- Associated Press - Wednesday, November 4, 2015

Recent editorials of statewide and national interest from New York’s newspapers:

The Adirondack Daily Enterprise on who should pay to provide the poor with legal representation.

Oct. 28

It’s been 52 years since the U.S. Supreme Court issued its 1963 decision in Gideon v. Wainwright that all states have been obligated to provide a plan for representation of indigent populations in both criminal courts and family courts.

Few would argue the Supreme Court erred in saying the poor have a right to legal representation. The argument over who pays the bill, on the other hand, began 50 years ago and continues to this day.

New York state complied with the Supreme Court’s ruling by passing the buck - mandating that counties establish a means to provide poor people with legal representation. In June 1965, C.L. Chamberlain, then executive director of the County Officers Association, sent Gov. Nelson Rockefeller a letter opposing the state’s decision to shift compliance onto counties.

“If this bill is needed, let the state pay the cost but not escape payment by mandating the same on local government,” he said.

We feel strongly that yes, “this bill is needed,” but yet the record also seems to clearly show that the state chose, in 1965, to pass the Supreme Court’s mandates - and their associated costs - down to counties, with grants to help mitigate the costs.

This is one of many sad examples of our state’s frequent response to federally mandated costs: Keep them off the state’s books and dump them down on the local property taxpayers. New York did the same kind of thing with Medicaid. This is a major reason property taxes are so high.

Indigent defense costs Essex County more than half a million dollars a year. In Franklin County, with a bit more crime and a bit more population, it costs roughly a million. It’s a necessary bill but one of many the state should be paying.

One alternative is a bill introduced by Assemblywoman Patricia Fahy, of Albany, that would require the state to reimburse counties for indigent defense services. Maybe that’s best or maybe it’s not, but the Supreme Court’s decision in Gideon v. Wainwright clearly lays the responsibility at the feet of the state. We’re pretty sure, given recent lawsuits and studies, that New York hasn’t met Gideon’s mandate satisfactorily for indigent defendants or the taxpayers who pay the bill. Let’s take this time to come up with a better plan.

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Online:

http://bit.ly/1GLooy7

The Auburn Citizen on changes to New York’s Joint Commission on Public Ethics.

Nov. 4

The state’s Joint Commission on Public Ethics has been dogged almost from its inception by questions of its effectiveness, independence and transparency, but if recommendations in a review report are followed, the panel has a chance of becoming the investigatory arm it was intended to be.

A review panel this week said that JCOPE should allow a simple majority vote to approve action, because as it stands, a small number of members have had the power to stop an investigation in its tracks.

The current 45-day window to decide on action after a report is filed should be extended, the report says, especially considering that the commission normally meets only once every four or six weeks. Recommendations also include increasing transparency in hiring practices, separating “advice” from “enforcement” staff, and following the spirit of state laws regarding open meetings and freedom of information.

At this point, some the recommendations are just that - recommendations. Others will require legislative action. We believe the commission should make the changes it can right away, and we urge the governor’s office and the Legislature to make sure that legal tweaks to JCOPE are taken care of at the start of the next legislative session.

The ethics commission has had several years to work out its kinks, but it continues to operate much less effectively than it should. This review report provides a solid outline for taking care of some of some of its biggest problems, and the advice should be heeded.

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Online:

http://bit.ly/1MhpbXU

The Poughkeepsie Journal on Congress avoiding a government shutdown and the challenges still remaining.

Nov. 4

For Congress, this is as good as it gets.

Facing the dreadful uncertainty about a budget deal that needed to be done to avoid mayhem, federal leaders have hammered out a reasonable two-year agreement that - at the very least - prevents the United States from reneging on its debts and keeps the government running. Such uncertainty, especially if it would have led to a government shutdown, would have greatly hurt any chances for a full economic recovery. Instead, President Barack Obama was able to sign the bill into law Monday.

The deal extends the country’s debt limit and does increase federal spending, with the new money evenly divided between military and non-military programs. The accord is, in short, a compromise between Republican and Democratic leaders. And it came at a time when impasses have become the norm in Congress. Former House Speaker John Boehner, of Ohio, deserves a lot of credit for pushing enough Republican support for the deal before he relinquished his position, giving way to new House Speaker Paul Ryan, of Wisconsin, to start with a clean slate. Boehner had been facing particularly difficult scenarios, trying to appease both moderate Republican leaders and those more closely aligned with conservative or tea party interests.

Getting any deal accomplished in this climate was an almost impossible task. The agreement also means the issue won’t become a political football during the presidential and congressional elections that will be held next November.

