Law

Federal vs. State (FGM) Updated

Update from the Detroit News:
“[T]he judge left intact conspiracy and obstruction charges that could send Nagarwala and three others to federal prison for decades.”

This story has me thinking about the powers of the State vs. the Federal government.

I am a firm believer that the individual States should regulate and enforce both criminal law and the practice of medicine.

States may make what I might consider errors in their specific codes and punishments. However, the 50 States act as individual laboratories for laws and law enforcement. As long as the States rather than the Federal government regulate these areas, citizens have a better access to the Legislators who make the laws and the bureaucracy that implement and enforce them. The voters can speak directly to their legislators in person and at the ballot box and, if truly unhappy or unwilling to wait for often slow legal changes, they can move to a State with laws they like.

These cases involve two doctors and multiple accomplices who conspired to bring girls across State lines in order to carry out Female Genital Mutilation (FGM).

The procedure is described in words and pictures at the link above and at the World Health Organization report(in .pdf), but here’s the short, least-horrifying-I-could-come-up-with version:

Pre-pubertal girls (two of the girls in this case were 7 years old at the time) are subjected to some degree of cutting in their genital area. The procedure may be anywhere between a minor cutting sufficient to cause bleeding without permanent structural or functional change, to removal of the entire labia majora and minora, along with the entire clitoris, with the vaginal opening sewn almost completely closed, only to be opened (obviously, traumatically) at marriage to allow vaginal intercourse and at childbirth.

The clitoris is a sensitive organ and very much an important part of the sexual function of the female body. The cutting site, the scarring, and the consequences of obstructed urine and menstrual flow can be life long. The actual reported goal is to make the girl chaste and impair her ability to engage in illicit sex and blunt her sexual pleasure.

FGM is a criminal act and should most certainly be malpractice under State’s medical codes. These sorts of cases would normally best be brought before the State courts.

The reason that these particular cases should be prosecuted (also prosecuted?) in Federal Court is that the girls were transported across State lines. In addition, they were irreversibly mutilated solely because they are females. If this latter doesn’t come under the 14th Amendment Equal Protection clause, I need a lawyer to explain that protection. In slow, simple language, please.

Now, I know some people will ask how I can oppose what is most likely a religious act and one that seems to come under both parental rights protection and the penumbra of “right to privacy.” And what about male circumcision?

The right to freedom of religion. Parental rights, and privacy do not have precedence over the rights not to be permanently harmed. Unlike male circumcision, there’s no medical reason to perform FGM, FGM directly impairs multiple bodily functions, and carries a significant risk of life long pain, repetitive infections, and even death.

It’s the legitimate function of government under our US Constitution and supported by the Declaration of Independence to protect the rights of individuals from being placed in harm’s way. These cases of mutilation are nothing but harmful for life, were performed on minors who are too young to consent, and were accomplished by conspiracy, using federally regulated telecommunications to make appointments, taking the girls across State lines, and utilized State licensed personnel, equipment, and medications.

I hope the Federal appeals overturn this ruling. Quickly!

Euroean Travel Politics

I’m very careful about politics when traveling. The media far too often tells us that the rest of the world doesn’t like the US since Trump was elected. The “Italian for Dummies” web page even has the phrase, “Non siamo americani.” (We aren’t American.”)

But my experience has been different: a lot of Europeans think Donald Trump is right about border security and limiting immigration. And we’ve heard this from citizens of England and Italy, who go out of their way to express their support of President Trump.

Last month, a British couple stopped to admire our narrowboat on the Thames. When they found out we were Americans, they turned the conversation to politics, support for Brexit and praise for President Trump.

We picked up our car at the Rome Airport on Friday and it happened again. Out of the blue, the 30-something agent asked, “What about Trump?”

I deferred answering to Larry and braced myself for criticism or ridicule of the President from our new aquaintance.

Instead, our Roman friend volunteered his approval of Donald Trump and the “changes’ both our countries are making in response to international pressure to accept overwhelming numbers of refugees.

He talked about the inability to vet the refugees picked up at sea, the effects on Italy’s employment situation, and the financial stress the boat loads of immigrants were causing Italy before his government’s recent refusal to accept ships full of migrants at Italian ports.

He said, “Trump is making changes. People are afraid of change, but this is good change.”

None of the people we talked to – or who made it a point to talk to us – expressed hate or racism. They are worried about the future if their countries and disapprove of “Brussels” forcing regulations on them, not simply afraid of foreigners.

I wonder who’s listening.

(BTW, several different sets of Canadians have initiated similar conversations. All approved of the President and disapproved of Trudeau.)

Is there a solution to the current immigration emergency?

I’m following and responding to the news reports and conversations on Twitter and Facebook about the arrests and separations of alien families because I’m looking for a solution that will work and have fewest unintended consequences.

We can spend all day screaming our objections or justifications and playing political games based on what should have been done and when, in the past and present. Or, we can tell our legislators that we recognize the reality of the circumstances, today, and that we need to make immediate changes, followed by more measured steps.

We urgently need to:

1. Ensure that the very young are safe and nurtured. This is an emergency, because of the damage that we know tactile deprivation has on small children. No more claims that some institutional rule prohibits holding a toddler;

2. Make sure that no more children are “lost” and that even those who are separated can communicate with their parents.

(Hospital arm bands? Schlitterbahn and the Toob renters in my home town use similar bands. The tracking numbers could follow numbers on the bands and would not only work better with digitizing information

Would it be possible/permissible to use RFID and/or GPS?

Delta uses bar codes attached to each suitcase and can text me when my suitcase is loaded or unloaded on the plane. Last month, when I was on a cruise, ATT texted me that I wasn’t covered by their international plan as soon as I stepped on the ship, before the ship left the dock.);

3. Speed up the process of reuniting the families;
(This last will be enabled by the above, but will also require resources for the rapid setting up of family shelters for those awaiting hearings, and hiring personnel for those shelters and judges to hear the cases and lawyers to represent the asylum seekers.);

4. Streamline the process for approving or rejecting application for asylum at the ports of entry. (See above. This may be a useful job for civilians -paif or volunteer – and the National Guard after apprehension and/or initial evaluation by Border Patrol);

5. Fix the laws concerning detention of children separated from their parents, the right of application for asylum for anyone who manages to step on US soil, temporary worker permits that do not allow family to immigrate, and for immigration in general;

6. Continue to identify, arrest, and prosecute people who willfully violate our immigration laws;

7. None of this is dependent upon or contradictory to securing the Border. All of them are enhanced by increased security, however;

8. Stop the partisan game playing!

It should be made clear that our government will follow the law as written. Perhaps we can continue the ads Obama’s Administration is said to have used in Central America.

