Claims And Issues

P.S. to Great Old Broads For Wilderness & National Old Growth Amendments

The place to leave electronic Comments (or as the Forest Service apparently calls them, Letters) is here, and if there is no link then you can copy this and put it in your browser:  https://cara.fs2c.usda.gov/Public//CommentInput?Project=65356.

The Forest Service will also accept Comments by U.S. Mail, as outlined in its Tips for Commenting on the Old Growth Amendment, DEIS, on the Forest Service website.  Download HowToSubmitComments-OldGrowthAmendmentDEIS

Once again, please remember that the deadline is tomorrow, Friday, September 20, 2024 at the end of the day!

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.  Interested in many things including Claims and Issues?  Check out my Substack newsletter. 

 

GREAT OLD BROADS FOR WILDERNESS & NATIONAL OLD GROWTH AMENDMENTS

“Old growth” is a condition, not a tree.  The Forest Service is proposing amendments to the National Old Growth plan in its draft Environmental Impact Statement (DEIS). 

The Great Old Broads For Wilderness (an outstanding, well-informed organization) recommends that you consider pinpoint Comments to the amendments proposed by the Forest Service in its DEIS.  After downloading the 192 pages of these proposals, I can understand why.

For convenience, I have scanned the two pages containing Standards 2b and 2c which the Great Old Broads For Wilderness group recommends we focus on.  In particular, “incidental” needs definition in proposed new Standard 2b, which would otherwise allow undefined “incidental” cutting or removal of trees in old-growth forest.

 Likewise, proposed new exception iv in new Standard 2c would allow “incidental tree-cutting or removal … for de minimis use for local community purposes.”  On this proposal, the group recommends deleting the “de minimis” exception entirely.  (It too is undefined, but unlike “incidental,” “de minimis” is seen as inherently incapable of definition, it is so broadly stated.)

The group also recommends restoring a Standard that is no longer in the Forest Service plan, called the “non-degradation Standard.”

I wrote above that the entirety of the amendments proposed by the Forest Service is 192 pages.  You can access that document if you wish, from the Forest Service website which I found by searching online.  Or you can take the benefit of my long, loong search this morning for the relevant Standards 2b and 2c, which I found in pages 52-53 of the document, numbered as pages 30-31.  I scanned them and you can access them here:  Download Stds2b&2c.  Unfortunately, when they were scanned they showed up sideways, but you can rotate the pdf.

The Great Old Broads For Wilderness petition which we can all sign if we wish to change the Forest Service planned amendments, is at https://docs.google.com/forms/d/e/1FAIpQLSdald-J83SkryJWJ0IhJM0EhoKtsNInWmCe5ALRAMKEC3EnDQ/viewform.

Good Commenting, and Good Petitioning!  Comments officially close at tomorrow’s end, September 20, 2024!  (If you’re like me, you’re a procrastinator too.  No time left to procrastinate here!)

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.  Interested in many things including Claims and Issues?  Check out my Substack newsletter. 

FTC AND DOJ SEEK INFO ON SERIAL ACQUISITIONS AND ROLL-UPS.

The Federal Trade Commission and the Antitrust Division of the U.S. Department of Justice are asking for information again.  Previously, both the FTC and the DOJ requested information regarding your experience in health care consolidations, mergers and acquisitions.

          Their current Request is for Information for Public Comment on Corporate Consolidation Through Serial Acquisitions and Roll-Ups.  It is a cousin to the previous request except that now they are requesting information from "all sectors and industries in the U.S. economy," to quote the FTC Press Release on May 23, 2024.

          To quote the Federal Trade Commission's June 9, 2024 Weekly Digest Bulletin, and specifically the lead article by Henry Liu, Director of the FTC's Bureau of Competition:  "You can play an important role in helping the antitrust agencies detect and deter serial acquisition strategies.  If you have any experience with serial acquisitions – as a consumer, worker, supplier, business or otherwise --please consider sharing that experience with us by submitting a public comment."  Your comments will help the antitrust enforcers understand how roll-up acquisition strategies can lead to "consolidation, higher prices, lower quality, or fewer choices for important products or services, leaving the American public worse off."

          As Mr. Liu explained in his article in the FTC Weekly Digest Bulletin, by law acquisitive firms are only required to tell the regulators about larger deals where one business acquires another, i.e., deals involving $119.5 Million or more.  Smaller deals fly under the radar.  Thus the description of these deals as "serial acquisitions" in which an acquisitive business buys up or otherwise takes over other businesses, one after another.  Private Equity firms are especially fond of this business strategy of serial acquisitions, and they generally call the strategy "roll-ups" because the PE firms roll up the competition by acquiring their competitors one business at a time.

          The deadline to leave Comments in reply to this Request for Information is July 22, 2024.  Share your experience and help us all with your knowledge!

          You can link to the Docket for your Public Comments in the above quotation from Liu's article, or you can proceed to www.regulations.gov.  You can leave your Comments for FTC-2024-0028, titled "FTC and DOJ Seek Info on Serial Acquisitions, Roll-Up Strategies Across U.S. Economy."   It's as easy as that, but just keep in mind that once your Comments are submitted, they will be posted to Regulations.gov where they will be available to the FTC, the DOJ, and the public.

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

COMMENTS IN RESPONSE TO REQUEST FOR INFORMATION ... Continued.

This article continues from the article published earlier today sharing my Comments as examples of Responding to the federal government's Request For Information regarding our personal experiences with the consolidation of healthcare services in this country.

