvaMed, the medical technology industry’s trade group.
But industry whistleblowers and government investigators say all that money changing hands can corrupt medical judgment and tempt surgeons to perform unnecessary and wasteful operations. In ongoing lawsuits, patients say they have suffered life-altering injuries from screws or other spinal hardware that snapped apart or live with disabilities they blame on defective knee or hip implants. Patients alleging injuries range from seniors on Medicare to celebrities such as Olympic gold medalist Mary Lou Retton, who had surgery to replace both her hips. The gymnast sued device maker Biomet in January 2018, alleging the hip implants were defective. The suit has since been settled under confidential terms.
The case of Chin’s company, SpineFrontier, is among more than 100 federal fraud and whistleblower actions, filed or settled mostly in the past decade, that accuse implant surgeons of taking illegal compensation from device makers — from surgeon entrepreneurs like Chin to marquee names like Medtronic and Johnson & Johnson. In some cases, device makers have paid hundreds of millions of dollars in fines to wrangle out of trouble for their involvement, often without admitting any wrongdoing.
Court pleadings examined by KHN identified more than 700 surgeons who have taken money, including dozens who pocketed millions in royalties, fees or other compensation from 2013 through 2019.
The names of hundreds more surgeons were redacted in court filings or sealed by judges.
Court filings named 35 spine surgeons who used SpineFrontier’s surgical gear, some for years. At least six of those surgeons have admitted wrongdoing and paid a total of $3.3 million in penalties. Another has pleaded guilty to criminal charges. It’s illegal under federal law to accept anything of value from a device maker for using its wares, though most offenders don’t face criminal prosecution.
Chin, 57, who lives in Fort Lauderdale, Florida, and owns SpineFrontier through his investment company, declined comment about the DOJ lawsuit or the consulting agreements.
“There is a court date [for the DOJ case] as ordered by a judge,” Chin said via email. “If we get to that point the facts of the case will be litigated.”
Back Surgeries Under Scrutiny
The nation’s outlay for spine surgery to treat back pain, or to replace worn-out knees and hips, tops $20 billion a year, according to one industry report.
Taxpayers shoulder much of that cost through Medicare, the federal program for those 65 and older, and Medicaid, which caters to low-income people.
In one common spinal procedure, surgeons may replace damaged discs with an implant and screws and metal rods that hold it in place. The demand for surgery to replace worn-out knees and hips also has mushroomed as aging boomers and others seek relief from joint pain that restricts their movement.
Perhaps not surprisingly, the competition for sales of orthopedic devices is fierce: Some 250 companies proffer a dizzying array of products. Industry critics blame the Food and Drug Administration, which allows manufacturers to roll out new hardware that is substantially equivalent to what already is sold — though it often is marketed as more durable, or otherwise better for patients.
“The money is just phenomenal for this medical hardware,” said Dr. James Rickert, a spine surgeon and head of the Society for Patient Centered Orthopedics, an advocacy group. He said most of the products are “essentially the same,” adding: “These are not technical instruments; [it’s often] just a screw.”
Hospitals can end up charging patients $20,000 or more for the materials, though they pay much less for them. Spine surgeons — who make upward of $500,000 a year — bill separately and may charge $8,000 to $20,000 for major procedures.
Which equipment hospitals choose may fall to the preference of surgeons, who are wooed by manufacturing sales reps possibly present in the operating room.
And it doesn’t stop there. Whistleblower cases filed under the federal False Claims Act allege a startling array of schemes to influence surgeons, including compensating them for joining a medical society created and financed by a device company. In other cases, companies bought billboard space or other advertising to promote medical practitioners, hired surgeons’ relatives, paid for hunting trips — even mailed checks to their homes.
Orthopedic and neurosurgeons collected more than half a billion dollars in industry consulting fees from 2013 through 2019, federal payment records show.
These gigs are legal so long as they involve professional work done at fair market value. But they have drawn fire as far back as 2007, when four manufacturers that dominated the hip and knee implant market, including a J&J division, agreed to pay $311 million to settle charges of violating anti-kickback laws through their consulting deals.
KHN found at least 20 whistleblower suits, some settled, others pending, that have since accused device makers of camouflaging kickbacks as consulting work, including paying doctors to sit on suspect “advisory boards” or other activities that entailed little work to justify the fees.
In November 2019, device maker Life Spine and two of its executives admitted to paying consulting fees to induce dozens of surgeons to use Life Spine’s implants in the operating room. In all, 21 of the top 30 Life Spine adopters were paid and they accounted for about half its total device sales, according to the Justice Department. Life Spine and the executives paid a total of $6 million in penalties. The company did not respond to requests for comment.
Similarly, SpineFrontier received “the vast majority” of its sales, more than $100 million worth, from surgeons who were compensated, the Justice Department alleges. Often, they were paid by way of a “sham” company run by Chin’s wife, Vanessa, from a mail drop in Fort Lauderdale, according to the Justice Department. Vanessa Dudley Chin, a defendant in the DOJ civil case, had no comment.
Kingsley Chin told KHN via email that he takes no salary from SpineFrontier, based in Malden, Massachusetts. In 2013, Chin received $4.3 million in income from the company, according to court filings in a divorce case in Philadelphia from an earlier marriage. In 2018, SpineFrontier valued Chin’s interest in the company at $75 million, according to government records, though its current worth is unclear.
SpineFrontier’s management thought paying doctors was “the only reliable way to steadily increase its market share and stave off competition,” Charles Birchall, a former business associate of Chin’s, alleged in a whistleblower complaint. The case is one of two whistleblower suits filed against SpineFrontier that the DOJ has joined and consolidated. Chin has yet to file a response in court.
From March 2013 through December 2018, the company offered some surgeons $500 or more an hour for “consulting,” which could include the time they spent operating on patients — even though they already were being paid by Medicare or other health insurers. Other surgeons were paid repeatedly to “evaluate” the same products, though their feedback was “often minimal or nonexistent,” according to the DOJ complaint.
Patient Injuries Pile Up
While the payments have piled up for doctors, so have injuries for patients, according to lawsuits against device makers and whistleblower testimony.
Orthopedic surgeon-turned-whistleblower Dr. Manuel Fuentes is suing his former employer, Florida device maker Exactech, alleging it offered “phony” consulting deals to surgeons who had complained about alarming defects in one of its knee implants.
Their findings should have been forwarded to the FDA to protect the public, Fuentes and two former Exactech sales reps alleged in their suit. Instead, the company paid the surgeons “to retain their business and secure their silence” about patients needlessly undergoing a second operation to address the defects implanted in the first, according to the suit. Lawyer Thomas Beimers, who represents Exactech in the case, said the company “emphatically denies the allegations and looks forward to presenting the real facts to the court.” In a court filing, the company said the suit was “full of conclusory, vague and immaterial facts” and said it should be dismissed.
In Maryland, spine surgeon Dr. Randy F. Davis faces a lawsuit filed in early 2020 by 14 former patients who claim he implanted counterfeit hardware from a device distributor that had paid him hundreds of thousands of dollars in consulting fees and other compensation.
Davis used the hardware, which had not been FDA-approved, on about 250 patients at the University of Maryland Baltimore Washington Medical Center in Glen Burnie, Maryland, according to the suit. Several patients say screws or other implants failed and they sustained permanent injuries as a result. One woman said she was left with little feeling in her right foot and needs a cane or walker to get around. Others claim “extreme mental anguish” for fear the hardware inside them will fail, according to the suit.
