Method for evaluating and establishing reimbursement rates for health care services authorized under the Indian Health Service contract health services regulations--selected IHS sites--IHS. Addition of sites to the IHS pilot project

The Indian Health Service (IHS) issues this notice to inform the public that additional sites will be added to the IHS Pilot Project now being conducted in the Portland Area. This Pilot Project is to determine whether an alternative method of evaluating and establishing reimbursement rates for contract health services (CHS) will result in greater participation and lower cost to the IHS. The additional sites include the Alaska Native Medical Center and other selected locations within the Alaska Area IHS; the metropolitan Billings, Montana vicinity and other selected locations within the Billings Area IHS; and the Cherokee Service Unit, within the Nashville Area IHS.     

Indian Health Service; statement of organization, functions, and delegations of authority--PHS

Part H, chapter HG (Indian Health Service) of the Statement of Organization, Functions, and Delegations of Authority of the Department of Health and Human Services, Public Health Service (PHS), chapter HG, Indian Health Service (IHS), 52 FR 47053-67, December 11, 1987, as most recently amended at 56 FR 22015-16, May 13, 1991, is amended to reflect the establishment of an organizational substructure for the Bemidji Area Office to more accurately reflect current activities in the Area Office.     

Essential medicolegal death investigation services: standardization of a survey instrument based on the Essential Public Health Services

The National Academy of Sciences recommends that states assess the performance of medicolegal death investigation agencies. To aid in performance assessment, we adapted an instrument based on the CDC's 10 Essential Public Health Services by translating the terminology to that of essential medicolegal death investigation services. This produced a survey that could be used to standardize reporting practices and services of agencies. To validate the instrument, a stratified random sample of 12 death investigation chiefs in 12 states was interviewed. This sample represented both medical examiner and coroner jurisdictions within the varying medicolegal structures. A cognitive testing process elicited how well participants could respond to and interpret the survey questions. The response was favorable in that the respondents agreed that given specific revisions toward question clarification, the instrument would be a useful and relevant tool for assessing system performance.     

In the Best Interests of an Indian Child: The Indian Child Welfare Act

Before passage of the Indian Child Welfare Act in 1978, state, private, and federal agencies systematically removed Indian children from their families and tribal communities, placing them with non‐Indian families with little appreciation for the detrimental impact that cultural deprivation would have on these children. State courts often ignored the sovereign authority of tribal courts with regard to their children, and were, more often than not, unwilling to acknowledge the importance of the perspective of the child's tribe and/or extended family members. With passage of the Indian Child Welfare Act in 1978, Congress imposed upon state child welfare practices substantive and procedural requirements to which state courts must adhere, most notably the mandate that state courts must now give primary consideration to the placement of Indian children within their extended families and tribal communities. In addition, federal law requires state courts to recognize tribal court authority and jurisdiction over tribal children. This article reviews the history of federal, state, and private practices that propelled Congress to pass the ICWA, the changes that have resulted from this vital legislation, and the challenges that face courts in ensuring that state courts meet these requirements.     

Indian Self-Determination and Education Assistance Act amendments--BIA, IHS. Notice of proposed rulemaking

The Secretaries of the Department of Interior (DOI) and the Department of Health and Human Services (DHHS) propose a joint rule to implement section 107 of the Indian Self-Determination Act, as amended, including Title I, Public Law 103-413, the Indian Self-Determination Contract Reform Act of 1994. A joint rule, as required by section 107(a)(2)(A)(ii) of the Act, will permit the Departments to award contracts and grants to Indian tribes without the unnecessary burden or confusion associated with having two sets of rules for single program legislation. In section 107(a)(1) of the Act Congress delegated to the Departments limited legislative rulemaking authority in certain specified subject matter areas, and the joint rule addresses only those specific areas. As required by section 107(d) of the Act, the Departments have developed this proposed rule with active tribal participation, using the guidance of the Negotiated Rulemaking Act.     

