A critic uses Facebook and Social Media to challenge government rule. The critic gains followers online. The government seeks to jail the critic.

FOUNDING FATHERS APPALLED !!!

This sounds like a rogue Mid-East nation or third world African state.

It is not.

This is happening in Trumbull County, Ohio.

A small businessman, Berry Meadows, who has run a septic installation company for many years had an argument with The Trumbull County Health Department.

TCHD is in charge of approving septic systems and responsible for approving installers.  The nature of the dispute is really not important. It has been the reaction of the government to quash any dissent that is down-right scary.

Mr. Meadows runs a company called Digging Dirt, LLC.  He is married to a very bright woman, Deanna, who assists in running their business.  They have three beyond adorable children and believe fiercely in the Word of God. What they thought was wrong, was a decision made by TCHD in conjunction with the State of Ohio EPA, or maybe on its own, to deny a septic system that Digging Dirt believed would produce a clean effluent and cost homeowners $3000 less per installation.  The Meadows believed the County had either directly or indirectly created a monopoly for one brand of septic system in the County and had cost the taxpayers of Trumbull millions of dollars.

So they took their dispute to the social media. They create a group site on Facebook called Trumbull County Septic News and it immediately gets followers. The Meadows do some digging of their own into ‘how things work’ and discover some real dirt!

They uncover what they believe to be a pattern of favors for friends of TCHD.
They fight to get public records. They sue TCHD for failure to provide the records. 
They ask for records to either prove or disapprove whether the Health Commissioner actually works the hours he is contracted to provide.
It’s a sweetheart job the health Commissioner holds and he refuses to release records that would show when he shows up to work.  He claims that such records pose a security risk.  Mind you that we are talking about a local health department and not the NSA.

The Trumbull County Septic News starts to take off.  The Meadows post the rants of the Health Commissioner, Dr. Enyeart on the website.  They post video of the entire meetings.

Kaboom. 

The Meadows ask for records that show the possibility that the local Sheriff got favorable treatment for a property with a non-compliant septic system. The property is owned by the Sheriff’s son and maybe there is nothing wrong, except Mr. Meadows asked for the records. 
He then asks for the records of the Board’s attorney who gets $3250 per month for a part-time gig.  The records show that the Board’s attorney didn’t have to pay up front for an inspection like most citizens. Once again maybe everything is kosher with the process, but it looks messy.

What happens next is straight from China’s or Syria’s play book of how to deal with a critic:

First call him crazy to anyone that will listen.

Next do not allow him or her to speak at the public meetings.
The local board hires the Sheriff’s office to post an armed guard and stand over seemingly anyone who has the temerity to make a public record request. 
Dr. Enyeart himself asks for the guard to be present at the Health Department.
And then when the subtle forms of intimidation do not work…..seek to imprison your critic.

 Amazingly the very top of the Sheriff’s chain of command gets involved with the case and seeks out a customer of Digging Dirt from 2007 that had a dispute.  The customer does not seek criminal charges but rightfully was claiming that they deserved a refund. They take their contract dispute to civil court and name Wells Fargo as a Defendant since they believe Wells Fargo released money in 2008 that should not have been released.  But the Sheriff’s office takes a contract case that is nearly 5 years old and charges Berry Meadows with felony Theft by Deception! 

The Health Department posts the newspaper article of my client’s arrest on its government website!

The high ranking Sheriff’s official then finds another customer of Digging Dirt and uses that case to file a criminal complaint for Theft by Deception. 

In Ohio and every other jurisdiction Theft by Deception is used when someone promises to do something that they have no intention of ever doing or delivering something that they cannot deliver in order to get someone’s money.  Digging Dirt had been doing hundreds of quality installs. This was not the scam of the door to door siding salesman taking a deposit then skipping town.

It is not coincidental that after months of posting damaging information about the Health Department and possibly the Sheriff’s office that a criminal charge is initiated, investigated and brought by the Sheriff’s office on civil matters that were very old.