          Turnover of professionals.  Before consolidation, I observed that the nurses who assisted my caregiver tended to remain the same from visit to visit.  Before consolidation, the nurses tended to be familiar with my chart on each successive visit, and in many cases had first-hand knowledge of what symptoms and conditions I may have presented in the past, with memories refreshed no doubt from my records including my chart.  For example, I have made it a point to say when a nurse or a tech or whoever draws my blood, to say that as long as they keep talking to me, we're going to be all right, and they did.  In fact, they remembered my saying that because they had heard it from me before, of course, even though my blood was not drawn regularly and still they remembered.

          After consolidation, the nursing turnover was so great and often that the nurses did not know me or my chart, including my reaction to having my blood taken.

          The patient portal.  This innovation has been with us for years, but I do not recall it existing before my local family practitioners' office where I was a patient for some 25 years, consolidated with a private equity firm.

          I resisted using the portal for a long time because I was used to my physicians contacting me, and not the other way around.  I ended my resistance to the portal when the futility of resistance became obvious; after the portal went into effect, my physicians' office no longer telephone me to let me know such things as test results were ready.   After consolidation and the portal took effect, I had to access their portal if I were going to know that test results, for example, were ready.

          In my experience, the advent of the patient portal altered the relationship between doctor and patient.  Before the portal arrived following consolidation with the private equity firm, the emphasis of my relationship with my physicians flowed from their office to me, I was the reason for their existence.

          After the portal arrived following consolidation, the emphasis of that relationship flowed from me to their office and nothing, absolutely nothing including the test results example I have mentioned, could happen unless I, the patient, approached their office through the so-called patient portal and not otherwise.  I learned this when I tried – unsuccessfully and often – to telephone..

          Thank you for your consideration of my Comments.

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

 

COMMENTS IN RESPONSE TO REQUEST FOR INFORMATION.

I left these Comments yesterday because the Request For Information document itself says that May 6 was the deadline.  The regulations portal showed the deadline as sometime in June.   I am going with the original document as I could not find any information anywhere that the deadline was extended, but use your own judgment, of course.

 

COMMENTS IN RESPONSE TO REQUEST FOR INFORMATION, DOCKET NO. ATR 102 (ALSO:  FTC DOCUMENT ID FTC-2024-0022-0001)

Question 1 asks about Effects of Consolidation.

          Scheduling errors increased greatly after my long-standing family practitioners' practice was consolidated with a private equity firm.  In my own experience, the people doing the scheduling changed after the consolidation, but they had been changing more frequently even before, as I recall.  Even with the earlier changes in staff, there were never any scheduling errors that I can recall. 

          After the consolidation, I personally experienced being scheduled as a patient for the wrong times on the wrong days.  It is one of the reasons I left that practice to become a patient elsewhere, after probably 25 years or more as their patient.

          Apparent staff turnover.  I have already mentioned that I personally observed staff turnover even before consolidation of my family practitioners' practice with a private equity firm.  Putting that in perspective, the turnover before consolidation was not like the turnover after consolidation.  Turnover was so frequent after consolidation that every appointment with their practice was an adventure in meeting staff that I had never met there before;  the office just did not seem capable as a result of keeping people for any length of time, certainly not for the length of time that passed between one appointment to the next.

          One notorious way that business owners increase their own take-home from their businesses is to reduce the expense of what they pay their workers.  I ran my own business for 40 years and so I believe myself qualified to comment on that practice as short-sighted and stupid from the point-of-view of having an ongoing business, and to comment as well that although I have never chosen that way of running a business myself, it is a way that is guaranteed to increase your short-term profits. 

          You are not interested in general Comments on the way that businesses are run, of course.  You have requested information on consolidation in health care markers.  I have already mentioned the effects on me of staffing shortages and scheduling errors at my local family practitioners' office.  Now I am going to tell you about the effects on me of professional shortages there.

To be continued ....

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

REQUEST FOR INFORMATION FROM YOU REGARDING HEALTH CARE PROVIDERS ...

... BY YOUR DEPARTMENT OF JUSTICE'S ANTITRUST DIVISION, BY YOUR DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND BY YOUR FEDERAL TRADE COMMISSION, if online, then before May 6, 2024.

All these Government agencies want to hear from all of us.  We can submit our comments online or mail them.  If we submit our comments online, we can use the Federal eRulemaking Portal at www.regulations.gov.   Whether we submit our comments online or by mail, they want us to identify our comments by Docket No. ATR 102.   (On the Federal Trade Commission's website, I noticed this number as well on the FTC website:  Document ID FTC-2024-0022-0001.  When I leave my comments online at www.regulations.gov, as I intend to do, I will use the Docket No. ATR 102 like they ask for, but I just wanted you to know in advance what you will see if you send your comments through the FTC's website.)

          These people want to hear from everyone who has a stake in Health Care in this nation.  They want to hear from stakeholders, whether or not the stakeholders also hold shares in the companies that hold themselves out as providing you with Health Care in this country.

          We will address different aspects of this Request for Information ("RFI") as time goes on, but that is not because the RFI is very long; it isn't very long.  It is only 12 pages long (11 pages, really, because the 12th and last page is only a signature page and does not have any text to read on it).  Rather, you and I will take our time together to look over the RFI because the information these agencies are looking for is huge.

          For example, the agencies list out 5 questions they are interested in, 4 specific questions and one last overall question that asks if there is anything else we would like to address that we haven't already told them about.

