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Today, one of the important problems in the cultivation and maintenance of agricultural and domestic animals, both in industrial and private farms, is the spread of ecto- and endoparasites, which cause a significant decline in animal productivity, endanger their health and cause economic losses. The study of the level of distribution and conducting of diagnostic studies on parasitoses of animals in farms with different production orientation is an important and integral part of the overall complex of preventive and health-improving measures. The research was carried out during 2007–2017 in livestock enterprises of Kharkiv Oblast. As a part of the research work, 540 samples were collected from livestock farms, of which 180 were from the premises for keeping pigs, 100 from premises for keeping sheep, 120 from premises for keeping cattle, 80 from premises for dogs and 60 – from the surrounding territories of the livestock enterprises. We found that the objects of livestock rearing (pig complex, sheep farm, dairy farm, cynological center) in Kharkiv Oblast have a significant level of sanitary contamination with exogenous forms of helminths (21.7–45.6%) and the soil of the territories (20.0–36.6%). From samples taken from premises for pigs, eggs of four morphotypes were isolated (Ascaris suum – 5.3%, Trichuris suis – 14.6%, Oesophagostomum dentatum – 60.6%, Strongyloides ransomi – 19.4%), from premises for sheep – three morphotypes (Dicrocoelium lanceatum – 3.8%, Trichuris ovis – 29.3%, Strongylata spp. – 46.9%), from premises for cows – three morphotypes (Neoascaris vitulorum – 2.7%, Trichuris skrjabini – 12.9%, Strongylata spp. – 34.5%), premises for dogs – four morphotypes (Toxocara canis – 6.1%, Toxascaris leonina – 5.4%, Trichuris vulpis – 20.6%, Ancylostoma caninum – 17.5%). It should be noted that the places most contaminated with eggs of helminths were manure gutters (100%) and the floor of livestock buildings (50.0–86.7%). It has also been determined that, in the conditions of the cynological center, the Musca domestica was the source of environmental contamination with exogenous forms of Toxocara canis and Trichuris vulpis, and that the Muscina stabulans and Stomoxys calcitrans can be the source of spread of larvae of Ancylostoma caninum and eggs of Trichuris vulpis respectively.
Amadi, E., & Uttah, E. (2010). Impact of physico-chemical factors of contaminated foci on the survival of geohelminths in Abua Communities, Niger Delta Nigeria. Journal of Applied Science and Environmental Management, 14(4), 117–121.
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Backhans, A., & Fellström, C. (2012). Rodents on pig and chicken farms – a potential threat to human and animal health. Infection Ecology and Epidemiology, 2, e17093.
Blaszkowska, J., Kurnatowski, P., & Damiecka, P. (2011). Contamination of the soil by eggs of geohelminthhs in rural areas of Lodz district (Poland). Helminthhologia, 48(2), 67–76.
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Boyko, A., Brygadyrenko, V., Shendryk, L., & Loza, I. (2009). Estimation of the role of antropo-zoonosis invasion agents in the counteraction to bioterrorism. Counteraction to Chemical and Biological Terrorism in East European Countries. NATO Science for Peace and Security Series A: Chemistry and Biology. Springer Nature, 309–315.
Chammartin, F., Scholte, R. G., Guimaraes, L. H., Tanner, M., Utzinger, J., & Vounatsou, P. (2013). Soil-transmitted helminth infection in South America: A systematic review and geostatistical meta-analysis. The Lancet Infectious Diseases, 13(6), 507–518.
Charlier, J., De Waele, V., Ducheyne, E., van der Voort, M., Vande Velde, F., & Claerebout, E. (2016). Decision making on helminths in cattle: Diagnostics, economics and human behaviour. Irish Veterinary Journal, 69, 14.
Charlier, J., van der Voort, M., Kenyon, F., Skuce, P., & Vercruysse, J. (2014). Chasing helminths and their economic impact on farmed ruminants. Trends in Parasitology, 30(7), 361–367.
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Dolbin, D. A., & Khayrullin, R. Z. (2017). Resistance of helminth eggs to unfavorable physical, chemical and biological factors of the environment (Literature review). Russian Journal of Parasitology, 39(1), 14–19.
Eysker, M., & Ploeger, H. W. (2000). Value of present diagnostic methods for gastrointestinal nematode infections in ruminants. Parasitology, 120(Suppl), 109–119.
Graves, A., Weaver, R. W., & Entry, J. (2009). Characterization of Enterococci populations in livestock manure using Biolog. Microbiological Research, 164, 260–266.
Greenland, K., Dixon, R., Khan, S. A., Gunawardena, K., Kihara, J. H., Smith, J. L., Drake, L., Makkar, P., Raman, S., Singh, S., & Kumar, S. (2015). The epidemiology of soil-transmitted helminths in Bihar state, India. PLoS Neglected Tropical Diseases, 9(5), e0003790.
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Ivanuk, V. P., & Bobkova, G. N. (2016). Epizootologiya kishechnykh nematodozov sviney v khozyaystvakh tsentral'nogo federal'nogo okruga RF [Epizootology of intestinal nematodoses of pigs in the economies of the central federal district of the Russia]. Vestnik of the Bryan State Agricultural Academy, 58(6), 86–91 (in Russian).
