Government Increasingly Promoting Sectarianism-Based Health Policy

Traditionally, physicians and other health care professionals are taught to put the care of the individual patient first.  Patients deserve care according to their own values as best they can be realized.  Physicians whenever possible should avoid substituting their own values for those of the patient.  In particular, they should avoid imposing their own religious beliefs on those of patients.

In the US, we live under a Constitution whose First Amendment states "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof."

Thus it is concerning that under the Trump administration we have seen efforts apparently meant to orient government agencies involved with health care and public health to a particular set of religious beliefs.  We summarized here instances in which appointments to government agencies seemed to be based on appointees' religious view, and/or in which appointees seemed to be promoting health policies based on their personal religious beliefs.  These included instances of appointees arguing against the adoption of children, and making assertions that "intersex patients do not exist, that contraception causes cancer and violent death, that pornography is a major public health hazard."

This year, we have seen more evidence that the administration has been appointing people to health care or public health related leadership positions based on their religious views, and promoting sectarianism-based health care and public health.

More Appointments Apparently Based on Religious Views Rather than Health Care or Public Health Expertise

In May, Reuters published an article entitled "the foot soldiers in the Trump-Pence religious health movement."  Its introduction stated

With Donald Trump’s election in 2016, Vice President Mike Pence emerged as a force in reshaping American health policy. Aligning the policy with Pence’s evangelical Christian principles, the administration stocked the Department of Health and Human Services and other federal agencies with a cadre of pro-life staff members.

The implication is that the appointments were made according to the appointees' religious beliefs, rather than their knowledge of or experience in relevant health care or public health spheres.

It included capsule biographies of several people heretofore unknown to me.

ANDREW BREMBERG

Position: Former head of Domestic Policy Council; now nominated as ambassador to the United Nations mission in Geneva.

Background: Bremberg, a health policy expert, served as co-chair of the HHS transition team that stocked the agency with religious conservatives before serving as chief of the White House policy operation. He drafted the expanded Mexico City policy that imposes anti-abortion rules on billions in U.S. health aid.

MAGGIE WYNNE

Position: HHS, Counselor for Human Services Policy

Background: A former HHS official under the Obama administration and director of the U.S. House Pro-Life Caucus, Wynne worked for the Knights of Columbus, a Catholic service organization, before rejoining HHS. She served on the transition team, helped bring in other anti-abortion activists and participated in attempts to prevent pregnant immigrant girls from obtaining abortions.

STEVEN VALENTINE

Position: Chief of Staff, Office of the Assistant Secretary for Health

Background: A former interim legislative director at Susan B. Anthony List, an anti-abortion group, Valentine helps supervise the Title X grant program. With other anti-abortion advocates in the office, he tried to end the Teen Pregnancy Prevention Program, [more about contraception than abortion] a move blocked by the courts.

VALERIE HUBER

Position: Senior policy advisor, HHS Office of Global Affairs

Background: The former president of a Washington group that championed 'sexual risk avoidance,' or abstinence as an alternative for birth control, Huber wrote a paper that said Christians should promote 'God’s sexual guidelines to life' in sex education and public health policy. Huber worked on the attempt to kill the Teen Pregnancy Program, and now works on international health policy.

MARCH BELL

Position: Chief of Staff, Office for Civil Rights

Background: An abortion opponent and former Justice Department attorney, Bell was staff director for a House panel that investigated Planned Parenthood [which provides contraception services, cancer screening, and other health services in addition to providing abortions] for selling baby parts, an inquiry that grew out of a controversial video sting operation.

MATTHEW BOWMAN

Position: Deputy general counsel, HHS

Background: As senior counsel at the Alliance Defending Freedom, an organization that defends religious conservatives, Bowman was part of a 'life litigation project,' working on cases against the contraception mandate in Obamacare. He himself has been arrested for demonstrating outside abortion clinics.

Note that these appointees advocacy of religious beliefs about health care were not limited to their views on the highly controversial topic of abortion, but also were directed against, for example, provision of contraception and other family planning services.