None of these should be done so that more people show up expecting immediate visas, green cards, or even healthcare and food stamps. They certainly shouldn’t believe that they have a right to immigration or to burden our social infrastructure and taxpayers.

Please comment on my Facebook page.

Edited numbering, BBN

Happy Birth Parent Day

Google Images for “Baby Daddy” card

That lawsuit I wrote about yesterday would not only would put an end to Texas’ Medical and legal regulations on abortion – including informed consent, waiting periods, and sonograms – the plaintiffs go out of their way to redefine mother and father, too.

“”1 Most people with the capacity to become pregnant identify as women. Historically, both jurisprudence and public health data have focused on women when addressing reproductive rights and health. But there is an emerging recognition in the law and society more generally that not all people who may become pregnant identify as women. See generally Glenn v. Brumby, 663 F.3d 1312, 1316-19 (11th Cir. 2011)

(holding, consistent with the weight of authority, that the Equal Protection Clause prohibits discrimination on the basis of “gender nonconformity”) (collecting cases); Robin Marantz Henig, How Science Is Helping Us Understand Gender, National Geographic (2017), https://www.nationalgeographic.com/

magazine/2017/01/how-science-helps-us-understand-gender-identity/. The Constitution protects the right

of all individuals to end an unwanted pregnancy, regardless of gender identity.”

From the UK, we see the inevitable results in a time of identity and personal choice :

“Lawyers have told a judge that he had been biologically able to become pregnant but had legally become a man when the child was born.

Or a parent, of either gender or any identity, who sees the child as his own person, human-enough to possess inalienable rights, rather than a political statement and a means to an end?

Safe, legal, and unrestricted?

06/16/18 7:30 AM Edited formatting, BBN

Existing tariffs, duty, and barriers to trade in Canadian law.

Current barriers on imports into Canada from the US affect dairy, wine, telecommunications like TV, cable, and broadcasting, and even software and “cloud” data storage.

https://www.export.gov/article?id=Canada-Import-Tariffs

In contrast, there are very few barriers to trade with Mexico.

(Edited to add the link to information on Mexico.)

The Day That Justice Died

Where is the freedom or justice in raiding the attorney/client privilege? Not just the offices and homes of a lawyer, but documents that most of us thought were protected by an all-but-inviolable privilege?

Supposedly, Cohen lied to his bankers about why he wanted a loan. Was it by comission or omission???Is it a Federal offence to not fully disclose why you want to go into debt?

Stormy Daniels threatened (black-mailed) to make accusations about Trump immediately before the 2016 election, got money and signed a contract, now wants to reneg (she pretty much has) on her contract, but the one who paid the money is the one who is being investigated/harrassed.

Why aren’t the Trump people demanding the same deals Hillary’s people got: immunity and non-disclosure agreements before sitting down with the FBI?

When were any of the Clinton lawyers or aides’ homes or offices raided?

Trump wasn’t my first, second or third choice in the Republican Primary of 2016.  And I’ve already mourned the death of the rule of law, back when Comey killed it.  But I agree with the President: this looks like a witch hunt.

Response to criticism about Texas Advance Directive Act

I’ve been having a long Facebook discussion with representatives of organizations, people who claim that I support coercion and killing patients because I defend the Texas Advance Directives Act, 166.0046. (TADA).

I want to respond as fully as I can. ( I’m bandwidth deprived today and will gradually add more links when I reach better signals. See here, here, and here for more explanations from earlier WingRight posts. Links to the law, the press, and previous blog posts by others can be found in those articles.)

It

(Edited 03/11/18 for typos, to add a link, and to clarify points originally made on Facebook in a long debate. BBN)

Disappointed by BVI Immigration 

A month ago, one week after Irma,  I came into Beef Island as volunteer doctor with a small medical relief group on a charter plane.   I was only given a visa for 30 days, even though I explained that I have a Non-Belonger Land Holder License (NBLHL), but didn’t have it with me when I canceled the rest of our vacation in Europe. 

Today I went to the government offices in Spanish Town with my NBLHL and was refused a visa extension until I could produce a return ticket. The officer informed me that the NBLHL only allowed me 6 months “per annum” and proceeded to examine my passport, as though to check how long I had been present in the Country this year. 

(I had to go up to Flow to get a good signal in order to buy the ticket online. I returned to find the officer leaving for lunch 15 minutes before noon.)

When I came in on September 14, there was no demand for a return ticket. At the time, there was a perceived shortage of doctors and we believed I would need to be self-sufficient for food and water as I wouldn’t have access to power or running water. The prisoners and looters were still at large. 

Thank goodness, nothing was quite as bad as we feared:  The British military had arrived by then; the wonderful people at Nanny Cay took great care of me and the rest of the group and we arrived the first day that Nanny Cay was able to turn on their desalination plant /water maker for a few hours.  

The medical need on Tortola was already improving enough that I was able to come to Virgin Gorda just 4 days later. Although they don’t need me either, I’ve been working at the clinic in Spanish Town at least two days a week ever since. I don’t want a job and don’t need the experience, but feel that I made a contract that I must keep. I also want the docs, nurses, and staff to know me if one of the feared medical crises does arise. 

BTW, That NBLHL I mentioned “authorizes”  immigration “to grant leave to land for a period not exceeding six months…” Not “per annum,” and there is no mention of a return ticket six months in advance. 

Larry and I have also applied for a “permit to reside”  which required the same documentation that we submitted –  and resubmitted after it was lost – for our NBLHL:  letters from law enforcement and character references, and financial statements. We were required to leave the Country while it was processed, but have been informed that it  languished in the Immigration department without action from 5 July to September 4 –  2 months before Hurricane Irma – and that it is most likely lost and will need to be resubmitted. 

If you saw my post last week, you’ll recall that when Larry was finally able to come to the BVI 3 weeks after I did, he was required to pay duty or produce receipts at Beef Island Customs on the 

(I had to go up to Flow to get a good signal in order to buy the ticket online. I returned to find Ms. Smith leaving for lunch 15 minutes before noon.)

When I came in on September 14, there was no demand for a return ticket. At the time, there was a perceived shortage of doctors and we believed I would need to be self-sufficient for food and water as I wouldn’t have access to power or running water. The prisoners and looters were still at large.

Thank goodness, nothing was quite as bad as we feared: The British military had arrived by then; the wonderful people at Nanny Cay took great care of me and the rest of the group and we arrived the first day that Nanny Cay was able to turn on their desalination plant /water maker for a few hours.

The medical need on Tortola was already improving enough that I was able to come to Virgin Gorda just 4 days later. Although they don’t need me either, I’ve been working at the clinic in Spanish Town at least two days a week ever since. I don’t want a job and don’t need the experience, but feel that I made a contract that I must keep. I also want the docs, nurses, and staff to know me if one of the feared medical crises does arise.

