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Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!
Rally to Protect Abortion Access
Dr. Manisha Sharma and I represented Doctors for America at a "Stop the Sham" rally on the steps of the US Supreme Court March 2, joining thousands of other supporters of women's access to safe and legal abortion care, on a very cold and windy day.
The 8 Justices were hearing oral arguments in one of the most significant abortion case in decades, Whole Woman's Health v. Hellerstedt. Abortion providers in Texas, led by Whole Woman's Health, have challenged Texas HB2, a law that forces abortion clinics to meet the standards of hospital-style surgery centers and requires providers to obtain admitting privileges at a nearby hospital. These TRAP (Targeted Regulation of Abortion Providers) laws are shams, designed to shut clinics down while pretending to make clinics safe. Much riskier procedures, such as colonoscopies, are never the targets of these types of laws. Already, with the law partially in place, about half of the more than 40 abortion clinics in Texas have closed. If the law comes into full effect, the Texas, a state with a population of 27 million, could be left with just nine or 10 clinics.
A small group of anti-abortion protesters was present, but the huge crowd supporting women vastly outnumbered them. We heard from numerous speakers, including Dr. Bhavik Kumar (a friend of Manisha and Texas abortion provider), Representative Jan Schakowsky, and Dr. Willie Parker (an abortion doctor in Mississippi). Stephanie Toti, the lawyer from the Center for Reproductive Rights, spoke to the crowd after she argued the case in front of the Supreme Court.
Dr. Katherine Scheirman is a retired internist and US Air Force Colonel who resides in New York.
Dismantling Racism in the Health System: The Time is Now, an Action-Oriented Forum
On Saturday, March 12th, The Health Department's Center for Health Equity was joined by the Icahn School of Medicine at Mount Sinai (ISMMS), the Institute for Family Health, Doctors for America-NY, White Coats for Black Lives, CUNY School of Public Health and several other organizations to co-host a day-long, action-oriented forum, "Dismantling Racism in the NYC Health System –The Time is Now." The event marked a historic day for the health community in New York City.
Racial and ethnic disparities in healthcare exist and because they are associated with worse outcomes in many cases, are unacceptable. Having grown up in a community that was either neglected or targeted, I was often skeptical about all the talking we learned to do as medical professionals. After seeing injustice and oppression, I knew that we needed more doers and fewer talkers. I went into my third year of medical school with my eyes open. I witnessed and then became part of many patient stories. It didn't take long to realize that institutional racism, structural violence and segregated care are alive and kicking, and that our own unconscious and conscious biases must be acknowledged and combated. We cannot perpetuate the seemingly endless cycle of oppression and, if we are to be the voice of those who are so often ignored or unheard, we must find our own voice. Obviously, in the world we are hoping to live in, we will learn to listen to those being ignored and not just become their voice.
I have been involved in a number of social justice initiatives in East Harlem, West Harlem, and the Indo-Caribbean community in Queens, NY, and have been privileged to work with fellow student leaders, community organizers, academic medicine leadership, social workers, teachers, local government officials, public health advocates, faith-based leaders and so many more inspiring individuals in various realms. I was fortunate to join the Doctors for America NY state leadership team in my third year of medical school. In this leadership position, I wanted to work with others to spearhead the formation of a citywide coalition that would have a unified voice on institutional racism. Doctors for America has been instrumental in raising awareness and action on social justice issues, including institutional racism. At the Doctors for America National Leadership Conference in November 2015, key leaders including Dr. Aletha Maybank, Deray McKesson and Jamar Brown spoke candidly on racism in health, and a true dialogue was started in the health community.
I was very familiar with the many dedicated people who were working tirelessly to undo racism in NYC – from student activists at Mount Sinai and other NY schools to faculty members at academic medical centers to community leaders advocating on a daily basis for basic human rights for all. I felt that too many people were doing extraordinary, emotionally and physically exhausting, herculean work in isolated silos. So, with lots of idealism and hope, our Doctors for America-NY team attempted to bring various stakeholders together.
On November 18th, 2015, representatives from a number of NYC institutions and organizations were able to sit together and make a commitment to dismantle institutional racism within the NYC health system. Over the past several months, we have met frequently to continue conversations and strategize for our upcoming work together. It is clear that individuals are ready to remove themselves from silos and unite their voices and hearts to combat racism. The citywide forum that we planned together was just the starting point of what promises to be sustainable, meaningful and collaborative work. We are so grateful that this work is supported by the NYC Department of Health under the leadership of both Dr. Aletha Maybank and our Commissioner of Health, Dr. Mary T. Bassett.
It has taken over 500 years to construct racism as a dominant, prevailing narrative - one that leads to inequities in health that are unfair and avoidable. It will take all of us to undo racism. This shared vision is larger than any one person, institution or organization.
We have created working groups in an effort to capitalize on the expertise of those in our coalition working in these areas, have smaller teams with actionable goals and commit to tackling a number of important issues at the same time. Creating a sustainable coalition of doers with a shared goal and united voice is our top priority. The forum was successful in setting the stage and bringing light to key areas within the realm of racism. The working groups are: Education & Curriculum Development, Health Policy & Legislation, Research, Access to Care, Representation in the Health Field, Intersectionality, Narrative Healing and Community Engagement & Advocacy.
Members of the coalition include: Center for Multicultural & Community Affairs, Icahn School of Medicine at Mount Sinai, Medical Education Department, Icahn School of Medicine at Mount Sinai, Committee of Interns and Residents / SEIU Healthcare, Department of Family & Social Medicine, Montefiore-Einstein, Doctors Council, Doctors for America-NY, Institute for Family Health, Latino Medical Students Organization, National Medical Association, Empire State Medical Association, Manhattan Central Medical Society, National Physicians Alliance-NY, New York City Department of Health's Center for Health Equity, Physicians for a National Health Program – NY Metro Chapter, Student National Medical Association, White Coats for Black Lives, the Doctors Council, The National Medical Association, People's Institute of Survival and Beyond-NY, SEIU, and Commission on the Public's Health System (CPHS). You can view the NYC DOHMH press release here.
If you are interested in getting involved or holding a similar forum in your area, please contact firstname.lastname@example.com.
Read on for an overview of the content of the forum:
Raising Awareness and Getting on the Same Page
Associate Commissioner of the NYC Department of Health and Director of the Center for Health Equity, Dr. Aletha Maybank, and Chair of SEIU Healthcare, Dr. Toni Lewis, chaired the program. Kamini Doobay, fourth year medical student at ISMMS and DFA-NY co-leader, shared the story behind the formation of the coalition and gave an overview of its goals and objectives. Dr. Ayman A.E. El-Mohandes, internationally renowned public health leader and Dean of the CUNY School of Public Health, welcomed participants to the CUNY Graduate Center and urged participants to fully engage and experience the energy and passion in the room: "Something is about to happen."