SCOTT LLOYD

Position: Former head of the Office of Refugee Resettlement, now senior advisor at the Center of Faith and Opportunity Initiatives

Background: When Lloyd ran the office responsible for caring for young migrants, he tried to block some of the underage women from having abortions, sparking court battles. A lawyer, Lloyd helped found a firm that worked on cases based on Catholic doctrine on birth control and abortion. 'The law is pagan territory,' he has written. 'Look no further than no fault divorce, legalized abortion on demand, and gay marriage as confirmation.'

I can find no information suggesting that any of the people above has direct experience or training in biomedical science, medicine, other health professions, or public health.  Note that in previous posts we had mentioned several of the people appearing in this article: Katy Taalento, Diane Foley, and Roger Severino. Others we had noted as apparently unqualified members of the Trump "beach head teams," but without knowledge of their sectarian focus.

More Administration Action Promoting Sectarianism-Based Health Policies

Several relevant articles have appeared this year.  In March, the Washington Post reported on efforts to promote policies oriented specifically to evangelical Christian and Catholic beliefs.   In summary,

In the first year of the Trump administration, Christian social conservatives placed in high-level jobs — [Valerie] Huber [see above] among them — focused mostly on U.S. policy. They were highly successful, pushing through a religious exemption to the Affordable Care Act’s birth-control mandate, prioritizing abstinence-only sex education and imposing what critics call 'gag rules' on family planning groups receiving $286 million in the United States and up to $7.4 billion around the world that prohibit them from referring for abortions.

Now, they are seeking to spread those views to the rest of the world by building a coalition of nations that would wield clout beyond the Trump administration.

In May, another Reuters article noted

the quiet, behind-the-scenes influence of Vice President Mike Pence, who has been driven throughout his political career by his evangelical Christian beliefs to restrict abortion and prioritize the rights of religious conservatives.

So,

Under the direction of two secretaries recommended by Pence, the Department of Health and Human Services has moved to slash funds from teen pregnancy-prevention programs, curb abortion both in the United States and abroad and strip civil protections for transgender patients.

The administration has emphasized abstinence programs, led by appointees who believe contraception harms women, and pushed to cut government funds for Planned Parenthood – a longtime cause for Pence while he was in Congress. Planned Parenthood, a national network of healthcare providers, offers infertility services, contraception and abortions.

Again, the focus goes way beyond the controversial abortion issue:

In Kenya, services are already being reduced, said Jedidah Maina, director of the Trust for Indigenous Culture and Health, which offers programs on sexual and reproductive health and operates a health services hotline. One partner organization no longer provides free healthcare for the impoverished, and another was forced to reduce HIV services, she said.

In Peru, the reproductive-rights advocacy group PromSex said it was unable to apply for a grant to combat human trafficking from the U.S. Agency for International Development because it fights for access to abortion. In a November 2017 email obtained by Reuters, a USAID contracting officer said if the group 'were carrying out activities or planning to carry out any activity related to family planning methods, it could not commit itself with the Government of the United States.'

Also,

Christine Dehlendorf, director of the Person-Centered Reproductive Health Program at the University of California, San Francisco, said HHS cancelled two grants for ongoing research into contraception. One was restored through litigation.

Dehlendorf said she lost about $800,000 in funding for a study of how well medical providers meet women’s contraception preferences, which included natural family planning methods favored by some conservatives. There was 'no reason to eliminate it other than a lack of a general desire to meet women’s reproductive health needs,' Dehlendorf said.

Top Administration Leaders Advocating Government Establishment of Religion

Recently, two top Cabinet Secretaries gave speeches in their official capacities advocating government oriented to particular religious beliefs, conservative Christian principles.  One was Attorney General William Barr, as reported by Mother Jones on October 12, 2019, decried the influence of people who do not believe in organized religion

'This is not decay,' Barr said. 'This is organized destruction. Secularists and their allies have marshaled all the forces of mass communication, popular culture, the entertainment industry, and academia in an unremitting assault on religion & traditional values.'

Then,

In his address Friday, Barr thundered against what he described as a 'moral upheaval.' 'Virtually every measure of social pathology continues to gain ground,' he said. 'Along with the wreckage of the family we are seeing record levels of depression and mental illness, dispirited young people, soaring suicide rates, increasing numbers of alienated young males, an increase in senseless violence and the deadly drug epidemic.'