BTW, That NBLHL I mentioned “authorizes” immigration “to grant leave to land for a period not exceeding six months…” Not “per annum,” and there is no mention of a return ticket six months in advance.

Larry and I have also applied for a “permit to reside” which required the same documentation that we submitted – and resubmitted after it was lost – for our NBLHL: letters from law enforcement and character references, and financial statements. We were required to leave the Country while it was processed, but have been informed that it languished in the Immigration department without action from 5 July to September 4 – 2 months before Hurricane Irma – and that it is most likely lost and will need to be resubmitted.

If you saw my post last week, you’ll recall that when Larry was finally able to come to the BVI 3 weeks after I did, he was required to pay duty or produce receipts at Beef Island Customs on the items (water filters, etc.) he brought, in spite of the moratorium.

Beyond investing in our home at Nail Bay on Virgin Gorda, Larry and I have done what we could to assist physically and financially in the BVI recovery after Irma. I’m not as enthusiastic about residency as I was in June or even a month ago, and do not feel at all welcomed by the BVI.

Personhood “TBD” 

“To Be Determined,” or the Schrodingder’s cat* version of human rights.

Does the possession of inalienable human rights depend on unknown future facts? Can the moral worth of a human being be determined by the actions of another human being – or by fate, the available and utilized medical technology?

Sherif Girgis discusses the theory of Princeton philosopher, Elizabeth Harman, in today’s Public Discourse. The professor’s view that abortion is – or may be – a neutral act has been the subject of discussion since she appeared in the YouTube video, Philosophy Time, produced by actor James Franco and Eliot Michaelson.

Besides the obvious problems pointed out by Girgis of defining “consciousness” and the TBD “kind” of a human fetus, there are other problems.

First, any concept of “inalienable” human rights would need to be discarded. There goes the Declaration of Independence and the basis of the United States Constitution.

In addition, Professor Harman’s theory would presumably allow the use of bodies of the human species for the benefit of humans with “moral worth,” as long as those bodies are never allowed to become conscious. This is the current practice of researchers using embryos, including those created for the purpose of manipulation and destruction.

But there’s nothing in this philosophy to prevent the intentional manipulation of a human body for research or to benefit others, as long as the body is never allowed to develop consciousness. Continual sedation or mutilation of the brain from the beginning – before consciousness – would prevent the development or acquisition of moral worth and rights.

In the process, “human” rights would cease to exist. The actions of others, laws and location and the potential use of technology would finally determine who is human enough to possess the right not to be killed. (Forget the right not to be “enslaved.”

What happens if (as Girgis proposes) the abortion itself is aborted or fails? Or if the brain isn’t damaged sufficiently to prevent consciousness?

Forget about opening the box: don’t put humans in there in the first place.

*I saw this analogy on a Facebook thread, but thought the same thought before I stole it.

Edited to correct my misspelling of Dr. Harman’s name.

Health Insurance Choice Is Bad?

Health insurance choice is bad?

The San Antonio Express News picked up a Washington Post op ed on those big, bad Republican plans to repeal Obamacare. Originally titled, “The reason Republican Republican health-care plans are doomed to fail,” by the editorial board that declared, “There’s no way to replace Planned Parenthood.”

And it’s bunk, even as prudently renamed and appropriately filed in the Opinion section.

What we are *actually *seeing *today is that costs are rising and insurers are withdrawing from States. Choices are certainly limited if there’s only one insurance company on the exchange and routine screening costs are “free” — But the care for treatment discovered at screenings is subject to high deductibles.

Limited coverage plans with major medical for extraordinary costs – rather than a wish list covered with other people’s money from first dollar – encourages personal responsibility and will cut costs. It would also allow people to own their insurance, rather than have it controlled and limited by current employers.

Science vs. Philosophy

R(obin) Alta Charo has once again been given a platform in the New England Journal of Medicine.

Poor Robin. She conflates ethics and philosophy with science. Although observing what “is” can lead to insight about which actions and manipulation lead to harm and which improve individual and group well-being, Science cannot prove or disprove philosophy, or determine what we “ought” to do.

Ms. Charo continues her career-long advocacy for elective, interventional abortion and against the inalienable human right not to be killed – all in spite of her assertion that she has no conflicts of interest in this essay. By declaring that Trump Administration appointees “embrace alternative science,” Robin makes her own gross scientific error. In addition to confusing “science” and philosophy, she bases much of her objection on an emphasis on “established pregnancies” and ignores the existence of the human embryo after fertilization but before implantation.

The very odd complaint about definitions of gestational age assumes that time varies according to when we start counting days.

Some state legislatures have tried to redefine pregnancy dating, shifting from the standard measure of time since last menses to time since probable fertilization. Such a definition falsely enhances the viability statistics for lower gestational ages and helps to bolster arguments for 20-week limits on abortion rights.

Again: Science is about what 《is,》 while ethics ought to be, not about true  《oughts.》

“Different” (Transgender at 4?)

The TexasGOPVote website chronicles the complaint by a “Conservative, Christian” mom  that her male to female (supposedly) transgender 6 year old shouldn’t be treated differently. I agree with the underlying sentiment that it is not the child’s fault.

The child is treated differently – by parents, peers, school nurses, and any educator, doctor or other professional or official who is complicit with this abuse of a 6 year old child – because the child *is* different. Medicine, physics, and the rest of the observable, measurable and verifiable universe don’t change because a child declares that cold is hot, up is down or boys don’t feel like “she” feels (at the highly experienced age of 6). 

It is disturbing to read about the apparent mistreatment of depression that this mother describes in her earlier blog. So disturbing that I’m inclined to ignore – or at least put off to another post – commenting on the stereotype in the description of “girly girl, Kai, in pink and sparkles” or of  the suggestion in mom’s earlier blog about Joseph as “gay” (at 2!)  for displaying supposedly “flamboyantly feminine mannerisms and love for all things girly.” 

How could anyone so misinterpret the repeatedly voiced desire of a 4 year old to be taken away to heaven because another 4 year old said her father called him a freak as equivalent to hating hair cuts ( or more “feminine mannerisms“)? How can she compare her “secret” research with the proper treatment her son needed?

Unfortunately, a 6 year old claiming to be transgender is different because he or she has had his or her perceptions of the world colored by the same adults who would not allow a child they loved to play with fire or jump off the highest point of the school building. 

The fact is that genetic and phenotypically female girls will always be “different” from Joseph. From the first penetration of the zona pellucida by a sperm bearing a Y chromosome, to the differentiation of the Wolffian duct, to the first time he urinated over someone’s shoulder into the air after birth, Joseph has been a male. Stereotypes aside, he will remain a male, however he acts or is medically or surgically manipulated. The genetic and phenotypical reality of his body will always affect any future medical or surgical treatment.