NYC Health Commissioner Mary T. Bassett delivered the first keynote presentation on "Race, Racism and Public Health." She delved deep into NYC's racialized pattern of health, referencing studies she published in 1986 and beyond. Commissioner Bassett dismissed claims that lifestyle choices allow for widely disparate outcomes.
"I don't think anyone decides, 'I want to live in a neighborhood with really bad housing, or poor air quality,'" she said. "Nobody says, 'I really prefer a neighborhood where there is only fast food available.' ... These are not personal choices. These are a lack of choice."
In addition to substantiating her claims with past and current data, Dr. Bassett told provocative, emotionally stirring stories from her childhood and her days working in the Black Panther Party's free medical clinic in Boston. Her presentation was compelling, informative and awe-inspiring.
Dr. Neil Calman, Chair of Mount Sinai's Department of Family Medicine and Community Health and CEO of Instiute for Family Health, then delivered a talk on medical apartheid in NYC hospitals.
"We don't have signs that say 'colored' anymore, but we've found more subtle ways to create racism in our health care system," he stated. He showed data that revealed that the US population whitens with age due to the premature death of people of color.
Dr. Calman also reported that enormous profits are being made by some of the institutions in NYC with the lowest numbers of uninsured patients and those on Medicaid. He proposed a "tax" on those profits to help to subsidize the care for the uninsured and those on Medicaid whose care is being provided largely by the public hospital system. A long time advocate for eliminating racial and ethnic disparities in the health care and health outcomes, he is known for his truth-telling and this forum was no exception. He was bold, transparent and moving.
Next up was an abbreviated form of the People's Institute for Survival and Beyond's Undoing Racism Workshop (URW). With an interactive workshop, Diana Dunn, Milta Vega-Cardona, Candida Brooks-Harrison and Christiana Best, challenged participants to analyze structures of power and privilege that hinder equity within the health system. They provided history that allowed us to understand how racism was consciously and systematically erected, and how it can be dismantled if people understand what it is, how it functions and why it is perpetuated.
After the URW, emotions and energy were high. Participants formed smaller groups and reflected on what they were thinking and feeling after the morning's sessions. Together, they explored their emotions and continued to create a safe space to engage and strategize.
Translating Awareness into Action
How do we use our knowledge to create action? That was the theme of the afternoon.
Dr. Camara P. Jones, President of the American Public Health Association and Senior Fellow at the Satcher Health Leadership Institute and the Cardiovascular Research Institute, Morehouse School of Medicine, delivered the second keynote presentation on, "Achieving Health Equity: Tools for a National Campaign against Racism." Her talk rejuvenated the spirits of everyone in the room and served as a call to action.
Dr. Jones' lifelong passion has been naming and addressing the impacts of racism on the health of our nation, and she has developed allegories that enable us to understand the many layers and nuances of institutionalized, personally-mediated and internalized racism. She shared her allegory, "A Gardener's Tale," in the jam-packed room filled with participants who were in awe of her passion, brilliance and vision.
The strategy and action panel was next up. In addition to collectively raising awareness of how racism affects health, the forum was the official kickoff of the coalition's working groups. Leaders in the fields of each of the working group areas were invited to speak on work they have done and what they envision as actionable goals for the working groups. The following speakers were dynamic, engaging, and informative:
Education and Curriculum Development: Sharon Washington , Ed.D., MPH
Health Policy and Legislation: Assembly Member Richard Gottfried
Access to Care: Neil Calman, MD
Community Engagement: Anthony Feliciano
Research: B. Cameron Webb, MD, JD
Intersectionality: Elizabeth Lorde-Rollins, MD, MSc
Narrative Healing: Alan Pean & Adjoa Duker, MD, MPH
Representation in the Health Field: Adam Aponte, MD
Kamini Doobay then delivered concluding remarks. She urged participants to commit to undoing racism in the health system together. "There is so much energy, passion and fire in this room. This shared goal is larger than any one of us, and now is the time for us to join together and have a unified voice – for the sake of our patients, communities, society and generations to come." She ended with proposed next steps.
We thank our champion sponsors, the Department of Medical Education at Icahn School of Medicine at Mt. Sinai, NYC DOHMH's Center for Health Equity, and the CUNY Graduate School of Public Health, and all of the other sponsoring organizations.
Kamini Doobay is a medical student co-leader of DFA-NY, who facilitated the formation of the coalition and is the liaison between member organizations.
Update on Medicaid expansion in LA
In 2008 Governor Jindal had proposed his own "Louisiana Health First" Medicaid expansion program. Four years later however, he had reversed course and, along with most other "Red State" Governors, was standing opposed to Medicaid expansion in Louisiana,
While the Affordable Care Act has provided many benefits beyond extending coverage to the poor through Medicaid expansion, most of the patients and families that I see and work with, live at or below the Federal Poverty Level, and therefore have been unable to obtain coverage through the ACA marketplace or exchanges. Meanwhile, unlike some states that already extend Medicaid benefits to adults up to 133% of Federal Poverty Level, the working poor in Louisiana are generally not eligible for Medicaid at all, leaving hundreds of thousands uninsured.
The Legislative session in Louisiana is short - only from March or April until first week of June. I attended my first legislative Health and Welfare Committee Hearing in Spring of 2013. Like most Americans, I didn't know that these legislative committee hearings are open to the public! Citizens are invited to fill out cards pro or con on bills being presented to be voted on during each hearing. These cards are counted and comments included are often read into the record. There are usually members of the public or government officials scheduled in advance to speak on the issue before the committee, but anyone present can also, on their submitted card, request to speak. I was not prepared or planning to speak that first day but I was asked to, and did. I have since been invited to present in favor of Medicaid Expansion, among other things, at other House and Senate Committee Hearings.
I joined the Campaign for Healthcare for Everyone Louisiana on meeting the Campaign Organizer, Alma Stewart, at that first legislative hearing. There are over forty local or state-wide organizations that are endorsed members of this campaign and over one hundred organizations and five hundred individual signed on to HCEL's initial 2013 public letter to Governor Jindal asking him to support of Medicaid Expansion. In addition to letter's to editors and op-eds penned by members of HCEL and others, there has been editorial support for Medicaid Expansion from all of the major local newspapers. HCEL set up separate committees to focus on legislative matters, media, education and grass-roots organizing which I think has been effective in providing a "multi-pronged" approach. As it became clear Medicaid expansion was not going to happen in 2013, HCEL developed a longer-range, eighteen month plan, with focus on making Medicaid expansion and important issue for the Gubernatorial election of 2015. Meanwhile, HCEL continued to partner and network with other groups working in support of Medicaid expansion, meeting with legislators, promoting letter writing campaigns, organizing or participating in press conferences or interviews on radio or TV, organizing or participating in rallies and "Dying for Coverage" candlelight vigils at the capital, visiting churches, health fairs and enrollment events, etc. In the Fall of 2014, in coordination with the American Public Health Association's annual meeting in New Orleans, HCEL organized a Day of Action in support of Medicaid expansion and both Alma Stewart and I were invited to present at the conference as well.