Karshima, S. N., Maikai, B. V., & Kwaga, J. K. P. (2018). Helminths of veterinary and zoonotic importance in Nigerian ruminants: A 46-year meta-analysis (1970–2016) of their prevalence and distribution. Infectious Diseases of Poverty, 7(1), 52.
Kochanowski, M., Karamon, J., Dąbrowska, J., Dors, A., Czyżewska-Dors, E., & Cencek, T. (2017). Occurrence of intestinal parasites in pigs in Poland – the Influence of factors related to the production system. Journal of Veterinary Research, 61(4), 459–466.
Kotelnikov, G. A. (1984). Gel'mintologicheskiye issledovaniya zhivotnykh i okruzhayushchey sredy [Helminthological studies of animals and the environment]. Kolos, Moscov (in Russian).
Kovalenko, I. I., Sentyrin, V. V., & German, I. V. (1998). Udoskonaleni metody diahnostyky hel’mintoziv ta eymeriozu ptakhiv [Improved methods for diagnosis of helminthiasis and eumeriosis of birds]. Veterinary Medicine of Ukraine, 7, 30 (in Ukrainian).
Manyi-Loh, C. E., Mamphweli, S. N., Meyer, E. L., Makaka, G., Simon, M., & Okoh, A. I. (2016). An overview of the control of bacterial pathogens in cattle manure. International Journal of Environmental Research and Public Health, 13(9), 843.
Mohd Zain, S. N., Sahimin, N., Pal, P., & Lewis, J. W. (2013). Macroparasite communities in stray cat populations from urban cities in Peninsular Malaysia. Veterinary Parasitology, 196(3–4), 469–477.
Nansen, P. (1987). Production losses and control of helminths in ruminants of temperate regions. International Journal for Parasitology, 17(2), 425–433.
Ngui, R., Lim, Y. A. L., Traub, R., Mahmud, R., & Mistam, M. S. (2012). Epidemiological and genetic data supporting the transmission of Ancylostoma ceylanicum among human and domestic animals. PLoS Neglected Tropical Diseases, 6(2), e0001522.
Nissen, S., Poulsen, I. H., Nejsum, P., Olsen, A., Roepstorff, A., Rubaire-Akiiki, C., & Thamsborg, S. M. (2011). Prevalence of gastrointestinal nematodes in growing pigs in Kabale District in Uganda. Tropical Animal Health and Production, 43(3), 567–572.
Paliy, A. P., Stegniy, B. T., Muzyka, D. V., Gerilovych, A. P., & Korneykov, O. M. (2016). The study of the properties of the novel virucidal disinfectant. Agricultural Science and Practice, 3(3), 41–47.
Paliy, A. P., Sumakova, N. V., Paliy, A. P., & Ishchenko, K. V. (2018). Biological control of house fly. Ukrainian Journal of Ecology, 8(2), 230–234.
Paller, V. G. V., & de Chavez, E. R. C. (2014). Toxocara (Nematoda: Ascaridida) and other soil-transmitted helminth eggs contaminating soils in selected urban and rural areas in the Philippines. The Scientific World Journal, 2014, e386232.
Pautova, E. A., Kurepina, N. Y., & Dovgalev, A. S. (2012). Toksokaroz v Respublike Altay. Geoinformatsionnoye (GIS) kartograficheskoye modelirovaniye [Toksokaroz in the Republic of Altai. Geoinformation (GIS) cartographic modeling]. Medical Parasitology and Parasitic Diseases, 4, 11–14 (in Russian).
Piwak, V. P., Bulik, R. E., & Zaxarchuk, O. I. (2007). Laboratorna diahnostyka parazytarnykh invaziy [Laboratory diagnosis of parasitic infestations]. Chernivtsi Medical University, Chernivtsi (in Ukrainian).
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Romanova, E. M., Indirakova, T. A., & Zonina, N. V. (2009). Mikrobnaya ekologiya zheludochno-kishechnogo trakta sobak pri toksokaroze sobak [Microbial ecology of the gastrointestinal tract of dogs with toxocarose dogs]. Izvestiya of the Samara Scientific Center of the Russian Academy of Sciences, 11(1/3), 167–168 (in Russian).
Salam, N., & Azam, S. (2017). Prevalence and distribution of soil-transmitted helminth infections in India. BMC Public Health, 17(1), 201.
Shalaby, H., Abdel-Shafy, S., & Derbala, A. (2010). The role of dogs in transmission of Ascaris lumbricoides for humans. Parasitology Research, 106(5), 1021–1026.
Silver, Z. A., Kaliappan, S. P., Samuel, P., Venugopal, S., Kang, G., Sarkar, R., & Ajjampur, S. S. R. (2018). Geographical distribution of soil transmitted helminths and the effects of community type in South Asia and South East Asia – A systematic review. PLoS Neglected Tropical Diseases, 12(1), e0006153.
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UNITED STATES v. JING BING LIANG March 31, 2004 No. 02-10549.
UNITED STATES v. PANG March 30, 2004 No. 03-10032.