The patients allege that Davis improperly disposed of defective screws and other hardware he removed rather than send the items for analysis or report the failures to authorities. Instead, the University of Maryland hospital sent “hush” letters to patients that falsely told them that no defects had been found, according to the suit. A spokesperson for the hospital, which also is a defendant in the suit, denied the allegations, noting: “We will vigorously defend this lawsuit and at its conclusion are quite confident we will prevail.” Davis and his lawyer didn’t respond to repeated requests for comment. The lawsuit is pending in Anne Arundel County state court.
Surgeons are free to implant devices they helped bring to market or promoted, though doing so can prompt criticism when injuries or defects occur.
That happened when three patients filed lawsuits in 2018 against Arthrex, a Florida device company. The patients argued they were forced to undergo repeat operations to replace defective Arthrex knee devices implanted by Pennsylvania orthopedic surgeon Dr. Thomas Meade.
Meade was not a defendant in the cases. But the patients accused him of misleading them about the product’s safety and a recall. One noted that Meade had served as a prominent consultant to Arthrex and had “participated in the design, testing, marketing, promotion and sales” of the knee implant. The patient alleged that Arthrex had paid Meade more than $250,000 for work that included “promotional speaking, travel, lodging, and consulting.”
In court filings, Arthrex admitted making payments to Meade for “consulting and royalties” but denied wrongdoing. The cases were settled in 2020. Meade did not respond to requests for comment.
Chin’s dual roles as SpineFrontier’s CEO and user of its hardware was called a “huge” conflict of interest by a judge in a pending malpractice case filed against him and the company in South Florida.
In that case, Miami resident Patrick Chapoteau alleges Chin performed back surgery in 2014 using SpineFrontier hardware even though it had little chance of success. According to the suit, a Chin-designed screw implanted to stabilize Chapoteau’s spine broke in half, causing him pain and disabling injuries.
In a legal brief, Chin’s lawyers argued that he regularly operates on people with disabling back problems, noting: “The surgery is sophisticated and challenging. On a few rare occasions, his patients have not obtained the relief they expected or experienced unanticipated complications that required additional care.”
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Joseph Wooten, a former Chin patient and Florida power company employee, alleged in a 2014 lawsuit in Broward County Circuit Court that Chin had 15 previous malpractice claims that had ended in more than $8 million in settlements, an assertion Chin’s lawyers disputed.
“He never told me of his bad record injuring people,” Wooten, 64, wrote in a court filing. He and his wife, Kim, said the surgery caused “debilitating and life-altering injuries.” The case has since been settled. Chin acknowledged no wrongdoing and the terms are confidential.
KHN reviewed court pleadings in nine settled malpractice cases in Philadelphia, where Chin served on the faculty of the University of Pennsylvania Medical School from 2003 to 2007, and six in South Florida filed since 2012. Details of the settlements are confidential. Five of the six South Florida cases are pending, including one filed in December by the widow of a man who died shortly after spine surgery. In all the cases and settlements, Chin has denied negligence.
In her lawsuit pending against Chin in South Florida, Nancy Lazo of Hialeah Gardens, Florida, said she slipped and tumbled down the stairs outside her Miami office, landing on her back and arm. When the pain would not go away, she turned to Chin and had two operations, in 2014 and 2015. Her lawyers allege that a SpineFrontier screw Chin implanted in her spine in the second procedure caused nerve damage. Lazo, 51, a former billing clerk with two adult sons, said she can no longer work and remains in “constant” pain. “Based on what my doctors have told me,” she said, “I will never get back to normal.” Chin denied any negligence and the case is pending.
“Based on what my doctors have told me, I will never get back to normal.”
— Nancy Lazo
Government Struggles to Keep Pace
Concerns that industry payments can corrupt medical practice have been aired repeatedly at congressional hearings, in media exposés and in federal investigations. The recurring scandals led Congress to require that device makers and pharmaceutical companies report the payments, starting in August 2013, to a government-run website called Open Payments. That website shows that payments to all doctors have risen from $8.6 billion in 2014 to just over $10 billion last year. A recent study found payments by device makers exceeded those of pharmaceutical companies by a wide margin.
Both the North American Spine Society and the American Academy of Orthopaedic Surgeons told KHN that close ties with the industry, while seeming to generate huge payouts to some surgeons, lead to the design of safer and better implants. “These interactions are really essential for good outcomes in patient care and that needs to be preserved,” said Dr. Joshua J. Jacobs, who chairs the orthopedic surgery department at Rush University Medical Center in Chicago and the AAOS’ ethics committee.
Although more than 600,000 American doctors lap up industry largesse, most do so through small payments that cover the cost of food, drinks and travel to industry-sponsored events. When it comes to big money, however, orthopedists and neurosurgeons dominate, collecting 25% of the total — even though they represent only 5% of the doctors accepting payments, according to the KHN analysis of Open Payments data.
Dr. Charles Rosen, a spine surgeon and co-founder of the advocacy group Association for Medical Ethics, said he was once offered $2,000 just to show up and watch an industry-sponsored panel. “It was quite unbelievable,” he said.
Rosen said while he believes a “relatively small number” of surgeons cash whopping industry checks, many who do so are influential figures who can “help direct medical care.”
Government data confirms that even as several orthopedic and neurosurgeons received tens of millions of dollars in 2019, 81% of them got less than $5,000 from industry.
Federal officials recently signaled their displeasure with the hefty fees paid to doctors who promote their products to peers, especially at restaurants, entertainment or sports venues that feature free food and booze but little educational content. In November, the inspector general at the Department of Health and Human Services issued a special fraud alert that such gestures could violate anti-kickback laws.
Companies that ignore the reporting law can be fined up to $1 million, though no fines were levied from 2014 through spring 2020, according to a CMS report. That changed in October, when device giant Medtronic agreed to pay the government $9.2 million to settle allegations that it paid kickbacks to Sioux Falls, South Dakota, neurosurgeon Dr. Wilson Asfora to promote its goods. Officials said the company sponsored more than 100 events at a Brazilian restaurant owned by the surgeon to clinch the sales. Just over $1 million of the fine was assessed for failing to report the transactions. A Medtronic spokesperson said the company fired or took other disciplinary action against the sales employees involved and “remains committed to maintaining the highest standards of ethical conduct.”
KHN identified four spinal device makers — including SpineFrontier — that have been accused in whistleblower cases of scheming to hide consulting payments from the government.
Responding to written questions, a CMS spokesperson said the agency “has multiple formal compliance actions pending which it is unable to discuss further at this time.”
But penalties for paying, or accepting, kickbacks often are small compared with the profits they can generate.
“Some people would say if you penalize companies enough, they won’t be making these offers,” said Genevieve Kanter, an assistant professor at the University of Pennsylvania Perelman School of Medicine. She said small fines may be chalked up to the “cost of doing business.”
The Federation of State Medical Boards does not keep data on how often its members discipline doctors for civil kickback offenses, according to spokesperson Joe Knickrehm. The federation has “long advocated for stronger reporting requirements,” Knickrehm said.
Justice Department officials would not discuss whether they are seeking fines from more surgeons. But in a statement in April 2020, then-U.S. Attorney for the District of Massachusetts Andrew E. Lelling noted that the government will investigate any doctor “who accepts money from a device manufacturer simply for using that company’s products.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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kashishipr · 3 years
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Behind the establishment of the IPAB
The Intellectual Property Appellate Board (hereinafter, the IPAB) was brought into being through a gazetted notification of the Central Government by the Ministry of Commerce and Industry on 15th September 2003 to hear appeals against the decisions of the Registrar under the IPR laws, namely, The Trade Marks Act, 1999 and The Geographical Indications of Goods (Registration and Protection) Act, 1999.