Each legislative session, more and more regular people from all over the state were coming to Senate and House committee hearings to show their support for Medicaid Expansion. The last hearing I attended required two additional over-flow rooms to accommodate everyone!
In 2015, in coordination with Dillard University, New Orleans, HCEL organized a televised Gubernatorial Candidate Forum on Healthcare in Louisiana. Despite the legislature's continued refusal to advance any bills in support of Medicaid expansion in Louisiana, all three Gubernatorial candidates had expressed at least willingness to consider some version. Representative John Bel Edwards was the only candidate, however, to make Medicaid Expansion a corner-stone of his campaign. I believe Governor Edwards' strong support for Medicaid expansion played an important role in his election and the Governor was true to his word, signing in support of Medicaid Expansion his first day in office!
Beyond HCEL, I have also been networking with Tulane students and residents who are part of Tulane University School of Medicine's Advocacy Track as well as other physician-advocate friends and, following the lead of Tulane resident, Sarah Candler, have been involved in efforts to revive the Louisiana Chapter of the American College of Physician's Health and Public Policy committee.
Most recently, as State Director for Doctors for America in Louisiana, I was invited to participate in Louisiana Public Broadcasting's Public Square program on Medicaid Expansion in Louisiana and was able to bring other DFA members to participate in the discussion as well. Meanwhile. HCEL, in collaboration with Louisiana Public Health Institute and the Department of Health and Hospitals - Office of Public Health, has also organized a state-wide Health Summit which will be held in Baton Rouge this Tuesday, March 29th.
There is still a lot of work left to do! Louisiana is struggling with an unprecedented budget crisis and some legislators have already filed bills to block or limit expansion, despite the obvious overall fiscal benefits to the state. Dr. Rebekah Gee, the new secretary of the Department of Health and Hospitals, is optimistic however, citing support even from many conservative legislators previously opposed. Another important point to keep in mind, is that access to health insurance does not always translate into access to care. While Rebekah Gee and others cite "new models" of care in development and while community clinics and even private hospitals are adding new primary care positions specifically for those newly insured under Medicaid expansion, a key to attracting and retaining providers will be ensuring adequate and reliable reimbursement. Medicaid Pay Parity, which would put Medicaid reimbursement on par with Medicare reimbursement rates, has been discussed by DHH and was part of the recommendations of Governor Edwards' newly created Healthcare Advisory Panel.
As a member of Doctors for America, I pledge to continue collaborating with dedicated community partners and fellow healthcare advocates in working towards a more equitable, healthier future for the people of Louisiana.
DFA Louisiana Dr.'s representing at filming of LPB Louisiana Public Square Jule Asserq, Heidi Sinclair and Sarah Candler (not pictured Dr. Christy Valentine)
Dr. Heidi Sinclair is the Louisiana State Director.
The next big abortion case
Next week, the U.S. Supreme Court will hear an important case regarding abortion access with far reaching implications.
The Whole Woman's Health v. Hellerstedt case challenges a restrictive Texas law, HB2, which was designed to prevent women from accessing their constitutional right to an abortion. This law puts the health and rights of millions of women at risk.
By requiring admitting privileges in a nearby hospital and imposing prohibitively expensive and unnecessary architectural modifications, clinics in Texas are closing. This places a huge burden on women, including military women and families, and severely restricts their access to this important Constitutional right.
As doctors and medical students, we know playing politics with women's health isn't just wrong, it's dangerous. That's why Doctors for America has signed onto an amicus brief urging the Court to strike down these medically unnecessary restrictions. But, we need your help to make the physician voice heard during the oral arguments.
Raise your voice and join us in telling the Court to strike down these requirements which harm, not help, women's health.
Here's what you can do:
1. Rally on the steps of the Supreme Court on March 2:
March 2, 2016, 8 AM – 12 PM at the U.S. Supreme Court, Washington, D.C.
(Please note: the form does provide an option to select a bus. While we are not organizing the buses, we are aware of the option for those traveling from NY, NJ, PA, OH, VA or NC).
2. Use this tool kit to take action in your community and online.
3. Join the conversation online at #StopTheSham:
Click here to add a Twibbon to your profile picture.
Click here to join the Thunderclap.
Dr. Katherine Scheirman resides in New York and is a retired internist and US Air Force Colonel.
Flint needs you
The Flint water crisis is a health and human rights issue. We need you to make your voice heard to help the victims of this preventable tragedy.
Nutritious food, clean air and water, safe shelter and communities. These are the most basic things our patients need to be able to be healthy and pursue their dreams. Yet, elected officials hid the dangerous levels of lead in the water until a pediatrician sounded the alarm on unusually high lead levels in children.
It's time we follow this doctor's lead and signal the alarm with leaders in Congress.
Send a letter to Congress to make sure Flint gets clean water and access to health care.
Lead poisoning is well known to cause lifelong medical and psychiatric problems for children, sapping the potential of both individual lives and entire communities. Reductions in lead poisoning rates - often against opposition from very powerful interests - is one of the biggest public health triumphs of the past century. The fact that lead poisoning has been allowed to return with a vengeance in one of the nation's poorest communities is an unconscionable tragedy that must be addressed with the greatest urgency.
Call on Congress to make clean water a priority: Provide funds to replace the lead pipes in Flint so people can drink water without being afraid it will make them sick. And make sure people in Flint get the health care they need.
We know that even as we write, more low-income communities beyond Flint are finding that their water is not as safe as they thought. That's why it's so important for doctors and medical students to stand up and speak up now.
Doctors for America: Exciting Work in 2015, Big Plans for 2016
2015 has been a big year for Doctors for America and the health of the nation. This week, we launch our end-of-year fundraising drive so we can keep going strong into 2016. We have so much to celebrate. Here are a few highlights from the year:
King v. Burwell: Doctors for America was at the forefront of the monumental King v. Burwell Supreme Court case. We made headlines and made sure the case was understood as a matter of people's health and lives – not politics. The Court's decision in favor of the ACA kept 6.4 million people from losing their ability to pay for health insurance.
Medicaid Expansion: We kept the heat on state legislators and governors to expand Medicaid in a dozen states including Utah, Texas, Florida, Maine, and North Carolina.
Supporting Key Health Issues: Through the year, Doctors for America supported efforts to renew the Children's Health Insurance Program, prevent the defunding of Planned Parenthood, address rising drug prices, and protect the nation's investments in prevention and low-income nutrition programs.
Celebrating our Surgeon General: We celebrated in person or on Periscope the change of command ceremony for our nation's 19th Surgeon General, our former president and co-founder Dr. Vivek Murthy.
National Leadership Conference: We had our most highly rated National Leadership Conference ever with engaging speakers on social determinants of health, food insecurity, remaining barriers to access, racial disparities, advocacy, and physician wellness.
CDC Gun Research Ban: We made national and international news when we demanded that that Congress end the ban on CDC and NIH gun violence research – just hours before another mass shooting in San Bernardino. Our #EndTheBan hashtag made over 3.2 million Twitter impressions in just 24 hours. We brought together 68 of the nation's leading medical and public health organizations. And, both President Obama and House Minority Leader Nancy Pelosi spoke up on the issue.