Sudden infant death syndrome: diagnostic practices and investigative policies, 2004

Using a 2004 population-based survey of all US medical examiner and coroner offices, we examined the characteristics of offices accepting an infant death case and calculated the percentage of offices that had death scene investigation or autopsy policies for the investigation of sudden unexpected infant death (SUID). We also calculated the percentage of offices that used and did not use sudden infant death syndrome (SIDS) as a cause of death, and we compared differences in characteristics among those offices.Of medical examiner and coroner offices, 52% did not report an infant death in 2004. Of the 7957 infant deaths reported, 43% occurred in jurisdictions that experienced 1 or 2 infant deaths. Of the offices that used SIDS as a classification, 34% did not have policies for conducting death scene investigations and autopsies for SUID. At least 5% of offices that reported an infant death did not use SIDS as a cause of death classification. These findings have important implications for understanding recent trends in SIDS and SUID. Supporting the implementation of national standards for investigating and certifying infant deaths could provide guidelines for consistent practices in medical examiner and coroner offices.     

A functional approach to sudden unexplained infant deaths

There is a great deal of variation in the methods and wording used by medical examiners in the medicolegal investigation and certification of infant deaths. This paper was created by the NAME Ad Hoc Committee on Sudden Unexplained Infant Death to address several specific issues, namely: * To establish a functional approach to the investigation of sudden unexplained infant deaths; * To outline a "bare minimum" set of recommendations to define the scope of investigation required; * To recommend methods and wording to be used when certifying infant deaths; * To develop a list of potential stressors or possible external causes of death that should be identified and reported on the death certificate and/or within a medical examiner/coroner office database. This paper was electronically posted for NAME member review and comment for a period of 30 days. The paper was further revised based on member comments and then submitted to the NAME board of directors in the fall of 2005 prior to the annual meeting. This text of this paper was officially approved and endorsed by the NAME board of directors on October 14, 2005, at the annual meeting in Los Angeles, CA.     

Perceptions of the Process: Indian Gaming as it Affects Federal Tribal Acknowledgment Law and Practices*

This paper places federal acknowledgment practices within a context of expanding Indian gaming. It argues that gaming has changed the discourses around tribal acknowledgment in the general public, at the Bureau of Indian Affairs, and in inter‐ and intra‐tribal politics. Ethnographic and archival research show that, while gaming has proven to be a highly effective development strategy, it has also given rise to backlash against, and suspicion towards, Indian groups seeking recognition of their tribal status. The intersection of acknowledgment practices with public perceptions about Indian gaming has resulted in an increased politicization of the administrative process for federal recognition.     

Memorandum of understanding between the Food and Drug Administration and the Indian Health Service--FDA. Notice

The Food and Drug Administration (FDA) is providing notice of a memorandum of understanding (MOU) between FDA and the Indian Health Service (IHS). The purpose of the MOU is to develop a more cohesive relationship to mutually address American Indian and Alaska Native issues within the context of each organization's jurisdiction.     

Indian Health Service; method for evaluating and establishing reimbursement rates for health care services authorized under the Indian Health Service contract health service regulations--Portland area--PHS. General notice

Indian Health Service (IHS) issues this General Notice to inform the public that IHS will conduct a pilot project in the Portland Area, IHS, to determine whether an alternative method of evaluating and establishing reimbursement rates for contract health services (CHS) will result in greater participation by health care providers and lower costs to IHS. The pilot project is limited to the Portland Area, and does not affect the present methods of evaluating and establishing reimbursements rates and awarding contracts for health care services in other IHS Areas. In addition, the pilot project does not change the current IHS payment policy requirement that health care services be procured at rates which do not exceed prevailing Medicare rates.     