So he seemed to imply that the cure for depression, mental illness, and drug abuse is ... conservative Christian religion.  Again, here is sectarianism-, not evidence-based health policy.  Note that the article also stated,

Barr’s depiction of a war between the non-religious and people of faith shocked legal experts, who saw Barr’s defense of religious freedom as an assault on the First Amendment’s protection against the government’s establishment of any religion.

In an editorial in the NY Times, Paul Krugman wrote in reference to Barr's speech

how inappropriate it is for Barr, of all people, to have given such a speech. The Constitution guarantees freedom of religion; the nation’s chief law enforcement officer has no business denouncing those who exercise that freedom by choosing not to endorse any religion.

Furthermore,

And he didn’t just declare that secularism is bad; he declared that the damage it does is intentional: 'This is not decay. It is organized destruction.' If that kind of talk doesn’t scare you, it should; it’s the language of witch hunts and pogroms.

Meanwhile, Secretary of State Mike Pompeo was even more explicit about how he deliberately establishes his religion in his government work, as reported by the Times of Israel also on October 12,

In his official capacity as America’s top diplomat, US Secretary of State Mike Pompeo delivered a speech on Friday on 'what it means to be a Christian leader' during a State Department event, prompting criticism that he crossed the line denoting the separation of church and state.

Addressing the American Association of Christian Counselors in Nashville, Tennessee, Pompeo emphasized what he deemed the main components of Christian leadership.

'I want to use my time today to think about what it means to be a Christian leader, a Christian leader in three areas,' he said. 'First is disposition. How is it that one carries oneself in the world? The second is dialogue, talking. How is it that we engage with others around the world? And third is decisions, decisions that we make.'

By the way, just to underline that this was an official speech, not just Pompeo speaking personally about his religious beliefs, the transcript of the speech is now on the official US State Department website here.

The Times of Israel quoted

Aaron Keyak, the former head of the National Jewish Democratic Council, [who] questioned the propriety of Pompeo’s using his platform to promote a particular religion.

'There’s obviously no issue with the secretary of state being a leader, nor his being a proud Christian,' Keyak told The Times of Israel. 'But it’s a problem that Secretary Pompeo thinks it’s appropriate to put those two words together and hold an official State Department event on being a Christian leader.'

'He’s an American leader, who is also a practicing Christian,' Keyak went on. 'Him talking as a Christian leader and billing it as such is an affront to our separation of church and state.'

Summary

As we said before, basing health care and public health decisions on political ideology or religious belief seems worse than just basing them on money, which had become prevalent in the dysfunctional US health care system. In some cases, the resulting mission-hostility seems to translate into violations of the US constitution.  For example, making health care decisions based on a particular religion's beliefs could be harmful for patients or citizens who do not share these beliefs, plus violate the Constitution's guarantee of freedom of a government establishment of religion.

For years, I thought that health care dysfunction was primarily about individuals and private organizations, including but not limited to pharmaceutical, biotechnology and device companies; hospitals and hospital systems; insurance companies, academic medical institutions; physicians and their practices; etc, etc, etc.  Consequently, I thought these individuals and organizations needed better awareness of health care dysfunction to provoke them to improve matters.  I thought of the government as being involved, but mainly because of well-intentioned, sometimes bumbling government actions and policies that often had unintended effects, and sometimes excess coziness with the health care industry.  While I knew that the government was subject to regulatory capture and various leadership problems, its role in health care dysfunction, at least in the US, seemed almost secondary.

But in the Trump era, there is a new (ab)normal.  All the trends we have seen since our last discussion of health care reform are towards tremendous government dysfunction, some of it overtly malignant, especially in terms of corruption of government leadership of unprecedented scope and at the highest levels, and overt influence of government-favored political ideology and religious beliefs on health care policy and other policies and actions.

I hope that our update above will add to the urgency pointing health care and public health professionals, patients, and all citizens towards a much more vigorous response.  US health care dysfunction was always part of the broader political economy, which is now troubled in new and dangerous ways.  We do not have much time to act.