The IPAB was established to accelerate the process of dispute resolution of matters pertaining to the specialized field of Intellectual Property (IP) by unburdening the High Courts and imposing an unbending timeline of three months to admit matters in appeal.
Disputes emanating from IP were being adjudicated, apparently, in a speedy fashion. However, matters demanding specialized or technical evaluation were an exception to the aforementioned, as was also observed in the case of Novartis AG vs. Controller General of Patents. Unavailability of specialized members and experts and inability to constitute the required forum under the IPAB led to an increase in the pendency of suits, estimated to at least 2626 trademark cases, 617 patent cases, 691 copyright cases, and 01 geographical indication case as of April 2020. However, since the responsibility of filling out vacancies lies at the heart and hands of the government, the backlash faced by the IPAB may seem a little unjustified.
Scrapping of the IPAB
The Tribunals Reforms (Rationalisation and Conditions of Service) Bill, 2021 could not be brought up during the Budget Sessions, 2021, and therefore, the Centre, through the powers vested in it by Article 123 of the Constitution, introduced the Ordinance, which made changes in the Finance Act, 2017. The Finance Act marked the first step of streamlining tribunals in India by merging pre-existent tribunals based on the similarity of work.
Through the promulgation of an Ordinance, namely the Tribunals Reforms (Rationalisation and Conditions of Service) Ordinance, 2021, published in the Gazette of India dated April 4, 2021 (the ‘Ordinance’) – the IPAB was divested of its original and appellate jurisdiction in matters concerning trademarks, patents, copyright, and geographical indications. In addition to the IPAB, it has also annihilated the Plant Varieties Protection Appellate Tribunal under the Protection of Plant Varieties and Farmers’ Rights Act, 2001. The rationale behind such a drastic modification can be found in the Statement of Objects and Reasons appended to the Bill tabled before the Legislative Houses, which states that the IPAB, including others, shall be abolished since the same does not substantially ward of the workload of the High Courts, given the above-mentioned statistics. Furthermore, the matters of adjudication do not affect people at large; or the public is not a litigant to such issues.
It is worthy of pointing out that the Government of India sought to rationalize tribunals in the year 2015. The tribunalisation of justice was checked out way before the accomplishment of the objectives, due to which it came into being in the name of benefiting the public, reducing the burden on the public exchequer, and remedying the administrative and infrastructural lagging of these tribunals.
The Ordinance resuming effect from April 4, 2021, states that all appeals against the decisions of the Registrar of Trademarks, the Registrar of Geographical Indications, and the Controller of Patents would now be filed before the concerned High Courts and appeals against the decision of the Registrar of Copyright would be filed before the concerned Commercial Courts, including the Commercial Division of the High Courts. Litigations pending before the IPAB have also been transferred to the respective High Courts and Commercial Courts. It is difficult to contemplate as to how such matters will be adjudicated in the absence of experts or technical, administrative support, especially concerning patents. The Ordinance is also silent on appointing such experts.
Conclusion: The Aftermath
On the brighter side, this can also be contemplated as a cause leading to the reduction of legal costs for the litigants. Due to lesser stratification in the hierarchy of adjudicating bodies, the time spent in dispute redressal of such litigants will also be reduced as there will be no need to challenge the IPAB’s orders by way of Writ Petitions before the concerned High Courts since a direct appeal will now lie before the High Courts.
However, at the offset, the issue of extended timelines and delays due to procedural formalities will remain a harsh and unresolved reality unless specific guidelines are adopted. The already burdened courts will encounter additional poundage. Furthermore, it may invite administrative issues, including arriving at a common ground on various IP-related matters since the order of one High Court is not binding on the other. Such instability may cause hindrance in developing a sound scientific temper as also enshrined in the Constitution.
Since the issue of speedy redressal remains unresolved, and the issue has again circled back to where it started from, it would be interesting to observe whether any improvements or additional measures or guidelines will be adopted to facilitate quick adjudication of disputes requiring specialized knowledge and skill. Only after undergoing the test of time can an assessment be drawn corresponding to whether this was a progressive stance in the right direction or against the National IPR Policy of 2016 intended to proffer speedy liquidation of backlogs. ✅ For more visit: https://www.kashishipr.com/
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recruitmentagencyca · 3 years
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All you need to know about employment agencies
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Employment Agencies act as an intermediary that excludes the time-consuming hiring process in order that business owners can allocate their efforts elsewhere. It assists job seekers and employers to match qualified candidates with companies with current jobs.
If your business requires extra labour, working with an employment agency can retain your company time, plus it proffers other perks, including flexibility and shortened potential legal risks.
Staffing agencies take a mark-up that commonly ranges from 25% to 100% of a hired employee’s salary.
However, using an employment agency isn’t the appropriate choice for every business, but if you’re looking to work together to meet your hiring needs, here’s what you require to notice about the strategy.
What does an employment agency actually mean?
An employment agency recruits employees for businesses that want to fill the required positions. When you need a fresh workforce and decide to work with an employment agency, the procedure is usually as follows:
1.Employers approach the employment agency:
First, you will make it to an agency that practices in your industry, mentioning details such as the number of employees required, job responsibilities, the timeline for employing new workers, and wages.
2. The agency concocts job depiction:
The agency then conveys the job portrayal for your business. If the candidate is a good match for the job, they will communicate to prospective candidates individually.
3. Employment agency assesses candidates:
Once candidates commence to applying for the vacant positions, the employment agencies recall their experience and qualifications before organizing and planning interviews. Later on, it selects the fittest person to bring into contact with the hiring manager in your business.
4. The employer takes the ultimate decision:
The hiring manager or business owner will visit the employment agency’s preferences before making the endmost hiring call. This is definitely going to save you and your staffs’ hours and hassle by helping to sort out multiple candidates.  
5.Agency oversees the paperwork:
Most agencies take care of all paperwork associated with new hires, such as taxes, contracts, and distinct payroll tasks.
What can an employment agency do for you?
Flexibility
Companies are trying to be more productive, and they only have workers when they are in full need. They require uncovering ways to not waste a single penny on a hiring agency. Temporary staffing only gives people what they need when they desire it, and those people stay productive.
The ease of using employment agencies became the primary motive in the pressure to bring in a worker who could adapt to the growth and flow of client business demand.
Quick hiring
Finding great talent has become difficult, and it takes a lot of time for managers to review the resumes and take the interview, despite being responsible for the day-to-day operations of their employees. Turning to a trusted employment partner can save time and money. An employment agency manager always visits candidates who can pre-screen and qualify candidates to ensure they are fit for that specific role.
Lessen the risk factor
Becoming an employer involves a number of legal obligations, such as providing insurance cover, covering certain taxes, and complying with labour laws. From a financial and operational point of view, hiring employees also comes with financial risks, especially if someone has been fired or has to leave unexpectedly. When you hire a staffing company, the agency takes over many of these responsibilities for you.
Final Thoughts
One of the most common misconceptions about hiring a staffing agency is that it is too high-priced to payout. One may think, why pay extra to recruit when you can hire someone yourself. Temporarily they are thinking of preserving money, but in the long run, using a staffing agency could ultimately save company expenditure.
Other common beliefs about employment agencies include the quality of their employees. Some companies believe that the employees who come through employment agencies are only there because they couldn’t get any jobs elsewhere.