In 2016, we have exciting opportunities to keep moving forward on improving the health of the nation.
As we continue to push on expanding Medicaid, we are hearing rumblings that a couple of states are getting ready to move. We will be right there to build momentum and make the case that expansion is good for people and good for states. We are also building a new campaign on Making the Most of Medicaid, which we will roll out in the early part of the year.
We are also opening a new focus on food insecurity, which affects one in seven of our patients - even though most of us don't know it. Hunger is a health issue that impacts the ability of our patients to be healthy and to keep their chronic conditions in check. Keep your eyes out for our new Food as Medicine initiative, and let us know if you have particular expertise in this area.
We will also work to build on our momentum to remove the CDC and NIH gun research restrictions. Plus, we have opportunities to bring physician voices to the challenges of rising drug prices, national and international policies on curbing and treating substance abuse including opioids, Supreme Court cases challenging access to abortions and contraception, payment reform efforts, and the myriad other issues that affect the lives of our patients. Of course, with the change of administration on the horizon, we will also be watching carefully to make sure the concerns of doctors and our patients are at the forefront.
Through it all, we will build new avenues to recruit, train, and support physicians and medical students to be the best advocates they can be for their patients and for a healthier America.
Thank you to all our members and supporters for making Doctors for America possible.
One final note, we rely on individual donations for the majority of our budget. As we close one year and open a new one, we hope that everyone can contribute whatever we can to ensure that Doctors for America can keep fighting for the health of the nation.
Please show your support for Doctors for America with a tax-deductible donation today.
Happy Thanksgiving!
On this Thanksgiving Day, we want to share a heartfelt thank you for being a part of the Doctors for America movement.
Thank you for coming together by the thousands from all 50 states to fight for equitable, affordable health care for all. Together, we are creating an America where everyone has the opportunity to lead a healthy and fulfilling life.
We create change because you choose action over cynicism - reading an email to get informed, signing a petition, sharing a patient story, writing an op-ed, joining a webinar, putting up a flier, running a campaign.
It is because of your efforts that the uninsurance rate in America is below 10% for the first time ever. Over 17 million more people are insured than when we first began this movement. With your continued efforts, We will get more people signed up for coverage before the end of open enrollment on January 31. We will expand Medicaid in every state and keep working until every person is covered. We will improve affordability, availability, and quality of care. And we will shine a light on social determinants like hunger and gun violence that affect our patients every day.
Did you know that Doctors for America members do all this on top of caring for over 1 million patients a month? Thank you to primary care doctors, psychiatrists, surgeons, neurologists, hospitalists, ob-gyns, anesthesiologists, cardiologists, and doctors of every specialty. To rural and urban doctors for your commitment to underserved communities. To private practice owners and tertiary care academics for improving care in every setting.
A special note of appreciation to those who are on call this weekend - caring for patients, answering their worried questions, bringing warmth and light to the sick during the holidays.
Thank you to physician administrators, researchers, innovators, and policymakers who bring a much needed clinical voice to policies and programs. To those who have committed their lives to public service and the uniformed services. To deans and medical educators for training the next generation of physicians. To retirees who have paved the way for the rest of us. To medical students whose energy and enthusiasm carry all of us forward.
Thank you to those who have donated funds to sustain our movement. Your support has been essential, and we are grateful for you.
Some of you are not doctors or medical students, but you stand with Doctors for America as our supporters and colleagues. Thank you for working alongside us to build a more just and equitable future for the health of the nation.
And thank you to Doctors for America's board members, state directors, advisors, and national campaign leaders who volunteer their time to lead our movement and to our small but mighty staff who support all of us.
On behalf of the whole Doctors for America family, may you and yours have a very happy, safe, and wonderful Thanksgiving.
Warm Wishes,
Alice Chen, MD
Executive Director
Haunted by Gun Violence
I am still haunted, over 30 years later, by the 18-year old woman I saw in the Emergency Room during my residency at the University of New Mexico. She had been shot in the chest, but was fully conscious when she arrived. "I'm not going to die, am I?" she asked plaintively. We worked as hard as we could on her, even cracking open her chest to massage her torn heart, but, tragically, all to no avail.
Years later, while making home visits, I encountered a 78-year old woman with severe rheumatoid arthritis who lived in subsidized housing in Richmond, VA. When I tried to coax her into at least taking walks in her first-floor apartment for exercise, she told me she wouldn't stand up after 2 p.m., because that was when the junior high kids got out of school, and "I might be shot."
Many of us have stories like these that we carry with us from our every day practices. While nothing will erase these tragedies, there is something we can do about them.
Over one thousand doctors and health advocates have signed our petition urging Congress to end the CDC ban on gun violence research. We will be delivering these signatures to Congress the week after Thanksgiving and need your help in gathering even more signatures in the final push, to reach our new goal of 2,000.
Please raise your voice and join us so we can speak up for all our patients, past, present and future, who may be impacted by gun violence.
This is a problem we can tackle! And we need to start by supporting, not banning, gun violence research at the CDC. Let's gather more of the data we need; let's have a resource that enables us to compare the effectiveness of various interventions.
Thank you for working for our patients and our families.
Lisa Plymate is our Washington State Director and an internist/geriatrician based in Seattle Washington.
Tell Congress: End the Ban on Gun Research
As physicians, we are outraged that this Nation continues to lose innocent lives from daily gun violence. Despite Sandy Hook and the continued tragedies since then, more than 89 Americans continue to die every day from gun violence.
You would be shocked to know that nearly 20 years ago Congress, under intense pressure from the gun lobby, passed a law blocking the Centers for Disease Control and Prevention (CDC) and the National Institute of Health (NIH) from carrying out the necessary research to better understand how to prevent gun violence.
Most recently, in June 2015, the U.S. House Appropriations Committee voted to maintain this funding ban. The result: a significant source of funding for evidence-based, scientific research into the causes of gun violence was blocked entirely, and a signal was sent to the entire scientific funding community that chilled almost all other outside research into this critical issue.
It's time to end the ban on CDC and NIH research so we can find solutions to the gun violence crisis.
Federal scientific data has driven policy to save lives from motor vehicle accidents, sudden infant death syndrome, lead poisoning, and countless other public health crises. It's time to do the same with gun violence.
Add your name to #EndTheBan on gun violence research.
Physicians must stand together to tell Congress to remove these barriers to common sense evidence-based research and include funding annually to look into the causes of gun violence. I hope you will join us.
Physicians must stand together to tell Congress to remove these barriers to common sense evidence-based research and include funding annually to look into the causes of gun violence. I hope you will join us.
For a safer Nation,
Nina Agrawal, MD
David Berman, DO
Drs. Agrawal and Berman are pediatricians and leaders of the DFA gun violence prevention campaign.
The work ahead
What an inspiring Doctors for America 2015 National Leadership Conference!
