Failure in preparedness, more than a grade

The Trust for America's Health (TFAH) report card on our Nation's preparedness affirmed that the United States is not prepared to respond effectively to a natural disaster or act of terrorism. The report is the organization's third annual study of U.S. preparedness for major health emergencies. Evaluating 12 different aspects of health emergency preparedness, the study ranked both the federal and the states performances. The federal government received an overall D+, and over half the states

garnered a score of 5 or less out of 10 possible points for key indicators of health emergency preparedness, such as capabilities to test for chemical and biological threats and hospital surge capacity to care for patients in a mass emergency.

Hawaii was one of 16 states to receive only 5 out of the ten indicators.

"We need to stop shrugging our shoulders and start rolling up our sleeves," Lowell Weicker, Jr., TFAH Board President is quoted as saying. TFAH formulated a Let's Get Real agenda for accelerated preparedness which includes:

• Leadership - "There needs to be a single, accountable official at the U.S. Department of Health and Human Services responsible for bioterrorism and public health preparedness."


• Accountability - currently there are "no defined, standardized performance measures for bioterrorism preparedness from CDC or regular reports of progress and vulnerabilities to the American people and Congress."


• Working with the Public - "The government should provide more consistent education and transparency to the public, so there will be greater understanding of roles and responsibilities during a difficult situation."


• Improving Basic Response Capabilities - "Information technology systems, emergency communications systems, and laboratory and other equipment all need to be modernized to meet current technology."

The Public Health Foundation (PHF) in response to the study called on Congress " to make new investments to eliminate the chaos and confusion that contributed to our woefully inadequate response to disasters like Hurricane Katrina."

Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism, 2005
(available in pdf, 1.8MB)

Executive Summary (available in pdf, 200KB)

See related FR posts, here and here

National park air tours

Noise concerns prompted Congress to pass the National Parks Air Tour Management Act of 2000, PL 106-181, title VIII, 114 Stat. 185 (pdf, 452KB, 137p., from GPO), to regulate air tours over national parks. The Act requires the Federal Aviation Administration (FAA) and the National Park Service to formulate air tour management plans (ATMPs) for parks where air tour operators apply to conduct tours. In a study released Jan. 27, the Government Accountability Office (GAO) reported that six years after the Act's passage, no ATMPs have been completed.

According to GAO, in January 2003 FAA and the Park Service began developing ATMPs for nine parks, the first six of which were in Hawaii: Haleakala and Hawaii Volcanoes National Parks; Kalaupapa, Pu'uhonua o Honaunau, and Kaloko-Honokohau National Historical Parks; and Puukohola Heiau National Historic Site. In July 2005 the latter three were removed from the ATMP process because air tour operators withdrew their applications for those parks and "instead agreed to fly at least one half-mile outside" the parks.

Among GAO's recommendations for more effective implementation of the Act are to give FAA and the Park Service greater flexibility in determining which parks require ATMPs and that FAA improve enforcement of the Act.

National Parks Air Tour Management Act: More Flexibility and Better Enforcement Needed, GAO-06-263
     Full report (pdf, 980KB, 69p.)
     Highlights (pdf, 76KB, 1p.)

Helping prisoners return to society

Most prisoners will eventually be released. Spending on corrections increased from $9 billion in 1982 to $60 billion in 2002 but success rates of re-entry for those released have not improved. Thus begins a brief article, on p. 7 in the January 2006 issue of State News, published by the Council of State Governments (CSG), announcing a report of the Re-Entry Policy Council. That Council was established by CSG "to assist policymakers in developing practices to provide a successful re-entry for those individuals returning to society."

The Council's 674-page report, authored by CSG and ten project partners, covers three broad areas: Part I - Planning a Re-Entry Initiative; Part II - Review of the Re-Entry Process: From Admission to the Institution to Return to the Community; and Part III - Elements of Effective Health and Social Service Systems. There are 35 policy statements, research highlights, and recommendations to implement the policy statements. The appendix on Programs covers each state.

