Pay Transparency in New York City as the new law begins to take effect

 Here's a report from Glassdoor Economic Research:

A First Glimpse into the Impact of Pay Transparency in New York City by Daniel Zhao

"On November 1, New York City’s pay transparency law went into effect, requiring job listings to include salary ranges. While the move represents an opportunity for job seekers to get greater pay transparency, high-profile errors as the new law went into effect have raised concerns about the efficacy of the law. With similar laws going into effect on January 1, 2023 in California and Washington State, we examined Glassdoor data to give an early view into how employers are grappling with pay transparency in New York City.

"Key Findings

"Pay ranges are being published on the majority of active job listings. 60 percent of job listings in New York City have employer-provided salaries as of November 12, and there are hints of a spillover effect to neighboring states.

"Ranges have widened significantly, but remain relatively narrow. The median width of salary ranges has widened from $10,000 in October to as wide as $20,000 so far in November. Less than 3 percent of daily active job listings in November have a salary range wider than $100,000.

"Professional services like Financial Services, Information Technology and Pharmaceutical & Biotechnology are the slowest to add pay ranges to their pay ranges. This may mean enforcing pay transparency will matter more in these higher-salary industries than in lower-wage industries."

Surrogacy guidelines: necessity, not convenience

 As surrogacy becomes increasingly well established in the U.S., it is regulated not only by state laws, but  also via voluntary standards put forward by trade organizations as conditions of membership.

One is  the SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY (SEEDS), which calls itself "a nonprofit organization founded by a group of egg donation and surrogacy agencies, whose purpose is to define and promote ethical behavior by all parties involved in third party reproduction." 

They have a set of guidelines published this year which member organizations are supposed to subscribe to.  One of those guidelines seems to say that surrogacy agencies should only work with intended parents who can't have children on their own. That is, they want to facilitate surrogacies that they regard as necessary rather than those that might be merely convenient.

SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY, STANDARDS of ETHICAL CONDUCT for SEEDS MEMBER AGENCIES

"24.Agency Screening of Intended Parents

"a. An Agency shall not provide service to Intended Parents unless they demonstrate a need for surrogacy associated with a disease, condition or status characterized by:

"i. the failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse;

"ii. a person’s inability to reproduce either as a single individual or with their partner without medical intervention; or

"iii. a licensed physician’s or mental health professional’s findings based on a patient’s medical, psychological, sexual, and reproductive history, age, physical findings and/or diagnostic testing. 

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The legal blog Above the Law has a post about this:

Should 'Social Surrogacy' Be Permitted? by Ellen Trachman

It says in part:

"What does the law say? States like Louisiana and Illinois specifically require documented medical need of intended parents in a surrogacy arrangement to comply with the state surrogacy law. Louisiana requires that a doctor “who has medically treated the intended mother … submits a signed affidavit certifying that in utero embryo transfer with a gestational carrier is medically necessary to assist in reproduction.”

"Utah previously required “medical evidence … show[ing] that the intended mother is unable to bear a child or is unable to do so without unreasonable risk.” But that provision was struck down by the State Supreme Court after determining it was unconstitutional as applied to a same-sex male couple and could not be read a in gender-neutral way. (The SEEDS standard is, by contrast, gender neutral.)

"Other states with surrogacy-specific statutes — like California, Washington, Colorado, New Jersey, and New York — are silent on medical need and, therefore, implicitly permit social surrogacy arrangements. And then those states with no surrogacy law, much of the country, permit social surrogacy by default.

"The SEEDS standard, of course, only applies to member agencies and does not prevent nonmember agencies from supporting social surrogacy arrangements or for those arrangements to occur independent of agencies."

***********

Stephanie Wang and I anticipated to some extent that this could be an issue in our paper

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798.

We surveyed populations in the U.S. and several other countries on transactions that were legal in some of them and illegal in others. We presented vignettes, and asked if they should be legal.  Because we wanted to give surrogacy a good chance of being perceived as repugnant, we made clear in the surrogacy vignette that there was no medical necessity, it was sought for convenience:

"James and Erica are a married couple in [home country]. They want to have a child, but Erica does not want to become pregnant due to the demands of her career as a model. Maria is a married mother in the Philippines. Maria’s husband is out of work, and Maria has decided to become a surrogate mother to earn additional income. James and Erica hire Maria to carry and give birth to a child from James and Erica’s sperm and egg. James and Erica pay Maria a year’s average income in the Philippines, and everyone signs a contract making it clear that James and Erica are the child’s biological parents and will have custody after the child is born."