Passionate, dedicated doctors and medical students from across the country gathered in Washington, DC to learn and connect on how to make the world better for our patients.
A movement that began 7 years ago is now 16,000 physicians and medical students strong. During that time we played a critical role in the passage of the Affordable Care Act (ACA) and then spent the past several years protecting the law against repeal and defunding attempts.
We have made tremendous progress on expanding access to care and we will continue to fight to expand Medicaid and protect the ACA. Yet, we know access alone is not enough. Too much of what happens outside the clinic walls is outside of our control.
There are still too many Americans who don't have safe places to walk because of gun violence in their communities, too many children who don't have access to the food they need to aid their developing bodies. These are the pressing problems facing our patients and communities across the country. These are the challenges physicians must join with community leaders to tackle to ensure we build a healthy America for everyone.
That's why I am so excited to share with you DFA 2.0. While we honor and respect our history, we are evolving as an organization to meet the pressing health challenges that lie before us. We have a new mission, vision and guiding principles that you can view on our website.
I hope you will join us in the year ahead to continue to address access to care and Medicaid expansion as well as, food insecurity, racial disparities, mental health, substance abuse, drug pricing, gun violence, health innovation, physician well-being, organizing skills, and more.
Change happens because doctors and medical students like you take leadership into their own hands. Whether you care about an existing campaign or a new issue we haven't tackled or listed here, we want to hear from you and help you create the change you want to see.
For a healthier America,
Mona Mangat, Chair
Alice Chen, Executive Director


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By: Roger Hayes
Location: Gt. Yarmouth Norfolk England
I have a genetic condition with which I was born and as a result I am lets say 'a bit vulnerable'.
I went to a an automobile scrap yard to get some spare part for my car. Arriving late in the afternoon and haveing to park several hundred yards from the main site office,
On my arrival I passed the dog compound which contained some very large very nasty looking wolf-like alsation dogs. I like dogs but these did not look very friendly.
I spent the rest of the afternoon looking at the very old cars. Eventually it started to get dusk and I decided to find the cars I needed to remove the spare parts.
When I went to the site office to pay for them it was closed. So I went up to to bungalow which was a few hundred yards from the site. When I knocked on the door, the woman who answered it looked as white as a ghost. Shocked and horrified she invited me in quickly. She summoned her husband. She expained what I had told her 'that I had spent the afternoon looking around at all the old cars in the scrapyard, then as it was getting late, decided to get my spare parts and as the site office was shut, was now trying to pay for them. He too went deathly white.
He explained that the site had closed two hours before and the dogs had been let loose from their compound. The noise I would have made hammering and knocking on cars should have alerted them.The fact I walked freely past the main site office where the dogs are normally lurking,to my car to get some more tools, then upto their home at the top of the hill unmolested.
The owners said that even the owners wife does not walk about on her own afer hours.
After the dogs [all six of them] had been made secure, I was escorted back to the main part of the compound then onto my car.
The owner said he just could not understand how I had been able to walk around the site, particularly where the dogs roamed, unmolested for 2-hours. I should have been attacked by the pack and ripped to pieces.
I have no idea. I never saw a dog all the while I was there except when I first arrived when they were in their compound. I believe my guardian angel was looking after me. I was very safe. The dogs as far as my angel was concerned, were very secure. They simply could not harm me.
Some may never see with earthly eyes these heavenly beings or know that they exist. Many are unaware of the numerous ways they have protected and guided us. We would like to share with you the stories of people who take pleasure in expressing how real angels are.
Saint Anthony was born Fernando Martins in Lisbon, Portugal. He was born into a wealthy family and by the age of fifteen asked to be sent to the Abbey of Santa Cruz in Coimbra, the then ... continue reading | shop
Nothing is known about St. Sebastian's youth other than the fact he may have come from southern France and he was educated in Milan. He joined the Roman Army in 283 AD, ostensibly to be of ... continue reading | shop
Teresa of Ávila was born Teresa Ali Fatim Corella Sanchez de Capeda y Ahumada in Ávila, Spain. Less than twenty years before Teresa was born in 1515, Columbus opened up the Western ... continue reading | shop
Carthusian monk and bishop, defender of papal authority. Anthelm was born in 1107 in a castle near Chambery, in Savoy, France. He was ordained a priest and visited the Carthusian Charterhouse at ... continue readingMore Saint of the Day
Saint Rita was born Margherita Lotti in Roccaporena, Italy in 1381. The day after her baptism, Rita was surrounded by a swarm of white bees, which went in and out of her infant mouth without hurting her. Rather than being alarmed, her family believed she was marked to ... continue readingMore Female Saints
Saint Michael the Archangel isn't a saint, but rather he is an angel, and the leader of all angels and of the army of God. This is what the title "Archangel" means, that he is above all the others in rank. St. Michael has four main responsibilities or offices, as we ... continue reading
John Gonzales de Castrillo was born at Sahagun, Leon Spain. He was educated by the Benedictine monks of Fagondez monastery there and when twenty, received a canonry from the bishop of Burgos, though he already had several benefices. He was ordained in 1445; concerned ... continue reading
In the year 1400, a young man came to the door of the largest hospital in Siena. A plague was raging through the city so horrible that as many as twenty people died each day just in the hospital alone. And many of the people who died were those who were needed to tend ... continue reading
By Marshall Connolly (CALIFORNIA NETWORK)
On September 4, 2016, Pope Francis will canonize Mother Teresa as a saint of the Roman Catholic Church. Her canonization is an important event for Catholics and all people around the world. Here's 3 reasons why. LOS ANGELES, CA (Catholic Online) - When Mother Teresa is ... continue readingMore Christian Saints & Heroes


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Loi Suites Recoleta Hotel in Buenos Aires, Argentina
Vicente Lopez 1955, Buenos Aires, AR, 1128
Loi Suites Recoleta Hotel
Vicente Lopez 1955, Buenos Aires, AR, 1128
Property Location
Location Description: In Buenos Aires (Recoleta)
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Pets not allowed Check-in time starts at 3 PM Check-out time is 11 AM
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The preferred airport for Loisuites Recoleta Hotel is Buenos Aires (EZE-Ministro Pistarini Intl.) - 28.2 km / 17.5 mi. Distances are calculated in a straight line from the property's location to the point of interest or airport and may not reflect actual travel distance.
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Women's Valentino 'Rockstud Rolling' T-Strap Pump, Size 8.5US
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97% Success Rate Helping More Than 10,000 Patients
Sleep disorders and jaw pain can be mysterious, frustrating and difficult to endure. The Alpher Center can help you get your life back. Dr. Elliott Alpher, director, is not only a sleep disorder, TMD and TMJ specialist; he is a pioneer and leader in relieving the pain and discomfort associated with your sleep disorder, TMJ, or TMD. Come to us with the confidence that we understand your jaw pain and sleep disorder symptoms, we can diagnose your problem, and we can treat it successfully and non-invasively.