UNITED STATES v. MACK March 30, 2004 No. 03-10204.
ZI LIN CHEN v. ASHCROFT March 30, 2004 No. 02-73673.
UNITED STATES v. BATTLES March 30, 2004 No. 00-15134.
IN RE: RODEO CANON DEVELOPMENT CORPORATION March 30, 2004 Nos. 02-56999, 02-57203.
DECKER v. ADVANTAGE FUND LTD GFL RGC LDC March 29, 2004 Nos. 01-17406, 01-17408.
Dwight D. MATHEWS; Charles N. Hord; Bill Buchanan; Everett M. Miller; Albert Munn; Tommie Lee Rush, Plaintiffs-Appellees, and Issiah Milton; Leroy P. Bateman; Otis C. Joiner; Ernest L. Oliver; Fred Smith; Carolyn Whatley; March 26, 2004 Nos. 02-15936, 02-16209.
JACKSON v. GIURBINO March 26, 2004 No. 02-57117.
UNITED STATES v. BYNUM March 26, 2004 No. 03-10231.
SINGH v. ASHCROFT March 26, 2004 No. 02-71594.
UNITED STATES v. NAGHANI March 26, 2004 No. 02-50168.
UNITED STATES v. BAUTISTA March 26, 2004 No. 02-50664.
FLORES CHAVEZ v. ASHCROFT March 25, 2004 No. 01-70748.
UNITED STATES v. KOONIN March 25, 2004 No. 02-50350.
UNITED STATES v. McNEIL March 24, 2004 No. 02-30039.
UNITED STATES v. RIOS BELTRAN March 24, 2004 No. 03-30177.
UNITED STATES v. BATTERJEE March 24, 2004 No. 03-10152.
PROVIDENCE HEALTH PLAN v. McDOWELL March 24, 2004 Nos. 02-35263, 02-35841.
RUIZ MORALES v. ASHCROFT March 24, 2004 No. 02-70693.
BROCKMEYER v. MAY March 24, 2004 No. 02-56283.
HERNANDEZ v. HUGHES MISSILE SYSTEMS COMPANY March 23, 2004 No. 01-15512.
GUO v. ASHCROFT March 23, 2004 No. 02-73527.
CEBALLOS v. GARCETTI March 22, 2004 No. 02-55418.
UNITED STATES v. ALVARADO GUIZAR March 22, 2004 No. 02-30220.
UNITED STATES v. SARBIA March 22, 2004 No. 03-10276.
CASWELL v. CALDERON March 18, 2004 No. 02-17177.
GALVIN v. ; Karen Oliveto, Re March 18, 2004 No. 00-17425.
GWADURI v. IMMIGRATION AND NATURALIZATION SERVICE March 18, 2004 No. 02-70629. Agency Nos. A71-842-149, A71-842-148, A71-842-147.
TOVAR LANDIN v. ASHCROFT March 18, 2004 No. 02-71359.
SINGH v. ASHCROFT March 18, 2004 No. 02-70867.
GEORGE v. Uninsured Employers Fund; Stephen J. Smith, Director of Industrial Relations; Department of Industrial Relations; State of California March 18, 2004 No. 01-16293.
UNITED STATES v. UNIVERSAL FRUITS AND VEGETABLES CORPORATION March 17, 2004 No. 02-55340.
UNITED STATES v. GLASS March 17, 2004 No. 03-50609.
DOE II v. TANDESKE March 17, 2004 No. 99-35845.
CHURCHILL VILLAGE, L.L.C., Barbara Dorsett, and Al Dorsett individually and on behalf of the general public; Barbara Dorsett; Al Dorsett; Seymour Lazar; Joan Chalmers; Judith Saporta, Plaintiffs, Harriet Skurman; Norman Hickman; Phyll March 16, 2004 Nos. 01-17059, 02-15354, 02-15391, 02-16838, 02-16906.
EMBURY v. KING March 16, 2004 No. 02-15030.
BUSHLEY v. CREDIT SUISSE FIRST BOSTON March 16, 2004 No. 03-15901.
DeVILLE v. Noreen Cardinale, Appellee. March 15, 2004 No. 02-16459.
OCEAN ADVOCATES, a non-profit organization; Fuel Safe Washington, a non-profit organization; North Cascades Audubon Society, a non-profit organization; Dan Crawford, an individual; Re Sources, a non-profit organization, Plaintiffs-Appellants, March 15, 2004 Nos. 01-36133, 01-36144.
MA v. ASHCROFT March 15, 2004 No. 02-70956.
SHIVARAMAN v. ASHCROFT March 12, 2004 No. 02-72436.
McGINEST v. GTE SERVICE CORP March 11, 2004 No. 01-57065.
MARTIN v. CITY OF OCEANSIDE March 11, 2004 No. 02-56177.
WRIGHT v. OREGON METALLURGICAL CORPORATION March 11, 2004 No. 02-35853.
DAMON v. ASHCROFT March 11, 2004 No. 02-71677.
BARAPIND v. ENOMOTO March 10, 2004 No. 02-16944.