What is amazing is that the local government officials could not contain themselves from understanding that their actions are nothing short of strong armed goons going out of their way to quiet opposition. 

This government and others are going to have to come to grips that they need to treat their social media critics with the same deference they treat the traditional news media.  I know they might like to jail a reporter or two, but it is against the law. 

Why can’t they look at their great government jobs and benefits and be happy to have them, instead of risking all of it to put some small businessman out of business and in jail.  Our framers of the Constitution called it the First Amendment for a reason.  They didn’t think to place it eighth or fifteenth or forget to list it at all.  It is the First Amendment and it guarantees that we will have free speech. Here is the entire First Amendment:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Oops maybe the local Health Board forgot about petitioning of government for a redress of grievances. Get used to it government.  Facebook, Twitter and blogs is part of the new press.  Do not try to jail your critics.  Try listening to them. Act like you understand that the truth will always come out.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Also published on eGuardianship.com http://eguardianship.wordpress.com// and on Attorney David Engler’s Blog  http://davidengler.wordpress.com//

For the last 12 years I have been a school board member of a county board and a career and technical center. On the county board or Educational Service Center we provide the services to help local districts improve. We also run special schools including one for emotionally disturbed children with varying behavioral issues; a school run in conjunction with a great program started by the local Juvenile Court Judge Theresa Dellick.  At the MCCTC almost a third of our students have an IEP. An IEP stands for Individual Education Plan. It is required by law and so many parents do not understand how important to ensure your child’s IEP is carefully constructed to specifically help your child no matter the cost or inconvenience to a district.

The worst thing I ever heard was from the lips of a fired teacher who told me how hard it was to chase after “tongue draggers” every day. My emotions were caught in between punching him and simply shaking my head. I am glad we fired him. Instead I will never forget those words and how insensitive some in education can be towards a child with a disability.  And if that disability is one of a severe emotional problem or a slight shade of Autism or Asperger’s, then most of our teachers are ill-trained to help the child with the different wiring. There are many teachers who just get it.  They are naturals at knowing how to reach the student with a disability that can be unnerving and tiring. They also understand the investment a parent has made in this child.  The teacher may have the child 6 hours a week or maybe more if an elementary student.

And often indifference is the answer from an administration concerned about increased costs.  So whether they admit it or not, every administrator knows that a diagnosis of a disability might bring years of extra costs for the district. In a famous case that went all the way to the Supreme Court, Forest Grove School District v. T.A. (2009) the court ruled that the district should have reimbursed the parents for the costs of private schooling since the District should have been aware of the disability and provide assistance to the family.  The District claimed they had no idea there was a problem. Justice Stevens of the Supreme Court stated: “We conclude that IDEA (Individuals With Disabilities Education Act) authorizes reimbursement for the cost of special education services when a school district fails to provide a FAPE (Free and Appropriate Public Education) and the private-school placement is appropriate, regardless of whether the child previously received special education or related services through the public school.” The cost to the district was $65000 to reimburse the parents and potentially $500000 in legal fees. 

Every school district is legally required to identify, locate, and evaluate children with disabilities (20 U.S.C. §1412(a)(3)). After the evaluation, the district may provide the child with specific programs and services to address special needs.

IDEA defines “children with disabilities” as individuals between the ages of three and 22 with one or more of the following conditions:

• Mental retardation
• Hearing impairment (including deafness)
• Speech or language impairment
• Visual impairment (including blindness)
• Serious emotional impairment
• Orthopedic impairment
• Autism
• Traumatic brain injury
• Specific learning disability, or
• Other health impairment                  (20 U.S.C. §1401(3); 34 C.F.R. §300.8).

For your child to qualify for special education under IDEA, it is not enough to have one of these disabilities. There must also be evidence that the disability adversely affects your child’s educational performance.