That is not necessarily the case, although one needs to search rigorously to find a decent agency. While many of the companies may seem it like a pricey investment, employment agencies can actually hire expert candidates. In addition, employees hired by employment agencies are generally masterful for their roles.
Manpower Services Edmonton
Staffing Agency Canada
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trentteti · 6 years
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Legal Field Trips: Criminal Law
Last week we kicked off a new series of posts covering various fields of the law. We started off in Wall Street, with a quick primer on securities law. This week, we’re going to move on to discuss criminal law.
I’m sure everyone reading this has watched Perry Mason, Law & Order, or some other criminal justice procedural. I’m going to avoid retreading the commonly understood elements of criminal law — the juries, the trials, etc. Rather, I’m going to draw from my (brief) tenures as an intern at a state public defender’s office and at a U.S. Attorney’s office to help give you a more realistic perspective of criminal law in real life.
Let’s start at the state level. I think the best description of life as a public defender or district attorney is hectic. Invariably, state criminal law practitioners are up to their ears in cases. The bulk of these cases will never go to trial, as the parties will negotiate pleas. District attorneys in New York that I’ve spoken to average a couple trials per year, and they’re usually relatively short. A large chunk of time is spent at arraignments and other pretrial hearings. On the defense side, attorneys try to spend time with each of their many clients to get a sense of the pleas they’ll choose to accept or the strategies they want to put forward. All in all, you probably won’t get very many “Perry Mason moments” of courtroom drama if you choose to go into state level criminal work, but you will definitely spend a lot of time arguing for or against Fourth Amendment motions to suppress.
Life in the world of federal crime is a little different, but there are many similarities. The vast majority of cases involve immigration offenses, which are federal crimes. Apart from that, most of the defendants are up on drug charges. There are also white collar criminal offenses, the criminal analogue to the securities fraud we discussed last time, and violent crimes, among others. As at the state level, the bulk of these cases plead out. Federal criminal attorneys spend a lot of time at proffer sessions, interviewing cooperating witnesses, and otherwise building their cases. The key difference between federal and state level criminal work is federal prosecutor’s ability to exercise discretion in choosing the cases they bring. State prosecutors have to prosecute every criminal offense that comes across their desk, whereas federal prosecutors can choose how to allocate their resources. As a result, the caseload, while still large, is less onerous than at the state level.
At the end of the day, criminal work is the best way to be a “real lawyer,” who actually argues cases to a jury. But going to trial is definitely not the norm, and most of the work is done behind the scenes negotiating deals. Most criminal lawyers feel passionately that they are helping effectuate justice, either by putting away bad guys or by checking the government’s ability to incarcerate the citizenry. Ultimately, it can be a very rewarding job, albeit one with ethical and moral dilemmas that do not accompany the work of closing a corporate deal or putting together a memorandum on zoning restrictions or insurance coverage.
Legal Field Trips: Criminal Law was originally published on LSAT Blog
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ompuri123 · 3 years
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Simple Way For Know The Grounds of khula in Pakistan Through Lawyers
Grounds of khula in Pakistan Through Lawyers:
In order to get divorce on grounds of khula in Pakistan through a family lawyer in Lahore Pakistan Advocate Jamila is the best Advocate. Where the wife has the right to proffer a claim of tafriq through the husband's bad treatment of the wife, she will be granted a divorce grounds of khula in Pakistan through a family lawyer in Lahore Pakistan without having to pay him compensation.
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Ibn Juzayy al-Kalbi said That One Of The Three Stipulations on khula is:
"That the woman's khula is by her own choice and because of her desire to separate from her husband without compulsion or harmful behavior from him. Then if either of these two preconditions is lacking the divorce is executed but khula is not." (Al-Qawanin al-fiqhiyyah) Divorce may be granted by the judge for:  Habitual ill-treatment of the wife  Non-fulfillment of the terms of the marriage contract  Insanity  Incurable incompetency  Quitting the conjugal domicile without making provision for the wife  Any other similar causes which in the opinion of the judge justifies a divorce  Compensation and iddah for khula starts once the case goes to court, the judge will first of all try to ascertain whether the wife really dislikes the husband so much that she can no longer live with him and whether he has been the guilty party in causing her suffering.
The Complete Khula Procedure in Pakistan:
Get the services of a Lawyer to file your case in court for khula in Pakistan after knowing the complete khula procedure in Pakistan. Advocate Jamila Ali is a professional lawyer in Lahore Pakistan for the service of all kinds of legal cases especially the Khula procedure for overseas Pakistani. You can easily dissolve your dissolution of marriage case in the light of Khula Pakistani Law. The CEO of the Jamila Law associate will provide you the best lawyer in Lahore to guide the khula process in Pakistan. The Khula Pakistan family law allows solving the family matters in Family Court. If you want to get brief information on the procedure of khula in Pakistan then call advocate Jamila Ali @ 0092-3234910089 
Then if the judge is satisfied that they cannot live together happily, he will fix as compensation anything that he considers proper, and the husband will have to accept that and divorce the wife on grounds of khula in Pakistan through a family lawyer in Lahore Pakistan. The following are some of the causes for which a wife ca n demands a divorce by authority of the qadi.
Family Lawyer in Lahore Pakistan For Khula:
Where the wife has the right to proffer a claim of tafriq through the husband's bad treatment of the wife, she will be granted a divorce without having to pay him compensation. Ibn Juzayy al-Kalbi said that one of the three stipulations on khula is: "That the woman's khula is by her own choice on grounds of khula in Pakistan through a family lawyer in Lahore Pakistan and because of her desire to separate from her husband without compulsion or harmful behavior from him. Then if either of these two preconditions is lacking the divorce is executed but khula is not." (Al-Qawanin al-fiqhiyyah)
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Divorce may be Granted by the Judge For:
Habitual ill-treatment of the wife Non-fulfillment of the terms of the marriage contract  Insanity Incurable incompetency  Quitting the conjugal domicile without making provision for the wife  Any other similar causes which in the opinion of the judge justifies a divorce Compensation and iddah for khula is once the case goes to court, the judge will first of all try to ascertain whether the wife really dislikes the husband so much that she can no longer live with him and whether he has been the guilty party in causing her suffering. Then if the qadi is satisfied that they cannot live together happily, he will fix as compensation anything that he considers proper, and the husband will have to accept that and divorce the wife on grounds of khula in Pakistan through a family lawyer in Lahore Pakistan.
As soon as khula is granted, the husband forfeits the right to take her back after divorce because it has been sought by the wife and she has given some compensation for her divorce. However, it is lawful for them to remarry in a new marriage after that with mutual consent.  According to the majority of the Muslims, the term of the iddah for the wife in case of khula is the same as for that for divorce since it is regarded as one type of divorce.
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price-law-firms · 3 years
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Where to get local expert attorneys?