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Off-duty NYPD cop among 2 killed in wrong-way crash
Officer Richard Christopher, 32, collided with the vehicle head-on during the morning rush hour traffic on the New York State Thruway
By PoliceOne Staff
NEW YORK — An off-duty officer driving the wrong way struck another vehicle Tuesday, resulting in his death and the death of the other driver.
NBC New York reports Officer Richard Christopher, 32, collided with the vehicle head-on during the morning rush hour traffic on the New York State Thruway.
The other driver killed was 59-year-old James DeVito. Both died at the scene, according to the report.
No others were hurt in the violent collision,
Investigators will be taking toxicology tests to determine if drugs or alcohol were present in the officer's system.
Officer Christopher served eight years on the force, according to the report. He was also an Army veteran.
It is unclear why Christopher was driving in the wrong direction. The investigation is ongoing.
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FILE–Tennis Hall of Famer Rod Laver returns the ball during the 1977 Wimbledon Lawn Tennis Championships in England. Laver suffered a stroke Monday, July 27, 1998 after doing an interview with ESPN, a network spokesman said. The 59-year-old Australian, whose 11 Grand Slam singles titles are one fewer than all-time leader Roy Emerson, was taken to UCLA Medical Center, ESPN spokesman Rob Tobias said. (AP Photo/files) ORG XMIT: NY178
NFL 3hr ago
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Arts Feature
Springtime for a Hit
A dynamic Producers pleases
By Julian Wolf
Musical mayhem comes to the Albuquerque Little Theatre stage with The Producers
Arts Interview
Don't Call It a Comeback
Hip Mama's been here for years
By M. Brianna Stallings
Print's not dead, baby! Read our interview with author Ariel Gore to hear why.
EVENT HORIZON (Wednesday, Jun 29)
Get Lost
What Are Fractals?
By Joshua Lee
Learn about fractals through presentations and hands-on activities.
EVENT HORIZON (Friday, Jul 1)
Beyond the Shadows
Beyond the Shadows
By Maggie Grimason
A nonverbal shadow puppet show for the whole family. Follow Paloma on her journey across the land on a quest to find a new place to call home.
EVENT HORIZON (Monday, Jul 4)
Ballads and Bottle Rockets
Battle of the Bands
By Monica Schmitt
Local bands compete to be the group that is most talented. Cash prizes offered to first and second place. Fourth of July celebration follows.
Today's Events
Summer Reading Concert: Watermelon Mountain Jug Band at East Mountain Library
Bluegrass/country music performance.
Complementary Contrast at Sorrel Sky Gallery
Darynda Jones at Jean Cocteau CinemaMore Recommended Events ››
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This page contains Pokemon Green Hints for GameBoy called "Two turn attacks" and has been posted or updated on Nov 17, 2006 by Tristonman7.
- Developer: Game Freak
- Publisher: Nintendo
- Genre: Role-Playing Console-style RPG
- Release: Feb 27, 1996
- ESRB: Not Set
Two turn attacks
When using a two turn attack, use a sleep attack first. For example, if you have a Venasaur that can use Solar Beam, use a sleep attack such as Sleep Powder to put the other Pokemon to sleep. If it is still fast asleep, use the two turn attack. If not, use the sleep attack again.
Please Submit a Problem for any incomplete, non-working or fake cheat listed above.
If you know other secrets, hints, glitches or level guides, then please Submit your Cheats and share your insights with other gamers.
Stuck in this game? Set a specific, clearly defined question and let other gamers answer your question or view answers to previously asked questions. If you think you are an expert then please try to help others with their questions.
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Rick Nash, left, of the New York Rangers controls the puck as he is covered by Tyson Strachan of the Florida Panthers in their NHL game in New York on Thursday.Mar 23, 2013FULL STORY
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Patient Education Tool: AHRQ'S Question Builder
The Agency for Healthcare Research and Quality offers two free, downloadable tools to help patients build questions for their physicians before a visit.
The notepads are designed help consumers prioritize the top three questions they wish to ask during their medical appointment. Consumers can also consult AHRQ's interactive "Question Builder" tool to come up with a personalized list of questions based on their situation.
Download the questions card or questions builder for use in your facility.
Note: View our database providing reports that link to free, downloadable and adaptable tools for use in hospitals, surgery centers and other organizations by clicking here.
Related Articles on Patient Engagement:
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Thursday, June 30, 2016
Home Automation Evaluation: Will Automating Your Home Increase Its Value?
Many people are inundated with commercials and advertisements that try to sell home automation to them. For individuals who plan to stay in their houses for their entire lives, the decision to purchase a system depends solely upon their wants. However, people who want to sell their house need to decide if a home automation system is appropriate. Making the wrong decision can lead to the house staying on the market for a protracted period of time or to a lower sum of money offered for the property. Considering the benefits and drawbacks of home automation and house value is important.
Actual House Value
You must understand that the precise definition of value and the abstract definition of value are not the same. When you first consider home automation systems, you likely feel that they add a greater level of security to your home, which, in abstract terms, is added value. However, when appraisers come to your house, they are unlikely to add the home automation system in to the appraised cost. They may provide you with extra value for your security system. Therefore, in a literal sense, the system might not add value to your house.
Attachments and Costs
When you sell a house, anything that is physically attached to the house is included, unless your sales proposal and contract call for something else. Knowing that the home automation system will remain can help to draw buyers to the property. Also, they may be willing to spend more money because they want the system. On the other hand, that means youll need to purchase a new home automation system when you move to your new house. You have to weigh the costs of buying a new system in comparison to how much more money you will make from installing one in your current house. If you dont currently have one, you are essentially installing the system twice, so you need to make sure that you have the money to do so.
Monitoring and Safety
Most people searching for new homes do make safety a priority. They want to check to see what the surrounding community is like, but they are also concerned about the house itself. A home automation system absolutely adds a layer of security. People can monitor their houses from virtually wherever they are. For some, that is a benefit. However, others view constant monitoring as a drawback. They may have privacy concerns and wonder if anyone else has access to their personal lives. Also, they may feel uncomfortable that you were the previous owner of the system and question if your access is enti>
Aesthetic Appeal and First Impressions
When people first walk into a house in which they are interested, they immediately begin to make assumptions about it. Therefore, if an element of your home automation system greets them at the door, you are making a first impression that says your house is modern and up-to-date. Many buyers will enjoy that appeal, but that isnt true for everyone. Some people might actually see your use of the automation system as a ploy to make them ignore other problems that may exist in the house.
Your Target Buyers
You have to consider what makes your house appealing to you, but if you are selling, you also must think about what your target buyers want to see. Your target buyers are the people who are most likely to buy your house. For example, if you have a small two-bedroom house, your target buyers are likely singles, couples or couples with one child. No matter who the targeted group is, you must consider if a home automation system is what they want. Some people, for example, are more interested in butcher block countertops or brand new bathrooms than home automation systems. However, others are interested in if your home automation system can save them money on homeowners insurance or other security systems.