          We will start with their first question, and they ask us to "identify, where possible, the question numbers your comments are intended to address."  Question 1 asks about Effects of Consolidation.

          If you are a patient – and who isn't at one time or another – they want to know how a transaction that involved your health care providers like home-and community-based services, health systems, nursing homes or ambulatory surgical centers to name a few, affected in any way the providers'  costs for you to obtain care, or ...

... costs of health insurance coverage, medical debt and access to charity care, quality of clinical or non-clinical care, quality of the patient’s experience, access to and denials of care, language access, types of goods and services offered, safety, utilization of services, drug utilization, staffing levels, mix of providers and medical support staff, practices regarding prior authorizations, other utilization management, or reimbursement strategies, referral practices, site of service for procedures, ease of access to providers, patient billing, collections, financial assistance practices, access to or sharing of patient information, differences in these areas in rural compared to urban settings, and differences in areas for marginalized patient populations, including differences by race, ethnicity, gender, sexual orientation, income level, disability, Tribal status, or citizenship status.

Think they left anything out?  Please remember that these are only examples of what you can talk to them about; they want to hear your experiences with these things, not somebody else's experiences.

     Whatever we do in leaving our comments to provide them with information, they want us to remember this very important thing:

DO NOT include sensitive or confidential information in the comments including: social security numbers, dates of birth, driver’s license numbers or other state identification numbers, financial account information, sensitive health information, or competitively sensitive information. Comments will be posted on the Internet and made available to the public (subject to exceptions such as for personal privacy information of persons other than the submitter).

TO BE CONTINUED .... Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

TODAY IS EARTH DAY. LEAVE A COMMENT!

Today is the 54th anniversary of Earth Day!  Celebrate by leaving a Comment about changes in your Health Care in 2024!

          Uncle Sam has a Request For Information (RFI), your information.  The RFI is only 12 pages long, which is not too long for Uncle Sam who can be very wordy as we all know.  Click on the blue underlined Request For Information to read all 12 pages of it.

• Have there been changes in your health care since a provider was bought or merged or changed procedures?
• Has your work safety in the health care industry, or have your wages from a health care provider, changed in recent times?
• Is health care affordable for you as a patient or as a taxpayer, both, since one or more of your health care providers changed their business operations because they were bought by some other company, or because they bought some other company or merged with it somehow?

THEN UNCLE SAM WANTS TO HEAR FROM YOU!

          Tell the U.S. Department of Justice, and the U.S. Department of Health and Human Services, and the Federal Trade Commission!  You can send your comments to them by U.S. Mail, or you can leave your comments online at www.regulations.gov.  Put the Docket Number ATR 102 on your comments, and send them in before May 6, 2024.  That's it!

          Except to remember this, as Uncle Sam put it:

Privacy Note: The agencies’ general policy is to make all comments received from members of the public available for public viewing in their entirety on the Federal eRulemaking Portal at www.regulations.gov. Therefore, commenters should be careful to include in their comments only information that they wish to make publicly available.

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

TOMORROW IS EARTH DAY. LEAVE A COMMENT!

Tomorrow is the 54th anniversary of Earth Day!  Celebrate by leaving a Comment on changes in your Health Care in 2024!

          Uncle Sam has a Request For Information (RFI), your information.  The RFI is only 12 pages long, which is not too long for Uncle Sam who can be very wordy as we all know.  Click on the blue underlined Request For Information to read all 12 pages of it.

• Have there been changes in your health care since a provider was bought or merged or changed procedures?
• Has your work safety in the health care industry, or have your wages from a health care provider, changed in recent times?
• Is health care affordable for you as a patient or as a taxpayer, both, since one or more of your health care providers changed their business operations because they were bought by some other company, or because they bought some other company or merged with it somehow?

THEN UNCLE SAM WANTS TO HEAR FROM YOU!

          Tell the U.S. Department of Justice, and the U.S. Department of Health and Human Services, and the Federal Trade Commission!  You can send your comments to them by U.S. Mail, or you can leave your comments online at www.regulations.gov.  Put the Docket Number ATR 102 on your comments, and send them in before May 6, 2024.  That's it!

          Except to remember this, as Uncle Sam put it:

Privacy Note: The agencies’ general policy is to make all comments received from members of the public available for public viewing in their entirety on the Federal eRulemaking Portal at www.regulations.gov. Therefore, commenters should be careful to include in their comments only information that they wish to make publicly available.

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

Health Care Changes? Uncle Sam Wants to Hear From YOU!

          Uncle Sam has a Request For Information (RFI), your information.  The RFI is only 12 pages long, which is not too long for Uncle Sam who can be very wordy as we all know.  Click on the blue underlined Request For Information to read all 12 pages of it.

         Here is the kind of thing that Uncle Sam wants to know about:

• Have there been changes in your health care since a provider was bought or merged or changed procedures?
• Has your work safety in the health care industry, or have your wages from a health care provider, changed in recent times?
• Is health care affordable for you as a patient or as a taxpayer, both, since one or more of your health care providers changed their business operations because they were bought by some other company, or because they bought some other company or merged with it somehow?

THEN UNCLE SAM WANTS TO HEAR FROM YOU!

          Tell the U.S. Department of Justice, and the U.S. Department of Health and Human Services, and the Federal Trade Commission!  You can send your comments to them by U.S. Mail, or you can leave your comments online at www.regulations.gov.  Put the Docket Number ATR 102 on your comments, and send them in before May 6, 2024.  That's it!

