The MacArthur Treatment Competence Study. II

This article reports the development and psychometric properties of three standardized and objectively scored measures, the MacArthur Treatment Competence Research Instruments. They were designed to assess abilities related conceptually to four legal standards for competence to consent to treatment: understanding, appreciation, rational manipulation (reasoning), and expressing a choice. Scoring reliability, internal consistency, intertest correlations, and test-retest correlations were examined with data from samples of hospitalized patients with schizophrenia, major depression, and ischemic heart disease, as well as matched non-ill community samples. The results indicate very good interscorer reliability and provide guidance for the use of the instruments and interpretation of their results in future research on patients' decisional abilities in treatment contexts.     

Issues raised by respiratory therapy arrangements

In large part due to the foregoing issues, Medicare program officials have focused on respiratory therapy as an area with great potential for abuse, and may well introduce significant reforms in the near future. Accordingly, any contractual arrangements for respiratory therapy programs of the type discussed above should be carefully reviewed for compliance with Medicare requirements and for a realistic assessment of the parties' potential exposure to liability under the anti-kickback statute. At a minimum, these agreements should provide for short "without cause" termination provisions, or include a so-called "jeopardy" provision that permits the parties to renegotiate or terminate their contract if significant changes occur in, or if the current arrangement is found or threatened to be found to violate, applicable law.     

As outcomes measurement and management become widespread, providers should beware of legal pitfalls

Until new statutes and court decisions clarify the law applicable to outcomes research, providers will continue to face new questions. In the meantime, paying careful attention to satisfying the requirements of existing laws protecting peer review information will put providers in the best position to minimize their exposure. Providers should review their current outcomes measurement and management systems to ensure that (1) they are structured to take full advantage of the confidentiality protections available under state law, and (2) appropriate access to outcomes data for those who need it is clearly provided for in the relevant documentation.     

Special report on reimbursement. HCFA enacts new enforcement remedies covering nursing facilities

While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come.     

The HIV-infected health care provider. Doe v. Attorney General of the United States

Doe demonstrates that once an employer enters into a relationship with an individual and thereafter determines that he or she may be disabled, the employer has the right to ask the individual questions about the possible disability when those questions are relevant to assessing his or her qualifications for continuing on the job. In fact, once a health care provider is on notice that an employee's or physician's disability may render the employee or physician no longer qualified, thereby potentially endangering patients, the provider is required to determine whether the person is qualified for the job. In these sensitive matters, employers must draw a fine line between unreasonably following up on every rumor on the one hand, and on the other hand investigating reliable information when there may indeed be a direct threat to patients.     

From underworld to underground

In the West economically motivated crime is usually perceived as a matter for the police while the performance of the economy is a matter for the political authorities. This paper argues that the growth and evolution of the modern underground economy has made such a distinction obsolete. Not only have the frontiers between the legitimate and the criminal sectors of the economy blurred, but the distinction between the explicitly criminal and the merely informal aspects of the modern underground economy has become largely meaningless. Given the tremendous growth of underground activity, this means that the issue must now be addressed not just on the enterprise level, as a police matter, but on the level of the economy as a whole, by economic policy makers. This in fact is something that many developing countries long ago realized. The paper therefore asks whether developing countries have been any more successful in using monetary, fiscal and balance of payments policy to mitigate the adverse social and economic impact of widespread underground economic activity than have Western countries who have relied mainly on the sanction of criminal law. It concludes that both approaches are deficient in so far as they neglect the degree to which modern underground activity can no longer be seen as a manifestation of deviant economic behavior so much as a virtual economic insurgency against the status quo distribution of income and wealth and the codes of economic behavior which accompany it. However dramatic are the financial manifestations of the spread of enterprise crime, ultimately the challenge it poses must be addressed as the political and ideological level.     

A. reviews: general

WARFARE IN THE LATIN EAST, 1192–1291. By CHRISTOPHER MARSHALL. (Cambridge Studies in Medieval Life and Thought, fourth series, 17.) Cambridge, Cambridge University Press, 1992. xiv, 290pp. 7 figures, 9 plates.