Now each school district should be well aware of its responsibilities.  But sadly not every administrator can see life from the eyes of a parent struggling to find help for their child.  The schools seem relieved if they can cause the child to graduate and be done with the financial exposure. The former Director of Special Ed for Maryland, Dr. Linda Bluth gave me the best advice ever.  “Our children do not fail…it is we who fail our children.” It is very difficult to cause a school culture to adopt this core belief.  It makes us accountable.  It denies us the ability to blame little to no achievement on a kid with a mental problem, a broken home, a history with children services, parents who think they know better(they almost always do) or some other societal bogeyman.  No we have to own it.  This means we will have failures.  And they will sting. 

But for the guardians and parents there is help for you. I have included some of the language in the federal IDEA statute above to help you know what to do.  The regulations can be found at www.gov/about/offices/list/users.  The country has 81 million students that fit this category.  Ohio has about 3 million.  We need more teachers and aides with special education training. We need to pay them more to encourage their numbers and recognize that their job makes teaching even tougher than it already is.  You can also look at www.mdlclaw.org/wp-content/uploads/2010/02/pub-special-ed-handbook. This handbook gives you sample letters to ask for independent evaluations  and how the legal process works.  Or hire a lawyer.

Most importantly we need parents to step forward and be armed with the law as you demand the very best possible Free and Appropriate Public Education for your child. The key word to me is appropriate.  These children are all so very different.   Make sure the IEP has real goals that can be measured without someone guessing that your son or daughter has advanced with soft logic.  Don’t give up and never be afraid to ask to talk directly to the Board of Education.  Often the Board members are shielded from the other side of the story. Do not assume that they will side with the administrators standing in your way.  

You have been given a child with special needs because you can handle it.  I do not need to tell you your journey is tough. Not everyone is going to be understanding.  But I can tell you that the law is on your side and many more people than you could possibly imagine.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Also published on Family Fault Lines Blog http://familyfaultlines.com/ and on eGuardianship.com http://eguardianship.wordpress.com//

Custody disputes take place in Juvenile Court, if the families are not married or Domestic Court, if the family is in the process of a divorce or have divorced previously.

Custody disputes take place in Juvenile Court, if the families are not married or Domestic Court, if the family is in the process of a divorce or have divorced previously.

Clearly having an agreement about how a couple will jointly parent the child or children is the best result.  But if there is no agreement, often accusations will fly.

And I warn all clients to be aware that the court might order a drug screen at any given time.  The courts will almost always take the child or children from the parent on illegal drugs and give custody to the parent who is not hooked.  Sometimes it is hard to find anyone not taking pain pills without a prescription. In one case both parents and a grandparent were dirty. In Ohio for the first time overdoses of drugs has overtaken auto accidents as the leading cause of accidental death.

In one case the mother was asked by the Magistrate to give a urine screen and she said she couldn’t because she had a yeast infection.  Everyone found that to be disgusting and a weak excuse.  Recently a nice looking young mother was asked to take a screen and at first she agreed.  Then after 15 minutes she comes back and said she had just pee’d before court.  The Court told her to drink some water. 30 minutes later still no urine.  I really didn’t need to see a drug test. She had all the signs.  Empty pill bottles without prescriptions.  Selling things from her house.  Unable to keep a schedule.  A doctor at an ER saying no narcotics for you after she came with a complaint of a tooth ache.  (I was thinking good for the doctor who checked the database from his Akron offices and saw she had filled 21 prescriptions for pain meds in the last two years.)

So she only sees her child if supervised.  That is the overwhelming power of the pain pill epidemic. This scourge does not see race, sex or income.  It is even more powerful than a mother’s natural instinct to care for her child. 

People can recover and get their children back.  But the road is very difficult and those who are nearest to the addict must not be fooled.  We the parents, or friend or guardian must dispense very tough love. Get help; call 211. You will find a counselor, clinic or N.A. Group.  It is a persistent enemy.  For some it is stronger than motherhood.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Also published on eGuardianship.com http://eguardianship.wordpress.com// and on Attorney David Engler’s Blog  http://davidengler.wordpress.com//

The former Director of Trumbull County Children Services resigned yesterday and was replaced by Timothy Schaffner, current director of Valley Services, which is a local social service provider with long standing contacts and contracts with CSB. This is not just a local story but one of how a dysfunctional organization can cure itself.