All that said, massive challenges remain. For starters, the national debt is at an alarmingly high $18 trillion. Over the past few decades, Congress and various presidents have failed miserably at getting the country’s fiscal house in order. They could do that by reducing spending overall and containing entitlement programs, but drastic cuts aren’t needed to get the job done. Rather, federal leaders can get there - or at least certainly put a dent in problem - by slowing the growth of government spending and raising revenues by closing tax loopholes, particularly to big oil and gas companies. Congress and the president also have gotten nowhere on fixing the tax code in general. The tax code should be greatly simplified. It’s far too complicated and, thus, has become far too easy for big corporations to evade paying some and, in some cases, a good chunk of their U.S. taxes. Especially in today’s economy, the playing field has to be leveled for small and big businesses.

Avoiding the detrimental impacts of a possible federal shutdown should be celebrated. But federal officials still have not done nearly enough to align tax-and-spending priorities with the 21st century.

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Online:

http://pojonews.co/1iD1ugG

The Staten Island Advance on a doctor’s conviction stemming from the deaths of three patients who overdosed on drugs she prescribed.

Nov. 4

Largely lost in all the sound and the fury about the misery and tragedy that are produced by prescription drug abuse is the issue of where these all drugs come from.

Unlike heroin, cocaine or marijuana, which are produced mostly in other countries, shipped by cartels into this country and distributed by a black-market network here, prescription drugs are produced by legitimate drug manufacturers for ostensibly legitimate purposes.

Yet, somehow, large amounts of the drugs typically abused by addicts - opioids such as Oxycontin, Vicodin and Percocet - find their way into the hands of people who shouldn’t have them.

Those drugs aren’t being smuggled across borders, for the most part. They are sold to doctors by the pharmaceutical companies, and the physicians are supposed to prescribe them only for legitimate medical reasons.

But the amount of opioids being diverted into the black market for eventual use by addicts suggests many more pills are being produced than are legitimately needed and that the pharmaceutical industry is only too happy to produce as many pills as it can sell, without concerning itself too much about how its products are being used.

Again, the drugs are legitimate, but the widespread abuse of them that we’ve seen grow to epidemic proportions in recent years is not.

The question is how these drugs get into the wrong hands. No doubt, many are stolen from shipments to distribution centers, hospitals, pharmacies and other facilities.

But one key link between manufacturer and abuser has to be doctors themselves. It’s a small minority of physicians and other health personnel, of course, but there are still too many who operate on the principle of giving their patients what they want, regardless of the ramifications.

Now, we are beginning to see consequences for such reckless and irresponsible behavior.

Just this past August, we learned of a physician assistant working in a Huguenot medical office who was charged with running a high-volume “pill mill.”

Reportedly, he received 27 visits over a three-year span from salesmen representing a large pharmaceutical company, Purdue, aggressively pushing him to prescribe their company’s products, specifically Oxycontin.

The sales reps were given bonuses in addition to salary based on the number of prescriptions written in their territory, according a settlement announced by state Attorney General Eric Schneiderman’s office.

The company was hit with $75,000 in fines, ordered to follow strict marketing guidelines and disclose its financial arrangements with “advocates” pitching its product.

The physician assistant was awaiting federal sentencing at last report.

But the case that should really be a shot across the bow of those health-care professionals who get involved in dubious transactions involving prescription drugs came to a head last week in Los Angeles.

Dr. Hsiu-Ying (Lisa) Tseng of Rowland Heights in Los Angeles County, was convicted of second-degree murder on Friday in connection with the deaths of three patients who overdosed on drugs she prescribed. (In fact, a dozen of her patients died under suspicious circumstances, though murder charges were brought in only three deaths.)

Prosecutors say she is the first physician convicted of murder in the U.S. for recklessly prescribing drugs to patients.

According to the Los Angeles Times, Deputy District Attorney John Niedermann said after the stunning conviction, “The message this case sends is, you can’t hide behind a white lab coat and commit crimes. A lab coat and stethoscope are no shield.”

Defenders of Dr. Tseng, including members of her family, insist she was deceived by conniving patients who craved drugs, but prosecutors maintain that she willfully ignored “red flags” that would have indicated to more careful physicians that these patients were addicted.

The Times reported that two other people admitted dealing drugs prescribed by Dr. Tseng.

Prosecutors say that in some cases, when patients complained to her about being addicted, she wrote them prescriptions for more narcotics to ease their suffering. According to the Times, the prosecution argued that Dr. Tseng cared little about her patients’ treatment and sometimes referred to them as “druggies.”

“She wrote them a prescription for the very thing they’re addicted to,” Niedermann said according to the Times. “She shoved them over that cliff.”