If not now, when?

If not us, who? 

Why Did the Head of the Center for Medicare and Medicaid Services Outsource Communications Functions to Private Public Relations Firms? - Ethical and Legal Questions

There is now never a dull moment at the Center for Medicare and Medicaid Services (CMS) an agency of the US Department of Health and Human Services (DHHS).  Its current director, Seema Verma, has developed a more efficient way to combine conflicts of interest with self-interest, bad management, and possibly worse.

Outsourcing CMS Communications to Private Public Relations Firms


In summary, Politico reported

The Trump appointee who oversees Medicare, Medicaid and Obamacare [Seema Verma] quietly directed millions of taxpayer dollars in contracts to Republican communications consultants during her tenure atop the agency — including hiring one well-connected GOP media adviser to bolster her public profile.

The communications subcontracts approved by Centers for Medicare and Medicaid Services Administrator Seema Verma — routed through a larger federal contract and described to POLITICO by three individuals with firsthand knowledge of the agreements — represent a sharp break from precedent at the agency. Those deals, managed by Verma’s deputies, came in some cases over the objections of CMS staffers, who raised concerns about her push to use federal funds on GOP consultants and to amplify coverage of Verma’s own work. CMS has its own large communications shop, including about two dozen people who handle the press.

The move to give large contracts to outside public relations (PR) firms seems unprecedented and seems unnecessary.  Per CNN

whether the issue was Medicare, Medicaid or Obamacare, prior heads of the agency were often quoted, profiled and in the news, so current officials said they’re puzzled why so much work is being outsourced.

'The head of Obamacare doesn't need outside consultants to get reporters to talk to her,' said one CMS official, who asked for anonymity. 'The job pitches itself.'

Ethical and Legal Issues

In addition, outsourcing communications to private PR firms raises multiple ethical, and possibly legal questions:

'Outsourcing communications work to private contractors puts the agency's ability to protect ‘potentially market-moving’ information from premature disclosure at considerable risk,' said Andy Schneider, a Medicaid expert who worked at CMS during the Obama administration and is now a researcher at Georgetown University.

Also,

But some career CMS staff have voiced their concerns to political appointees within the agency about routing taxpayer dollars to GOP consultants and helping a federal official like Verma improve her personal brand, said two individuals aware of those conversations. Oversight groups also have raised concerns, saying the behavior, as described to them by POLITICO, would appear to cross ethical lines.

'There are a host of ethical and contractual problems with appointees steering contracts to political allies and subcontractors, and possibly a violation of the ban on personal services contracts if the work is being performed at the direction of the appointee,' Scott Amey, general counsel of the Project on Government Oversight, told POLITICO. 'Contracts are supposed to be above reproach, with complete impartiality, and without preferential treatment, and the HHS Inspector General should review this [Porter Novelli] contract and the activities under it to ensure they are proper.'

The choice of PR firms led to the concerns about steering contracts to "political allies."

The subcontracts are part of a $2.25 million contract administered by Porter Novelli, an international public relations firm that performs a wide variety of government services. CMS’ new top communications official Tom Corry confirmed the arrangement. Two other individuals said CMS also spent at least $1 million on earlier contracts with GOP communications consultants.

One subcontract is with Pam Stevens, a longtime GOP media adviser who specializes in setting up profiles of Republican women. A second subcontract is with Marcus Barlow, whom Verma worked with in Indiana and considered hiring as a top communications official in 2017 before he was blocked by the White House.

And,

A third contract is with Nahigian Strategies, a firm run by a high-profile pair of brothers. Keith Nahigian consulted with several GOP presidential campaigns; Ken Nahigian briefly led President Donald Trump’s presidential transition team in 2017.

In other words, hiring contractors because of their political affiliations for the purposes of burnishing the image of particular government bureaucrats appears to be an abuse of power.