UNITED STATES v. BARAJAS AVALOS March 10, 2004 No. 02-30301.
UNITED STATES v. TAPIA MARQUEZ March 9, 2004 Nos. 03-50167, 03-50223.
BATSON v. COMMISSIONER OF THE SOCIAL SECURITY ADMINISTRATION March 9, 2004 No. 02-35471.
UNITED STATES v. CORDOVA BARAJAS March 9, 2004 No. 02-10668.
SIDDIQUI v. UNITED STATES March 9, 2004 No. 02-17123.
SAN JOSE CHRISTIAN COLLEGE v. CITY OF MORGAN HILL March 8, 2004 No. 02-15693.
WEBSTER v. WOODFORD March 5, 2004 No. 02-99009.
IN RE: Marciano ELLIS March 5, 2004 No. 01-70724.
LEEVER v. CARSON CITY March 4, 2004 No. 02-16525.
CHIA v. CAMBRA March 4, 2004 No. 99-56361.
UNITED STATES v. BIRD March 3, 2004 Nos. 02-30246, 02-30282.
SPECIAL INVESTMENTS INC v. AERO AIR INC GE March 2, 2004 No. 02-55788.
THOMAS v. ASHCROFT March 2, 2004 No. 02-71656.
UNITED STATES v. CANALES GOMEZ March 2, 2004 No. 03-50106.
UNITED STATES v. HOVSEPIAN March 2, 2004 Nos. 99-50041, 99-56922, 00-55320, 01-55247.
ANDIA v. ASHCROFT March 2, 2004 No. 02-70648.
UNITED STATES v. KEESEE March 1, 2004 No. 02-10333.
FARUQI v. DEPARTMENT OF HOMELAND SECURITY March 1, 2004 No. 03-56972.

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The Certified Equity Professional Institute (CEPI) is part of the Leavey School of Business at Santa Clara University in California's Silicon Valley. The CEPI was founded in 1989 by a group of equity compensation professionals. Their mission was to establish, promote, and provide certification and continuing education for the equity compensation industry. Since its founding, the CEPI's self-study curriculum has served as the industry's educational standard. Organizations and individuals use CEPI exams as a measurement of basic (Level 1), intermediate (Level 2), and advanced (Level 3) knowledge, skills, and abilities related to equity compensation.
The CEPI's ongoing GPS (guidance, procedures, systems) project has produced a series of books designed to provide impartial guidance for everyone working in the field. This volume combines the four GPS books currently assigned to CEP candidates (Employee Stock Purchase Plans, Restricted Stock and Restricted Stock Units, Performance Awards, and Global Equity Plans), all updated for 2019.
Like the other books used in the CEPI program, the new 2019 edition features spiral coil binding so you can lay the pages flat while studying or at the exam, a feature first added in the second printing of the 2018 book last year due to popular demand.
Employee Stock Purchase Plans, 2019 ed.
Restricted Stock and Restricted Stock Units, 2019 ed.
Global Equity Plans, 2019 ed.
From Restricted Stock and Restricted Stock Units, 2019 ed.
Q35: Has the IRC Section 162(m) Limit Been Observed?
A corporate tax deduction may be claimed for the ordinary income recognized by the employee upon vest of restricted stock. The corporate tax deduction is limited (IRC §162(m)) for "covered" employees whose compensation exceeds the $1 million cap for the year. Specifically, IRC §162(m) limits a publicly held corporation's deduction for compensation paid to each of its principal executive officer (PEO), principal financial officer (PFO), and its next three highest compensated officers, excluding the PEO and PFO, to $1 million per year. In addition, if an individual is considered to be a covered employee at any time during a tax year commencing after 2016, he or she will retain the covered employee status permanently. All future payments to such individuals (as well as their beneficiaries) will be subject to the $1 million deduction limit, even if the individual is no longer an officer or employee of the corporation at the time of payment unless the payment is covered by grandfathering rules discussed below. For many companies, this limitation may be a material item for financial statement purposes.
Under prior law, performance-based compensation was not subject to the $1 million cap. The definition of performance-based required that the compensation was contingent on the "attainment of one or more performance goals" and met numerous other requirements.
The Tax Cuts and Jobs Act of 2017 (TCJA) eliminated this exception. As a result, generally all incentive compensation (e.g., performance shares) paid to covered employees after the 2017 tax year are subject to the $1 million deduction limit, unless it meets the IRC §162(m) grandfather rule.
The grandfather rule applies to compensation provided under a written binding contract that was in effect on November 2, 2017, and that has not been materially modified after such date. Under the grandfather rule, such compensation would be subject to the IRC §162(m) rules in effect prior to enactment of the TCJA, including being eligible for a deduction for performance-based compensation.
The Treasury Department and the IRS have provided detailed guidance on the application of the grandfather rule, explaining that a written binding contract is a payment obligation under applicable state law in which the employer does not have any discretion to unilaterally reduce or eliminate the covered employee's right to such award.