He said she prescribed “crazy, outrageous amounts of medication” to patients who didn’t need the pills.

However, her attorney, Tracy Green, maintained during the court proceedings, “That’s what malpractice cases are about. She did not murder people,” adding, “She got in over her head.”

But the prosecution charges that between 2007, when Dr. Tseng joined the Rowland Heights clinic where her husband worked, and 2010, their office made $5 million.

“Why would somebody do this?” Niedermann asked at the trial. “Five million reasons.”

“It’s disappointing,” Green said of the guilty verdict. “I don’t think it bodes well for doctors in America.”

At least not for those like Dr. Tseng.

Let’s hope others take note.

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Online:

http://bit.ly/1MHPIj3

The Wall Street Journal on the Obama Administration’s policy in Syria.

Nov. 2

So the U.S. government that was surprised by Vladimir Putin’s takeover of Crimea, surprised by his invasion of eastern Ukraine, surprised by his plan to sell S-300 missiles to Iran, and surprised by his intervention in Syria now thinks the Russian strongman will sue for peace in Syria on U.S. terms and oust Bashar Assad.

“Russia’s intervention is a powerful example of the law of unintended consequences,” said Deputy Secretary of State Antony Blinken at a security conference in Bahrain this weekend. “It will have two primary effects. First, it will increase Russia’s leverage over Assad. But second, it will increase the conflict’s leverage over Russia. And that in turn creates a compelling incentive for Russia to work for, not against, a political transition.”

Secretary of State John Kerry’s right-hand man even used a Vietnam War-era word to describe Putin’s supposed predicament: “The quagmire will spread and deepen, drawing Russia further in.”

Somehow we doubt Putin feels so beleaguered. So far his intervention in Syria has stabilized Assad’s regime and let the Syrian go on offense principally against rebels who are fighting both him and Islamic State. Russia has done so at the relatively modest cost of some weapons transfers, bombing runs, and 2,000 or so military advisers.

Putin was also able to midwife Iran’s presence at the peace talks for the first time. Kerry acquiesced to Iran’s participation and strong-armed our Sunni Arab allies to go along. The Obama Administration’s diplomatic logic seems to be that Iran will also throw over its long-time satrap in Damascus now that it has a seat at the table and Assad is stronger. In victory, it will surrender.

Where’s Richard Holbrooke when you need him? The diplomat, who died in 2010, understood that durable settlements are possible only when the U.S. negotiates from a position of strength. He was able to negotiate peace in the Balkans in the mid-1990s after he convinced President Bill Clinton to secretly arm Croatia against marauding Serbia. Clinton also supported NATO bombing to stop Serbian predations in Bosnia.

Only after the balance of forces on the ground had evened out did the Serbs seriously negotiate a settlement. It’s a measure of this Administration’s detachment from Middle East reality that it won’t even learn from successful Democratic foreign intervention.

It’s not as if President Obama lacks military options to make a difference in Syria. Yet he has rejected every serious Pentagon proposal. He won’t create a no-fly zone in Syria to protect refugees and anti-Assad rebels because it risks upsetting Russia and his antiwar domestic base. And he won’t deploy U.S. Apache attack helicopters to assist coalition ground forces because he doesn’t want to too obviously contradict his claim that he ended the Iraq war.

Instead Obama announced last week he will dispatch all of 50 U.S. special forces soldiers to assist Kurdish troops who are fighting Islamic State. It isn’t clear what their mission will be or how far they will be deployed into Syria. No soldiers in the world are more capable than U.S. special operators, and presumably they’d be able to call in air support when needed.

But so small a force is also far more vulnerable to being killed or captured by Islamic State forces. The deployment sounds more like an attempt by the White House to respond to its Russian humiliation by showing Americans it is at least doing something more against Islamic State. But it doesn’t seem to be part of a serious new military strategy.

If Obama really wants to put pressure on Russia and Iran to negotiate in Syria he would create a Sunni alternative to both Assad and Islamic State. This would include destroying Assad’s air force, which the U.S. military could easily do, while joining with Syria’s neighbors and Europeans to create a no-fly zone for refugees and anti-regime and anti-ISIS forces.

The President could also raise the cost of Russia’s serial foreign adventures. This would include arming Ukraine so it can defend itself against Russian incursions, and strengthening sanctions to raise domestic political pressure on Putin.

Obama will do none of this. Instead he will send out Messrs. Kerry and Blinken to assert that U.S. retreat is really success, that Russian advances are really defeat, and that five years of war will soon yield to peace because Obama believes against all Syrian evidence that the arc of history bends his way.

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Online:

http://on.wsj.com/1XPy6Ur

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