Recovering from the Effects of Domestic Violence: Implications for Welfare Reform Policy

This article highlights the importance of understanding how the impact of domestic violence renders participation in welfare‐to‐work programs highly problematic since the symptoms of post‐traumatic stress disorder (a not uncommon outcome of domestic violence experience) can undermine the victim's best efforts to benefit from training and return to work programs. A short history of PTSD is provided with the cautionary note that definitions of PTSD remain in flux. Sub‐categories of PTSD, such as Battered Women's Syndrome, are also reviewed. Recovery from PTSD is not described in psychotherapeutic terms, but in rehabilitative terms with an emphasis on those recovery processes which facilitate restoration of psychological and functional capacities, leading to participation in welfare‐to‐work or retraining programs with labor market participation as the goal.     

Gainsharing: a call for guidance

Gainsharing is a device by which hospitals and physicians share in the development, implementation, and proceeds resulting from the mechanisms to make the provision of healthcare more efficient and cost effective. The goal of gainsharing programs is to save hospitals money while maintaining the same or better quality of care--a goal that will ultimately result in both better care and lower expenses for payors and for society as a whole. Nevertheless, the OIG has ruled that gainsharing programs are per se illegal. This Article analyzes the reasons behind the OIG's determination and argues that, contrary to the OIG's conclusion, the advisory opinion process is legally and practically the best way to deal with the issues raised by gainsharing programs.     

Therapeutic misadventure. An 11-year study from a metropolitan coroner's office

"Therapeutic misadventure" and its alternative forms is a controversial, though necessary, manner of ruling deaths that result from unexpected complications of medical procedures. Such cases must be brought to the attention of the medical-legal office so that they are thoroughly investigated and documented, and so that appropriate and consistent rulings are made. While it is not generally agreed that a ruling of therapeutic misadventure implies medical negligence, a number of such cases do become the bases for litigation. During an 11-year period in a metropolitan coroner's office that examines about 2,000 cases yearly, 44 cases were ruled therapeutic misadventure, an incidence of 0.46%. A recent increase in such cases is probably the result of improved case finding and investigation. The largest category was that of surgical complications, followed, in order, by complications of anesthesia and of therapeutic and diagnostic procedures, and by drug reaction. No case occurred in ambulatory surgery. There apparently has been a low incidence of attendant lawsuits. The study of cases of therapeutic misadventure is potentially of great value in identifying outcomes and trends, and for the prevention of such cases in the future.