You can see in the paper (or in this 2020 blog post) that (even) under these circumstances, clear majorities favored making this kind of voluntary surrogacy legal, not only in the U.S. and Philippines where surrogacy is legal, but also in Spain and Germany where surrogacy is illegal.

Abortion protections and restrictions in the midterm elections

 Here's a post-election report from the NYT on how abortion protections and restrictions fared in the midterm elections. (It tries to reflect not only specific referenda and constitutional amendments, but also the platforms of elected candidates...)

Where the Midterms Mattered Most for Abortion Access  By Allison McCann, Amy Schoenfeld Walker, John-Michael Murphy and Sarah Cahalan

"The first election to put abortion rights to the test after the Supreme Court overturned Roe v. Wade appears unlikely to reshape the map of abortion access — at least not overnight. Voters in much of the country reinforced the status quo, choosing candidates who are likely to either maintain existing protections or restrictions in their states, or deepen them."

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Here's MSNBC's roundup, in an opinion piece that looks more at specific laws on the ballot:

The 2022 midterms abortion results should surprise literally no one. When voters get a say in their own individual reproductive rights, most want to keep them. By Emma Gray,

"On Thursday, Montana’s “Born Alive” legislative referendum officially failed.

...

"This meant that Montana’s voters joined Vermonters, Michiganders, Californians and even voters in deep-red Kentucky in protecting abortion rights. Vermont, Michigan and California enshrined reproductive freedom in their state Constitutions, and in Kentucky, voters struck down a proposed constitutional amendment that would have explicitly stated that there is no right to abortion in the state."

Colorado legalizes magic mushroom/psilocybin therapies

 Denver is the mile high city, and the 2022 midterm elections have now legalized therapy with magic mushrooms/psilocybin, which has medical uses in treating post-traumatic stress disorder, among other things.

Colorado becomes second state with legalized ‘medicinal psychedelics’ by Olivia Goldhill in Statnews

"Colorado is the second state to legalize psychedelics, following Oregon’s 2020 passage of a similar ballot question. Like Oregon, Colorado plans to create licensed “healing centers” where people can take magic mushrooms under supervision.

“This is a truly historic moment. Colorado voters saw the benefit of regulated access to natural medicines, including psilocybin, so people with PTSD, terminal illness, depression, anxiety and other mental health issues can heal,” Kevin Matthews and Veronica Lightning Horse Perez, leaders of Natural Medicine Colorado, which campaigned for the measure, wrote in a statement emailed to STAT.

...

"The most advanced study for psilocybin, a Phase 2b trial on the drug for treatment-resistant depression published earlier this month, found the drug was effective at inducing remission in many patients, but the results were less striking than in earlier studies."

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And from Time Magazine:

Colorado Voted to Decriminalize Psilocybin and Other Psychedelics,  by Tara Law

"Colorado voters have approved the broadest psychedelic legalization in the U.S., which would decriminalize five psychedelic substances and enable adults to receive psychedelics at licensed centers.

...

"The ballot measure decriminalizes the possession of certain psychedelic drugs for personal use in the state and specifically legalize psilocybin, the psychedelic component of magic mushrooms, for use at licensed facilities starting in 2024. (In those ways, it’s similar to 2020 measures approved in Oregon, which decriminalized possession of small amounts of drugs in 2021 and is launching a psilocybin access program in 2023.)

"However, Colorado’s Proposition 122 goes further in several ways. In addition to decriminalizing possession, it decriminalizes the growing and sharing of five psychedelics for personal use: psilocybin, psilocyn (a psychedelic also found in magic mushrooms), dimethyltryptamine (commonly known as DMT, which is found in plants and animals, including certain tree frogs), ibogaine (derived from the bark of an African shrub), and mescaline (which is primarily found in cacti; however, Prop 122 excludes peyote). It also clears a pathway for the use of all these psychedelics at “healing centers”—facilities licensed by the state’s Department of Regulatory Agencies where the public can buy, consume, and take psychedelics under supervision. The regulated access program would initially be limited to psilocybin, which would launch in late 2024, but if recommended by a Natural Medicine Advisory Board appointed by the governor, it could be expanded to include DMT, ibogaine, and mescaline in 2026."