          Except to remember this, as Uncle Sam put it:

Privacy Note: The agencies’ general policy is to make all comments received from members of the public available for public viewing in their entirety on the Federal eRulemaking Portal at www.regulations.gov. Therefore, commenters should be careful to include in their comments only information that they wish to make publicly available.

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

REQUEST FOR INFORMATION FROM YOU REGARDING YOUR HEALTH CARE PROVIDERS ...

... BY YOUR DEPARTMENT OF JUSTICE'S ANTITRUST DIVISION, BY YOUR DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND BY YOUR FEDERAL TRADE COMMISSION, if online, then before May 6, 2024.

These Government agencies want to hear from you.  We can submit our comments online or mail them.  If we submit our comments online, we can use the Federal eRulemaking Portal at www.regulations.gov.   Whether we submit our comments online or by mail, they want us to identify our comments by Docket No. ATR 102.   (On the Federal Trade Commission's website, I noticed this number as well on the FTC website:  Document ID FTC-2024-0022-0001.  When I leave my comments online at www.regulations.gov, as I intend to do, I will use the Docket No. ATR 102 like they ask for, but I just wanted you to know in advance what you will see if you send your comments through the FTC's website.)

          These people want to hear from everyone who has a stake in Health Care in this nation.  They want to hear from stakeholders, whether or not the stakeholders also hold shares in the companies that hold themselves out as providing you with Health Care in this country.

          We will address different aspects of this Request for Information ("RFI") as time goes on, but that is not because the RFI is very long; it isn't very long.  It is only 12 pages long (11 pages, really, because the 12th and last page is only a signature page and does not have any text to read on it).  Rather, you and I will take our time together to look over the RFI because the information these agencies are looking for is huge.

          For example, the agencies list out 5 questions they are interested in, 4 specific questions and one last overall question that asks if there is anything else we would like to address that we haven't already told them about.

          We will start with their first question, and they ask us to "identify, where possible, the question numbers your comments are intended to address."  Question 1 asks about Effects of Consolidation.

          If you are a patient – and who isn't at one time or another – they want to know how a transaction that involved your health care providers like home-and community-based services, health systems, nursing homes or ambulatory surgical centers to name a few, affected in any way the providers'  costs for you to obtain care, or ...

... costs of health insurance coverage, medical debt and access to charity care, quality of clinical or non-clinical care, quality of the patient’s experience, access to and denials of care, language access, types of goods and services offered, safety, utilization of services, drug utilization, staffing levels, mix of providers and medical support staff, practices regarding prior authorizations, other utilization management, or reimbursement strategies, referral practices, site of service for procedures, ease of access to providers, patient billing, collections, financial assistance practices, access to or sharing of patient information, differences in these areas in rural compared to urban settings, and differences in areas for marginalized patient populations, including differences by race, ethnicity, gender, sexual orientation, income level, disability, Tribal status, or citizenship status.

Think they left anything out?  Please remember that these are only examples of what you can talk to them about; they want to hear your experiences with these things, not somebody else's experiences.

     Whatever we do in leaving our comments to provide them with information, they want us to remember this very important thing:

DO NOT include sensitive or confidential information in the comments including: social security numbers, dates of birth, driver’s license numbers or other state identification numbers, financial account information, sensitive health information, or competitively sensitive information. Comments will be posted on the Internet and made available to the public (subject to exceptions such as for personal privacy information of persons other than the submitter).

TO BE CONTINUED .... Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

COMMENTS ON PROPOSED RULES

Here's a sample of leaving Comments on proposed rules.  These are Comments I left on one of the Civil Rights Division's proposed rules on Nondiscrimination on the Basis of Disability in the use of Medical Diagnostic Equipment.  Once I realized perfection is not required, I realized how easy it is to leave Comments on proposed rules.  I hope you have the same experience including the realization that perfection is not required!

COMMENTS ON "NONDISCRIMINATION ON THE BASIS OF DISABILITY:  ACCESSIBILITY OF MEDICAL DIAGNOSTIC EQUIPMENT OF STATE AND LOCAL GOVERNMENT ENTITIES":

Re:  RIN 1190-AA78.

To the Civil Rights Division, U.S. Department of Justice:

This Comment will address your proposed addition in a new Subpart I of a new § 35.213, Qualified staff.

As written this proposed rule is more aspirational than mandatory.  It would be a good starting point perhaps when combined with more specific rules on staffing.

These do not have to be precise or expressed in ratios (such as 1:1, God forbid) that would overwhelm the presumed expertise of the State and local entities using Medical Diagnostic Equipment.  It is probably wiser, at least at first and for now, to leave precise staffing ratios to them.  However, it is equally possible and wiser to provide more than aspirational goals.

Are not Nursing Homes subject to specific staffing ratios?  My understanding is that they are.  Propose a rule or rules that refer to such rules/regulations adopted in similar settings regulated by other agencies and Departments, without expressly incorporating by reference the separate standards that have been adopted for other entities and attempting to apply them directly to the State and local entities you address.

Further, if you need assistance in formulating such rules about staffing, by all means get it.  Consult with private organizations that deal with all sorts of populations that encounter MDE both from the receiving end and from the user end of things, and ask how they have resolved staffing issues such that the people who use this equipment "successfully operate accessible MDE, assist with transfers and positioning of individuals with disabilities, and carry out the program access obligation regarding existing MDE."  KFF is a more-or-less private organization that comes to mind; I am certain that you will think of others and that your proposed rules will benefit from the experience of the receivers and users of MDE as relayed to you through private organizations.