Also, Porter Novelli subcontracted with one Brett O'Donnell, who was involved in the following controversial episode which could be interpreted as a threat to the free press, which is protected by the Bill of Rights:

In a February 2018 incident, contractor Brett O'Donnell barred a Modern Healthcare reporter from a media call for refusing to alter a story that had rankled Verma. CMS officials walked back that threat within days and said a week later that Porter Novelli’s subcontract with O’Donnell, a longtime GOP consultant, would not be renewed. But CMS never provided any explanation of O’Donnell’s role or responsibilities. O’Donnell declined to comment for this article.

We wrote about his incident here. 

Given that federal officials like Verma swear

I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same;

for Ms Verma to have enabled the hiring of a contractor who tried to suppress press freedom could certainly be interpreted as mission-hostile management, or worse. 

Questions About Conflicts of Interest


Although not mentioned in the Politico article, the choice of Porter Novelli as the main contractor may raise concerns about conflicts of interest, it seems to me.


Porter Novelli is a huge public relations firm.  It has substantial business with the government.  However, it is also known for its "health and wellness" practice, per its profile in EverythingPR.  According to SourceWatch, its clients have included multinational pharmaceutical companies: Pfizer, Wyeth, and GlaxoSmithKline.  One of the practice's leaders once was Peter Pitts, who frequently spun stories to advance pharma interests, and who founded the Center for Medicine in the Public Interest (CMPI), which received considerable money from pharma and has often seemed to be an advocate for the industry.  Some examples of Pitts' work were discussed here, and his apologia for opioid manufacturers here.


Discussion

Perhaps there is more to come on this story.  Today, Politico reported that after the publicity of Ms Verma's contract with Porter Novelli et al, those contracts have been suspended. 

 Previously, US News & World Report noted that

House Energy and Commerce Chairman Frank Pallone on Friday called on an inspector general to investigate a report that a top health official appointed by President Donald Trump spent millions of taxpayer dollars on GOP communications consultants.

Also,

Pallone called the contracts a 'highly questionable use of taxpayer dollars' and wants investigators to determine how the contracts got approval and if there was any breach of regulations and ethical guidelines.'

'Given that this agency should be spending tax dollars to ensure Americans can access quality health care, it is particularly egregious that it is using millions to ensure its Administrator has access to outside public relations and image building services,' Pallone said in a statement.

'I intend to ask the HHS OIG [the U.S. Department of Health and Human Services Office of Inspector General] to immediately begin an investigation into how these contracts were approved, whether all regulations and ethical guidelines were followed, and why taxpayers are stuck paying for these unnecessary services. This is not the way to drain the swamp.'

In any case, the Trump administration continues to come up with new and innovative conflicts of interest affecting health care policy and regulation.  We have discussed the rotational velocity of the revolving door that has supplied health care industry stalwarts to become government health care policy-makers and regulators (most recent example is here, and most recent example involving CMS is here).   Now a top DHHS official has decided to commission and big PR firm well known for its pharmaceutical industry clients to promote her attempts to bolster "her tenure running Medicare and Medicaid ... marked by attacks on both programs and their beneficiaries," per a commentary in the National Memo.

This is not the first time we have discussed Ms Verma's conflicts of interest.  Here we noted how she advised the Indiana, Kentucky, and at least seven other states' Medicaid programs while working for Hewlett-Packard, a contractor for those programs.  (Note that Hewlett-Packard was also a big Porter Novelli client, per SourceWatch.)  But she continues to expand her reputation for mingling government functions and commercial interests.

Ms Verma also apparently has used outsourcing to add a propaganda element to government communications (Recall that public relations was just the term Bernays picked because he thought sounded better than "propaganda.")  Furthermore, that propaganda seemed meant not to improve the health of the public, but to enhance Ms Verma's personal image. That seemed to be an abuse of power, in my humble opinion.

Moreover, there was at least one incident in which the propaganda function may have turned into a threat against press freedom (the O'Donnell incident above), and hence was certainly an example of mission-hostile management, and could easily also be viewed as an abuse of power.

We have long written about conflicts of interest, but until 2016, our cases were mostly conflicted academics, health care professionals, or leaders of private health organizations, e.g., hospitals, academic organizations, pharmaceutical companies etc.  Now the most striking cases are coming from the Trump regime.