I wish him well in the new job and hope that his initial comments of having many friends at the agency and an appreciation for their commitment to protecting children and families does not preclude leadership that requires culture change. The death roll of children who have had direct CSB involvement over the last 9 years should be cause for institutional soul searching, not “way to go Brownie” comments.

A change of director is not enough. The problems are not going to be solved with a simple “we will fix what the State says is wrong” and be done with this ugliness. There is a wide felt sense in the Trumbull County population that CSB serves the agency is one that cannot be trusted.

Already the new director has parroted the Board’s and old Director’s misplaced belief that my actions are those of a lawyer seeking a quick dollar and publicity at CSB’s expense. That attitude will spawn additional mistakes and then litigation and lead to the proverbial fix of putting lipstick on a pig. The lipstick will be happy billboards and sugar coated statements that we protect children and-by-the-way-trust-us.

Like I said earlier, I hope Director Schaffner makes a difference. I offer my help. CSB will eventually crumble if changes are not made to the organization. CSB needs to share in accepting responsibility for the boy that died from cancer where his parents never took him for care, or the toddler that was molested in the agency or processing home studies based on fiction or allowing children to be murdered by a person they approved as a caregiver.

Director Schaffner would be the rare government bureaucrat who understood that it is healthy in any relationship to accept blame, seek forgiveness and then redeem. The relationship is with the people truly served by CSB. They are largely poor, minority, drug dependent, uneducated and abuse victims themselves. Show respect to these citizens and you will get it back in return. Do not settle for just correcting what the State says you failed to do. Seek to be a leader and adopt the model of service deliveries being pioneered across the country. And for sure: stop blaming the victims (your clients). If a child is injured, abused, neglected, murdered or dependent it is our fault. Change the culture. Please.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Also published on Attorney David Engler’s Legal Blog http://davidengler.wordpress.com//

In Jupiter, Florida the local Walgreen’s has been having a great couple of years. This means however that hundreds of mostly younger 20 to 40 year olds are hopelessly hooked on life ruining oxycodone. And when the Oxy’s run out or they can’t steal from Grandma’s prescription anymore then the next best cheapest high is heroin.

The DEA filed an affidavit that allowed for the search warrant at the Jupiter Walgreen last month. The Walgreens affidavit showed sharp increases in oxycodone purchases at each of the pharmacies under investigation in southern Florida. For example, a pharmacy in Fort Myers went from selling 95,800 units of oxycodone in 2009 to more than 2.1 million units in 2011 – good for 67 percent of all the oxycodone purchased by pharmacies in that same zip code in 2011.

Read more here: http://www.miamiherald.com/2012/04/06/2735265/dea-searches-fla-walgreens-in.html#storylink=cpy

In the first two months of this year, the DEA added, 53 Walgreens pharmacies are listed in the agency’s top 100 purchasers of oxycodone. In 2009, none were on the list.

Earlier this year, the DEA released figures showing that Florida may be losing its distinction as the nation’s leading illicit source for painkillers because of the ongoing law enforcement crackdown and several new laws. Florida also last year began operating a prescription drug tracking system and database aimed at combating illegal diversion of the drugs.

The abuse of prescription drugs is epidemic in the country. This is a clear example of where there needs to be a national database so a doctor or law enforcement can type in a name to see if the patient has been pill shopping. Also warnings can be built into the system to show hot spots of pharmacy and pill mills that are complicit in this plague. 70% of all of my custody cases involve someone using opioids.

It started in Appalachia, caught fire in Tennessee, then Florida and now all states.