Hopefully, no one will be complicit with medical or surgical castration or other mutilation until this child is legally competent to consent. In that case,  his body will still be phenotypically male, entering puberty, when he enters middle school, whether as as Joseph or Kai. Now, that will be a  “difference” evident to all the girls, including the ones who have never seen male genitals. 

It will be very evident to the survivors ​of sexual abuse. Hopefully, they called the police after they were abused.

Contrary to the claim in the blog,  Lt. Governor Patrick and the “Bathroom Bill” didn’t start the trans debate.  School districts in Texas were changing policies, entire cities have passed ordinances, and the last President issued an Executive Order that threatened Federal education dollars. 

And preditors are taking advantage of the increased access available due to the transgender debate: men like Paul Witherspoon, Levandus Gacutan, Christopher Hambrook, Richard Rodriquez, Jason Pomare, Sean Patrick Smith, or the many unnamed men who have been not reported to the police when they enter previously gender-segregated areas like poolside changing rooms, shower rooms or gym locker rooms. (I’ll let you research those names.)

Thanks to “Conservative, Christian” mom, the world is being misrepresented to other children who are encouraged to consider pathological behavior as not “different.” Because of “feelings” the rest of us are repeatedly told to ignore the difference –  and observable,  measurable, and verifiable facts. 

And this specific child is being abused. 

Beverly B Nuckols, MD. 

Equal, but special

A Facebook friend, Michael Smith, made an excellent comment about the contrast between “separate but equal,” and “equal, but special.”

I spent some time yesterday at the Texas State Capitol Reagan Building discussing House Bill 2899 by Simmons, which would prohibit local governments and other regulatory authorities from creating a new “order, ordinance, or other measure to protect a class of persons from discrimination; to reduce or expand a class of persons protected under state law from discrimination.”

The consensus of a group of people waiting for the House State Affairs Committee to begin was that the Bill is a thinly veiled “attack” on the LGBT community and transgender persons in particular. The comment that made me go into my Don Quixote tilting windmills mode was about just wanting to “peeing in peace” and the false claims of fears for safety of women and children.

I pointed out that that it is reasonable for women to have fear when confronting a man in a closed space and that we all expected privacy and security in bathrooms, locker rooms and other public places where people disrobe. (Yes, I used the term “disrobe.” And “intimate spaces.” I’m a nerd.)

I was told that I was speaking from “privilege” (!) for my example of caution when entering an elevator with a strange man and objecting to the stereotype that the brains of men and women are different and the assertion that men and women simply think differently. I heard that segregation of the sexes in public bathrooms is a new phenomenon and that the Roman baths, such as those in Pompeii were completely different matters, mainly due to the religion of the time.  And of course, several of the group told of the danger of violence against gays or trans but that there has never been any crime against other people by transgender person

Two of the people claimed to be transitioned from male to female. While demanding “respect,” they told stories of having coworkers fired for refusing to use their preferred pronouns. and engaged in very real “hate speech,” mocking and assigning hateful motives and emotions to me. The same person who pointed out that little boys can be molested in men’s bathrooms then said that *I* was the one who must obviously consider anyone with a penis a predator.

The group was secure in the belief that the fears of violence and abuse of the LGBT community outweigh not only the fears of victims of sexual abuse or parents of children and thousands of years of social norms.

Cities, but claiming to write non-discrimination ordinances create environments where some people are “equal, but special” – or a specially protected class of persons. George Orwell put it another way: “Some animals are more equal than others.”

Law makers to doctors: “Keep the patient alive” 

If only we doctors – or legislators, lawyers and probate judges – really had the power to “keep the patient alive” as this article claims two new Bills  (  HB 4090 & SB 1213) in front of the Texas Legislature will (force doctors to) do. 

The article is misleading in its claim that a committee or a hospital decides whether or not a therapy is given: Texas doctors practice medicine in Texas. Even the Bills make it clear that the “attending physician” makes the decision whether or not to follow the patient’s (or more likely, the surrogates’) medical request.

We – Texas doctors, hospitals, and legislators – have tried repeatedly over the last decade to amend the law, Texas’ Advance Directive Act,   to increase the time frame. Last Session, we helped to ensure that food and water can’t be withheld. The lawyers and those who would have Estate (probate) judges involved in every dispute – even at the bedside of the dying – have blocked effort after effort because the Bills did not include liability for the doctor. 
These Bills are just the camel’s nose under the tent of Texas’s tort reform. Worse yet, we’d end up with medical expert testifying against medical expert in court, with the judge eventually telling the doctor how to practice medicine. It would also severe the “ethicists” who actively seek to undermine conscience protections for health care professionals.
If you’ll notice, the Bills also remove the requirement for the patient to pay for any transfer, too. I don’t suppose that the tort lawyers ​will pay for the ambulance or plane ride.

Do you want Texas law to force doctors to practice against our consciences​? 

How long and how far should any man or woman be forced by law to act against his or her will?

​Would you like to refuse?

Shocking Bill from Texas’ Jason Villaba, Republican State Representative from Dallas’ District 114 :  HB 1938 would make organ donation after death “opt out” for anyone applying for a driver’s license in Texas.

Texas would be the first State to pass such a law.

Organ donation is a public good for those who wish to do so. However, there is no ethical or legal precedent for treating human bodies – living or dead – as public property or commodities.

From the Bill as introduced:

(2)  for an applicant who is 18 years of age or older:
	(A)  specifically ask each applicant the
	question, “Would you like to refuse to join the organ donor
	registry?” and state, “If you answer ‘no’ to the previous question
	or do not answer the previous question, you consent to join the
	organ donor registry by performing either of those actions.”; and
	(B)  if the applicant does not affirmatively
	refuse to be included in the registry under Paragraph (A), provide
	the person’s name, date of birth, driver’s license number, most
	recent address, and other information needed for identification
	purposes at the time of donation to the nonprofit organization
	contracted to maintain the statewide donor registry under Section
	692A.020, Health and Safety Code, for inclusion in the registry.

http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB01938I.htm

More Fake News (5 year old handcuffed – NOT)

The Baltimore Sun is one of the online news sites I read because it’s more reliable than others. Usually.
Now, they’ve published an opinion piece with a falsehood about “inhumane acts” that were supposedly the result of President Trump’s Executive Order on travel to the United States from certai countries. At less one of those stories was easily debunked with a quick news search.

The story that a 5 year old boy was handcuffed is at false, according to a news report by WUSA9, from Washington, DC:

We tracked down the actual photo to a controversy in Kentucky involving sheriff’s deputies handcuffing young students with learning disabilities, back in 2015.

Another story going around is that a 5 year old Syrian girl was hand-cuffed by Immigration, also at Dulles. 