Report of the Re-Entry Policy Council
      [Report no longer available]

Maui stats

Maui County's Office of Economic Development (OED) and the Hawai`i Business Research Library (HBRL) have published the 2005 Maui County Data Book, described in the introduction by Mayor Arakawa as "the definitive statistical reference work on Maui Nui – Kaho`olawe, Lana`i, Maui and Moloka`i." Providing general statistics and data on areas as education, land use, communications and transportation, energy, construction, housing, finance, labor, and more, the County Data Book of 2005 is the 13th annual edition and contains 247 pages.


Maui County Data Book
(available in pdf, complete volume, 1.7MB; and in pdf, by chapter, from HBRL)

Minors and violent, sexual video games

The Congressional Research Service (CRS) issued a report on Jan. 18 on the constitutionality of limiting minors' access to video games rated M (Mature) or AO (Adults Only). These ratings, which have no legal effect, are given by the Entertainment Software Ratings Board (ESRB), a non-governmental entity established by the Interactive Digital Software Association (ISDA). ESRB's criteria for its M and AO ratings are found on its website:

Titles rated M (Mature) have content that may be suitable for persons ages 17 and older. Titles in this category may contain intense violence, blood and gore, sexual content, and/or strong language.

Titles rated AO (Adults Only) have content that should only be played by persons 18 years and older. Titles in this category may include prolonged scenes of intense violence and/or graphic sexual content and nudity.

The CRS report states that the primary constitutional issue is whether a statutory ban of these videos to minors would violate the First Amendment right of free speech. According to CRS, the U.S. Supreme Court has never ruled on the constitutionality of such a statute, but every lower federal court has found such statutes unconstitutional or issued a preliminary injunction on the likelihood that the statute in question would be found unconstitutional.

The report analyzes the application of First Amendment principles to violent and sexual material and discusses violent and sexually explicit video games decisions. It concludes that for an effective ban, the government would have to present empirical evidence that the games harm minors or cause them to become violent. Even so, because of the vagueness of the M and AO ratings, a law prohibiting video games with these ratings could be found "unconstitutional on its face."

Constitutionality of Proposals to Prohibit the Sale or Rental to Minors of Video Games with Violent or Sexual Content or "Strong Language", CRS report, RL33232
(pdf, 72KB, 15p., from Open CRS)

Listings of Attorney General opinions

The Legislative Reference Bureau (LRB) is required by §28-3, Hawaii Revised Statutes, to provide the Legislature, prior to each regular session, with a list of the most recent opinions of the Attorney General (AG). LRB prepares digests of the opinions for its listings (pdf, 376KB, 39p.), available online beginning with opinions from 1985. The most recent listing, of two 2005 (pdf, 12KB, 1p.) opinions, is also available separately. Listings from 1961 are available in hard copy at the Library. Full opinions from 1993 may be found on the Attorney General's web site. The AG also provides a link to the web site of the Hawaii State Bar Association (HSBA) which offers AG opinions for the years 1987-1992.

Basic is not proficient

Associated Press (AP) published a story Friday on the literacy of today's college students. The same test the National Assessment of Adult Literacy (NAAL) gave to evaluate English literacy among adults (see FR, here), and which determined one in 20 adults to be not literate in English, was used for the college survey by the American Institutes for Research (AIR). According to AIR's press release:

Twenty percent of U.S. college students completing 4-year degrees - and 30 percent of students earning 2-year degrees - have only basic quantitative literacy skills, meaning they are unable to estimate if their car has enough gasoline to get to the next gas station or calculate the total cost of ordering office supplies...

While the findings put current students well above adults with similar levels of education, it is suggested basic is not good enough for an educated population.

The Literacy of America's College Students, Final Report
(available in pdf, 1MB, from AIR)

Final Report's Appendices
(available in pdf, 1MB)

Fed's Beige Book - Economic snapshot

The term Beige Book refers to the report, "Summary of Commentary on Current Economic Conditions by Federal Reserve District," published by the Federal Reserve Board (FRB) eight times a year. The first Beige Book of 2006 was released today. The book consists of a Summary and a report by each of the twelve Federal Reserve Districts (Boston, New York, Philadelphia, Cleveland, Richmond, Atlanta, Chicago, St. Louis, Minneapolis, Kansas City, Dallas, and San Francisco) on the economy in their respective regions. About Hawaii, the San Francisco District report notes:

District travel and tourism activity remained vigorous, especially in Hawaii, where growth in visitor numbers and spending has been setting records and hotel occupancy rates have continued to rise.