Marijuana legalization advances in the 2022 elections

Time Magazine published this map under the headline "Why Marijuana Had a Terrible Night in the 2022 Midterm Elections"

It doesn't look so terrible to me, so much as increasingly inevitable. The grey states on the map (where marijuana remains entirely illegal) are shrinking steadily: it doesn't appear that opponents will succeed in making America grey again.

 "Nineteen states and the District of Columbia allow recreational use of marijuana; 13 states outlaw it entirely. The rest of the states—including Arkansas, South Dakota and North Dakota—allow its use for medicinal purposes. It remains illegal under federal law."

*********

It's going to become increasingly hard for States to enforce draconian laws against something that is legal in neighboring states.  That doesn't mean that legalization is always going to go smoothly--the end of Prohibition didn't end alcoholism, and the end of marijuana prohibition won't make marijuana chemically safer (in fact competition will develop strains that are chemically more potent).  But removing legal risks from what would otherwise be uncontrolled black markets, and taking them out of the hands of criminals, still seems to have momentum.

Black markets in abortion pills

 Americans differ in their opinions about whether American women have a right to end a pregnancy, or whether state legislators have the right to decide the issue for residents of their state.  Six American Supreme Court justices hold the latter opinion, and so overturned the constitutional right defined 50 years ago by the same court in Roe v. Wade.

This means that different states are going to have different laws about abortion. But medical technology is such that abortion pills exist, and can arrive in the mail. So even State laws criminalizing that may not stop it, when abortion and abortion pills remain legal in other states. That is, we're about to see a situation ripe for black markets. We may also see a legal conflict among the states.

The NY Times has a story on that:

Risking Everything to Offer Abortions Across State Lines. Doctors and midwives in blue states are working to get abortion pills into red states — setting the stage for a historic legal clash.  By Emily Bazelon

"When the landscape settles, abortion is likely to be illegal or severely restricted in at least 20 states — where just two years ago, in 2020, about 250,000 people had abortions. It is clear that clinicians in those states will face imminent prosecution if they continue to provide abortions. What is much less clear is what happens if providers in blue states offer telemedicine abortions to women in states where that’s against the law. These clinicians, too, could be arrested or sued or lose their medical licenses. To protect themselves, they may have to give up traveling to certain parts of the country — and it’s still no guarantee.

"In the face of so much uncertainty and an invigorated anti-abortion movement, large organizations and most clinicians are loath to gamble. But Aid Access providers think that the end of Roe calls for doctors to take bold action. Their answer is to mail many more pills to women who otherwise may be forced to carry pregnancies they don’t want.

"The court’s decision overturning Roe last June, Dobbs v. Jackson Women’s Health Organization, polarized the public while opening the door to a new threat — a direct clash among the states over abortion law. In jettisoning the single national standard Roe established, the court invited states to pass or enforce their own laws, which could be diametrically opposed to those of neighboring states."

"Sitting in her office in New York, hundreds of miles from states that could go after her, Prine, at 71, was close to retirement and willing to take chances. “I don’t want younger physicians to be embroiled in lawsuits or criminally charged,” she said. “I’m the one that should happen to. Doctors like me who are at the end of our careers, we should be the ones to step up.”

"Article IV of the Constitution, which addresses the relationships among states, says that if a person charged with a crime in one state flees to another, she must be “delivered up,” or extradited, to the first state. If a doctor from Connecticut, for example, went to Texas, performed an illegal abortion there and then went home, Connecticut would have to send that doctor to Texas for prosecution. But courts have held in the past that if the person never set foot in the state that is prosecuting her, then she didn’t flee, and her state of residence has no constitutional obligation to extradite her. 

...

"But there’s a catch. If a provider travels outside her home state while Texas has a warrant for her arrest, another state without a shield law could follow the customary practice of interstate cooperation — and extradite her to Texas. In addition, if an abortion provider in a pro-access state like Connecticut is sued in Texas rather than prosecuted, Article IV requires the states to help enforce a civil judgment. Connecticut would probably be obligated to comply in collecting damages, for example, if a family member of a woman who had an abortion won a lawsuit for the wrongful death of a fetus. To deter these sorts of suits, Cohen, Donley and Rebouché suggest that states that want to shield their abortion providers could authorize them to countersue for interfering with legally protected health care. “If you’re hoping for a $1 million judgment in Alabama, but you know New York will let someone try to get it back from you, maybe you don’t sue in the first place,” Cohen says.