Money-saving Properties
A home automation system can also attract buyers and add value in terms of saving money. Make sure that prospective buyers know how a home automation system could help to save them money on energy bills. Buyers generally want to save money; however, you will have some buyers who are concerned about how much the home automation system costs to maintain and run.
Whether or not a home automation system adds value to your house varies. Each element has two sides to it, and getting to know the current market in your area can help you make the right decision.
Full Story >
Why Get Involved In Your Community Association?
Question. I have lived in my community association for a number of years. Unlike the horror stories we occasionally read about regarding bad Boards or illogical enforcement of covenants, our community seems to be working fine. We have a good board of directors and a competent manager. One of our long time board members plans to resign for personal reasons, and a number of residents have encouraged me to "throw my hat into the ring." I am seriously considering this possibility, but seek your guidance.
Answer. You have lived in your community for a long time, and are pleased with the way it is working. Do you know why? Most likely it is because there is a conscientious, hard-working board of directors, who are concerned about the welfare -- financial and otherwise -- of your association.
A community association does not function -- good, bad or otherwise -- without leadership. Often, as you have read about, boards of directors are on ego trips. Even though they may care about the welfare of the association, they are more interested in preserving and fostering their own personal agendas. Indeed, I know of one association in which the outgoing Board President seriously considered putting his picture in the social room, as a reminder of his long-term service to the Association.
But the great majority of board members are hard-working and honest. Service on the Board is not fun; the hours are long and the pay is zero. Budgets have to be planned to meet the needs of the association while at the same time satisfying the pocketbooks of the owners. Rules have to be adopted -- and then enforced. Delinquencies have to be addressed, and it is often difficult -- if not embarrassing -- to have to approach your neighbor or your friend to remind him/her there is a delinquency.
I do not know how many owners there are in your community. But regardless of size, boards must understand they are running a business -- and some of these businesses have budgets which are as large or larger as corporations trading on the New York Stock exchange.
This is a serious responsibility, which cannot be taken lightly. Many years ago a Court ruled in the State of Maryland that Board members only have to exercise good business judgment in carrying out their board responsibilities. This means that unless someone can prove fraud, cheating or stealing, a court of law will not second guess the decisions of a board of directors -- even if their decision turns out to be the wrong one.
Despite this "good business judgment" rule, I still maintain that a member of the board has a fiduciary duty to the owners who elected him/her to the board. This means that a board member must act fairly, honestly, openly and -- of most importance -- use common sense in making decisions which impact on the entire community.
Many years ago, the President of a large association gave his "state of the community" speech at the annual meeting. I take the liberty of quoting some of his remarks:
For the past two years, I have served as your President. You have called me at all hours of the day and night; you have pushed me into the swimming pool, and have poured molasses into my gas tank. The hours are long, and the pay is zilch.
But, if I would not have served, you [expletive deleted] would have screwed it all up.
I cannot add much more to this erudite speech. You have an investment in your association, and service on the Board of Directors is a way -- perhaps the only way -- of preserving that investment.
Full Story >
How The Internet Isnt Changing Real Estate
"This is going to change the way real estate is purchased forever" Thats a claim I hear about once a week at the real estate magazine that I edit. Usually its for a new app or website that provides a nifty way of doing something >
But does it change the industry? Not really. Yes, most buyers now do their real estate searches online and they use the Internet to gather mortgage information and maybe compare interest rates. Its not like the old days when only real estate agents had access to listings of homes for sale and only banks and mortgage brokers could explain the ins and outs of getting a mortgage.
But when it comes down to actually buying a house and arranging a mortgage, a large majority still turn to real live people to help with the transaction, rather than taking a do-it-yourself path.
When first-time buyers are looking for a real estate agent, half of them pick one based on a personal recommendation from family for friends, according to the 2016 Mortgage Consumer Survey by Canada Mortgage and Housing Corp. CMHC. The survey also found that family members and real estate agents have the most influence in consumers choice of which mortgage broker or lender they will use.
When looking for advice, 64 per cent of first-time buyers spoke to a real estate agent, the same number that asked family members for guidance. Others contacted for advice were lawyers, mortgage lenders and mortgage brokers.
For specific mortgage advice, a survey of adults under the age of 40 who dont currently own a home but plan to do so, conducted by Mortgage Professionals Canada, says that 66 per cent consulted with a bank first, followed by mortgage brokers 36 per cent, financial advisors 36 per cent and friends or family 33 per cent. Twenty-two per cent first went to a mortgage comparison website, while 20 per cent consulted other websites. The survey found 21 per cent asked their real estate agent for mortgage advice.
Entitled The Next Generation of Homebuyers, the survey found that despite the talk of real estate bubbles in Vancouver and Toronto, and much publicity about the high debt levels of Canadians, young people still want to buy a home.
"The majority believe in a recovering economy and feel that Canadian real estate is a good long-term investment," says survey author Kyle Davies. "Much like generations before them, most dream of homeownership."
The survey says 76 per cent of respondents think that real estate is a good long-term investment, and 72 per cent said mortgages are "good debt".
Davies says that historically, "Canadians have viewed mortgages as good debt compared to other forms of debt, which typically carry a range of negative emotions."
Why are Canadians so interested in buying a house? Again, the reasons are likely the same as their parents and grandparents cited: starting a family, getting a promotion or a raise, getting married and moving to a new job were the most common responses.
And like their parents, 80 per cent are hoping to live in a low-rise dwelling rather than a condominium. Fifty-nine per cent are looking for a detached home, 18 per cent a condo and 13 per cent are looking for a semi-detached property.
Davies says a nice neighbourhood and safety are the most important features the next generation of home buyers is seeking in a home. Next on the list are potential for resale value, type of home and a short commute.
"There are long-held beliefs in real estate concerning what buyers will pay a premium for when deciding on a home purchase," says Davies. "We decided to investigate this, and presented 26 features to respondents in an exercise to determine the must-haves as well as the nice-to-haves."
He found that neighbourhood, short commute, safety, type of home and potential for resale were most commonly cited as things for which the potential buyers would pay a premium. They were willing to sacrifice smart technology, rental units, finished basement, quality of schools and age of building if it was necessary to stay within their budgets and timelines.
Most of those who plan to buy a home 73 per cent will use personal savings as the source of their down payment. Thirty-three per cent will use a loan, 33 per cent a TSFA and 29 per cent an RRSP. Although an estimated 750 billion is expected to be inherited by Canadians in the next 10 years, only 21 per cent expect to fund their down payment with a gift from family, with 15 per cent planning to use a loan from family.
When it comes time to renew a mortgage, the CMHC survey found that 81 per cent of respondents stay loyal to their current lender.
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7 Overlooked Traditional Methods To Generate More Business
Like most industries, real estate has been overtaken by digital marketing. Which is a good thing. A historic number of homes are now listed online, and the vast majority of homebuyers, including people born pre-internet, are discovering homes via Google and other web sources. All of these things only help the industry.