MINORITES RELIGIEUSES DANS L'ESPAGNE MEDIEVALE [ = Revue du Monde Musulman et de la Méditerranée, 63–4]. Aix‐en‐Provence, Edisud, 1992. 292 pp. 150FF.

THE TRANSMISSION OF KNOWLEDGE IN MEDIEVAL CAIRO. By JONATHAN BERKEY. Princeton, Princeton University Press, 1992. x, 238pp. $39.50.

PRAGMATISM IN THE AGE OF JIHAD: THE PRECOLONIAL STATE OF BUNDU. By MICHAEL A. GOMEZ. Cambridge, Cambridge University Press, 1992. xiii, 252 pp. £35.00.

THE CHURCH OF THE EAST AND THE CHURCH OF ENGLAND. A HISTORY OF THE ARCHBISHOP OF CANTERBURY'S ASSYRIAN MISSION. By J.F. COAKLEY. Oxford, Clarendon Press, 1992. £45.00.

WOMEN, ISLAM AND THE STATE. By DENIZ KANDIYOTI. London, Macmillan, 1991. 271pp. + index.

MARRIAGE ON TRIAL: A STUDY OF ISLAMIC FAMILY LAW. By ZIBA MIRHOSSEINI. (Society and Culture in Modern Middle East Series.) London, I.B. Tauris, 1993. 200 pp. + notes and index.

WOMEN IN THE MIDDLE EAST: PERCEPTIONS, REALITIES AND STRUGGLES FOR LIBERATION. Edited by HALEH AFSHAR and MARY MAYNARD. Basingstoke, Macmillan, 1993. xiv, 250pp.

WRITING WOMEN'S WORLDS: BEDOUIN STORIES. By LILA ABU‐LUGHOD. Berkeley, Los Angeles and Oxford, University of California Press, 1993. xxiii, 266 pp., bibliography. $30.00 (hb), $12.00 (pb).

NASSER'S BLESSED MOVEMENT: EGYPT'S FREE OFFICERS AND THE JULY REVOLUTION. By JOEL GORDON. Oxford, Oxford University Press, 1992. vii, 254 pp.

WAR AND PEACE IN ISRAELI POLITICS: LABOR PARTY POSITIONS ON NATIONAL SECURITY. By EFRAIM INBAR. Boulder and London, Lynne Rien‐ner, 1991. 184pp., appendices. £21.95.

TURKEY AND THE WEST: CHANGING POLITICAL AND CULTURAL IDENTITIES. Edited by METIN HEPER, AYSE ÖNCÜ and HEINZ KRAMER. London/New York, Tauris, 1993. xiv, 289 pp.

TURKEY'S NEW GEOPOLITICS: FROM THE BALKANS TO WESTERN CHINA. By GRAHAM E. FULLER and IAN O. LESSER, with PAUL B. HENZE and J.F. BROWN. Boulder and Oxford, Westview Press, 1993. xv, 197pp.

THE SOCIALIST MOVEMENT IN TURKEY, 1960–1980. By IGOR P. LIPOVSKY. Leiden, Brill, 1992. ix, 190pp. $48.75.

ISLAM IN MODERN TURKEY: RELIGION, POLITICS AND LITERATURE IN A SECULAR STATE. Edited by RICHARD TAPPER. London/New York: Tauris, 1991. v, 314 pp.

SIBAWAYH THE PHONOLOGIST: A CRITICAL STUDY OF THE PHONETIC AND PHONOLOGICAL THEORY OF SIBAWAYH AS PRESENTED IN HIS TREATISE AL‐KITAB. By A.A. AL‐NASSIR. London and New York, Kegan Paul International, 1993. xx, 130 pp.

AL‐MADKHAL ILā TAQWīM AL‐LISāN WA‐TA'LīM AL‐BAYāN. By IBN HISHāM AL‐LAKHMī. Edited by JOSÉ PÉREZ LÁZARO. (Fuentes Arábico‐Hispanas, no. 6.) Madrid, Consejo Superior de Investigaciones Científicas & Insti‐tuto de Cooperatión con el Mundo Árabe, 1990. 2 vols. 219; 599pp.