"The closest historical analogy, however imperfect, for the coming clash may be the conflict between Southern and Northern states over fugitive slave laws in the 19th century. “There are genuinely significant differences between slavery and abortion, morally and legally,” says Jamal Greene, a law professor at Columbia University. “But it’s a reasonable starting point for understanding why it’s a problem, in a nation that wants to hold itself together, when individual states are allowed to make policy about basic rights that people feel extremely strongly about, on both sides.”

"Tensions among the states can become corrosive. The framers of the Constitution gave enslavers the power to recapture enslaved people who escaped to free states. As the cause of abolition gained support, some free states passed personal liberty laws that protected Black people from kidnapping. In 1842, in Prigg v. Pennsylvania, the Supreme Court weighed in on the side of the South, striking down the conviction in Pennsylvania of a slave catcher for kidnapping a mother and her children."

This Supreme Court term has many cases on repugnant transactions and controversial markets

 The newly conservative-dominated Supreme Court is ready for its second term, and has a docket full of what readers of this blog know I think of as controversial markets and repugnant transactions.  While previous court decisions have expanded individual rights on these subjects, such as abortion, the present court seems to view them not as individual rights but as States' rights.  But that may be too simple a characterization of this brand of conservative jurisprudence. We're going to learn more about that as the term plays out. (I'm personally most worried about what decisions will be made about election law, because of the effect those decisions may have on future decisions.)

Here's the NYT on the coming caseload:

As New Term Starts, Supreme Court Is Poised to Resume Rightward Push. The justices return to the bench on Monday to start a term that will include major cases on affirmative action, voting and discrimination against gay couples. Several will take on questions about race.  By Adam Liptak

"The last Supreme Court term ended with a series of judicial bombshells in June that eliminated the right to abortion, established a right to carry guns outside the home and limited efforts to address climate change. As the justices return to the bench on Monday, there are few signs that the court’s race to the right is slowing.

"The new term will feature major disputes on affirmative action, voting, religion, free speech and gay rights. And the court’s six-justice conservative supermajority seems poised to dominate the new term as it did the earlier one.

...

"Several of the biggest cases concern race, in settings as varied as education, voting and adoptions.

"They include challenges to the race-conscious admissions programs at Harvard and the University of North Carolina. As in last term’s abortion case, Dobbs v. Jackson Women’s Health Organization, longstanding precedents are at risk.

"The court has repeatedly upheld affirmative-action programs meant to ensure educational diversity at colleges and universities, most recently in 2016. In an interview that year, Justice Ruth Bader Ginsburg said the issue had been permanently settled.

...

"Mr. Trump went on to name three members of the Supreme Court, including Justice Amy Coney Barrett, who succeeded Justice Ginsburg after her death in 2020.

"Those changes put more than 40 years of affirmative action precedents at risk, including Grutter v. Bollinger, a 2003 decision in which the Supreme Court endorsed holistic admissions programs, saying it was permissible to consider race as one factor among many to achieve educational diversity. Writing for the majority in that case, Justice Sandra Day O’Connor said she expected that “25 years from now,” the “use of racial preferences will no longer be necessary.”

"The court seems poised to say that the time for change has arrived several years early in the two new cases, Students for Fair Admissions v. Harvard, No. 20-1199, and Students for Fair Admissions v. University of North Carolina, No. 21-707. They are set to be argued on Oct. 31.

...

"A challenge to the constitutionality of the Indian Child Welfare Act of 1978, which makes it hard for non-Native Americans to adopt Native children, may also turn on whether the court views those safeguards as based on race, making them vulnerable to constitutional review. The law at issue in the case, Haaland v. Brackeen, No. 21-376, was a response to a history of children being removed from their tribes and heritage; arguments will be heard on Nov. 9.

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I think the two university affirmative action cases are no longer as closely linked as they were before the appointment by President Biden of Justice Ketanji Brown Jackson, who has two degrees from Harvard, and may have to recuse herself. See this cryptic note from the Supreme Court's website: 20-1199 STUDENTS FOR FAIR ADMISSIONS V. PRESIDENT AND FELLOWS OF HARVARD COLLEGE

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Earlier:

Wednesday, June 8, 2022

What might the assisted reproduction gray market look like, post Roe?