In addition to staffing requirements, your proposed rules ought to be more specific about your expectations concerning training of the people, i.e., the employees, who actually use this equipment "in, or in conjunction with, medical settings by health care providers for diagnostic purposes."

Once again, the big drawback here is that the rule you propose in Section 35.213 is more aspirational than mandatory.  Perhaps that approach was your intent.  If so, that approach is unsatisfactory to the disabled people who encounter MDE wielded by poorly trained individuals or perhaps even used by people who are not up to the task of using MDE the way the manufacturers intended it to be used.  Provide the State and local entities you regulate with the means to measure the performance of these people, their employees – and let them know in the process, expressly or better yet, implicitly – that you too are measuring their performance with MDE.

Drawing from the lived experience of people that has already been reported to private organizations, follow the same approach concerning training as you take to obtain information on proposed further rules regarding staffing, above. 

To summarize, combine your aspirational message with at least some mandatory language, and write some proposed rules that are more specific for the State and local entities in implementing your aspirational message.

Please read the disclaimer.  

THE ACCESSIBLE WHEELCHAIR USER'S BATHROOM

Here is a challenging survey for you or anyone you know who is a wheelchair user and faces access issues to a bathroom.  I have cut and pasted the survey questions to the bottom of this article because a form I received and downloaded, unfortunately will not download here.  You can work around that by cutting and pasting the bottom of this article, and then printing it as a form.

After this information is filled out, can you share it with the Civil Rights Division of the U.S. Department of Justice?  If you can, leave a Comment on their proposed new rules to combat Nondiscrimination on the Basis of Disability:  Accessibility of Medical Diagnostic Equipment of State and Local Government Entities, leaving the code name, RIN 1190-AA78,  on your Comment at the Federal eRulemaking website:  https://www.regulations.gov.

I know what you are thinking.  How does this affect the use of Medical Diagnostic Equipment (MDE) at facilities run by State and Local Governments?  Two answers.

First, the U.S. Department of Health and Human Services has proposed similar rules.  Between them, the rules proposed by the DOJ and the earlier rules proposed by HHS will cover virtually every provider of Medical Diagnostic services who takes Federal money including from Medicare and Medicaid.  Expect DOJ to share your Comment with Health and Human Services.

Second, the places where MDE is found includes hospitals, physicians' offices, and X-ray labs.  Do these places not have restrooms?  Sure they do.  Do these places not have patients in wheelchairs?   Sure they do.

So get cracking, and when the form is filled out to survey Accessible Bathrooms For A Wheelchair User, send it if you can to the Federal Government – and make someone's life easier by making the bathroom more accessible to them.

HOW ACCESSIBLE IS YOUR ACCESSIBLE BATHROOM FOR A WHEELCHAIR USER—Really?

Location:

Name of critiquer:

Email address of critiquer:

1. Doorway (5 lbs. of pressure to be ADA compliant)
2. Automatic entry
3. Very easy open
4. Challenging but doable
5. Almost impossible
6. Space in bathroom to maneuver?
7. Yes
8. No
9. Where is handicapped stall located?

 

 

4. Is the space in the stall adequate to accommodate a motorized wheelchair? How about a helper as well?

        

5. Is purse holder on door of stall lower?

         `                                                                                                 

6. Grab bars
7. Where?
8. How many?
9. Good height?
10. Toilet height
11. Too Tall
12. Too Low        
13. Just right
14. Toilet easy to flush?
15. Sink
16. Slide under?
17. See yourself in mirror?
18. Soap accessible?
19. Paper towels in reach for manual wheelchair users?

Please read the disclaimer.  This blog article ©2024 Dennis J. Wall.  All rights reserved.

TWENTY NUMBERED ISSUES, TAKE 3 FOR NOW: END DISABILITY DISCRIMINATION.

For the past week, you have received and read about opportunities for Comments on rules to help make Medical Diagnostic Equipment accessible to all people:  The identifier for the Federal government is RIN 1190-AA78, and you can submit your Comments at the Federal eRulemaking website:  https://www.regulations.gov.

The MDE rules proposed by the Civil Rights Division of the U.S. Department of Justice follow similar rules proposed earlier by the U.S. Department of Health and Human Services.  Between them, these Departments will cover most if not all of the State and local governments, hospitals, physicians' groups, and other people that take Federal money, such as from the Medicare and Medicaid programs.

The Department of Justice has written twenty (20) specific invitations on Issues for Comment, within its proposed Notice of Proposed Rulemaking which you can find at Volume 89 Federal Register, pages 2183-2195 and at the Americans With Disabilities Act website:   https://www.ada.gov.

Take 3 of these specific issues to help frame your thoughts for now:

1. The Department seeks

public comment on whether different

scoping requirements should apply to

different types of MDE (e.g., requiring a

higher percentage of accessible exam

tables and scales than accessible x-ray

machines).

Has it been your experience that there is a need for more accessible exam tables than accessible X-ray machines?  (That's what they mean by "scoping requirements":  how many should be required.)   Whatever your experience may be or whatever you may think about this, take their invitation to Comment and tell the Department!

2.           The Department seeks information

             regarding:  The burdens that the rule’s

proposed approach to dispersion may

impose on people with disabilities e.g.,

increased wait times if accessible MDE

needs to be located and moved;

embarrassment, frustration, or

impairment of treatment that may result

if a patient must go to a different part

of a hospital or clinic to use accessible

MDE).

Again, they are looking for information about YOUR experience, not theirs.  And not someone else's theoretical daydreams, but YOUR EXPERIENCE.  Tell them in a Comment!