The guy that cleans your carpets may be taking from the medicine cabinet or maybe it is the grandson. $15 on the streets for one pill is a powerful motivator.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website

Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal Law

Also published on Attorney David Engler’s Legal Blog http://davidengler.wordpress.com//

Medicare does not have any program to pay a family caregiver. Medicare has only limited coverage for home care, and when it does cover home care it does so through a Medicare-certified home health care agency. It does not pay independent caregivers, family or otherwise.

But that does not mean you are without a solution because most money spent on nursing and home health care comes from the States who pay for Medicaid in partnership with the federal government.

In many states, Medicaid has a program to directly pay a person needing home care, and that person can turn around and use the money to pay a family member (or anyone else) to provide that care. If the person who needs help in order to stay at home rather than go to a nursing home has too many assets; the senior in need might still qualify for such a direct payment program. That’s because in many states eligibility for these programs is extended to people who have low income and assets though not low enough to qualify for Medicaid.

These payments work through a state program, called Passport, Cash and Counseling or other similar name, often run through the state’s Medicaid program. To learn more about these cash assistance programs, contact the local Medicaid office usually run through the local welfare department. (now often called Jobs and Family Services) If your state has a Cash and Counseling or similar state cash assistance program, you can get information about it at a local Medicaid office. To find a local Medicaid office, contact the Eldercare Locator by phone toll-free at 800-677-1116, or online you can go to any search engine and type in “Medicaid” and the name of the state.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website

Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal Law

Originally published on eGuardianship.com http://eguardianship.wordpress.com//

Adult Protective Services (APS) is responsible for investigating reports of suspected abuse, neglect, or exploitation of Ohioans aged 60 and older. Similar agencies exist in every state. APS is part of each Ohio County Department of Job & Family Services (CDJFS). The Ohio Revised Code defines “abuse” as infliction upon an adult by self or others of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm, pain, or mental anguish. “Neglect” is defined as the failure of an adult to provide for self the goods or services necessary to avoid physical harm, mental anguish, or mental illness or the failure of a caretaker to provide such goods or services. “Exploitation” means the unlawful or improper act of a caretaker using an adult or an adult’s resources for their monetary or personal benefit, profit or gain.

APS can petition Probate Court for a temporary restraining order to prevent interference or obstruction of its investigation by any person, including the abused adult. The court must find (a) that there is reasonable cause to believe the adult is being or has been abused, neglected, or exploited, and (b) that access to the adult’s residence has been obstructed. APS can also petition the court to approve a service plan providing involuntary services. The adult must receive a notice describing his or her rights and the consequences of a court order at least five working days before a hearing on the petition. An indigent adult has the right to a court-appointed attorney. Notice of the hearing must also be sent to the adult’s guardian, attorney, caretaker and spouse.
The court must find by clear and convincing evidence that (a) the adult has been abused, neglected, or exploited; (b) the adult is in need of protective services; (c) the adult is incapacitated; and (d) no other person authorized by law is available to give consent. If the court so finds, it must issue an order requiring protective services for up to six months, but can be re-authorized for up to a year.

But like with any governmental organization, APS can be too intrusive. Before they act there needs to be clear authority that an adult can be removed.

Recently, I met a distressed couple who had their Mother literally yanked from their home in the final months of her life. An anonymous tip was given by the Mother’s long time “friend” that she wanted to go back to the care-takers residence. The mother was in full scale dementia and would answer a few questions correctly and if asked would parrot the name of the “friend.” In horror the family of the elderly woman watched as APS took the mother from their home and moved her back to the friend’s house. After the Mother was there the friend arranged for her entire estate to pass to him. An attorney helped in the sham transfer.

In a matter of months the family desperate for help asks the Probate Judge to order an evaluation of the Mother. She had dementia for at least a year and was unable to make any decisions on her own. Be careful when a governmental agency says that it knows best. Hold on to your liberty because they are about to snatch it from you.

