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.     

Fiji: country profile

Fiji is a country consisting of 300 South Pacific islands, of which the largest is Vitu Levu, which includes the capital, Suva. The islands are home to 700,000 people, of whom 50% are Indian, 46% Melanesian, and the rest Chinese or European. The official language is English, and the major religions are Hinduism and Christianity. Literacy is 79% for men and 64% for women, whose status is generally low in this patriarchal society. Infant mortality is 27/1000 live births, but life expectancy is 70 years. The British began sending missionaries and manufactured goods in the early 1800s and annexed the islands in 1874 as a source of sugar, for which they expropriated the land and imported the Indians as agricultural workers. Sugar remains the largest export along with coconut oil, gold, and timber. Manufactured goods, food, fuel, and chemicals are imported, and the national debt is over $200 million. Foreign investment, mostly by Australia, is $13.2 million. Inflation is 20%; 200,000 people are unemployed, and poverty is general except for the urban elite. The Fijian dollar is worth US. 80. Independence, granted in 1970, replaced colonial control with military governments, currently that of Colonel Rambuka, who refused to allow a democratically elected government to take office. Faced with a declining economy and the political power of the fascist Taukei movement, the Indians, who had been the shopkeepers, craftsmen and bureaucrats during the later period of colonial rule, have been emigrating en masse.     

Swaziland: country profile

Although Swaziland had been independent from colonialism for 20 years, a powerful monarch, King Mswati II, continues to control the country's political, religious, and social system. Swaziland has a population of 676,000, half of whom are under 15 years of age. The infant mortality rate is 105/1000 live births and 25% of children die before they reach their 5th birthday. Life expectancy is 54 years. Tribal chiefs, representing the king, hold and distribute about half of the national land. Most of the fertile land remains in the hands of white settler farmers. The concentration of income in foreign companies and urban centers has exacerbated poverty in rural areas. Depreciation of rand-linked local currency has boosted export earnings, but it has also raised the price of food and medical imports. Swaziland's main exports are sugar, wood pulp, chemicals, and fruit, most of which go to the UK and South Africa. The major food crops are maize, beans, groundnuts, and sorghum. About half of the working population is engaged in small-scale subsistence farming, but food yields are declining. The major producers are foreign companies attracted by Swaziland's low taxes and cheap labor supply.     

The transition of migratory patterns in medium-sized cities

"The authors attempt to present some empirical findings regarding a phenomenon which they chose to call the 'transition in migratory patterns'.... The general hypothesis states that: changes in migratory patterns are due to an interaction between those economic, political and social processes which affect the distribution of the population; and that this interaction is also highly influenced by macroeconomic politics--an arena where technology plays a dominant role." Data are for Guadalajara and the state of Jalisco in Mexico. (SUMMARY IN ENG)     

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.