And

...residential real estate markets showed little or no sign of cooling, and conditions reportedly heated up further in some markets, such as Oregon and especially Hawaii.

The Beige Book is issued two Wednesdays before each Federal Open Market Committee (FOMC) meeting. While the FRB is responsible for the discount rate and reserve requirements, the FOMC is responsible for open market operations. Together, the Federal Reserve sets monetary policy and the interest rate.

Summary of Commentary on Current Economic Conditions by Federal Reserve District (Summary & 12 District Reports)

Death with dignity

As reported in national news (see, New York Times (NYT)), the U.S. Supreme Court decided Tuesday that the Controlled Substances Act (see previous FR post, here) does not give the right for the federal government to "punish Oregon doctors who complied with requests under the state's law. The law allows mentally competent, terminally ill patients to ask their doctors for lethal drugs." The Pew Research Center for the People and the Press released survey results last week reporting that an overwhelming majority of Americans (84% approval) favor the right to die (terminally ill patients making the decision to be kept alive or not through medical treatment), with many discussing and personally planning end-of-life treatment. However, Pew Center further qualifies the findings on assisted suicide, reporting:

But Americans make a distinction between allowing a terminally ill person to die and taking action to end someone's life. The public is deeply divided over legalizing physician-assisted suicide; 46% approve of laws permitting doctors to help patients to end their lives, while about as many are opposed (45%).

The survey also reports on public views on such issues as the politics, support, and morality for end-of-life treatments; abortion and the death penalty; and mercy killings.

Strong Public Support for Right to Die
(available in pdf, 136KB, from The Pew Center; news release available in html)

Improving nursing home quality, safety

The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for Medicare and Medicaid programs and compliance with federal nursing home standards. (States contract with CMS to conduct annual nursing home surveys.) Since 1998 the Government Accountability Office (GAO) has issued a series of reports on nursing home quality and safety and weaknesses in federal and state oversight. Today GAO released an assessment of CMS's progress in addressing oversight deficiencies. GAO found a decline in nursing homes with serious quality problems but noted two continuing issues: inconsistency in how states conduct surveys and understatement of quality problems.

One of the initiatives CMS has taken to improve its services is a Web site, Nursing Home Compare, to provide information on nursing homes in each state.

NURSING HOMES: Despite Increased Oversight, Challenges Remain in Ensuring High-Quality Care and Resident Safety, GAO-06-117
     Full report (pdf, 1.62MB, 81p.)
     Highlights (pdf, 60KB, 1p.)
     Abstract (html)

California's $3 billion rebate

Associated Press (AP) reported Thursday on the California Public Utility Commission's (CPUC) approval of Gov. Schwarzenegger's California Solar Incentive Program, encouraging homeowners to install solar panels for renewable energy. Reported in FR here, the original project was proposed by the governor but died in the state legislature over labor issues. According to AP:

The PUC voted 3-1 to provide $2.9 billion in rebates for solar panels between 2007 and 2016. Last month, the five-member commission approved $300 million in rebates for 2006.

Interim Order Adopting Policies And Funding For The California Solar Initiative
(available in pdf, 156KB, from CPUC)

Retirement security - oxymoron?

It was a given - give your working life to a company and the company would give back to you - security for your golden years, all the pension you accrued and health benefits for life. Now that given is being taken away. A recent New York Times article, one of many in a similiar vein, laid out the reality of the vanishing pension and the shift to 401(k) plans, leaving workers "on their own" for funding their retirement.

The Pew Charitable Trusts, in partnership with Georgetown University's Public Policy Institute and the Brookings Institution, began the Retirement Security Project (RSP) to help "middle- and lower-income Americans to save for a financially secure retirement." Over the last few years, RSP has published a number of papers on retirement security. The following recent reports may be of interest:

A brief 3-pager, Common Sense Reform to Promote Retirement Security (pdf, 80KB), gives an overview of 401(k)s, retirement savings mistakes, and improving the system.

The Automatic 401(k): A Simple Way to Strengthen Retirement Savings (pdf, 352KB, 16p.). Under most current 401(k)s, workers must actively choose to participate in a plan, then face daunting investment decisions, and thus may be discouraged from enrolling. Automatic plans would make participation the default option, and workers would have to actively opt out. The paper advocates automatic enrollment, automatic escalation, automatic investment, and automatic rollover.