3. The Department seeks

public comment on this proposal, as

well as any specific information on:

The effectiveness of programs used

by public entities in the past to ensure

that their staff is qualified[.]

Have any experience with or thoughts about whether hospital workers today can operate Medical Diagnostic Equipment so that the equipment is accessible, and so that you receive the kind of good medical examination that you deserve?

How about physicians' staff, what is your experience and what are your insights about them in this regard?

Should job postings, employment applications and job interviews match the new dynamics of operating Medical Diagnostic Equipment and, if so, how?

After employees are hired, will more and better MDE training help?  More and better training on interacting with People With Disabilities?

Whatever your experience, and whatever your insights, once again:  SHARE them in your Comments!

To quote the Civil Rights Division of the DOJ:  "All comments must be submitted on or before February 12, 2024."

SHARE YOUR COMMENTS!

Please read the disclaimer.  This blog article is offered to the public domain to make clear that leaving Comments is cool!

MEDICAL DIAGNOSTIC EQUIPMENT: THE MEANING OF ACCESS FOR ALL.

The Department of Justice as it was run in 2017 withdrew previous attempts to look at whether equipment and furniture in "services, programs, and activities provided by State and local governments and public accommodations, are accessible to people with disabilities."

In 2021, this effort was restored.  The results of a change in approach include proposed new rules for Nondiscrimination On the Basis of Disability concerning Medical Diagnostic Equipment used in or with medical settings for medical specialists to make diagnoses.  The HHS was the first to propose new rules for all entities receiving Federal financial assistance.

The Civil Rights Division of the U.S. Department of Justice is proposing much the same new rules for Medical Diagnostic Equipment to be accessible to all of the public in "the services, programs, and activities offered by State and local governments" and by "public entities," under Title II of the Americans With Disabilities Act.  As the Federal government itself has written in its proposal for these new rules, "there are likely no public entities in the healthcare sector that do not receive some form of Federal financial assistance."  89 F.R. at 2192.

The need for new rules and Standards for Medical Diagnostic Equipment is no longer open for debate, if it ever really was.  What is open for discussion are your own Comments on how these proposed rules and Standards can work best.  Based on information provided by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, the Department of Justice estimates "that this title II ADA proposed regulation would affect 6,905 public entities."  Id. That's a lot of public entities.

Before you, your family, or anyone you know goes to any medical exams for diagnosis, help make these proposed rules and regs the best that they can be!  You can submit your Comments online at the Federal eRulemaking website, https://www.regulations.gov, with the identifying information "RIN 1190-AA78" which will help the people processing your Comments match them with the proposed rules.  They are called rulemaking for Nondiscrimination on the Basis of Disability; Accessibility of Medical Diagnostic Equipment of State and Local Government Entities.  To read them, you can internet search that name, or if you prefer to search with a cite, you can input 89 Federal Register 2183-2195, or last but not least, you can check out the notice of this proposed rulemaking on https://www.ada.gov.

Comment now!  The Civil Rights Division is waiting to hear what you've got to say.

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

PERFECTION IS NOT REQUIRED. "REASONABLE MODIFICATIONS": THAT'S WHAT'S REQUIRED.

He rolled into the examination room in his wheelchair.  There he stayed for the whole exam, in his wheelchair, while his doctor listened to his heart and lungs, looked inside his ears and throat, and then announced:  "I assume everything below the waist is fine."  The doctor was done with his exam.

          She rolled into the examination room in her wheelchair.  With the help of her doctor's staff, she transferred to a standard exam table but the staff had to stand by to make sure she did not fall off, as the table did not have guardrails.

          These are experiences reported to the National Council on Disability.  They are a big part of the reason that the Civil Rights Division of the U.S. Department of Justice is proposing to overhaul rules and adopt Standards for the use of Medical Diagnostic Equipment or "MDE."

          These and similar experiences are also a big part of the reason that the U.S. Department of Health and Human Services proposed new rules last September that would apply to healthcare providers that take Federal money like Medicare and Medicaid.  The DOJ and the HHS are operating in tandem, together.

          Perfection is not required under any of these proposed rules and Standards.  "Reasonable modifications" are what they require, and what Title II of the Americans With Disabilities law requires.

          Share your own experiences, and your thoughts and ideas.  You can Comment on the rules proposed by the Civil Rights Division and the Department of Justice on the Federal eRulemaking website:  https://www.regulations.gov, writing "RIN 1190-AA78" on your Comments so that they are sure to match up with these proposed rules.  You can find the proposed rules at https://www.ada.gov, or by internet searching "Nondiscrimination on the Basis of Disability:  Accessibility of Medical Diagnostic Equipment of State and Local Government Entities" (the HHS rules apply to providers who receive Federal funds, while the DOJ rules will apply to State and Local Government Entities), or if you prefer citations, at 89 F.R. 2183-2195.

          Share your Comments!  Tell them what you have lived through and what you think! 

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.  

MAKING YOURSELF HEARD WITH COMMENTS ABOUT YOUR EXPERIENCES.

The "stakeholders" made themselves heard for years.  They told the Architectural and Transportation Barriers Compliance Board ("Access Board") what they thought about technical standards for Medical Diagnostic Equipment before the Access Board published Standards for that Equipment.  The last time Standards were published was 7 years ago, in January 2017.

         Since then we have examining tables that are too high for disabled people to climb up on in order to get a medical examination by their doctors.