The anything-but-right-wing Snopes has already published a denial about the little girl. (Of course, the verdict is, “Mixture,” rather than,”False.” Can’t go risk validating anything that might have resulted from the Trump EO, I guess.)

In this case, the father even said the airport officials were kind to the family.

All of which confirms that we need to do our own research and seek out”alternative” sources to confirm or deny “facts” reported in the news.

National Security Letters

​While we were distracted by whether Kellyanne Conway was “lying” about “alternative facts” and how mean Bannon and Spicer are, the FBI quietly lifted the gag order on National Security Letters issued by them during the previous Administration.

Now, I’m not a lawyer, so the following is a lay explanation.

These “Letters” are in fact, subpoenas issued by a government agency. They don’t require a judge or FISA Court review or warrant. 

Get this: the laws authorizing the NSLs are called “Patriot” and ” Privacy” Acts and the gag order provisions have been vetted by the Ninth Circuit of Appeals:

However, the government appealed to the Ninth Circuit Court of Appeals, which vacated her ruling and sent the case back to the district court. Last month that court ruled that the gag order challenge was no longer relevant because the USA Freedom Act had successfully addressed the issue of gag orders. 

Google, Twitter, Facebook, and others reported the release from the gag order during the last couple of months. Yahoo, along with the others, has been fighting in court and some of the Letters have been disclosed to the targets:

Over the past several years, Google challenged 19 NSLs in court and last year won the right to tell WikiLeaks employees that their data had been requested.

I sincerely thought that all of these sorts of subpoenas were required to eventually go through approval of a FISA Court judge. Hopefully, the Trump Administration will not continue the Obama Administration’s abuse of these Letters and that Congress will correct the law.

Don’t regulate plants!

​Ridiculous! It’s a plant. Which literally grows like a weed – or house plant – and doesn’t require manufacturing or processing to use. What business does government have in outlawing a plant?

Marijuana laws are in the news in Texas, once again. I hear and read plans to make money from taxes and autocratic demands to”protect” people from the plants. The same Republicans who demand legalization of the sale of raw milk and think gambling dollars should stay in the State argue against any decriminalization of marijuana.

Even if you don’t have sympathy for the thousands  jailed for use while the plant is illegal, the raids on gardens, seizures of farms or the arrests of people because owners are suspected of growing illegal *plants* should make you consider the harm from draconian narcotics laws. 

In fact, my trouble getting poppy seeds for the hard, back in the’90’s is what changed my mind about these laws. The Clinton Administration was arresting people for selling seeds and dried pods used in crafts:

“Somniferum is the only poppy species mentioned in the federal Controlled Substances Act of 1970, where it is listed as a Schedule II drug, the same as cocaine. The entire poppy plant, not just the opium that oozes from its green seedpod, is considered contraband.

“But the law specifically exempts somniferum seeds, those blue-gray dots you find on your bagel. So chew on this: Seed companies can legally sell opium-poppy seeds, but gardeners who buy those seeds break the law by planting them.

Republicans are advocates of personal responsibility and remind others about the words in the Declaration of Independence. We should know that legitimate laws are intended to protect us from the infringement of inalienable rights by third parties — and the government. Laws are not meant to protect us from ourselves.

In a liberty-minded, Republican-controlled State and Nation, there shouldn’t be any laws against growing seeds from your grandmother’s heritage poppies or your new neighbors’ marijuana plants.

Addendum: a 1992 article about poppies at Thomas Jefferson’s Monticello:

“Thomas Jefferson planted white opium poppies at Monticello. They grew in the historic garden near Charlottesville, Va., until last June, when they were yanked up.

****

“The center even sold the seeds. Until its governing board — “which has a mania for being legal,” Mr. Fitzpatrick said — decided to press the issue.”

Pay attention: it’s policy, not bias

The consensus of media pundits and bloggers, as well as quite a few liberal and even Conservative op-ed authors, is that Donald J.Trump was elected President out of some misguided national populism and anger at Congress, fueled with a lot of racism, misogyny and hate. The fact that those same voters elected a Republican majority in the House and Senate  – sending virtually every eligible Republican incumbent back to DC – is glossed over.

The idea that Conservatives really believe in small government and equal opportunity supported by personal responsibility is rarely voiced. That we might actually vote, not only for President but consistently down ballot, in order to defend the Bill of Rights and the right to life is ignored while we are accused of xeno-, homo-, and poly-whatever-phobia. I read that I am “afraid” of other lifestyles, religions, and losing my “privilege” based on being a White Christian.

Personally, I approve of most of the Republican Platform, especially where it addresses core Conservative issues, such as low taxes and equal treatment under the law. I want a Legislature that will uphold the Constitution as it’s written and defend against the infringement of inalienable rights. I don’t want activist judges nominated or confirmed at any level of the Federal Court system, especially the Supreme Court. I hope President Trump and the Republican Congress majority will decrease the hassle factors and threats placed on the practice of medicine and business in general by an overreaching Federal bureaucracy.

And, yes, my sense of fairness hopes that our existing immigration laws will finally be enforced, as an outcome of the”equal treatment under the law.”

Instead of facile clichés fed by cherry-picked sound bites and the latest talking points from the Left, try looking at and listening to the 59 Million voters across the country who elected a Republican candidate for President, and ensured a Republican majority including all those “establishment” candidates in both the House and Senate. 

It’s the Republican platform and Conservative policy that we Conservatives voted for, not one man.

The day the Rule of Law died 

November 6, 2016 – a Sunday afternoon – FBI Director Comey announced that his agency’s investigation of Hillary Clinton’s selfie-server is closed, still without recommendation to charge the former Secretary of State. He destroyed any confidence that the United States is a nation of laws.

From the New York Post:

” From within the SCIF, Santos — who had no clearance — “collected documents from the secure facsimile machine for Clinton,” the FBI notes revealed.:

“Just how sensitive were the papers Santos presumably handled? The FBI noted Clinton periodically received the Presidential Daily Brief — a top-secret document prepared by the CIA and other US intelligence agencies — via the secure fax.”

Among the FBI notes on their investigation into those once-deleted emails from Clinton’s selfie-server were some indicating that Clinton regularly required her Washington, DC maid to print out official State Department documents, including classified information.

That’s right: her maid, a woman without any security clearance at all.

Again, while these emails and the access by the maid present new information to most of us, the FBI knew that they existed and that they were among the 30,000+ emails that were deleted *after* Congress had served Clinton with a subpoena.

We can assume that the emails had been marked as personal by the (again, no-security-clearance-) lawyers to whom Clinton delegated the task of dividing the contents of the selfie-server into those that were not and those that were State Department business.  Clinton claimed that neither group of emails contained classified documents, so she saw nothing wrong with turning over a memory stick containing the emails to the lawyers.