Many employers have existing plans and arrangements that were in effect on November 2, 2017, and were designed to meet the performance-based compensation exception. Such employers may still be able to take advantage of this exception and fully deduct the pay. Similarly, many individuals who were not covered employees under prior law, but became covered employees following the enactment of the TCJA have existing incentive pay arrangements that were not designed to satisfy the performance-based compensation exception - namely, PFOs of listed corporations or all executive officers of unlisted corporations now treated as publicly held by virtue of having debt registered with the SEC. Employers may rely on the grandfather rule to fully deduct certain pay to such employees. A complete analysis of the issues associated with IRC §162(m) and a discussion of its grandfather rule are beyond the scope of this publication.
SEC proxy rules require that the Compensation Committee's report state its policy with respect to IRC § 162(m) (i.e., whether compensation paid to the corporation's officers is or is not intended to be fully deductible). This policy should be reviewed annually to determine that it accurately reflects the Committee's policy and the corporation's actual pay practices.


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Revisiting Civil Rights Case Mendez v. Westminster.
≈ Comments Off on Revisiting Civil Rights Case Mendez v. Westminster.
As I wrote about earlier in the blog, the case Hernández v. Texas was decided just two weeks prior to Brown; but there is another little-known case that was instrumental for the American civil rights movement: Méndez v. Westminster. While many scholars of educational desegregation assure us that the beginning of the end of the ‘separate but equal’ doctrine was set underway with Brown v. Board of Education. It could be argued that the beginning of that end may actually date back seven years prior, Méndez v. Westminster, which ended the almost 100 years of segregation that had remained a practice since the end of the U.S.-Mexico War of 1848 and the signing of the Treaty of Guadalupe Hidalgo. The end of the U.S.-Mexico War gave rise to ‘anti-immigrant sentiments [that] resulted in increased measures to segregate Mexican-Americans from so-called ‘white’ public institutions such as swimming pools, parks, schools, and eating establishments.’. . .

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AAEM has steadfastly advocated for due process in EM contracts. This article points out the vulnerability of physicians despite access to "due process." The courts have provided substantial protection to the hospital and medical staff. It is important not to be lulled into a false sense of security by the provision of due process in your contract. You need to be careful in your dealings despite your arrangement. On the other end of the spectrum, there is little that AAEM or folks like the author of this piece can do for you once you sign a contract that eliminates your right to due process through a "termination without cause" provision.
by Charles I. Artz, Esq.
Recent appellate court decisions in Pennsylvania and other jurisdictions raise the question whether the immunity afforded hospitals and reviewers under the federal Health Care Quality Improvement Act (HCQIA) have allowed the peer review system to be improperly utilized, or even abused in some cases.
It had an objective, reasonable belief that its action furthered quality health care.
It made an objective, reasonable effort to obtain the facts.
Under the totality of the circumstances, the physician being reviewed received adequate notice and hearing (i.e., due process) procedures.
The organization had a reasonable belief that its actions were warranted.
Superficial review of this four-part test suggests physicians should receive due process throughout the entire peer review, and serious quality of care issues must exist before a physician's privileges can be suspended, reduced or revoked. Case law and experience demonstrate the contrary.
In Manzetti v. Mercy Hospital of Pittsburgh, the Pennsylvania Supreme Court held on July 18, 2001, that the hospital and reviewers were entitled to immunity under HCQIA. The Supreme Court disregarded all evidence relating to the reviewed physician's competitors' involvement in the case and attacks against him. The Court stated that any self-interest, bias or conflicts of interests by the reviewers were immaterial. According to the Court, the only time HCQIA precludes an economic competitor from involvement in the internal peer review process is at the hearing panel phase of the case; however, HCQIA does not preclude economic competitors from perpetrating due process violations and inculcating bias throughout the early phases of the review process. Under most hospital bylaws, by the time the physician gets to the fair hearing panel, the burden has shifted against the physician with the requirement that the physician prove by clear and convincing evidence that all prior decisions were arbitrary and capricious or factually baseless. Practical experience demonstrates this is a virtually impossible burden to sustain and standard to satisfy.
The Supreme Court also held that the "reasonable effort" prong of the four-part HCQIA immunity test is satisfied if the review activities are "sensible," but they do not have to be "flawless." Thus, the Supreme Court has countenanced due process violations and errors in the peer review process.
In Donnell v. HCA Health Services of Kansas, Inc., the Kansas Court of Appeals held on July 6, 2001 that physician peer reviewers are immune from liability under HCQIA even if their investigations are sloppy, negligent, and wrong. Physicians must prove bad faith and malice to have a peer review decision overturned.
This decision, like Manzetti above, allows a hospital to make serious mistakes about the quality of a physician's health care. It also permits termination of the physician's staff privileges, and the detrimental effect of a Data Bank entry, all with immunity from liability and practical impunity.
In Meyer v. Sunrise Hospital, the Nevada Supreme Court held on May 15, 2001, that a hospital's decision to terminate a physician based upon a single incident, regardless of the high quality of care the physician provided throughout the remainder of his career, was sufficient to protect the hospital under HCQIA's immunity provisions.
