Assessment of competency for execution? A guide for mental health professionals

Assessment of competency for execution presents two compelling ethical questions for mental health professionals: whether clinicians can ethically provide such assessment, and if so, how it should be done in order to maximize quality and minimize ethical conflict. In this article we address the issue of whether to participate and, if so, how. The question of whether to participate is discussed by summarizing the arguments for and against participation and offering guidelines for making a decision. The question of how to proceed is discussed in two contexts: preadjudication (before a formal decision about competency) and postadjudication (following a determination of "incompetent" and transfer of the offender to another facility for treatment and further assessment). Finally, recommendations are made regarding research that would improve the quality of execution competency assessments.     

Cyprus: Federation Under International Safeguards

Constitutional engineering to overcome ethnoregional cleavagesis being put to a severe test on Cyprus, where Greek and Turkishcommunities haltingly endeavor to salvage a divided state Threeyears after independence in 1960, the attempt to govern throughfunctional federalism ended in civil war. Intervention by Greeceand Turkey in 1974 resulted in a de facto partitioning of therepublic into two ethnically homogeneous areas. Under UnitedNations auspices, communal elites bargain for a consociationalsettlement, balancing national autonomy and individual rights.The solution requires international safeguards guaranteeinga new constitution and providing for "free cities" under a bicommunaladministration. Failure of the international community to actwill lead to a partitionist solution as manifested by a growingacceptance of Turkish Cypriot statehood.     

The Medicare secondary payor provisions: possible rewards and pitfalls

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.