Media Matters covered the maid stories. The point that they made was strictly on Conservative bias and the timing of when the classified emails became classified. There was no coverage about the President’s morning briefing from intelligence sources or on the illegality of giving access to the SCIF. There was certainly no insight into the fact that the documents could later be determined to be classified is the EXACT reason that a person without the appropriate clearance should not be given access!

I’m disgusted. I’m angry. I want to commit felonies of my own – felonies yet to be determined, but of my choice and according to my own schedule.

But since I do believe in the Rule of Law and its benefits, I want to know what my Senators Cruz and Cornyn and my Congressman Lamar Smith intend to do clean house in the Federal  government.

And I don’t mean, “with, like a cloth.”

(Edited @ 7:05 PM on November 7, to add comments on Media Matters and to correct the cloth comment. BBN)

Obama’s Abortion Cronyism 

Obama’s new Health and Human Services regulations will prohibit consideration of whether a provider does abortions – or sells body parts – or not.

Kansas and Texas, among other States, attempted to prioritize their limited tax dollars, preferring to steer money – and patients – toward continuing and comprehensive caregivers – primary care providers- over  reproductive health “boutiques:”

When PP sued, they lost. But Obama arbitrarily stripped the State’s Title X funds and gave the money to PP, anyway.

The “most transparent Administration ever” went further:

 In New Hampshire, the administration even refused to disclose information about its direct Planned Parenthood grant, claiming disclosure would harm the nonprofit’s “competitive position.”””

What competition??? That’s pure cronyism and blatant support of the Democrat’s  – and Obama’s – pro-abortion political ideology.

Edited 11/12/16: misspelling of Services in first sentence BBB

Lawlessness for All (A Modest Proposal)

​​Tell me why I should believe that  “Latinos” are a big homeogeneous blob who don’t care about anything else except immigration, including law and order?  

The news yesterday was full of “Latinos” declaring that they have turned away from voting for Donald Trump after his speech on immigration in Phoenix. 

These people on the “news channels” and social networks claimed that an entire group of people, all lumped together because of who their parents are or what language they speak, are of the same mindset, and will vote as a block to ensure that some people – dare I say “their people” –  are treated differently under the law from everyone else 

There’s no justice  in ignoring the law. On the contrary, inconsistent enforcement of the law is injustice:  it infringes on everyone’s rights. Everyone’s liberty is placed at risk by inconsistent enforcement at the whim of whoever has the biggest gun, the most votes or the latest appointees to the US Distric Attorneys offices and Federal Courts.  Whoever has power gets to decide which of us is “more equal.”

Illegal aliens have at least committed a misdemeanor for the first offense. If they’re working, they are probably using false Social Security numbers, possibly committing  identity theft –  not a victimless crime, even if you believe the reports that illegal aliens contribute more than they cost society.

So, here’s my “Modest Proposal,” with apologies to Vicar Swift.

If you think we should just let illegal aliens hide out for 10 years, then self-report (yeah, sure) , sign up for fines and an English as a Second Language class,  how about treating every equivalent infringement the same?

Let us each pick our own tort or crime, to be determined at our convenience. Give everyone a year or 10 – after the fact – to self-report, pay a fine, take a class  and go on.

Start with other cases of identity theft, then move on to Federal offenses like voter fraud, money laundering, Medicare and Medicaid fraud and abuse, on to failure to pay the IRS, bank fraud, embezzlement.

After all, it’s only fair.

Trump can’t run 3rd Party in Texas?

Read the Texas Secretary of State information page on Presidential candidates, here. (http://www.sos.state.tx.us/elections/candidates/guide/president.shtml )

I’m not a lawyer, but it appears to me that Texas election laws will prevent Trump from placing his name on the ballot as a 3rd Party candidate in 2016.

Any lawyers disagree?

New Braunfels Resident’s River Pass Isn’t “Free”

New Braunfels residents will get to join the crowds gathering along the Comal River every single summer holiday or weekend day, if we want to play in our rivers. (Which are actually State owned rivers.)

Our New Braunfels City Council not only promoted the ancient tradition of queuing up, they made sure we do so while visiting our Parks more often, too!

Even residents who live on the rivers and/or will only be on the Guadalupe will find themselves in Hinman or Prince Solms in order to use their “free” Pass to obtain wrist bands each and every single day if you enter or exit either the Comal or Guadalupe by City land with your tube, kayak or canoe. (noodle, life jacket, snorkel or scuba gear, too?)

Here’s the City Council ordinance info:

Between Memorial Day and Labor Day of each year, all persons in possession of water oriented recreational equipment on the premises known as the City Tube Chute, Prince Solms Park, Hinman Island Park or using public exits on the Comal or Guadalupe Rivers, must be wearing a city-issued wristband. ( http://www.nbtexas.org/DocumentCenter/View/7497)

From the nbtexas.org River Pass page:

Residents

New Braunfels Residents, who reside inside the corporate city limits, can receive a Resident River Pass at no charge to avoid paying the River Management Fee.

Then take your Resident River Season Pass (or your purchased Resident Swim Pass or Resident Family Swim Pass) to one of the three booths set up at Hinman Island Park and Prince Solms Park, or to a River Outfitter, to obtain your free wristband when you tube on Saturdays, Sundays and holidays between Memorial Day weekend through Labor Day.

AND:

Note: If you are resident using private property to enter or exit the river while tubing, but will still utilize public land to get on or off of the river, you will need a wristband to be in compliance with the ordinance. ( http://www.nbtexas.org/riverpass)

Won’t the “last exit” be fun this year?

Just in case you were wondering who and what the “Municipal Code” covers:

Public river exit means Cypress Bend Park, Lincoln Street River Exit, Garden Street River Exit, Hinman Island Park, City Tube Chute and any other City-owned right-of-way or property with frontage on the Comal or Guadalupe Rivers currently not leased to another entity.

Water-oriented recreational equipment means tubes, kayaks, rafts, canoes and all other forms of personal watercraft.

There are going to be three (3) (Yes, 3!) booths where these wrist bands can be obtained.  The 3 booths will be at Hinman Island and Prince Solms Park – none at the City limits or parks along the Guadalupe.

Won’t we all have fun getting to know our neighbors and the visitors to our City as we all line up in front of these three booths on Saturday mornings? After finding parking?

Here’s an idea: The bands may also be obtained from a River Outfitter. Maybe the Outfitters will deliver the wrist bands to our New Braunfels residences?

The City Council and Mayor can be reached, here.  http://www.nbtexas.org/index.aspx?nid=298

You can call 830-221-4000 to try to get more information from the City of New Braunfels. Good luck!

Human rights for this class of persons?

How human is human enough for human rights?