Automatic Investment: Improving 401(k) Portfolio Investment Choices (pdf, 276KB, 12p.) expands on automatic investment from the above report.

The Smith-Conrad Retirement Security Legislation (pdf, 100KB, 11p.) analyzes the Retirement Savings and Security Act of 2005 (S. 1359, pdf, 128KB, 60p., from GPO) currently in Congress. The bill includes automatic 401(k) provisions and increasing incentives to save, but the authors conclude that other provisions relating to life annuities and tax incentives make the proposed legislation "likely to do more harm than good."

Hawaii emergency health services, not so good

The American College of Emergency Physicians (ACEP) released its first ever report card of the nation's emergency health services. The national overall grade was C-, the ACEP finding many states' emergency systems are operating "under extreme stress." Hawaii ranked 34th overall among states with its shortage of hospital space and trained professionals (see related FR post, here):

• Number of registered nurses per 1,000 people (41st)
• Number of hospital-staffed beds per 1,000 people (37th)
• Trauma centers per 1 million people (45th)
• Annual payments per fee-for-service enrollee in Medicare (51st)

Hawaii also "finished next to last in the nation in alcohol-related fatalities as a percentage of all traffic fatalities (50th)."

The report continues:

The state received its poorest mark of D- for its Medical Liability Environment. State legislators have done very little to enact reforms that would curb rising medical liability insurance premium rates, which are causing some good doctors to leave the state and others to reduce their availability to emergency patients.

Complete National Report
(available in pdf, 5.5MB, from ACEP)

Hawaii Report Card Detail
(available in pdf, 148KB)

Hawaii LRB Study : Bioprospecting: Issues And Policy

The Hawaii Legislative Reference Bureau (LRB) has published Report 1, 2006 requested by the 2005 Hawaii Legislature. This report was undertaken in response to House Concurrent Resolution No. 146, H.D. 1. The Bureau has been requested to "conduct a study on the fair and equitable sharing of benefits arising from research, indigenous knowledge, intellectual property, or application of biological resources that are public natural resources held in trust by the State for the benefit of the people."

Bioprospecting: Issues And Policy Considerations
(available in pdf, 17MB, from LRB)

Fact Sheet (available in html)

Hawaii LRB Study : On-Call Crisis In Trauma Care

The Hawaii Legislative Reference Bureau (LRB) has published Report 2 of 2006, a request by the 2005 Hawaii Legislature. This report was prepared in response to House Concurrent Resolution No. 229, S.D. 1, adopted during the Regular Session of 2005, that requested the Legislative Reference Bureau to identify and analyze any appropriate government response to the increasing unavailability of physician specialists for emergency call at trauma centers. "Having more than one cause, the shortage of on-call physician specialists at trauma centers clearly requires more than one solution," the report finds.

On-Call Crisis In Trauma Care: Government Responses
(available in pdf, 516KB, from LRB)

Summary (available in html)

Medical marijuana

An AP story on Jan. 3 reported that Rhode Island became the 11th state to legalize medical marijuana and the first since the U.S. Supreme Court ruled in June that people who smoke medical marijuana can still be prosecuted under federal drug laws.

Earlier, on Dec. 29, the Congressional Research Service (CRS) published a review of federal and state policies on the subject as Congress debates whether to continue supporting the executive branch's pursuit, by the Drug Enforcement Administration (DEA), of medical marijuana patients and providers. There are currently two bills in Congress. The States' Rights to Medical Marijuana Act (HR 2087, pdf, 36KB, 4p., from GPO) would move marijuana from Schedule I to Schedule II of the Controlled Substances Act and allow its medical use in states that have such programs. The Steve McWilliams Truth in Trials Act (HR 4272, pdf, 36KB, 4p., from GPO) provides an affirmative defense that medical use of marijuana is legal under state law. (The CRS report lists 11 states that allow medical marijuana, and this was prior to Rhode Island's legalization, but notes that one of them, Arizona, has no active program because its law provides for marijuana prescriptions and federal law prohibits doctors from prescribing marijuana; other states' laws allow doctors to recommend marijuana.) In 2000 Hawaii became the first state to legalize (H.R.S. [§329_121-128]) medical marijuana by legislation (Act 228, SLH 2000) rather than by ballot initiative.