Probate Court acted quickly but it was too late. The Mother died a few days after the mental health assessment. Her possessions real and personal would have passed to the children, but for the friend getting everything transferred.

More than the money the family loss the beauty of being with their parent as she lived her final months. All they are left with is bitterness towards a government going too far and a scrapbook of memories.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website

Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal Law

Also published on Attorney David Engler’s Legal Blog on April 3, 2012 http://davidengler.wordpress.com// and on eGuardianship.com http://eguardianship.wordpress.com//

Florida’s laws are pretty consistent with those throughout the country. The “Stand Your Ground” law will not be a factor if George Zimmerman is charged with a murder or manslaughter charge. (he will be…better to let a jury be the potential bad guy that acquits Zimmerman) Was the force of a deadly weapon necessary to end the threat of violence Trayvon Martin had against Zimmerman, if he is believed at all?

Renee Stutzman of The Orlando Sentinel on March 31, 2012 laid out the differences between murder and manslaughter:

“A 35-year-old Sumter County man whose hungry python strangled a 2-year-old child was guilty of manslaughter. So was the doctor who gave Michael Jackson a lethal dose of a sedative.

Copyright © 2012, Orlando Sentinel”

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website

Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Also published on Attorney David Engler’s Legal Blog on April 1, 2012 http://davidengler.wordpress.com//

Have you ever received an Explanation of Benefits letter from your insurance provider and cannot figure out what you owe? You are not alone in deciphering a hospital bill. At http://www.latimes.com/health/la-me-lopez-medicalcosts-20120325,0,6538717.column/ Steve Lopez describes how a father received a $5000 dollar emergency bill for his daughter’s tummy-ache!

STEVE LOPEZ

So they went to Providence Tarzana Medical Center’s emergency room, where Moser handed over his insurance information. He had lost his job in TV production, and later bought his own medical insurance. To keep the monthly premiums manageable, he went for a plan with a $5,000 deductible.

“I kept asking, ‘Is this really necessary?’ ” said Moser, who first questioned the emergency room staff about the need for an IV drip to administer a saline solution.

The staff agreed not to do the saline solution. After some blood work, the doctor recommended an ultrasound, which Moser questioned. He relented, though, when the doctor said it wasn’t absolutely necessary but would rule out anything serious. And it did, so Ella went home with what was diagnosed as nothing more than an upset stomach, from which she quickly recovered.

But when the bill arrived, John Moser felt a sharp pain in his own gut.

The cost for just walking in the door of the emergency room? That came to $1,288. The ultrasound nicked him an additional $1,135. A comprehensive metabolic panel (blood analysis) was billed at $1,212.

Moser was also charged $158, accidentally, for the saline solution he had turned down. The total came to $4,852.55, not counting separate bills that would arrive later and total nearly $1,000, including $540 for pathology and $309 for the doctor.

“I was shocked,” said Moser.

The first bill, $4,852.55, was confusing, as medical bills often are. It said “your health plan has recently made a payment on your account.” It said the balance, $2,571.85, “is now your financial responsibility.”

When Moser mentioned the bill to his father, Marvin Moser flipped.

“Yes, the fees in ERs are off the wall all over the country,” the professor of medicine told me, but he found Tarzana’s to be extraordinary. “The one thing that stands out, beyond belief, is $1,212 for a metabolic panel.”

That’s a test, Dr. Moser said, in which a technician draws blood for chemical analysis, and it takes just minutes. Moser questioned not only the charge, but the usefulness of the test in his granddaughter’s case.

Out of curiosity, I went online to see what a lab might charge for a comprehensive metabolic panel.

Any guesses?

Some labs advertise prices as low as $39.

Glenn Melnick, who teaches hospital economics at USC, was not surprised.

“By and large, these prices are fictitious numbers,” said Melnick, who argued that Tarzana and most other hospitals routinely charge astronomical fees, especially for emergency room services.