We have long written about self-interested and mission hostile management, but again, until 2016, our cases were mostly about leaders of private health organizations.  Now the most striking cases are coming from the Trump regime.

How can be talk about true health care reform without talking about true reform of our current government?

Free Press? Don't Need No Stinkin' Free Press - Center for Medicare and Medicaid Services (CMS) Tries to Intimidate Modern Healthcare Journalist

Remember the good ol' days, when most US challenges to free speech or the free press in health care came from aggrieved corporate or academic managers?  Now government health agencies have gotten into the act, never mind First Amendment guarantees of free speech and a free press.

CMS Attempted to Intimidate a Journalist for Modern Healthcare

This story first appeared on the blog of the Association of Health Care Journalists, and has now been summarized in only one media outlet, The Hill.  Per Felice Freyer, the Vice President of the AHCJ, Virgil Dickson, a reporter for Modern Healthcare, wrote a

Jan. 23 story about the abrupt resignation of Brian Neale, an official who oversaw Medicaid and helped move it in more conservative direction.

After providing statements from [director of the Center for Medicare and Medicaid Services (CMS) Seema] Verma and Neale, Dickson quoted 'industry insiders' who said the departure was prompted by 'some sort of disagreement between Verma and Neale that erupted in the past few days.' He also mentioned that one source said Neale had been concerned about the workload. 

That rather bland report seemed to displease the management of CMS.  Ms Freyer noted,

After the article appeared, Dickson received an email from Brett O’Donnell, a communications contractor working for CMS. O’Donnell called reports of a disagreement or workload problems 'false speculation' and said it was 'irresponsible' to mention them without more details.

Dickson stood his ground, noting that the information came from multiple, reliable sources. But he agreed to speak with Neale for clarification, and subsequently added Neale’s denial of a disagreement.

That was not enough for Mr O'Donnell:

The next day, O’Donnell wrote to Dickson’s editor, Matthew Weinstock, asserting that the article was inaccurate and demanding that the references to workload and the disagreement be excised. O’Donnell’s email also stated: 'Short of fully correcting the piece we will not be able to include your outlet in further press calls with CMS.'

The next week,

 Virgil Dickson, Washington bureau chief for Modern Healthcare — believed the agency was making good on its threat on Thursday when, he said, his phone went mute during a CMS press call and a woman’s voice told him he was not allowed to participate. An editor later confirmed with CMS officials that he had been banned from press calls, Dickson said.

The Context of the Intimidation


CMS is, of course, a government agency, and so must heed the First Amendment of the US Constitution, part of the Bill of Rights,

Congress shall make no law ... abridging the freedom of speech, or of the press

Nonetheless, this appeared to be a clear attempt to intimidate a reporter trying to uphold the tradition and guaranteed Constitutional right of freedom of the press.  As Ms Freyer wrote,

the attempt to alter a story by threatening to cut off access raises deep concerns among journalists.

'Administrator Verma seems to think she can bury inconvenient facts by threatening reporters with blacklisting,' said Ivan Oransky, M.D., president of the Association of Health Care Journalists, the world’s largest organization of reporters, editors, and producers covering health care.

'That tactic won’t work – truth will out,' Oransky said. 'But the very act of trying to stifle a press report is a frightening assault on the First Amendment. AHCJ intends to vigorously protest this bullying.'

Furthermore,

Aurora Aguilar, editor-in-chief of Modern Healthcare, told AHCJ that the incident is unlike anything she has seen in more than 20 years in journalism.

'I don’t think I’ve ever come across a situation where I was asked to remove something from a story in a way that felt like censorship,' she said.

Making this all the more extraordinary, consider some more background.  Modern Healthcare is hardly some revolutionary pamphlet, and Virgil Dickson was not aspiring to be another Thomas Paine.  As Ms Freyer wrote,

Aguilar said Dickson is known as a thorough and fair reporter. Modern Healthcare, whose subscribers are chiefly executives from health care systems and insurance companies, publishes articles about CMS once or twice a day.  

As an aside, Mr O'Donnell, who seemed to be acting as Seema Verma's bully, is not a CMS, or government employee.