Medical Marijuana: Review and Analysis of Federal and State Policies, CRS report, RL33211
(pdf, 220KB, 44p. from Open CRS)

Kelo - legal comments on HR 4128

The Supreme Court's holding in Kelo v. City of New London
(pdf, 412KB, 58p., from the Supreme Court) (June 23, 2005) that private property can be taken for private economic development to serve a "public purpose" prompted many legislative proposals in states and Congress to limit this use of eminent domain.

In Congress, the current principal "Kelo bill" is H.R. 4128 (pdf, 48KB, 13p., from GPO), the Private Property Rights Protection Act of 2005. The Congressional Research Service (CRS) recently issued legal comments on H.R. 1428 and the Bond Amendment. (The Bond Amendment, limiting federal funds to public-use condemnation, was inserted into an FY2006 appropriations bill, enacted as PL 109-115. The full text of the Bond Amendment is in the CRS report.) Legal comments are made on four sections of H.R. 1428 (in this order): sections 2, 8, 4, and 3. Section 2, Prohibition on Eminent Domain Abuse by States, is the "heart" of the bill. In Section 8, Definitions, the key term analyzed is "economic development." Mention is made here of Hawaii Housing Authority v. Midkiff (html) as a leading Kelo precedent. Section 4 covers Private Right of Action, and Section 3, Prohibition on Eminent Domain Abuse by the Federal Government, is the federal counterpart to Section 2.

See earlier FR posts on Kelo via here.

Condemnation of Private Property for Economic Development: Legal Comments on the House Passed Bill (H.R. 4128) and Bond Amendment, CRS Report, RL33208
(pdf, 80KB, 17p., from Open CRS)

States assisting veterans

There are approximately 700,000 unemployed veterans, and the U.S. Department of Labor (Labor) expects that number to increase as service members leave active duty. In 2002 Congress passed the Jobs for Veterans Act (JVA) (PL 107-288, pdf, 76KB, 16p., from GPO) to improve employment and training for veterans and encourage employers to hire them. The Government Accountability Office (GAO) was mandated to review the implementation of JVA and released its report Dec. 30.

JVA amended two Labor programs that are exclusive to veterans and administered by the Veterans' Employment and Training Service (VETS): the Disabled Veterans' Outreach Program (DVOP) and the Local Veterans' Employment Representative program (LVER). (For its review, GAO surveyed state VETS directors and state workforce administrators.) JVA not only changed the way services are provided through DVOP and LVER but gave states more flexibility to tailor services to their area veterans; that greater flexibility, however, calls for greater accountability. GAO recommends that Labor improve its oversight and monitoring functions, assist with integrating staff into one-stop service centers, and better enforce federal contractor requirements.

VETERANS' EMPLOYMENT AND TRAINING SERVICE: Labor Actions Needed to Improve Accountability and Help States Implement Reforms to Veterans' Employment Services, GAO-06-176
      Full report (pdf, 1.6MB, 62p.)
      Highlights (pdf, 208KB, 1p.)
      Abstract (html)

Meth offender registry

Modeled on sex offender registries, Tennessee's Meth Offender Registry Database was recently launched, the Los Angeles Times reported Dec. 30. The registry, the first of its kind in any state, was created by the Meth-Free Tennessee Act of 2005 (Chapter 18, pdf, 44KB, 8p., from the 2005 Tennessee General Assembly). Administered by the Tennessee Bureau of Investigation (TBI), the web site displays the names of persons convicted after March 30, 2005, of manufacturing meth. The conviction must be of a "substantive violation," not "conspiracy, attempt, and facilitation" (from the site).

According to the Times article, Tennessee lawmakers were responding to "pleas from landlords and property owners who could be bankrupted quickly by the cost of cleaning contaminated properties." (See FR here for more on meth labs clean-up.) In 2004 Tennessee authorities seized 1,574 meth labs (second only to Missouri) and placed more than 700 children in foster care. A TBI spokeswoman said meth labs "'were becoming a public threat to the extent that you couldn't even feel safe in your own neighborhood.'"