The attorneys or lawyers are the professionals in law who advise clients and represent on behalf of them for their legal rights in criminal and civil cases. Therefore, they have to communicate with all the people involved in cases like the clients, colleagues, judges, and others. In addition, they have to perform various researches and analyses on the problems regarding legal issues. The attorneys also have to present their facts verbally and written to the clients and others and argue on the client's behalf. Other activities of attorneys include preparing and filing legal documents, such as wills, deeds, contracts, and many more. They also have to develop strategies for resolving cases early and cost-effectively instead of going for trial. The attorneys may also have specialization in particular fields and work on the legal activities of those fields. The work of expert local and criminal attorneys helps the clients in many ways. Local attorneys The benefits of proffering a local person to local attorneys are different and also valid. Let us understand the reasons for hiring local attorneys near me. • Working with a local attorney is a significant advantage; they will understand all the situations and fit the pieces together even before the process starts. For example, your local attorney will likely know the officer who gives you a traffic ticket. They also have good connections with the judges, the prosecutors, and even court clerks. • Every court has a particular rule, and everyone has to abide by the rules. A non-local attorney will likely not know the rules and will offend the judge. On the other hand, the local attorneys have advantages in that they will understand the rule of the local courts and thus will help you build a good image even before the hearing starts. • The local attorneys are most likely to maintain a positive reputation inside the courtroom. In addition, they will come prepared with the best tactical approach for advancing your rights. Criminal attorneys The work of criminal attorneys is to represent the clients facing criminal charges in state, federal, and appellate courts. The scope of practice in the case of criminal lawyers may include bail bonding hearings, parole, appeals, revocation hearings, and many others. As part of the job, the criminal attorney near me will likely investigate the case and interview witnesses. In addition, they will build a defense and also will further develop case strategies. They will research case laws, criminal codes, and also procedural laws. Criminal attorneys have strong thinking and analytical skills that will help develop legal strategies and also help to analyze various case laws. They also have excellent interpersonal skills for building a solid relationship among clients and attorneys. In addition, they possess an in-depth understanding of state, federal as well as local rules. Finally, they have good connections with local judges and thus, help navigate the criminal justice system with high efficiency. To sum it up The attorneys have different cases every day, and they need to have in-depth knowledge of every rule. The criminal attorneys, especially the local ones, will help to get your rights more efficiently. Price Firm Law provides the best attorneys for such cases.
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melissawalker01 · 4 years
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DOPL Hearings
A professional license represents the culmination of years of perseverance and sacrifice. It carries with it not only the key to your livelihood but a new world of responsibilities. For many professions, these responsibilities are governed and enforced by the Utah Division of Occupational and Professional Licensing (DOPL). DOPL is a Utah state agency tasked with the licensing, investigation, and regulation of roughly 60 different professions within the state. From plumbers and dieticians to funeral directors and midwives, contractors, doctors, DOPL acts as gatekeeper and watchdog in an effort to preserve the legitimacy and integrity of dozens of professions. And these are, without a doubt, valuable functions, both to consumers and to professionals within these fields.
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But a DOPL inquiry represents a challenge not only to your competency and judgment but also to your very livelihood. At worst, your professional license could be revoked. But even a suspension or a public reprimand can have serious repercussions for your professional reputation. Once a complaint has been filed with DOPL, it goes through a preliminary review. That review results in one of three findings: I. no violation; II. violation, but beyond DOPL’s jurisdiction or authority; III. or violation within DOPL’s jurisdiction or authority. The first finding is, of course, the best outcome for a professional against whom a complaint has been made. When there is a finding of no violation, the file is closed and no public reporting of the matter occurs. The second finding generally does not end the matter. DOPL may pass the matter along to the appropriate authority to investigate, or DOPL may issue a letter of concern regarding the matter to the professional involved. A letter of concern will bring the issue to the professional’s attention, and it will give the professional a chance to respond. A letter of concern is not public, and it is not a disciplinary action. However, a letter of concern on file with DOPL may have an effect on DOPL’s determination on any future complaint. The third finding will trigger a more in-depth investigation by DOPL. At what point the professional is notified depends on the individual investigation. Depending on what the evidence shows, one of a few different types of hearings will be called. These are administrative hearings, as DOPL generally functions under the Utah Administrative Procedures Act.
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The hearings usually take the shape of a mini-trial. In every instance, the professional will have an opportunity to be heard, and to tell his or her side of the story. Navigating administrative procedures even the “informal” ones can be perilous. And your story and personality can get lost in the shuffle. If you’re facing disciplinary actions from DOPL, please contact a competent Lawyer. Informal Violations Are Resolved In One Of Three Ways: • Administrative Citations: A citation is the imposition of a cease and desist order in response to the unlawful or unprofessional conduct. Examples of citable offenses are practicing without a license, exceeding the scope of a license and hiring someone who is requires to be licensed that is unlicensed. • Stipulated Agreement: A stipulated agreement is a written settlement accepted by all applicable parties with regard to the involved individual’s license. It may also result in the voluntary surrender of an individual’s license. • Informal Adjudicated Proceedings: Is a case that is initiated by notice of agency action and decided or resolved by a file review as opposed to a hearing.
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Formal Violations Are Resolved As Follows
• Stipulation Agreements: Same as informal stipulated agreements. • Formal Adjudicative Proceedings: Is a proceeding initiated by a notice of agency action with a Petition and decided or resolved through a formal administrative hearing. This is similar in some ways to a civil court. Each party may present evidence in response to the case. An administrative law judge rules on all evidence, procedures and legal issues. DOPL is represented by an Assistant Attorney General and the involved individual may be represented by personal legal counsel. At the conclusion of the hearing, the Board considers the evidence and makes a recommendation regarding the status of the individual’s license. The recommendation is submitted to the director of DOPL who may accept the entire recommendation or may issue a modified supplemental order. Recent items that have been brought before the Board for consideration are: • Tele-dentistry • Advertising • Anesthetic and Sedation Rules Update • Administration of Botulinum Toxin and Dermal Fillers by dentists.
Pre-litigation Hearings in Medical Malpractice
• In Utah, medical malpractice tort reform began in earnest in 1976. Over the intervening years, the reforms have multiplied. New layers of limitations and procedural complexity have developed, seemingly by accretion. Almost nothing has been discarded. The result is a web of time-consuming requirements that a prospective claimant must successfully negotiate before ever filing a lawsuit. If you represent the petitioner, the goal of this process is to obtain a certificate of compliance. The certificate is a prerequisite to filing a complaint in all cases except those against dentists. • The First Step Petitioner serves a notice of intent to commence litigation on the care providers. Within 60 days, the petitioner must file a request for prelitigation review with the Utah Division of Occupational and Professional Licensing (DOPL) with a copy of the notice attached. • The notice must be served as a complaint or sent by certified mail. Claims against dentists, but not the dentists’ clinic and staff, require only a notice. Dentists are exempt from the prelitigation hearing requirements.