O’Donnell, the consultant who threatened to blackball Modern Healthcare, is not a member of the media affairs offices for CMS or for HHS.

He was only described as a "contractor."  He also is a contractor with a checkered past.

He is a Republican strategist who has helped GOP candidates in their political campaigns. In 2015,O’Donnell pleaded guilty to lying to U.S. House ethics investigators about how much campaign work he did with money that came from office accounts rather campaign accounts.

The USA Today story linked above further stated that his guilty plea

is the first time anyone has been charged with a federal crime for lying to the House Office of Congressional Ethics, which was set up in 2008 to vet allegations against lawmakers and staff and recommend further action to the House Ethics Committee.

The charges against him included,

during his interview with OCE investigators, O'Donnell 'knowingly and intentionally made several false statements to OCE in an effort to minimize and conceal the true nature and scope of his role as it related to [Broun's] campaigns.' For example, he told OCE investigators, 'I never felt like any of my campaign work was expected as part of my duties.'

Summary and Discussion

It appears that  respected reporter for a well-known US health care business publication was barred from participation in CMS conference calls after some rather mild reporting on his part offended CMS leadership.  There seemed to be an attempt to intimidate the reporter by a federal "contractor" paid by CMS, a contractor who was a criminal, that is, who had pleaded guilty to a federal crime of lying to the Conressional Ethics office. 

 How far have we descended.

On Health Care Renewal we have been writing about attempts to limit free speech or free discussion in the press in the health care sphere for more than 10 years.  Through 2015, nearly every case we discussed involved large academic institutions, hospital systems, or for-profit health care corporations trying to limit criticism of their products, actions, leadership, etc.

I do not recall any serious cases involving US government agencies.  After all, the US has a long tradition of freedom of speech and the press, enshrined in our constitution.

However, in 2016, we started viewing with alarm the implications of candidate then President Donald Trump's apparent attempts to intimidate the press and citizens who exercise their rights of free speech (e.g., look here).  Now we have a US government health agency slipping into the role of thought police, and using the hired services of a federal criminal to intimidate a journalist.

The anechoic effect is now being shrouded in much deeper shadows.  We may need a new Thomas Paine.

ADDENDUM 13 February, 2018 - This post was republished in OpEd News on February 12, 2018.

A Tangled Web of Perversity by a Healthcare Company Owner - Subpoenaing Emails of Law Student Critics at NYU Law School, Where He is a Trustee

At Healthcare Renewal, we are largely calling for removal from healthcare of perverse managers and perverse management practices. 

One of those practices is the attempted silencing of critics.

This recent story is simply stunning in the audacity of its principal regarding "shutting up" critics, this time two law students at a law school of which he is a Trustee:

Law School Trustee's Company Chills Critical Speech With Subpoena For Students' Personal Emails

Mon, Apr 21st 2014 1:14pm

http://www.techdirt.com/articles/20140418/18013426963/law-school-trustees-company-chills-critical-speech-with-subpoena-students-personal-emails.shtml

A New York University trustee has found a way to chill speech critical of him and the [healthcare] companies he owns: subpoena the personal emails of two particularly outspoken opponents.

A New York University Law trustee's company wants two students to hand over their personal emails after they circulated a letter criticizing him, according to a subpoena.

The law students, second-year Luke Herrine and first-year Leo Gertner, were targeted after they helped circulate a letter denouncing NYU Law School trustee Daniel Straus, who owns Care One Management, a home health aide and nursing home company embroiled in a labor dispute.

The two students started a petition asking for the removal of Straus from the Board of Trustees, pointing out that a law school should probably be associated with someone who respects the law, something Straus' companies seem to have trouble doing. His two companies, CareOne (http://care-one.com/) and HealthBridge Management (http://www.healthbridgemanagement.com/), have been cited at least 38 times by the National Labor Relations Board for violating federal labor laws. In addition, HealthBridge was held in contempt of court for refusing to allow 600 workers to return to their jobs at their pre-strike pay levels.

"A law school should probably be associated with someone who respects the law" seems an oxymoron, not to mention protected speech under the First Amendment of the U.S. Constitution: http://en.wikipedia.org/wiki/First_Amendment_to_the_United_States_Constitution.