Tribal law enforcement authority to enforce state laws

This paper summarizes the current status of the ability of tribal law enforcement officers to enforce state law in all states that have Indian country – defined in 18 U.S.C. § 1151 as any Indian reservation, dependent Indian communities, or Indian allotments – within their borders. It is important to understand the current status of those officers as their agencies look to improve public safety in their nations. First, for context, we provide a brief background on tribes and tribal law enforcement. Then, we present a summary of the legal jurisdictional challenges faced by tribal law enforcement. Finally, we analyze the current status of tribal law enforcement officers in each state and conclude with a summary and concluding remarks.     

Redesignation of Contract Health Service Delivery Area--Indian Health Service, HHS. Final notice

This notice advises the public that the Indian Health Service (IHS) is redesignating the geographic boundaries of the Contract Health Service Delivery Area (CHSDA) for the Grand Traverse Band of Ottawa and Chippewa Indians ("The Band"). The Grand Traverse CHSDA was comprised of Leelanau County in Michigan. This county was designated as the Band's CHSDA when the IHS published its updated list of CHSDAs in the Federal Register of January 10, 1984 (49 FR 1291). The redesignated CHSDA is comprised of six counties in the State of Michigan, i.e., Leelanau, Antrim, Benzie, Grand Traverse, Manistee, and Charlevoix. This notice is issued under authority of 43 FR 34654, August 4, 1978.     

中国国际海底区域开发立法探析

"区域"开发对国家具有重要的战略意义,但我国缺乏调整"区域"开发的国内立法。法律的缺失于我国"区域"开发的发展不利,也无助于我国在国际海底管理局及有关规章的制定中发挥更大作用,更有可能引发国家责任。以《联合国海洋法公约》为主体的"区域"法律制度,为我国"区域"开发立法提供了法律依据,也为我国"区域"开发立法应遵循的原则提供了指引。采用专门立法来调整"区域"内的活动是国际上通行的模式,也更加符合我国的实际情况,因而应为我国所采纳,以推动我国履行该《公约》赋予的义务,提升我国在"区域"国际法规则制定中的话语权,规范我国在"区域"内的活动,维护与拓展我国在"区域"的利益。     

Indian health--PHS. Proposed rule

The Department of Health and Human Services (HHS) is proposing to make technical amendments to Indian Health Service (IHS) grant regulations to make them conform to HHS regulations on grant administration, thereby eliminating duplication and conflict within the regulations.     

Medicolegal death investigator workplace safety hazards: A scoping review of the literature

In the United States, medicolegal death investigation practices and policies pertaining to sudden unexpected deaths are mandated by state government. Practices vary across states, which contributes to inconsistency in job prerequisites and training. In preparation for a study focused on occupational safety and health of medicolegal death investigators in their on-scene and follow-up activities, a scoping review was conducted to document known occupational safety risks and health-related conditions associated with death investigation. Searches used Boolean and subject heading operators both broad and narrow in scope, and search terms included scene responder, hazard, investigator, forensic pathology, injury, and safety. Twenty-five articles met inclusion criteria, which included seventeen survey-mixed method designs, two systematic reviews, five quasi-experimental designs, and one case study. Twelve articles addressed mental health and eleven focused on risks associated with infectious disease. One article addressed the risk of chemical exposure from cyanide among autopsy personnel (including forensic pathologists) and nine included a wide range of employees within the setting of medical examiner or coroner offices. One article, addressing burnout, included employees in a forensic science laboratory setting as well as medicolegal death investigators and two articles included forensic pathologists and medicolegal death investigators. Only one article addressed medicolegal death investigators specifically. Articles addressing occupational and environmental hazards of medicolegal death investigators associated with musculoskeletal, respiratory, cardiovascular, radiological, nuclear, electrical, or explosive threats were not identified. There is little published about safety risks inherent in conducting death investigations. Research is needed to adequately inform health promotion and injury prevention strategies.     