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• If the notice is filed less than 90 days before the statute of limitations would expire, the new limitations period is 120 days from the date of service. • Filing the request tolls the statute of limitations until dismissal of the prelitigation proceeding; 60 days from issuance of the panel’s opinion or issuance of a certificate of compliance; or the expiration of time for holding a hearing. • Setting a Hearing After filing the request, DOPL either issues an approval or a denial. If denied, the statute of limitations will no longer be tolled and the time will run until petitioner files a new request for prelitigation review. • Dismissal does not affect the new 120-day time limit if you served the notice within 90 days of expiration of the statute of limitations. The request must be filed with DOPL within 60 days of serving the notice or a new notice and request will need to be served and filed. If the request is approved, respondent files a notice of appearance of counsel within 15 days. The respondent may also request a specific specialty to sit on the panel. • The petitioner will then contact the respondent to establish two mutually-acceptable dates for a prelitigation hearing. Petitioner files a notice of availability for hearing and type of health care provider panelists requested. The dates must be at least 45 days after filing the notice of availability. If you fail to timely file, DOPL can dismiss your request though DOPL may grant an extension on request. • If a notice of availability cannot be agreed to, petitioner files an affidavit of respondent’s failure to reasonably cooperate in scheduling hearing. This must be filed within 180 days of the request and must state that the prelitigation hearing could not be held within 180 days of request. • If DOPL determines that respondent failed to cooperate and that petitioner cooperated, they will issue a certificate of compliance. If DOPL determines that respondent cooperated or that petitioner failed to cooperate, petitioner must file affidavits of merit within 30 days of this determination in order to obtain the certificate. • If the agreed dates are acceptable to DOPL, they will issue a notice of prelitigation hearing and panel composition. Parties have five days to object to the composition of the panel. • If at any time the parties stipulate that the hearing will serve no useful purpose, DOPL will cancel the hearing and issue a certificate of compliance. • If there is a scheduling conflict, the parties have five days after discovery and two days prior to the hearing to file for a continuance. It will only be granted in extraordinary circumstances. If the continuance is granted, the requesting party must establish two mutually-agreeable dates for rescheduling. They must be no later than five days after the order of continuance and the hearing must occur within 180 days of the request. • If the petitioner is the requesting party and a rehearing is not timely filed, DOPL will dismiss the request without prejudice. If the respondent is the requesting party and a rehearing is not timely filed, DOPL will establish a new date that is acceptable to the petitioner and disallow continuances from the respondent. • The Hearing Counsel for petitioner and respondent should arrange to attend the hearing with their clients. Prelitigation hearings are informal and nonbinding. There is no transcript made. There is no cross examination; however, the panel members may ask questions. The hearings are confidential. • Each party will have 15-20 minutes to make a presentation to the hearing panel. Each party may submit evidence by proffer. Attorneys have a wide variety of approaches. Most submit a selection of relevant records and explain their view of the case in the context of the records. They may choose to use medical imaging or diagrams or attach medical literature. Respondent physicians will often explain the care they provided. Some attorneys submit expert affidavits at the hearing. The petitioner may offer a brief rebuttal. • Following the hearing, the panel deliberates and decides whether there was a breach in the standard of care; and whether the breach in the standard of care harmed the petitioner. The panel issues its opinion within 30 days of the hearing. If the answer is affirmative to both questions, the opinion is meritorious and DOPL issues a certificate of compliance. If the answer to either question is negative, the opinion is non-meritorious. If non-meritorious, the petitioner must file affidavits of merit within 60 days of issuance of the panel opinion. Within that time, the petitioner may seek a 60-day extension to file the affidavits by submitting an affidavit for extension. • Affidavits of Merit There must be one from counsel and one or more from appropriate health care provider(s) that address the issue(s) that the panel found to be non-meritorious. • The health care provider affidavit regarding standard of care must be from a care provider with the same licensure as the respondent. If one respondent is a physician, there need be only one physician affidavit as to all respondents if the physician offers an opinion as to each respondent. • If the panel found no breach of the standard of care, the health care provider affidavit(s) must include an opinion that there was a breach and that the breach caused the harm complained of in the notice. • If the panel found a breach in the standard of care but no causation, the affidavit only needs to address causation. • After the affidavits are filed, DOPL issues a certificate of compliance.
Professional License Defense Process
A professional license investigation is generally initiated by Utah Division of Occupational and Professional Licensing (DOPL) after a complaint has been filed. Understanding the professional license defense process can help not only provide a sense of understanding during a difficult period, but also help you avoid pitfalls that may limit your defenses.
How Arrests & Convictions Affect Professional Licenses in Utah
If you’re a licensed professional in Utah like a doctor, teacher, Dentist, Contractor, or real estate broker your livelihood may be in jeopardy for sustaining certain kinds of criminal convictions. Authorities across the state are reviewing court records, running fingerprint checks and investigating complaints. Professionals without clean records face license revocation or suspension. The good news is that professionals have vested interests in their licenses. The board, department or commission that regulates you can’t just take away your license without giving you a chance for a hearing.
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Can I Lose My License Because Of A Conviction?
Maybe you caught a few DUI’s or engaged in an out-of-character shoplifting spree. Maybe you did something really stupid involving weapons or narcotics. Maybe you made a mistake and now have things under control. When it comes to professionals and criminal convictions in Utah, however, even if you’ve turned things around, fulfilled your probation terms, gotten your case dismissed, etc., past convictions can continue to haunt you. If you were convicted of a crime that your regulatory board or department considers substantially related to your fitness to do your job, it may be able to revoke or suspend your professional license. In fact, you might be reading this because you’ve already received an accusation notifying you of conviction-related discipline. If you don’t hold a license but have applied for one, you might have received a statement of issues.
Can I Have A Hearing On My Discipline Case?
The hearings are governed by the Administrative Agency Law and the General Rules of Administrative Practice and Procedure. Unlike civil litigation in the courts, there is very little discovery in the administrative law setting. The prosecution will generally supply copies of documents it intends to introduce at the hearing. It is important that the attorney knows which additional documents to request so that he or she can properly defend the case. In certain situations where the prosecutor will not turn over evidence, the attorney must request a prehearing conference with the hearing officer to obtain the documents. Additionally, the hearing examiner has the authority to issue subpoenas to various third parties to either attend the proceedings or produce relevant documents. It is important that the attorney be familiar with the administrative law process to properly defend the professional.
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gordonwilliamsweb · 3 years
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Device Makers Have Funneled Billions to Orthopedic Surgeons Who Use Their Products
Dr. Kingsley R. Chin was little more than a decade out of Harvard Medical School when sales of his spine surgical implants took off.
Chin has patented more than 40 pieces of such hardware, including doughnut-shaped plastic cages, titanium screws and other products used to repair spines — generating $100 million for his company SpineFrontier, according to government officials.
Yet SpineFrontier’s success arose not from the quality of its goods, these officials say, but because it paid kickbacks to surgeons who agreed to implant the highly profitable devices in hundreds of patients.
In March 2020, the Department of Justice accused Chin and SpineFrontier of illegally funneling more than $8 million to nearly three dozen spine surgeons through “sham consulting fees” that paid them handsomely for doing little or no work. Chin had no comment on the civil suit, one of more than a dozen he has faced as a spine surgeon and businessman. Chin and SpineFrontier have yet to file a response in court.
Medical industry payments to orthopedists and neurosurgeons who operate on the spine have risen sharply, despite government accusations that some of these transactions may violate federal anti-kickback laws, drive up health care spending and put patients at risk of serious harm, a KHN investigation has found. These payments come in various forms, from royalties for helping to design implants to speakers’ fees for promoting devices at medical meetings to stock holdings in exchange for consulting work, according to government data.
Health policy experts and regulators have focused for decades on pharmaceutical companies’ payments to doctors — which research has shown can influence which drugs they prescribe. But far less is known about the impact of similar payments from device companies to surgeons. A drug can readily be stopped if deemed harmful, while surgical devices are permanently implanted in the body and often replace native bone that has been removed.
Every year, a torrent of cash and other compensation flows to these surgeons from manufacturers of hardware for spinal implants, artificial knees and hip joints — totaling more than $3.1 billion from August 2013 through the end of 2019, a KHN analysis of government data found. These bone specialists make up a quarter of U.S. doctors who have accepted at least $100,000 or more, and two-thirds of those who raked in $1 million or more, from the medical device and drug industries last year, the data shows.
“It is simply so much money that it is staggering,” said Dr. Eugene Carragee, a professor of orthopedic surgery at the Stanford University Medical Center and critic of the medical device industry’s influence. Much of the money is deemed to be compensation for consulting duties or medical research, or royalties for inventing, or fine-tuning, new surgical tools and techniques. In some cases, it pays for trips or splashy junkets or rewards surgeons for promoting products to their peers.