Justice Taney on slavery, in the ruling on the Dred Scott case:
“”

The question before us is, whether the class of persons described in the plea in abatement [people of Aftican ancestry] compose a portion of this people, and are constituent members of this sovereignty? We think they are not, and that they are not included, and were not intended to be included, under the word “citizens” in the Constitution, and can therefore claim none of the rights and privileges which that instrument provides for and secures to citizens of the United States. On the contrary, they were at that time considered as a subordinate and inferior class of beings, who had been subjugated by the dominant race, and, whether emancipated or not, yet remained subject to their authority, and had no rights or privileges but such as those who held the power and the Government might choose to grant them. “

Nevertheless,  today’s Supreme Court hearing didn’t deal with the question of whether the zygote/embryo /fetus is human enough. It dealt with the regulations for abortion businesses and the doctors who work for them. These are essentially the same rules imposed on Federally Qualified Healthcare Centers.

Doctors must offer continuing care and the buildings should allow safe egress and sanitary standards of care.  The challenge is against State protections for the women who have chosen abortion.

Posted from WordPress for Android. Typos will be corrected!

I’m quoted in Houston Chronicle about Supreme Court hearing

By 7 PM, there was a line of people setting up to spend the night in front of the Supreme Court of the United States building. They hope to be able to watch the Court proceedings on Wednesday when the Texas abortion law, HB2.

Here’s the coverage from Brian Rosenthal of the Houston Chronicle, about Texans, like me, who travelled to DC for the hearing. I’m quoted as ‘helpful about the future of the law in the last few paragraphs.

Beverly Nuckols, 60, a New Braunfels family doctor who flew in for the arguments, said she was happy that a long and just process finally could be coming to an end.

Nuckols said was hopeful about the ruling because she was confident in the law.

“I believe we will get a tie,” she said.

Jury Indicts Two Antiabortion Activists Linked to Planned Parenthood Videos – WSJ

Ethics 101: The man and woman who were indicted for their actions exposing the harvesting of baby parts by Planned Parenthood were doing our duty to protect the right to life.

Rights impose duties on third parties, privileges do not.

Abortion, especially elective abortion of healthy babies in healthy mothers, is not a right. It is an illicit privilege granted by an act of law. No one has a duty to enable or act to cause an elective abortion at the request of a woman.

It is an “illicit” privilege, since the right not to be killed is an inalienable right. Each of us in society has a duty imposed by that right to prevent its infringement.

http://www.wsj.com/articles/grand-jury-indicts-2-anti-abortion-activists-linked-to-planned-parenthood-videos-1453761641

Edited 1/27/16 to clean up grammar and add links. BBN

Texas Advance Directive Act: What the lawyers really want

I’ll admit that I’m not a lawyer and have to do my homework to even attempt to understand lawyer-speak. (For example, see this definition of “Abatement”) How I wish more lawyers would admit they aren’t doctors, especially when they accuse doctors and entire hospital committees of killing patients.

Earlier this week, I reviewed the latest sensationalized case involving lawyers and lawyer-lobbyists playing doctor in the media and courts to overturn Section 166.046 of the Texas Advance Directive Act (“TADA”).

TADA outlines the process to settle disputes between an attending physician and the patient (or the family of a patient) when the medical judgment of the doctor about what is medically appropriate for the patient conflicts with the demands for treatment that the patient or family wants *that* particular doctor to perform.

Texas law prohibits the removal of “artificially administered nutrition and hydration” and pain medications unless the doctors determine they will cause further harm. However, a ventilator, intubation tubes in the throat, cardio-version (CPR), surgery and invasive procedures or tests are not ordinary or comfort care and are considered “life-sustaining” treatment that may be removed or withheld from a patient with a terminal disease if the patient’s doctor determines that are not medically appropriate. There is certainly no provision in Texas law to intentionally stop a patient’s breathing or to otherwise cause certain death.

The lawyers lobbying and suing against TADA admit in both public statements and legal complaints that they will settle for nothing less than “Due Process,” lawyer-speak reference to the Fourteenth Amendment clause, “due process of law.” They demand that every dispute about medically appropriate care between doctors and patients be argued – by lawyers – in court, preferably with a risk of “liability” for the doctor, any committee member who reviews the case under TADA, and the hospital where the patient is under care. Judges, and possibly juries, would determine the local medical standard of care, which medical procedures are appropriate for which patients, and liability. Lawyers and judges would essentially practice medicine instead of doctors.

To summarize this latest case, court records document** the affidavit from the attending physician of a 46 year old Pasadena, Texas man, Chris Dunn. Mr. Dunn was admitted to the ICU at Houston’s Methodist hospital unresponsive after a major gastrointestinal bleed due to metastatic pancreatic cancer led to his emergency transfer from a hospital in his hometown. Mr. Dunn was on a ventilator and suffering from liver, kidney, and respiratory failure. He had fluid in his lungs, necessitating higher and higher pressures on the ventilator. He had fluid leaking into the abdominal cavity due to the liver failure, ascites, that required intermittent draining. He also suffered from hepatic encephalopathy, a form of variable dementia and delirium.  His doctors and his father agreed that the repetitive, invasive treatments necessary to maintain the ventilator and treat the multi-organ failure should be stopped because they were causing Mr. Dunn harm, while comfort care would continue.

In their lawsuit against the hospital, a group of lawyers brought in by Mr. Dunn’s mother and Texas Right to Life sued the hospital in Mr. Dunn’s name, although there was a question about both Mr. Dunn’s ability to legally consent and the legal status of either parent alone to make medical decisions on Mr. Dunn’s behalf. In fact, the court ruled an “Abatement” or suspension of the lawsuit on December 4, 2015, until the legal guardianship for Mr. Dunn could be settled in another court. And, sadly, in spite of continued treatment in the Intensive Care Unit, on a ventilator, with IV and tube feedings, and all the repetitive blood tests, suctioning, and invasive procedures these treatments required, Mr. Dunn succumbed to his disease before that other court could meet to name a guardian.