         We have examining chairs that some ophthalmologists use in examining diseases of the eye – except that they cannot examine the eyes of disabled people who cannot get in ordinary exam chairs without reasonable modifications.

         And we have so many other features of Medical Diagnostic Equipment that were not made for Disabled People.  But they were supposed to be, if Title II of the Americans With Disabilities Act has any meaning.

         The new rules proposed by the Civil Rights Division of the U.S. Department of Justice do NOT require your doctor to purchase all brand-new equipment to accommodate the Disabled.

         Like the rules previously proposed by the Department of Health and Human Services for all health care providers that take Federal money, only "reasonable modifications" are involved here.  Reasonable modifications – that's what Title II of the Americans With Disabilities Act requires.  And that's all that the rules proposed by the Department of Justice for State and local governments and by HHS for takers of Federal funds would require too:  Reasonable modifications.

         This time, don't leave it up to the commercial "stakeholders" to Comment on Medical Diagnostic Equipment.  Share your own Comments with the Civil Rights Division and the Department of Justice – they're waiting for your Comments!

         You can submit Comments at all hours of the day and night at the Federal eRulemaking website:  https://www.regulations.gov, putting "RIN 1190-AA78" on your Comments so that they can be identified with the proposed rules you want to Comment on.  And here is a link to the Notice of Proposed Rulemaking by the Department of Justice:  https://www.ada.gov.  You can also find the proposed rules by internet searching "Nondiscrimination on the Basis of Disability:  Accessibility of Medical Diagnostic Equipment of State and Local Government Entities," or if you prefer to enter citations in your browser's search bar, you can find the proposed rules at 89 F.R. 2183-2195.

         Thank you for your leaving a Comment!

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved. 

PUTTING THE SQUEEZE ON DISCRIMINATION ON THE BASIS OF DISABILITY.

The Centers for Disease Control and Prevention estimates that approximately 61 Million adults have a disability in this country, and that 13.7% of them have a mobility disability,  including serious difficulty walking or climbing stairs – but also including serious difficulty in getting a medical diagnosis or a dental exam or an eye exam.  That translates into more than 8.5 Million adults with a mobility disability.

        The Civil Rights Division of the U.S. Department of Justice is proposing to revise its rules, alongside rules previously proposed by the U.S. Department of Health and Human Services, in an effort to make Medical Diagnostic Equipment as accessible as possible to Persons With Disabilities.

        Their notice of proposed rulemaking is available at https://www.ada.gov, or by internet searching "Nondiscrimination on the Basis of Disability:  Accessibility of Medical Diagnostic Equipment of State and Local Government Entities," and for the citation-minded, at 89 F.R. 2183-95.  (This isn't just about State and Local Government Entities.  It's about you.  Remember that Health and Human Services is proposing similar rules for various health care providers that take Federal money such as Medicare and Medicaid.)

        Medical Diagnostic Equipment (or MDEs, the people writing these rules work in Washington, D.C., remember) is equipment used in or together with medical settings for the purposes of medical diagnosis by health care providers.       

        Examples of this definition may help to make it clear.  Medical Diagnostic Equipment includes:

• Medical examination tables.
• Examination chairs (including for eye exams and for dental exams).
• Weight scales.
• Mammography equipment.
• X-ray machines and other radiological diagnostic equipment.

      Have you or anyone you know ever had difficulty getting on a medical exam table because of a disability?

      Or having your weight taken at a doctor's office?

       Or had trouble with a mammogram (notoriously difficult to encounter for everyone), because of a disability?

      If the answer to any one of these or similar questions is "yes," then the people that work at the Civil Rights Division of the Department of Justice want to hear from you!  Think that they are working there because the money is so good?  Not likely.  More like they work there because they want to work on rules like these.

      Even if they didn't want to listen to you, they have to.   It's the law that they are required to read every single Comment.  So Comment about your own experience or that of your friends, neighbors, and family.  The people at the Civil Rights Division want to know about your personal, lived experience along with the data and briefs and memos paid for by others who are sure to Comment.  Add your voice and your experience.

      Make the resulting rules true because the rules take account of true experience.

      You may submit any and all Comments on the Federal eRulemaking website at https://www.regulations.gov, making sure to put "RIN 1190-AA78" on them so that your Comments get hooked up with the proposed rules that concern you.  The deadline for submitting Comments is February 12, 2024.

      And remember:  The United States Department of Justice, through its Civil Rights Division, invites your Comments.  Take them up on it and Comment!

Please read the disclaimer.  ©2024 Dennis J. Wall.  All rights reserved.

NONDISCRIMINATION ON THE BASIS OF DISABILITY: CIVIL RIGHTS DIVISION'S PROPOSAL.

The Civil Rights Division of the United States Department of Justice has issued a Notice of proposed rulemaking about Nondiscrimination against Disabled people, which has been officially published at 89 Federal Register 2183 (Friday, Jan. 12, 2024).  Here is the pdf format:  Download Notice of Proposed Rulemaking Civil Rights Division Dept of Justice Nondiscrimination on the Basis of Disability (Jan. 12 2024).

All Comments must be submitted on or before February 12, 2024.  I intend to submit a Comment or two, never having been shy about expressing my opinions, like most people in the United States.

It's quick.  My Comments and yours do not need to be written for lawyers.  Quite the opposite.  Just write your Comments for people.  If you have personal experience to share, please share it.  In any case, feel free to share your thoughts and points of view about the many subtle forms that even well-meaning decisions bring discrimination against the disabled as well.