One Justice on the Supreme Court recognized the unfairness of the statute, but was compelled to uphold the decision. The Justice noted that HCQIA can sometimes be used, "not to improve the quality of medical care, but to leave a doctor who was unfairly treated without any viable remedy." That Justice also stated: "basically as long as the hospitals provide procedural due process and state some minimal basis related to quality health care, whether legitimate or not, they are immune from liability, which leaves the hospitals free to abuse the process for their own purposes."
In Freilich v. Board of Directors of Upper Chesapeake Health, Inc., a federal court in Maryland held on May 14, 2001, that the HCQIA immunity provisions do not violate due process or equal protection under the U.S. Constitution.
Review Must Be 100% Wrong?
In Brader v. Allegheny General Hospital, 167 F.3d 832 (3rd Cir. 1999), it was proven that the hospital's outside expert report had several incorrect conclusions. The Court of Appeals, however, ignored these mistakes because it found the report to be "otherwise thorough." The Court implied that the expert report must be entirely mistaken, and that the mistakes must be obvious. Because they were not, the hospital's decision was not unreasonable, and the first and fourth prongs of the HCQIA immunity test were satisfied.
In Gordon v. Lewistown Hospital, 714 A.2d 539 (Pa. Cmwlth. 1998), Commonwealth Court found that there is a presumption of validity of the hospital's disciplinary procedures. An outside consultant was retained. The Hearing Officer was an attorney, who was determined not to be in economic competition with the physician, but was a neutral party. Even though some of the physician's direct economic competitors were involved in the decision, and there was evidence of a history of hostility toward him, none of those individuals participated in drafting the outside report. The Court then looked to the totality of the process leading to the professional review action. Under that broad test, even though some parts of the process were critically flawed and biased, the Court said, in totality, the physician got all the process he was due.
These cases are the latest in a series of decisions nationwide leaving physicians who are subjected to peer review without any legal remedies, and without any right to secure a fair hearing and a fair outcome.
An "adverse action" following peer review results in the hospital reporting (through the Medical Board) the physician to the National Practitioner Data Bank, commonly referred to as the "Data Bank." Many reports conclude physicians' care was "incompetent," "unprofessional" or other professionally disastrous terms. Economic experts have opined that such a negative statement in the Data Bank directly results in substantial economic loss to a physician. The Pennsylvania Supreme Court in Hayes v. Mercy Health Corp., 559 Pa. 21, 739 A.2d 114 (1999) stated that a physician's Data Bank entry may, if left unchallenged, have a deleterious effect on the physician's medical career.
The author has represented orthopedic surgeons, cardiologists, OB/GYNs, thoracic surgeons, anesthesiologists, ophthalmologists, family physicians, internists and other specialists in hospital peer review cases and medical staff privileges litigation. More often than not in the author's experience, peer review is initiated against a physician for one of three reasons: (1) by economic competitors for financial reasons; (2) in retaliation against the physician for not "playing ball" in one manner or another (economic or otherwise); or (3) in retaliation for the physician raising concerns about other physicians' care and seeking to have those providers' outcomes reviewed. The state "whistleblower" law does not protect these physicians. The Pennsylvania Peer Review Protection Act, which allows physicians to litigate tort and contract breach claims in state court against hospitals whose peer review is effectuated by malice or bad faith, has been "trumped" (although not technically preempted) by the federal HCQIA immunity standards.
Hospital bylaws impose difficult legal standards and burdens on physicians. Typically, after a physician is the subject of an adverse recommendation or an adverse action by a medical executive committee, the physician is given a fair hearing. Traditional notions of fairness might lead one to believe that the hospital would have the burden of proof by at least a preponderance of the evidence to demonstrate the physician's quality of care was below some recognized and measurable standard warranting a quality of care concern. After all, hospitals have a legitimate concern about corporate liability and "negligent credentialing" following the Supreme Court's Nason Hospital decision in 1991.
Absolutely every set of hospital bylaws the author has reviewed do not contemplate a truly fair system for the physician being reviewed. Instead of the hospital accepting the burden of proof with a reasonable standard based upon measurable guidelines for quality infractions, the bylaws shift the burden of proof to the physician and create a nearly impossible standard to overcome. The physician typically has the burden to prove that the hospital's decision was arbitrary and capricious. Some bylaws even state that the physician must prove that there was no material basis for the action or there was a complete absence of facts in the record to support the action. An utterly biased, sloppy, negligent and mistake-riddled report by an outside reviewer still cannot be overcome by this enormous burden if there is just a shred of truth in the report.
As the case law outlined above illustrates, the physician's economic competitors and antagonists can initiate the peer review process, retain outside consultants and virtually direct the outcome of the report that will form the basis of the hospital's adverse action. After the antagonist's bias, conflict of interest, self-interest, direct economic competition and retaliation motives are all effectuated, they are immaterial and not reviewable by the courts, since all of those problems purportedly can be remedied by retaining a three-member independent panel to conduct the hearing.
Most fair hearing panels are truly independent. But, even if the panel calls "balls and strikes" fairly, the burden of proof and standard of review are so high it cannot be overcome practically. There is no legal remedy or recourse to the physician under the "totality of the circumstances" test. Hospitals have figured out that all they need to do is establish an independent fair hearing panel, give minimal due process at that final phase of the case, and their immunity will be intact.