In their lawsuit against the hospital, the lawyers even accuse “the facility” (not the attending doctor) of planning to actively euthanize Mr. Dunn by the deliberate use of injections intended to cause his death, rather than to relieve his pain:

“Defendant scheduling . . . and Defendant administering, via injection, a combination of drugs which will end his life almost immediately, thus warranting immediate intervention by this court.” (**p.2)

The lawyers further declared that the doctors and the Methodist Biomedical Ethics Committee – and every doctor or hospital committee – would be corrupted by their affiliation with the hospital:

“The statute does not provide adequate safeguards to protect against the conflict of interest inherently present when the treating physician’s decision is reviewed by the hospital “ethics committee” to whom the physician has direct financial ties.
“Texas Health and Saftey [sic] Code violates Plaintiff’s right to procedural due process by failing to provide an adequate venue for Plaintiff and those similarly situated to be heard in this critical life-ending decision. The law also fails to impose adequate evidentiary safeguards against hospitals and doctors by allowing them to make the decision to terminate life-sustaining treatment in their own unfettered discretion.” (**pp. 5,6)

And,

“Under Tex. Health and Safety Code 166.046, a fair and impartial tribunal did not and could not hear Dunn’s case. “Ethics committee” members from the treating hospital cannot be fair and impartial, when the propriety of giving Dunn’s expensive life-sustaining treatment must be weighed against a potential economic loss to the very entity which provides those members of the “ethics committee” with privileges and a source of income.” (**p. 7)

 

Lawyer-speak notwithstanding, I can’t figure out – and the lawyers don’t tell us – how to ensure that “unfettered” pancreatic cancer presenting with multi-organ failure followed “due process” in Mr. Dunn’s case. Other than lawyers from each side hiring and paying even more doctors to re-examine the patient and re-view the existing medical records, repeated clinical exams and nurses’ notes, lab work and non-invasive scans of the liver and abdomen, what would a judge or jury consider “evidentiary safeguards against doctors and hospitals?”

But in news article after blog post, lawyers (but no doctors) claimed that “the hospital wanted to kill” Mr. Dunn.  Lawyers (but no doctors) claimed there were un-named additional tests and treatments which could have changed the diagnosis, treatment or prognosis. Lawyers (but no doctors) disputed the medical judgment of the very doctors from whom the lawsuit demanded continued intensive care.

In their lawsuit, the lawyers also declared that, “Members of a fair and impartial tribunal should not only avoid a conflict of interest, they should avoid even the appearance of a conflict of interest, especially when a patient’s life is at stake.” (*p. 7) But that didn’t stop them from including an ironic and self-serving demand that Methodist hospital pay their “Attorney fees and costs.” (p. 12)

**(Protected “.pdf” “Images” of the original legal documents quoted below can be found online, here.  The document images aren’t link-able and can’t be copied or printed, so I will have to type up and share quotes. See Family case number 2015-69681. The quotes above are from document number 6796448.pdf, “Plaintiff’s Original Verified Petition and Application for Temporary Restraining Order and Injunctive Relief.”)

Texas Advance Directive Act, when the doctor refuses

Here’s Section 166.046 of the Texas Advance Directive Act,  the part of Texas Law that is in the news, these days. This part only applies when there is a disagreement between the doctor (whom the patient wants to continue treatment) and the patient or his surrogate about treatment decisions.

Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR TREATMENT DECISION. (a) If an attending physician refuses to honor a patient’s advance directive or a health care or treatment decision made by or on behalf of a patient, the physician’s refusal shall be reviewed by an ethics or medical committee. The attending physician may not be a member of that committee. The patient shall be given life-sustaining treatment during the review.

(b) The patient or the person responsible for the health care decisions of the individual who has made the decision regarding the directive or treatment decision:

(1) may be given a written description of the ethics or medical committee review process and any other policies and procedures related to this section adopted by the health care facility;

(2) shall be informed of the committee review process not less than 48 hours before the meeting called to discuss the patient’s directive, unless the time period is waived by mutual agreement;

(3) at the time of being so informed, shall be provided:

(A) a copy of the appropriate statement set forth in Section 166.052; and

(B) a copy of the registry list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer or to assist in locating a provider willing to accept transfer that is posted on the website maintained by the department under Section 166.053; and

(4) is entitled to:

(A) attend the meeting;

(B) receive a written explanation of the decision reached during the review process;

(C) receive a copy of the portion of the patient’s medical record related to the treatment received by the patient in the facility for the lesser of:

(i) the period of the patient’s current admission to the facility; or

(ii) the preceding 30 calendar days; and

(D) receive a copy of all of the patient’s reasonably available diagnostic results and reports related to the medical record provided under Paragraph (C).

(c) The written explanation required by Subsection (b)(4)(B) must be included in the patient’s medical record.

(d) If the attending physician, the patient, or the person responsible for the health care decisions of the individual does not agree with the decision reached during the review process under Subsection (b), the physician shall make a reasonable effort to transfer the patient to a physician who is willing to comply with the directive. If the patient is a patient in a health care facility, the facility’s personnel shall assist the physician in arranging the patient’s transfer to:

(1) another physician;

(2) an alternative care setting within that facility; or

(3) another facility.

(e) If the patient or the person responsible for the health care decisions of the patient is requesting life-sustaining treatment that the attending physician has decided and the ethics or medical committee has affirmed is medically inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). This subsection does not authorize withholding or withdrawing pain management medication, medical procedures necessary to provide comfort, or any other health care provided to alleviate a patient’s pain. The patient is responsible for any costs incurred in transferring the patient to another facility. The attending physician, any other physician responsible for the care of the patient, and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after both the written decision and the patient’s medical record required under Subsection (b) are provided to the patient or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g), except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would:

(1) hasten the patient’s death;

(2) be medically contraindicated such that the provision of the treatment seriously exacerbates life-threatening medical problems not outweighed by the benefit of the provision of the treatment;

(3) result in substantial irremediable physical pain not outweighed by the benefit of the provision of the treatment;

(4) be medically ineffective in prolonging life; or

(5) be contrary to the patient’s or surrogate’s clearly documented desire not to receive artificially administered nutrition or hydration.

(e-1) If during a previous admission to a facility a patient’s attending physician and the review process under Subsection (b) have determined that life-sustaining treatment is inappropriate, and the patient is readmitted to the same facility within six months from the date of the decision reached during the review process conducted upon the previous admission, Subsections (b) through (e) need not be followed if the patient’s attending physician and a consulting physician who is a member of the ethics or medical committee of the facility document on the patient’s readmission that the patient’s condition either has not improved or has deteriorated since the review process was conducted.

(f) Life-sustaining treatment under this section may not be entered in the patient’s medical record as medically unnecessary treatment until the time period provided under Subsection (e) has expired.

(g) At the request of the patient or the person responsible for the health care decisions of the patient, the appropriate district or county court shall extend the time period provided under Subsection (e) only if the court finds, by a preponderance of the evidence, that there is a reasonable expectation that a physician or health care facility that will honor the patient’s directive will be found if the time extension is granted.

(h) This section may not be construed to impose an obligation on a facility or a home and community support services agency licensed under Chapter 142 or similar organization that is beyond the scope of the services or resources of the facility or agency. This section does not apply to hospice services provided by a home and community support services agency licensed under Chapter 142.

Added by Acts 1999, 76th Leg., ch. 450, Sec. 1.03, eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 1228, Sec. 3, 4, eff. June 20, 2003.

Amended by:

Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0503, eff. April 2, 2015.

Acts 2015, 84th Leg., R.S., Ch. 435 (H.B. 3074), Sec. 5, eff. September 1, 2015.