Of course, and it’s all part of a years-long game in which the charge for service, the true cost of the service, and the acceptable payment are in three different orbits. And that doesn’t even take into account how the charges are adjusted up or down depending on who’s paying them and whether they have worked out a deal. How can patients hope to make sense of such an indefensibly convoluted system?

Starting Monday, President Obama’s healthcare reform act will get a hearing before the U.S. Supreme Court. But how can you have an honest conversation about soaring healthcare costs and health insurance, Dr. Moser asked, without addressing the maddening fictions built into the system? Patients seldom know in advance what they are being charged, he said, and many later find themselves in “medical bill bankruptcy.”

Melnick said hospitals argue that they lose money providing service to the uninsured, and by not getting reimbursed enough for Medicare or Medicaid patients. There’s some truth to that, Melnick said, but prices are set artificially high to help balance the books on the backs of paying customers. In the case of a $1,200 charge for entering an emergency room, Melnick said, the Medicare reimbursement is likely to be $300 or less, and far closer to the hospital’s true cost.

“Hospitals have figured out they can rapidly increase charges in the ER,” Melnick said, “and that will lead them to get higher amounts even from insurance companies they negotiate with.”

This is a very big deal, Melnick said, because half of all patients admitted to a hospital in California go in through the emergency room. Melnick said there’s also been a huge increase in the number of patients who lost group coverage and purchased individual plans with high deductibles, making them more vulnerable to exorbitant charges.

“More and more, people are seeing their deductibles eaten up on one visit.”

Melnick directed me to a state website (http://www.oshpd.ca.gov/chargemaster/) where every California hospital lists its fees. I did a little surfing and it appeared that the comprehensive metabolic panel for which Tarzana charged $1,212, Cedars-Sinai Medical Center lists a price of $786.45 and Ronald Reagan UCLA Medical Center charges $350.

A Tarzana spokesperson, Patricia Aidem, sent me a statement defending Ella’s care. “A child’s life was in our team’s hands and they acted accordingly…” said the statement.

It added that Providence hospitals spend millions each year on charity care for those who can’t pay. Aidem also provided data from the state website showing higher fees at other hospitals than Tarzana charged in the Moser case, including $2,678 for an abdominal ultrasound at West Hills Medical Center and a $4,413.24 emergency room visit at Cedars.

But that’s just the point. The price swings are so dramatic that they seem arbitrary, if not indefensible. I can’t predict how the Supreme Court will rule on healthcare, but I’m prepared to issue my judgment: It’s a mess.

(Look for a column in the next week on how the bill for Ella Moser’s tummy ache was settled and tips on how to avoid going broke from a minor medical emergency.)

steve.lopez@latimes.com

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Also published on eGuardianship.com on March 26, 2012 http://eguardianship.wordpress.com// and Attorney David Engler’s Legal Blog http://davidengler.wordpress.com//

In my earlier blog I wrote about my Mother finding a new friend in the weeks of her final dawn. “Wanda and Stella” was about the two WWII era nurses that made a pact to go to heaven together.

Mom died on February 3, 2012 and Stella died March 3, 2012. The following piece is from Louis Begley who writes with beauty about friends lost as we age. This was published in the March 18, 2012 New York Times.

“My mother died in 2004, two days short of her 94th birthday, and 40 years and two months to the day after the death of my father. He died at 65; for the preceding four or five years he had been in poor health.

My mother and I lived through the German occupation in Poland; my physician father, having been evacuated with the staff of the local hospital by the retreating Soviet army, spent the remaining war years in Samarkand. Left to fend for ourselves, my mother and I became unimaginably close; our survival depended on that symbiotic relationship. All three of us — I had no brothers or sisters — arrived in the United States in March 1947, and once here I began to keep her at arm’s length. Especially during her long widowhood, I feared that unimpeded she would invade my life, the life she had saved. I remained a dutiful son, watching over her needs, but was at first unwilling and later unable to be tender.