The JCAHO accreditation manual for hospitals contains medical staff standards. One standard requires "mechanisms, including a fair hearing and appeal process, for addressing adverse decisions for existing medical staff members and other individuals holding clinical privileges for renewal, revocation, or revision of clinical privileges." When discussing the broad HCQIA immunity and typical hospital bylaws burden shifting and standard setting procedures that are anything but fair and balanced, JCAHO staff take the position that they "don't care about detail" even if, as applied, the physician has no chance to overcome the standards.
Although courts have no hesitancy involving themselves in the intricacies of physician practice in the context of medical malpractice liability, courts take a contrary view when physicians seek redress as a result of faulty peer review and retaliation. In Lyons v. St. Vincent Health Center, Commonwealth Court stated: "It is not up to the courts to second-guess hospitals in their decisions as to the best way to deliver services; it is up to the institution itself."
A physician subjected to peer review may have little chance of surviving unless early and aggressive measures are taken. Understanding the case law and limitation on judicial remedies, it is prudent for the physician and counsel to quickly retain the best conceivable expert in the subject area to address the outside reviewer report. In many cases, it becomes very clear that the outside reviewer's report significantly overstates quality of care infractions, is based on no published peer reviewed medical journal articles or positions, and is academically pedantic without taking into consideration reasonable and acceptable standards of care.
Successful resolution using this strategy can be achieved with minimal disruption to the physician, including perhaps CME and monitoring, without causing a damaging Data Bank entry.
The process described in this article has led many physicians, and some organizations, to propose a statewide peer review requirement that would utilize independent, non-biased peer review organizations that make judgments based upon clearly acceptable standards, taking into consideration reasonable differences of opinion. Like a physician being judged for a licensure infraction, the burden of proof would remain on the entity seeking to impose discipline (the hospital) with at least a preponderance of the evidence standard, if not a clear and convincing standard. Only this level of independence would balance the playing field and return quality of care to the forefront of peer review.
Charles I. Artz, Esq., is the founder of the law firm Charles I. Artz & Associates, located in Harrisburg, Pa.
This article originally appeared in Physician's News Digest. Please visit their website at www.physiciannews.com for additional information. Reprinted with permission.

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We take the protection of personal data, very seriously. We would like to explain here how we protect your data and what it means for you when you use our personalized services. Of course, we comply with all the legal requirements regarding data protection to ensure maximum protection of your privacy. We comply with the provisions of the General Data Protection Regulation (GDPR) and the New Federal Data Protection Act (BDSG-neu) due to the adaptation of data protection law in line with Regulation (EU) 2016/679 and we comply with the implementation of Directive (EU) 2016/680 (Data Protection Adaptation and Implementation Act EU - DSAnpUG-EU).
This data protection statement applies to DriveNow's website, which can be accessed under the domain https://www.drive-now.com/de/en/ ,and the various subdomains (hereinafter referred to as "our website").
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Personal data is information that can be associated with you as an individual. Examples include your name, address, postal address, telephone number and email address. Non-personal data is information such as the number of users of a website or service.
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Personal data is collected via this website if you provide it to us on your own initiative and consent, e.g. by registering, filling out forms, sending emails or by booking a DriveNow vehicle. We use this data for the purposes indicated in each case or resulting from the enquiry, thus for example the reservation enquiry for handling your reservation requests. Transmission to third parties will only take place if this is expressly permitted by law or if you have agreed to the transmission within the framework of your registration or during an active business relationship. Apart from this, you can principally use the general information on drive-now.com without disclosing your personal data.
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In the following we describe the processing of data within the registration process.
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The section below describes the data processing associated with the PostIdent process and within the framework of the DLCS Tool.
As an alternative, you can also use the DLCS Tool offered on our website for driver license verification. To this end, we use the data you specified as part of your registration as well as a copy of your driver license (front and back) for review by our staff. After the verification, the data that was processed for this purpose will be deleted.
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In the following we describe data processing in the context of the use of Google Maps.
In the following, we describe processing procedures within the framework of using cookies in detail.
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This data is used exclusively for anonymous evaluation of the use of the website and is never merged with the personal data stored by us. Using the information obtained through clickstream analysis, we make our website as attractive as possible in order to best meet our customers' needs.
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Our website uses the re-marketing function of Google AdWords, a service provided by Google Inc.,1600 Amphitheatre Parkway, Mountain View, CA 94043, USA. This technology enables us to place automatically generated, target-group-specific advertisements on our website after your visit. The ads are based on the products and services that you clicked on during your last visit to our website.
If you don’t wish to receive user-based advertising from Google, you can opt out of advertisements in the Google display settings.
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Google will use this information for the purpose of evaluating your use of the website, compiling reports about website activities for website operators and to provide other services related to website and internet use, in particular functions for Google Analytics reports on performance according to demographic characteristics and interests. Google Analytics Demographics and Interest Reporting allows us to use data from Google's interest-based advertising and/or data from third parties about our advertising audience (e.g. age, gender and interests) in conjunction with Google Analytics for targeted and optimised advertising activities, strategies and content of our website.