CareOne's current legal battle with a local labor union, Service Employees International Union (SEIU), something that has dragged on for years at this point, has seemingly turned into a convenient way for Straus to get back at his critics. Of course, CareOne claims otherwise.

CareOne spokesperson Deborah Maxson said the deadline for the requested information is April 25.

“Straus is not a party to the lawsuit and is not managing the litigation,” Maxson said.

Straus may not be a party to this lawsuit, but these are his companies, and there can be very little doubt that Straus would prefer the ongoing criticism of his business efforts be halted. If CareOne wants to use the excuse that Straus isn't a "party" to this lawsuit, then it needs to extend that same courtesy to the two students, who also aren't a "party" to the ongoing legal fight.

But they're defenseless students, and in healthcare matters, dissing a high-ranking healthcare management  person seems to be a crime that such persons cannot seem to tolerate.  (I won't get into the psychopathological issues that may come into play).

Then there's the content sought by the subpoenas. This, too, mentions Straus directly, even as CareOne claims this has nothing to do with him. According to a letter sent by the Board of Trustees to NYU administration, this is what CareOne is hoping to obtain:

“The subpoenas requested information regarding any contact the students may have had with SEIU and any activity they may have engaged in, such as protests or meetings, relating to Mr. Straus or CareOne...”

If Straus isn't "party" to this lawsuit, why does CareOne need information relating to Straus? Beyond that, the information requested bears all the hallmarks of trying to use the power of the court to silence free speech. Protests and meetings, both activities covered by the First Amendment, are mentioned specifically by the subpoena.

Perhaps some members of the generation after the "Greatest generation" have such low self-esteem that they have to bully mere students into submission.

For what it's worth, NYU has stepped up and has provided the students with the pro bono help of one of the school's lawyers. It also issued a very carefully-worded defense of the students, no doubt mindful of Straus' $1.25 million annual endowment.

“The Law School is not a party to the litigation between Care One and SEIU, and will remain uninvolved in it," the school wrote in a statement to DNAinfo New York sent Thursday. "We vigorously support the right of our students to express their views and to organize and participate in lawful demonstrations and other protest activity, at the same time that we acknowledge that parties to litigation are permitted, subject to applicable rules and judicial oversight, to gather evidence in support of their case."

Further statements reiterated NYU's support for its students' rights but also noted it considered Straus to be an "upright and honorable person."

That said, it seems that there is a clear -- and somewhat massive -- conflict of interest for Straus to remain on the board of trustees at NYU Law at the same time he's using the legal process to demand the email contents from two of its students.

Conflicts of interest are nothing new to healthcare.

As is noted by the students' new petition demanding the withdrawal of the subpoenas, this sort of activity, undertaken by a "victim" of criticism, will discourage others from approaching anything remotely controversial.

Forcing students to turn over emails and other private communications in litigation that does not concern them can chill free speech on campus and make students think twice about raising their voice about controversial issues. This is antithetical to NYU's mission of open academic inquiry and commitment to the public interest.

That's assuming the mission of NYU and other universities still remains "open academic inquiry."  Many have begun to doubt that, and with good reason; e.g., see http://www.bloombergview.com/articles/2014-04-22/free-speech-zones-and-other-college-lies as just one example.

Rather than address these concerns, Straus is allowing (or directing) his company to shut down his critics by seeking personal communications from non-party NYU students. Straus also has additional leverage with the university should this fail to keep future criticism at bay. Of course, there's always a chance NYU will side with the students and decide that Straus' companies don't really reflect the culture it's trying to instill in its students. But until this all plays out, we're just witnessing the sort of tactics deployed by entities who would rather shut people up than address their concerns.

I note the following statement on the web page of Care One Management:

"With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities."

With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.
- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf

With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.

- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf

With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.

With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.

- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf P { margin-bottom: 0.08in; }A:link { }

In healthcare, I remind, the "shut people up" mentality results in patient injury and death.  It seems to me that this Trustee is not just setting a bad example for the legal profession, but it also throws the management of his healthcare organizations into question.

-- SS