My abhorrence of the ravages and suffering inflicted on the body by age and illness, which predates my mother’s decline in her last years, is no doubt linked to there being no examples of a happy old age in my family. The grandparents, uncles, aunts and cousins who might have furnished them all met violent deaths in World War II.

Unsurprisingly, dread of the games time plays with us has been a drumbeat in my novels. Thus, arms akimbo, majestic and naked, standing before a glass, Charlie Swan, the gay demiurge of “As Max Saw It,” illustrates for the younger narrator on his body the physiology of aging: misrule of hair, puckered brown bags under the eyes, warts like weeds on his chest, belly, back and legs, dry skin that peels leaving a fine white snow of dandruff. Listening to him, the younger man is reminded of his own father in a hospital, permanently catheterized, other tubes conducting liquids to his body hooked up to machines that surround his bed like unknown relatives. He prefers his mother’s “triumphant” exit. A headlong fall down the cellar stairs kills her instantly.

I have followed the progress into old age of Albert Schmidt, like me a retired lawyer, in three novels. Schmidt is 60 when we meet him in 1991; when we part on New Year’s Day 2009, he is 78, therefore a couple of years older than I was then. Life has not been kind to him, but so far, Schmidt enjoys excellent health, marching up and down the Atlantic beach in Bridgehampton and New York City’s avenues, and doing laps in his pool. Although he worries about performance, his libido is intact. Nevertheless, the reflection of his face in the window of a shop is frightening: he sees a red nose and bloodshot eyes, lips pursed up tight over stained and uneven teeth, an expression so lugubrious and so pained it resists his efforts to smile. My appreciation of my own charms is not very different. Like Schmidt, I see that nothing good awaits me at the end of the road, and that passing years will turn my life into a Via Crucis.

And yet my body, like Schmidt’s, continues to be a good sport. Provided my marvelous doctor pumps steroids into my hip or spine when needed, it runs along on the leash like a nondescript mutt and wags its tail. My heart still stirs when I see a pretty girl in the street or in a subway car, but not much else happens. Except that, since by preference I stand leaning against the closed doors, she may offer me her seat. When last heard from, Schmidtie figured he had another 10 years to live. I have a similar estimate of my longevity. Such actions as buying a new suit have become dilemmas. The clothes I have may be fatigued and frayed, but won’t they see me through the remaining seasons? Can the expense of money and waste of time required to make the purchase be justified?

My mother did not remarry after my father died. She lived very comfortably, but alone, in an apartment 15 blocks away from my wife’s and mine. If we were in the city, we went to see her often and then daily as her condition deteriorated in the last two years of her life. Our children and grandchildren tried to see her often, too — and those visits brought her great joy — but they live far away and the happiness was fleeting. During her last decade she was very lonely. Most of the friends she had had in Poland had been killed. Those who had escaped and settled in New York one by one became homebound or bedridden, lost their minds or died. Or she found they bored her. Hearing poorly, tormented by arthritis in hip and knee joints, too proud to accept a wheelchair, she stopped going to museums, concerts and even the movies. She had loved sitting on a Central Park bench and putting her face in the sun. That humble pleasure was also abandoned; she couldn’t get the hang of using a walker.

Having rehearsed the bitter gifts reserved for age, T. S. Eliot wrote in “Little Gidding” that “the end of all our exploring/ Will be to arrive where we started/ And know the place for the first time.” The closer that place — the human condition — is to home, the harder it is to take in. I could speak movingly of Schmidt’s loneliness after the loss of his daughter, calling his existence an arid plane of granite on which she alone had flowered. But it has taken me until now, at age 78, to feel in full measure the bitterness and anguish of my mother’s solitude — and that of other old people who end their lives without a companion.”

Louis Begley is the author of several novels, including “Schmidt Steps Back.”
A version of this op-ed appeared in print on March 18, 2012, on page SR7 of the New York edition with the headline: Age and Its Awful Discontents.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

Also published on eGuardianship.com on March 20, 2012 http://eguardianship.wordpress.com//