Device makers say the long-established practice leads to higher-quality, safer products. “Doctors help develop and refine medical devices, and they even create new devices themselves, sharing their intellectual property with companies to help save and improve patients’ lives,” said Scott Whitaker, president and CEO of AdvaMed, the medical technology industry’s trade group.
But industry whistleblowers and government investigators say all that money changing hands can corrupt medical judgment and tempt surgeons to perform unnecessary and wasteful operations. In ongoing lawsuits, patients say they have suffered life-altering injuries from screws or other spinal hardware that snapped apart or live with disabilities they blame on defective knee or hip implants. Patients alleging injuries range from seniors on Medicare to celebrities such as Olympic gold medalist Mary Lou Renner, who had surgery to replace both her hips. The gymnast sued device maker Biomet in January 2018, alleging the hip implants were defective. The suit has since been settled under confidential terms.
The case of Chin’s company, SpineFrontier, is among more than 100 federal fraud and whistleblower actions, filed or settled mostly in the past decade, that accuse implant surgeons of taking illegal compensation from device makers — from surgeon entrepreneurs like Chin to marquee names like Medtronic and Johnson & Johnson. In some cases, device makers have paid hundreds of millions of dollars in fines to wrangle out of trouble for their involvement, often without admitting any wrongdoing.
Court pleadings examined by KHN identified more than 700 surgeons who have taken money, including dozens who pocketed millions in royalties, fees or other compensation from 2013 through 2019.
The names of hundreds more surgeons were redacted in court filings or sealed by judges.
Court filings named 35 spine surgeons who used SpineFrontier’s surgical gear, some for years. At least six of those surgeons have admitted wrongdoing and paid a total of $3.3 million in penalties. Another has pleaded guilty to criminal charges. It’s illegal under federal law to accept anything of value from a device maker for using its wares, though most offenders don’t face criminal prosecution.
Chin, 57, who lives in Fort Lauderdale, Florida, and owns SpineFrontier through his investment company, declined comment about the DOJ lawsuit or the consulting agreements.
“There is a court date [for the DOJ case] as ordered by a judge,” Chin said via email. “If we get to that point the facts of the case will be litigated.”
Back Surgeries Under Scrutiny
The nation’s outlay for spine surgery to treat back pain, or to replace worn-out knees and hips, tops $20 billion a year, according to one industry report.
Taxpayers shoulder much of that cost through Medicare, the federal program for those 65 and older, and Medicaid, which caters to low-income people.
In one common spinal procedure, surgeons may replace damaged discs with an implant and screws and metal rods that hold it in place. The demand for surgery to replace worn-out knees and hips also has mushroomed as aging boomers and others seek relief from joint pain that restricts their movement.
Perhaps not surprisingly, the competition for sales of orthopedic devices is fierce: Some 250 companies proffer a dizzying array of products. Industry critics blame the Food and Drug Administration, which allows manufacturers to roll out new hardware that is substantially equivalent to what already is sold — though it often is marketed as more durable, or otherwise better for patients.
“The money is just phenomenal for this medical hardware,” said Dr. James Rickert, a spine surgeon and head of the Society for Patient Centered Orthopedics, an advocacy group. He said most of the products are “essentially the same,” adding: “These are not technical instruments; [it’s often] just a screw.”
Hospitals can end up charging patients $20,000 or more for the materials, though they pay much less for them. Spine surgeons — who make upward of $500,000 a year — bill separately and may charge $8,000 to $20,000 for major procedures.
Which equipment hospitals choose may fall to the preference of surgeons, who are wooed by manufacturing sales reps possibly present in the operating room.
And it doesn’t stop there. Whistleblower cases filed under the federal False Claims Act allege a startling array of schemes to influence surgeons, including compensating them for joining a medical society created and financed by a device company. In other cases, companies bought billboard space or other advertising to promote medical practitioners, hired surgeons’ relatives, paid for hunting trips — even mailed checks to their homes.
Orthopedic and neurosurgeons collected more than half a billion dollars in industry consulting fees from 2013 through 2019, federal payment records show.
These gigs are legal so long as they involve professional work done at fair market value. But they have drawn fire as far back as 2007, when four manufacturers that dominated the hip and knee implant market, including a J&J division, agreed to pay $311 million to settle charges of violating anti-kickback laws through their consulting deals.
KHN found at least 20 whistleblower suits, some settled, others pending, that have since accused device makers of camouflaging kickbacks as consulting work, including paying doctors to sit on suspect “advisory boards” or other activities that entailed little work to justify the fees.
In November 2019, device maker Life Spine and two of its executives admitted to paying consulting fees to induce dozens of surgeons to use Life Spine’s implants in the operating room. In all, 21 of the top 30 Life Spine adopters were paid and they accounted for about half its total device sales, according to the Justice Department. Life Spine and the executives paid a total of $6 million in penalties. The company did not respond to requests for comment.
Similarly, SpineFrontier received “the vast majority” of its sales, more than $100 million worth, from surgeons who were compensated, the Justice Department alleges. Often, they were paid by way of a “sham” company run by Chin’s wife, Vanessa, from a mail drop in Fort Lauderdale, according to the Justice Department. Vanessa Dudley Chin, a defendant in the DOJ civil case, had no comment.
Kingsley Chin told KHN via email that he takes no salary from SpineFrontier, based in Malden, Massachusetts. In 2013, Chin received $4.3 million in income from the company, according to court filings in a divorce case in Philadelphia from an earlier marriage. In 2018, SpineFrontier valued Chin’s interest in the company at $75 million, according to government records, though its current worth is unclear.
SpineFrontier’s management thought paying doctors was “the only reliable way to steadily increase its market share and stave off competition,” Charles Birchall, a former business associate of Chin’s, alleged in a whistleblower complaint. The case is one of two whistleblower suits filed against SpineFrontier that the DOJ has joined and consolidated. Chin has yet to file a response in court.
From March 2013 through December 2018, the company offered some surgeons $500 or more an hour for “consulting,” which could include the time they spent operating on patients — even though they already were being paid by Medicare or other health insurers. Other surgeons were paid repeatedly to “evaluate” the same products, though their feedback was “often minimal or nonexistent,” according to the DOJ complaint.
Patient Injuries Pile Up
While the payments have piled up for doctors, so have injuries for patients, according to lawsuits against device makers and whistleblower testimony.
Orthopedic surgeon-turned-whistleblower Dr. Manuel Fuentes is suing his former employer, Florida device maker Exactech, alleging it offered “phony” consulting deals to surgeons who had complained about alarming defects in one of its knee implants.
Their findings should have been forwarded to the FDA to protect the public, Fuentes and two former Exactech sales reps alleged in their suit. Instead, the company paid the surgeons “to retain their business and secure their silence” about patients needlessly undergoing a second operation to address the defects implanted in the first, according to the suit. Lawyer Thomas Beimers, who represents Exactech in the case, said the company “emphatically denies the allegations and looks forward to presenting the real facts to the court.” In a court filing, the company said the suit was “full of conclusory, vague and immaterial facts” and said it should be dismissed.
In Maryland, spine surgeon Dr. Randy F. Davis faces a lawsuit filed in early 2020 by 14 former patients who claim he implanted counterfeit hardware from a device distributor that had paid him hundreds of thousands of dollars in consulting fees and other compensation.