Perhaps the biggest proof of the webs influence is that youre reading this article, and your colleagues and competitors get a lot of information from sites like this. The consumer side is doing the same thing, literally "consuming" everything the web has to offer. The internet is mostly free, it conveniently travels in your pocket, and its full of valuable content.
Everything new eventually gets "less new"
Savvy agents know how to successfully leverage digital media to attract prospects. They take advantage of a vast array of proven real estate sales tools, such as lead generation apps, social media, email newsletters, and other methods. Theres no question that if you know what youre doing, these techniques work incredibly well.
Yet with all that said, once most people catch on to something, it loses some effectiveness. "New and innovative" doesnt work if millions of people are doing it. The first business to advertise on TV soap operas in the 1940s made a killing. Soon other businesses caught on, and it lost its impact. A more recent example is Google. Remember when their ads were still fresh and cutting-edge? In 1999, only the forward thinkers advertised with Google search ads, and they raked in the cash. Today, everyone and their grandmother has figured out that Google is the modern day yellow pages, making it way more competitive and less profitable.
Old-School methods still work
Ironically, now that agents are flocking to the online world, you can actually stand out from competitors by using traditional marketing methods. To be clear, Im not suggesting you reduce your digital marketing, social media, apps, or anything else. In fact, my company ScoreApprove has helped thousands of agents stand out from the crowd to boost their leads.
Rather, my point is that since most of your competitors have figured out how to use Zillow and Facebook, and many old school methods are as effective as ever, it seems like a no-brainer to supplement your new-school techniques by investing at least some time into the old brick and mortar approach.
If you want to generate more qualified leads, faster than ever, you need a combination of new and traditional marketing methods. One great digital tool is ScoreApprove, used by thousands of agents to get better leads by offering homebuyers their credit score, credit protection, score tracking, and many other amazing benefits.
To learn more, visit ScoreApprove.com today.
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Payment Of Referral Fees To Unlicensed Persons Is A Tricky Subject
More than a few real estate agents are confused about the laws governing referral fees. Some dont even know that there are any laws governing referral fees. Some know, but dont care.
Particularly problematic is the issue of paying referral fees to people who do not have a real estate license. An agents unlicensed brother in-law might ask for a sum of money in return for referring to him a person who intends to buy a house; and the agent very well might agree. Indeed, agents will sometimes solicit referrals from unlicensed persons. They may even advertise that they will pay a certain fee for the referral of buyers or sellers.
Real estate transactions and the activities of real estate agents are subject to a variety of both state and federal laws. The fact that there are these two different authorities provides some explanation for the common confusion about referral fees.
California real estate law permits the payment of referral fees to unlicensed persons. Other states may prohibit that. In California, the only restriction is that the recipient of the referral fee must not have any involvement in the transaction itself. Their sole role can only be to introduce the buyer or seller to the agent. They must not get involved in such things as valuing the property or trying to arrange financing.
Federal law is different from California law in this regard. It allows the payment of referral fees from licensee to licensee; but it prohibits, in most cases, the payment of referral fees to unlicensed persons.
The >
There are a number of exceptions to the RESPA prohibition against referral fees. If the transaction is a residential building that is greater than four units, it is exempt. If it is commercial, or vacant land, it is exempt. The same goes for transactions that are for cash, or those that are seller-financed.
Given the number of cash transactions occurring in the past few years, a lot are exempt from the RESPA prohibition against referral fees.
Still, it is >
Nor is this just a matter of interest for real estate agents. It is also of concern to those unlicensed persons who want to receive referral fees.
12 USC Section 2607 a says, "No person shall give and no person shall receive any fee... [pursuant to a referral agreement]". My emphasis. Subsequently, Section c3 goes on to exempt referral fee arrangements between licensees. But it does not exempt referral fee arrangements between licensed and unlicensed persons. In short, if a referral fee is paid to an unlicensed person in a transaction covered by RESPA i.e. the vast majority of transactions, both the agent and the recipient will be guilty of a violation.
This being the great country that it is, there are always those with a creative solution. "We dont call it a referral fee. We say it is a finders fee." The response, however is: No, it still quacks like a duck.
Violations of Section 2607 are punishable by fines of up to 10,000 and a maximum of one year in prison. Its something to think about.
Bob Hunt is a director of the California Association of Realtors. He is the author of Real Estate the Ethical Way. His email address is .
Full Story >
Is The Gray Hardwood Floor Trend Right For You?
Gray floors starting popping up as a trend a few years ago, and theyve grown in popularity and desirability alongside gray walls and gray kitchens and gray everything else. But you dont have to have gray in every part of your home to embrace this trend. Cool and sophisticated, gray hardwood provides a solid foundation upon which an array of dcor >


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Dave Mustaine Net Worth: Dave Mustaine is an American musician and singer who has a net worth of $20 million. Dave Mustaine was born September 13, 1961 in La Mesa, California. He best known as the was the original lead guitarist for the American heavy metal band Metallica and cofounder, rhythm and lead guitarist, and lead singer of the American thrash metal band Megadeth. His first band, Panic, was short-lived, as two members of the band were killed in a car crash after Panic's second show. Mustaine then joined Metallica as their lead guitarist. In 1983, Mustaine was fired from Metallica due to drinking, drug use and overly aggressive behavior, as well as personality conflicts. Mustaine then started the short-lived band Fallen Angels, which folded due to what Mustaine cited as lack of "chemistry, (the) energy, (the) spark…". In 1984, Mustaine joined Megadeth and added 'lead vocals' to his resumé within the band. In addition to his Megadeth duties, Mustaine also appeared in the 1988 Penelope Spheeris-directed metal documentary Decline of Western Civilization II: The Metal Years, covered the Democratic National Convention for MTV in 1992, joined former Fear frontman Lee Ving for a one-off project dubbed MD.45 (their lone album was 1996's The Craving) and designed his own line of instruments for the Jackson guitar company. After several near-death experiences, Mustaine cleaned up his act for good in the late-'90s, as Megadeth continued to tour and crank out further releases—1999's experimental Risk and their first release for the Sanctuary label, 2001's The World Needs a Hero. The band was the subject of a VH1 Behind the Music episode that same year, with Dave Mustaine being the primary focus.
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Dave Mustaine
Date of Birth
Sep 13, 1961 (54 years old)
Singer, Musician, Songwriter, Actor, Record producer, Singer-songwriter, Author, Guitarist, Talent manager
United States of America
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Andrew Bynum, Philadelphia's Bigfoot, has been spotted in the Penthouse Club, a gentleman's establishment in northeast Philly. Crossing Broad found this photo of Bynum with hostess Rach, taken last night.
The photo was posted to Instagram but has since been deleted.
3. The girl who posted the photo, "Rach_Recklesss," gave a brief account of the evening's festivities.
4. Bynum also has a message for Philadelphia fans who may be angry that he is being paid $16,100,000 this year to go to the Penthouse Club and take cherry noir Goose shots.
At least he's taking shots of some kind.
H/T Crossing Broad.
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