Tuesday, June 11, 2019

Adoption is complex even when it doesn't include State and Tribal rights...

Facebook data, abortion prosecution, and search warrents

 The Guardian has the story:

Facebook gave police their private data. Now, this duo face abortion charges  Experts say it underscores the importance of encryption and minimizing the amount of user data tech companies can store. Johana Bhuiyan

"In the wake of the supreme court’s upheaval of Roe v Wade, tech workers and privacy advocates expressed concerns about how the user data tech companies stored could be used against people seeking abortions.  

...

"when local Nebraska police came knocking in June – before Roe v Wade was officially overturned – Facebook handed the user data of a mother and daughter facing criminal charges for allegedly carrying out an illegal abortion. Private messages between the two discussing how to obtain abortion pills were given to police by Facebook, according to the Lincoln Journal Star. The 17-year-old, reports say, was more than 20 weeks pregnant. In Nebraska, abortions are banned after 20 weeks of pregnancy. The teenager is now being tried as an adult."

********

And the Washington Post focuses on search warrents:

Search warrants for abortion data leave tech companies few options. Facebook’s role in a Nebraska case underscores the risks of communicating on unencrypted apps. By Naomi Nix and Elizabeth Dwoskin 

"Prosecutors and local law enforcement have strict rules they must follow to obtain individuals’ private communications or location data to bolster a legal cases. Once a judge grants a request for users’ data, tech companies can do little to avoid complying with the demands.

...

“If the order is valid and targets an individual, the tech companies will have relatively few options when it comes to challenging it,” said Corynne McSherry, legal director at the privacy advocacy group Electronic Frontier Foundation. “That’s why it’s very important for companies to be careful about what they are collecting because if you don’t build it, they won’t come.”

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And then there's this to watch out for, also from the Guardian:

How private is your period-tracking app? Not very, study reveals. Research on more than 20 apps found that the majority collected large amounts of personal data and shared it with third parties.  by Kari Paul

*******

The Washington Post offers some advice on keeping your data private (it's not so easy...)

Seeking an abortion? Here’s how to avoid leaving a digital trail. Everything you should do to keep your information safe, from incognito browsing to turning off location tracking.  By Heather Kelly, Tatum Hunter and Danielle Abril 

More on UNOS in the hot seat and calls for reform of the U.S. deceased donor transplant system

 Here's another report about the recent Senate Finance Committee hearing about UNOS, which includes a redacted version of the U.S. Digital Service report calling for UNOS's functions to be broken up. (UNOS, the United Network for Organ Sharing, is the federal contractor that runs the U.S. deceased donor transplant system.)

Transplant System Urgently Needs Overhaul, Experts Say— UNOS CEO skewered for alleged failures in management during a Senate Finance Committee hearing by Shannon Firth, Washington Correspondent, MedPage Today

"Members of the Senate Finance Committee and fellow witnesses roasted the head of the United Network for Organ Sharing (UNOS) during a hearing on Wednesday, over what Committee Chair Ron Wyden (D-Ore.) characterized as "gross mismanagement and incompetence."

...

"A report from the U.S. Digital Service issued last year determined that the network lacks the technical capacity to modernize the system. The report recommended that the contract for the system, worth $248 million, be separate from a contract for policy management, according to The Washington Post.

"Sen. Elizabeth Warren (D-Mass.), not one to mince words, told Brian Shepard, CEO of UNOS, "I'll just be clear. You should lose this contract. You should not be allowed anywhere near the organ transplant system in this country. And if you try to interfere with the process of turning the contract over to someone who can actually do the job, you should be held accountable for that."