Davis used the hardware, which had not been FDA-approved, on about 250 patients at the University of Maryland Baltimore Washington Medical Center in Glen Burnie, Maryland, according to the suit. Several patients say screws or other implants failed and they sustained permanent injuries as a result. One woman said she was left with little feeling in her right foot and needs a cane or walker to get around. Others claim “extreme mental anguish” for fear the hardware inside them will fail, according to the suit.
The patients allege that Davis improperly disposed of defective screws and other hardware he removed rather than send the items for analysis or report the failures to authorities. Instead, the University of Maryland hospital sent “hush” letters to patients that falsely told them that no defects had been found, according to the suit. A spokesperson for the hospital, which also is a defendant in the suit, denied the allegations, noting: “We will vigorously defend this lawsuit and at its conclusion are quite confident we will prevail.” Davis and his lawyer didn’t respond to repeated requests for comment. The lawsuit is pending in Anne Arundel County state court.
Surgeons are free to implant devices they helped bring to market or promoted, though doing so can prompt criticism when injuries or defects occur.
That happened when three patients filed lawsuits in 2018 against Arthrex, a Florida device company. The patients argued they were forced to undergo repeat operations to replace defective Arthrex knee devices implanted by Pennsylvania orthopedic surgeon Dr. Thomas Meade.
Meade was not a defendant in the cases. But the patients accused him of misleading them about the product’s safety and a recall. One noted that Meade had served as a prominent consultant to Arthrex and had “participated in the design, testing, marketing, promotion and sales” of the knee implant. The patient alleged that Arthrex had paid Meade more than $250,000 for work that included “promotional speaking, travel, lodging, and consulting.”
In court filings, Arthrex admitted making payments to Meade for “consulting and royalties” but denied wrongdoing. The cases were settled in 2020. Meade did not respond to requests for comment.
Chin’s dual roles as SpineFrontier’s CEO and user of its hardware was called a “huge” conflict of interest by a judge in a pending malpractice case filed against him and the company in South Florida.
In that case, Miami resident Patrick Chapoteau alleges Chin performed back surgery in 2014 using SpineFrontier hardware even though it had little chance of success. According to the suit, a Chin-designed screw implanted to stabilize Chapoteau’s spine broke in half, causing him pain and disabling injuries.
In a legal brief, Chin’s lawyers argued that he regularly operates on people with disabling back problems, noting: “The surgery is sophisticated and challenging. On a few rare occasions, his patients have not obtained the relief they expected or experienced unanticipated complications that required additional care.”
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Joseph Wooten, a former Chin patient and Florida power company employee, alleged in a 2014 lawsuit in Broward County Circuit Court that Chin had 15 previous malpractice claims that had ended in more than $8 million in settlements, an assertion Chin’s lawyers disputed.
“He never told me of his bad record injuring people,” Wooten, 64, wrote in a court filing. He and his wife, Kim, said the surgery caused “debilitating and life-altering injuries.” The case has since been settled. Chin acknowledged no wrongdoing and the terms are confidential.
KHN reviewed court pleadings in nine settled malpractice cases in Philadelphia, where Chin served on the faculty of the University of Pennsylvania Medical School from 2003 to 2007, and six in South Florida filed since 2012. Details of the settlements are confidential. Five of the six South Florida cases are pending, including one filed in December by the widow of a man who died shortly after spine surgery. In all the cases and settlements, Chin has denied negligence.
In her lawsuit pending against Chin in South Florida, Nancy Lazo of Hialeah Gardens, Florida, said she slipped and tumbled down the stairs outside her Miami office, landing on her back and arm. When the pain would not go away, she turned to Chin and had two operations, in 2014 and 2015. Her lawyers allege that a SpineFrontier screw Chin implanted in her spine in the second procedure caused nerve damage. Lazo, 51, a former billing clerk with two adult sons, said she can no longer work and remains in “constant” pain. “Based on what my doctors have told me,” she said, “I will never get back to normal.” Chin denied any negligence and the case is pending.
“Based on what my doctors have told me, I will never get back to normal.”
— Nancy Lazo
Government Struggles to Keep Pace
Concerns that industry payments can corrupt medical practice have been aired repeatedly at congressional hearings, in media exposés and in federal investigations. The recurring scandals led Congress to require that device makers and pharmaceutical companies report the payments, starting in August 2013, to a government-run website called Open Payments. That website shows that payments to all doctors have risen from $8.6 billion in 2014 to just over $10 billion last year. A recent study found payments by device makers exceeded those of pharmaceutical companies by a wide margin.
Both the North American Spine Society and the American Academy of Orthopaedic Surgeons told KHN that close ties with the industry, while seeming to generate huge payouts to some surgeons, lead to the design of safer and better implants. “These interactions are really essential for good outcomes in patient care and that needs to be preserved,” said Dr. Joshua J. Jacobs, who chairs the orthopedic surgery department at Rush University Medical Center in Chicago and the AAOS’ ethics committee.
Although more than 600,000 American doctors lap up industry largesse, most do so through small payments that cover the cost of food, drinks and travel to industry-sponsored events. When it comes to big money, however, orthopedists and neurosurgeons dominate, collecting 25% of the total — even though they represent only 5% of the doctors accepting payments, according to the KHN analysis of Open Payments data.
Dr. Charles Rosen, a spine surgeon and co-founder of the advocacy group Association for Medical Ethics, said he was once offered $2,000 just to show up and watch an industry-sponsored panel. “It was quite unbelievable,” he said.
Rosen said while he believes a “relatively small number” of surgeons cash whopping industry checks, many who do so are influential figures who can “help direct medical care.”
Government data confirms that even as several orthopedic and neurosurgeons received tens of millions of dollars in 2019, 81% of them got less than $5,000 from industry.
Federal officials recently signaled their displeasure with the hefty fees paid to doctors who promote their products to peers, especially at restaurants, entertainment or sports venues that feature free food and booze but little educational content. In November, the inspector general at the Department of Health and Human Services issued a special fraud alert that such gestures could violate anti-kickback laws.
Companies that ignore the reporting law can be fined up to $1 million, though no fines were levied from 2014 through spring 2020, according to a CMS report. That changed in October, when device giant Medtronic agreed to pay the government $9.2 million to settle allegations that it paid kickbacks to Sioux Falls, South Dakota, neurosurgeon Dr. Wilson Asfora to promote its goods. Officials said the company sponsored more than 100 events at a Brazilian restaurant owned by the surgeon to clinch the sales. Just over $1 million of the fine was assessed for failing to report the transactions. A Medtronic spokesperson said the company fired or took other disciplinary action against the sales employees involved and “remains committed to maintaining the highest standards of ethical conduct.”
KHN identified four spinal device makers — including SpineFrontier — that have been accused in whistleblower cases of scheming to hide consulting payments from the government.
Responding to written questions, a CMS spokesperson said the agency “has multiple formal compliance actions pending which it is unable to discuss further at this time.”
But penalties for paying, or accepting, kickbacks often are small compared with the profits they can generate.
“Some people would say if you penalize companies enough, they won’t be making these offers,” said Genevieve Kanter, an assistant professor at the University of Pennsylvania Perelman School of Medicine. She said small fines may be chalked up to the “cost of doing business.”
The Federation of State Medical Boards does not keep data on how often its members discipline doctors for civil kickback offenses, according to spokesperson Joe Knickrehm. The federation has “long advocated for stronger reporting requirements,” Knickrehm said.
Justice Department officials would not discuss whether they are seeking fines from more surgeons. But in a statement in April 2020, then-U.S. Attorney for the District of Massachusetts Andrew E. Lelling noted that the government will investigate any doctor “who accepts money from a device manufacturer simply for using that company’s products.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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