Medical Terminology Coding Systems and Medicolegal Death Investigation Data: Searching for a Standardized Method of Electronic Coding at a Statewide Medical Examiner’s Office*

Abstract: Medical examiner and coroner reports are a rich source of data for epidemiologic research. To maximize the utility of this information, medicolegal death investigation data need to be electronically coded. In order to determine the best option for coding, we evaluated four different options (Current Procedural Terminology [CPT], International Classification of Disease [ICD] coding, Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], and an in‐house system), then conducted internal and external needs assessments to determine which system best met the needs of a centralized, statewide medical examiner’s office. Although all four systems offer distinct advantages and disadvantages, SNOMED CT is the most accurate for coding pathologic diagnoses, with ICD‐10 the best option for classifying the cause of death. For New Mexico’s Office of the Medical Investigator, the most feasible coding option is an upgrade of an in‐house coding system, followed by linkage to ICD codes for cause of death from the New Mexico Bureau of Vital Records and Health Statistics, and ideally, SNOMED classification of pathologic diagnoses.     

Variability in cancer death certificate accuracy by characteristics of death certifiers

Death certificates are the source for mortality statistics and are used to set public health goals. Accurate death certificates are vital in tracking outcomes of cancer. Deaths may be certified by physicians or other medical professionals, coroners, or medical examiners. Idaho is one of 3 states that participated in a Centers for Disease Control and Prevention-funded study to assess the concordance between cancer-specific causes of death and primary cancer site among linked cancer registry/death certificate data. We investigated variability in the accuracy of cancer death certificates by characteristics of death certifiers, including certifier type (physician vs coroner), physician specialty, years of experience as death certifier, and number of deaths certified. This study showed significant differences by certifier type/physician specialty in the accuracy of cancer mortality measured by death certificates. Nonphysician coroners had lower accuracy rates compared with physicians. Although nonphysician coroners certified less than 5% of cancer deaths in Idaho, they were significantly less likely to match the primary site from the cancer registry. Results from this study may be useful in the future training of death certifiers to improve the accuracy of death certificates and cancer mortality statistics.     

联合国国际公约对死刑的规定及中国的应对

联合国自成立以来一直关注死刑的问题，先后通过了一系列国际公约与会议决议，尤其2007年“暂停死刑执行”决议的通过，对世界死刑废止进程产生了实质性的影响。中国作为联合国常任理事国之一，仍然在法律中保留着死刑以及实际执行死刑。如何应对死刑废止全球化的趋势，是刑法学界与司法界共同面临的问题。应从联合国公约决议关于死刑规定的流变入手，在解读相关条约决议的内容基础上，结合中国实际提出刑事立法与司法上应对策略。     

Legitimizing American Indian Sovereignty: Mobilizing the Constitutive Power of Law through Institutional Entrepreneurship

Extensive sociolegal scholarship has addressed the utility of law as a mechanism through which marginalized groups may promote social change. Within this debate, scholars employing the legal mobilization approach have thus far highlighted law's indirect impact, beyond the formal arenas of law, via effects on the "legal consciousness" of reformers and would-be reformers. This article contributes to this debate, and the legal mobilization framework in particular, by theoretically identifying and empirically documenting ways through which the constitutive power of law may be effectively used by challengers to more directly pursue changes in institutionalized practices themselves. The article examines the strategic use of law by a set of American Indian tribal leaders in the state of Washington who, over a 13-year period, consciously meshed or "cohered" legal and extrajudicial efforts to gain recognition of their sovereign political status. Through a mode of agency known as "institutional entrepreneurship," they utilized the multiplicity of law and exploited resources and opportunities inhering within the state itself, but outside the courts. In the context of ambiguous legal precedent and widespread local challenges to tribal rights, they mobilized latent discourses of federal Indian law that legitimated the sovereign governmental status of tribes. Importantly, they circulated tribal sovereignty discourses well beyond the field of law, but through the authoritative activity and voice of the state, and in doing so, generated a precedent-setting recognition of tribal sovereignty.