HT: Frank McCormick

**********

And here is a Senate memo issued just prior to the hearing:

“A System in Need of Repair: Addressing  Organizational Failures of the U.S.’s Organ Procurement and Transplantation Network”

"This bipartisan investigation began in February 2020 when then-Chairman Charles Grassley, then-Ranking Member Ron Wyden, Senator Todd Young, and Senator Benjamin Cardin sent a letter to UNOS expressing their concerns about the adequacy of patient safety standards and belief that OPOs are failing to recover thousands of viable organs each year. 16 The letter also highlighted an investigation by the Department of Health and Human Services, Office of Inspector General (HHS OIG) and news reports, shining a light on “lapses in patient safety, misuse of taxpayer dollars, and tens of thousands of organs going unrecovered or not transplanted,” leading to questions about the adequacy of UNOS’ oversight of OPOs.”17

"In 2021, the investigation continued under the leadership of now-Chairman Wyden and Ranking Member Grassley of the Senate Judiciary Committee with a series of bipartisan requests for information sent to HHS,18 CMS,19 HRSA, and the Office of Management and Budget. Staff also broadened the scope of the investigation to include concerns about the inadequacy of the OPTN information technology system and its impact on patients. 

...

Based on documents and internal memoranda, the Committee found that:

• The OPTN is failing to provide adequate oversight of the nation’s 57 OPOs, resulting in fewer organs available for transplant.

• The lack of oversight by UNOS causes avoidable failures in organ procurement and transplantation resulting in risks to patient safety. These failures include testing procedure errors, transportation issues resulting in life saving organs being lost or destroyed in transit, and process and procedure failures.

• UNOS lacks technical expertise to modernize the OPTN IT system, resulting in risk of system interruption or technical failure with the potential to harm patients across the country."

...

"While not the sole focus of the Committee’s investigation, Senator Grassley and Senator Wyden’s staff also heard concerns from patients, transplant center staff, and OPO staff that UNOS lacks technological expertise or the willingness to develop and maintain an adequate IT infrastructure. Staff also heard concerns that the archaic IT system results in delays in placing organs, organs being discarded, and inaccurate data being used to place organs because of its dependence on staff manually entering hundreds of donor and transplant candidate data points rather than upgrading to systems better able to transfer data across Electronic Medical Record platforms.

"These concerns were validated in a report from the independent U.S. Digital Service (USDS), which is housed within the Executive Office of the President and provides consultation services to federal agencies on information technology.115 The report, titled Lives Are at Stake, states that UNOS has been able to wiggle through and around most new contract requirements for the OPTN technology by hand-waving at change with technical jargon, while making no substantive progress. The USDS also states that:116

• UNOS is incapable of modernizing the OPTN IT infrastructure;

• the core systems are fragile;

• OPTN technology limits policy development;

• UNOS is resistant to change; and,

• OPTN system is dependent on a disjointed and inadequate user experience.

"Ultimately, USDS determined that these technological failings are in fact placing lives at stake and recommended that HHS take action to create a better organ transplant system and enable better patient outcomes, including updating NOTA to create flexibility in how the OPTN is serviced by contractors."

...

"Based on the investigation’s findings, Committee staff makes the following recommendations to improve the OPTN:

• Remove barriers to competition by removing the specific requirement for HHS to contract only with a “non-profit entity that has an expertise in organ procurement and transplantation;”

• Increase the pool of potential bidders by clarifying that the OPTN functions described in NOTA and subsequent amendments may be operated by more than one contractor, since few contractors will have adequate clinical knowledge and expertise in IT, policy development, and data collection and reporting, and policy compliance activities;

• Promote innovation in all OPTN functions (e.g., policy development, compliance and patient safety mentoring, IT infrastructure, coordinating transport of organs, etc.) as the best qualified entities with distinct skill sets could compete for contracts for these functions;

• Remove a major barrier for entry for bidders by providing authority for HHS to procure a government owned, contractor operated modern IT system to facilitate the OPTN functions;

• Increase security and innovation in the OPTN system by ensuring the new IT system is based on current technologies and operated and maintained by a contractor with adequate IT knowledge and experience;

• Ensure the continued viability of the OPTN by authorizing HHS to collect fees from transplant hospitals when adding a patient to the national organ transplant waitlist. This would replace a current fee structure authorized by regulation which is not flexible enough to provide funding for multiple contracts;

• Increase transparency and accountability for chain of custody and transportation of organs procured for transplant by providing for public reporting, as appropriate, on the status of organs in transport; and,

• Increase accountability for organs lost, damaged, or delayed in transport by requiring oversight and corrective action for such incidents.

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Earlier:

Wednesday, August 3, 2022

UNOS and organ transplant technology

Thursday, August 4, 2022

UNOS hearing in the Senate

UNOS hearing in the Senate

 Yesterday in D.C. ... a tough hearing of the Senate Finance committee.  You can listen to the video now, but it looks like the committee will populate the links to documents only slowly.