It's easy.  AND they are required by law to read your Comments!  It doesn't get any better than this.

You may submit Comments, identified by RIN 1190-AA78, on the Federal Rulemaking Website at https://www.regulations.gov.  Just follow the website's instructions for submitting Comments.  No worries.

Besides finding the Notice of Proposed Rulemaking in the officially published Federal Register, you can also find this "NPRM" as the people in Washington, D.C. call it at https://www.ada.gov.

Comments are good!

GO FORWARD

Please read the disclaimer.  This article ©2024 Dennis J. Wall.  All rights reserved.

THEY'RE STILL IN POWER, YOU KNOW. COMMENT ON THEIR PROPOSALS ....

... at least until January 20, 2021.

Another Comment period closes on another proposal.  Their proposal deserves your Comments, as their proposals mostly have deserved your Comments for four years.  The situation has not changed yet, you know.  They are still in power, still making proposals, and Comments are still necessary.

    What follows is information for you to use regarding the Comment period that ends today on their proposal to circumvent federal labor laws that govern the federal workforce.  Feel free to copy all or any part of the following in order to leave your own Comments.

(LexisNexis)

Temporary and Term Employment

A Proposed Rule by the Office of Personnel Management (OPM).

TO:  regulations.gov

Docket No.:  2020-20038.

RIN:             3206-AN92.

Comment Period Deadline:   November 10, 2020.

Summary:  Currently, "permanent" federal employees are in positions that are expected to continue indefinitely.  "Temporary" or "term" employees are in positions with a fixed end date.  The current proposed change would increase the present maximum limit of four years for most "nonpermanent" workers from 4 to 10 years.

Relevance and Justification:  The American Federation of Government Employees has pointed out that federal agencies could use their authority to fill more positions with employees who will be out of their jobs when their term ends, as they do now under even more limiting rules.  The AFGE notes that this sets the stage for a "disposable workforce," as distinct from a career federal workforce.   The practice of hiring term and temporary federal workers is apparently widespread at the present time as it is, "with some individuals serving for years and years rotating from one temporary position to another without job security and without proper access to benefit programs," the National Treasury Employees Union has observed.

     Term employees in federal employment may not qualify for an annuity benefit and may not be eligible for the same percentage of federal contribution to premiums to continue their federal health insurance coverage when they retire.  Further, term employees do not have a right to appeal.  As the public policy director of the AFGE has said, "It's a streamlined way to fire people--when your term has ended, they can fire you because your term has ended."

CONCLUSION

Your proposed rule circumvents federal labor laws that apply to federal workers.  It is contrary to law.  It must be withdrawn or, if it is not withdrawn, then it must be struck down as soon as it is issued, if ever.

   Thank you for your consideration of these Comments.

Please read the disclaimer.  This article ©2020 Dennis J. Wall.  All rights reserved except that as stated, permission is freely given to quote all or part of the above Comments in any Comment on the proposed rule that may be left on regulations.gov, by any reader, with or without attribution.

 

"If you do not help in this effort, who will?"

The Consumer Financial Protection Bureau has proposed a new rule that would contradict what Congress wrote in the Dodd-Frank Act.  They don't have the votes in Congress.  So, they are trying to make law in proposed rules like this one.

Injustices like this must be opposed.  The success is in the opposition, not always in the result.  Feel free to use, paraphrase, or rephrase my own Comments below.  I was inspired by a National Consumer Law Statement on this proposed new rule, myself.  The important point is that proposed new rules like this one must be opposed.  If using my language is inspiration, too, for you to leave your own Comments in opposition, that is all to the good.

To rephrase the writer and philosopher Albert Camus who wrote about actions during a Plague among other things, this may be a country now in which people suffer.  We may not be able to do anything about that at the moment.  But we can lessen the number of suffering people.  If you do not help in this effort, who will?

The CFPB's Notice of Proposed Rulemaking is on www.regulations.gov where you can leave your Comments.  The docket number is CFPB-2020-0028.  The RIN is 3170-AA98.

Thank you.

This rule proposed by the CFPB would immunize lenders from legal liability for making mortgage loans without regard to borrowers’ ability to repay if the borrower remains current for the first three years of the loan and the loan meets other requirements. This proposed new rule and new immunity for lenders is contrary to the Dodd-Frank Act.

In the Dodd-Frank Act, Congress required that before booking a loan so to speak, that lenders must make a good faith determination of a borrower’s ability to repay it. Further, Congress expressly allowed borrowers to defend foreclosure by asserting a defense that the lender ignored the borrower’s lack of ability to repay in making the loan.

There are many reasons a homeowner can make payments even for years and even when their mortgage is unaffordable. Examples drawn from real-world experience have been reported including "payments from roommates who are not on the mortgage, borrowing money, or even going without essentials such utilities or medical care." The Congressional choice to enact protections to homeowners to save their homes in the Ability-to-Repay rule already contemplated this situation and allowed for it. That is a policy choice. It is the policy choice made by Congress in the statutes that make up Dodd-Frank. No mere administrative agency including the CFPB has authority to repeal statutes, and no mere agency including the CFPB has the power to enact this proposed rule.

Congress wrote the Ability-to-Repay rule to prevent market excesses that contributed to the Great Recession. Many communities, especially low-income neighborhoods and communities of color, still have not recovered from the Great Recession. It is never a good idea to induce a Second Great Recession, but it is particularly not a good idea during a Pandemic.

Thank you.

Please read the disclaimer.  ©2020 Dennis J. Wall.  All rights reserved.