[Update: better video link-- 

https://www.youtube.com/watch?v=iA2wuSN7POs ]

A System in Need of Repair: Addressing Organizational Failures of the U.S.’s Organ Procurement and Transplantation Network

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Date: Wednesday, August 3, 2022Time: 02:30 PMLocation: 215 Dirksen Senate Office Building

OPEN IN NEW WINDOW

Agenda

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Pursuant to guidance from the CDC and OAP, Senate office buildings are not open to the public other than official business visitors and credentialed press at this time. Accordingly, in-person visitors cannot be accommodated at this hearing. We encourage the public to utilize the Committee’s livestream of the hearing, available on the website at https://www.finance.senate.gov/. 

Member Statements

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1.  Ron Wyden (D - OR)
   •  Download Statement
2.  Mike Crapo (R - ID)

Witnesses

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1. Brian Shepard
   Chief Executive Officer
   United Network for Organ Sharing (UNOS)
   Richmond , VA
   • Download Testimony
2. Diane Brockmeier, RN
   President And CEO
   Mid-America Transplant
   St. Louis , MO
   • Download Testimony
3. Barry Friedman, RN
   Executive Director
   AdventHealth Transplant Institute
   Orlando , FL
   • Download Testimony
4. Calvin Henry
   Region 3 Patient Affairs Committee Representative
   Organ Procurement and Transplantation Network (OPTN)
   Atlanta , GA
   • Download Testimony
5. Jayme Locke, M.D., MPH
   Director, Division Of Transplantation, Heersink School Of Medicine,
   University of Alabama at Birmingham
   Birmingham , AL
   • Download Testimony

Related Files

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	Report On Organizational Failures Of The United States Organ Procurement
	Exhibit List Of The Report On Organizational Failures Of The United States Organ Procurement
	Appendix A - ABO Incompatibility Case 1
	Appendix B - ABO Incompatibility Case 2
	Appendix C - Cancer Transmission Case 1
	Appendix D - Cancer Transmission Case 1
	Appendix E - Kidney Death Case
	Appendix F - Courier Case 1
	Appendix G - Courier Case 2
	Appendix H - Airline Case 1
	Appendix I - Airline Case 2
	Appendix J - Allocation Error Case
	Appendix K - Donation After Circulatory Death Case 1
	Appendix L - Donation After Circulatory Death Case 2
	Appendix M - Kidney Trash Case
	Appendix N - Financial Allegations Case
	Other Documents Related To The Report On Organizational Failures Of The United States Organ Procurement

 How do I submit a statement for the record?

Any individual or organization wanting to present their views for inclusion in the hearing record should submit in a Word document, a single-spaced statement, not exceeding 10 pages in length. No other file type will be accepted for inclusion. Title and date of the hearing, and the full name and address of the individual or organization must appear on the first page of the statement. Statements must be received no later than two weeks following the conclusion of the hearing.

Statements can be emailed to:

Statementsfortherecord@finance.senate.gov

Statements should be mailed (not faxed) to:

Senate Committee on Finance
Attn. Editorial and Document Section
Rm. SD-219
Dirksen Senate Office Bldg.
Washington, DC 20510-6200

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Here's a Washington Post story that came out yesterday, while the hearing was in progress:

70 deaths, many wasted organs are blamed on transplant system errors An investigation by the Senate Finance Committee blamed the fatalities on errors in screening organs for disease, blood-type mix-ups and other mistakes  By Lenny Bernstein and Todd C. Frankel August 3, 2022 at 2:30 p.m. EDT

SCOTUS on dialysis and DaVita

 The Supreme Court delivered a number of decisions recently, and the news coverage has rightly focused on the decisions that will increase guns and decrease abortions.  

But another decision has implications for how dialysis is financed for patients with kidney failure. It's going to take some time for all the adjustments that will now start to be made to determine what this means for the financing of kidney care.

Briefly, all kidney failure patients are eligible for Medicare coverage for dialysis, but private insurers covered the first 30 months (and pay much more than Medicare rates).  The case concerns a health insurance program that sought not to pay those rates, and in the case of MARIETTA MEMORIAL HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN ET AL. v. DAVITA INC. ET AL.  the Supreme Court ruled in favor of the health plan.

Here's the story from Reuters:

U.S. Supreme Court rules against DaVita over dialysis coverage  By Nate Raymon

"June 21 (Reuters) - The U.S. Supreme Court on Tuesday rejected dialysis provider DaVita Inc's (DVA.N) claims that an Ohio hospital's employee health plan discriminates against patients with end-stage kidney disease by reimbursing them at low rates in hopes they would switch to Medicare.

"In a 7-2 decision authored by conservative Justice Brett Kavanaugh, the court ruled that Marietta Memorial Hospital's employee health plan did not violate federal law by limiting benefits for outpatient dialysis because it did so without regard to whether patients had end-stage renal disease. A lower court had ruled in favor of Denver-based DaVita.Following the ruling, shares of DaVita, one of the nation's two largest dialysis providers, closed 15% lower. Shares of German rival Fresenius Medical Care (FMEG.DE) dropped 9%."

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Here's a blog from the law firm that won the case, Vorys, Sater, Seymour and Pease LLP :

6/21/22 Vorys Wins 7-2 at U.S. Supreme Court in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc 

"On June 21, 2022, the U.S. Supreme Court released its decision in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc. siding with petitioners (our side) and our client Marietta Memorial Hospital, its employee group health plan and health plan third-party administrator, for which Vorys argued the case.  The Court found that the group health plan does not impermissibly “‘differentiate in the benefits it provides’ to individuals with end-stage renal disease or ‘take into account’ whether an individual is entitled to or eligible for Medicare.”  The Supreme Court decision overturned a split decision by the U. S. Court of Appeals for the Sixth Circuit.

...

"The case began on December 19, 2018, when DaVita, a commercial dialysis provider, sued Marietta Memorial Hospital, a small community hospital located in Marietta, Ohio; the Hospital’s medical plan, the Marietta Memorial Hospital Employee Health Benefit Plan; and the Hospital’s third-party administrator, Medical Benefits Mutual Life Insurance Company, in the United States District Court for the Southern District of Ohio.  DaVita, a large, for-profit dialysis provider, alleged violations of the Medicare Secondary Payer Act (MSPA) and Employee Retirement Income Security Act (ERISA).  The Defendants, represented by Vorys, filed a motion to dismiss, which the District Court granted. 

"DaVita appealed to the United States Court of Appeals for the Sixth Circuit, which disagreed with the District Court decision.  Marietta appealed the district court decision to the U.S. Supreme Court. 

"On November 5, 2021, the U.S. Supreme Court granted a writ of certiorari, agreeing to hear the case.   In recognition of the importance of the case, the office of the Solicitor General of the United States filed an amicus brief, joined in the oral argument and urged the U.S. Supreme Court to rule in favor of the Marietta Memorial Hospital, its group health plan and the third-party administrator.  Oral arguments took place on March 1, 2022."

Medical aid in dying in Italy--a first

 The NYT has the story:

Man Paralyzed 12 Years Ago Becomes Italy’s First Assisted Suicide  By Elisabetta Povoledo

"Paralyzed 12 years ago in a traffic accident, “Mario” faced a series of legal, bureaucratic and financial hurdles in his pursuit of death

"On Thursday, “Mario,” identified for the first time by his real name, Federico Carboni, ended his life, becoming Italy’s first legal assisted suicide, in his home in the central Italian port town of Senigallia.

"Mr. Carboni, an unmarried truck driver, was surrounded by his family, friends, and people who had helped him to achieve his goal, including officials with the Luca Coscioni Association, a right-to-die advocacy group that assisted Mr. Carboni during the past 18 months and announced his death.

...

"An Italian court ruling has declared assisted suicide permissible in Italy under certain limited circumstances, but there is no legislation enshrining the practice, which for Mr. Carboni, led to delays.

...

"In a landmark ruling in 2019, Italy’s Constitutional Court said that assisted suicide could not be considered a crime as long as certain conditions were met.

...

"The Constitutional Court ruled that in some cases assisting someone could not be considered a crime as long as the person requesting aid met certain conditions: they had to have full mental capacity and suffer from an incurable disease that caused severe and intolerable physical or psychological distress. They also had to be kept alive by life-sustaining treatments.

...

"The Roman Catholic Church is firmly opposed to assisted suicide and euthanasia, which it has called “intrinsically evil” acts “in every situation or circumstance.”