Google may also transfer this information to third parties as required by law or if said third parties process this data on behalf of Google. In any event, Google will not associate your IP address with other data held by Google.
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This website uses Google Analytics with the extension "anonymizeIp()". As a result, IP addresses are further processed in abbreviated form, so that a connection to a particular individual can be ruled out. If the data collected about you is personal in nature, it will be excluded immediately, and the personal data will be deleted immediately.
We use Google Analytics to analyse and regularly improve the use of our website. We can improve our offering and make it more interesting for you as a user with the statistics gained. For the exceptional cases in which personal data is transferred to the USA, Google has submitted itself to the EU-US Privacy Shield, https://www.privacyshield.gov/EU-US-Framework.
This website also uses Google Analytics for a device-independent analysis of visitor flows, which is carried out via a user ID. You can disable cross-device analysis of your usage in your Google Account under "My information", "Personal information"
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This website also uses the “adjust.io” analytical technology of adeven GmbH, Saarbrücker Str. 37a, 10405 Berlin, (“adeven”). adeven uses IP and Mac addresses of users for its analysis, which are exclusively used anonymously. No conclusions about individuals can be drawn. The information collected through this tool is exclusively used to analyse the function and usage of the website by generating anonymous evaluations and charts on the number of visits, number of pages accessed by each user etc. The analyses are exclusively used for the purposes of our own market research and the optimisation and user-friendly design of our website. By using this website for analytical purposes, you consent to the processing of anonymous data in the manner and for the purposes set out above. You can opt out of the collection and storage of data at any time with future effect by sending an e-mail to optout@adjust.io.
App performance tracking: Our mobile apps use the app performance and analysis technology “adjust”, a service provided by adjust GmbH ("Adjust"). When you launch the DriveNow app, “adjust” collects install and event data our iOS and Android mobile apps in order to help us understand how our users are interacting with our apps and to optimize and analyze mobile ad campaigns. For such analysis, “adjust” uses your IDFA or Google Play Services ID, and your anonymized (hashed) IP- and MAC address. The hashes used are one-way hashes and it is not possible to identify you or your mobile device individually. The legal basis for the processing is based on Art. 6 para. 1 f) GDPR. The legitimate interest lies in the analysis and improvement of our mobile advertising campaigns. Your data will (not) be transferred transnationally.
You can opt out of the collection and storage of data at any time with future effect by sending an e-mail to optout@adjust.io.
Our website uses DoubleClick by Google Inc. via Trakken Web Services GmbH, Zirkusweg 1, 20359 Hamburg, Germany to present you with relevant advertisements. When you open a website and see a display of an advertisement placed via websites of the Google advertising network or click on it, a DoubleClick cookie may be stored in your browser. The DoubleClick cookie identifier allocated to your browser is the same cookie that is used when you visit websites, in which advertising programs by DoubleClick are applied. This cookie allocated to your browser contains a pseudonymous identification number (ID) and can check which ads were displayed in your browser and how many ads have been viewed. These cookies do not contain any personal information. In connection with our re-marketing measures, we may show you advertisements tailored to your preferences on the basis of this information. Re-marketing collects and saves information about your surfing habits in anonymous form for marketing purposes.
DoubleClick only allows Google and its partners to place advertisements on the basis of prior visits to our website or other websites. Google transmits the information generated by cookies to a server in the United States for analytical purposes and saves it there.
The transmission complies with legal requirements or occurs within the scope of order processing. Under no circumstances will Google combine your data with other data collected by Google. By using this website, you consent to the processing of data collected about you by Google in the manner of data processing and for the purposes set out above. You can prevent the storage of cookies by selecting the corresponding settings in your browser; however, you may not be able to fully use some of the features of our website in this case.
If you wish to be excluded from VWO analysis and test methods, you can arrange this at https://vwo.com/opt-out/.
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Detailed additional information on this topic can be found at the following websites: youronlinechoices, Network Advertising Initiative and/or Digital Advertising Alliance. These websites also contain details about deleting cookies from your device.
The above-mentioned data processing activities and the associated purposes are our legitimate interest, on the legal basis of Art. 6 (1), lit. f, GDPR.
This website uses some technologies provided by Facebook, Inc, 1601 S. California Ave, Palo Alto, CA 94304, USA ("Facebook"). These technologies are explained in more detail below.
Within our Internet presence we use the "Facebook pixel" from Facebook Inc. 1601 S. California Ave, Palo Alto, CA 94304, USA ("Facebook"). This allows users' behaviour to be tracked after they have seen or clicked on a Facebook ad. This process is used to evaluate the effectiveness of Facebook advertisements for statistical and market research purposes and can help to optimise advertising measures.
Our legitimate interest lies in the aforementioned data processing processes and the purposes pursued with them. For this purpose, Art. 6 para. 1 lit. f GDPR provides the legal basis.
The section below explains our data processing for the purpose of product information and advertising.
We want to provide our customers with regular product recommendation e-mails. For this purpose, we use the e-mail address you specified as part of registration, your name and your date of birth. Our product recommendation e-mails are intended to inform you about products we offer, in which you may be interested on the basis of your most recent lease. In addition, we want to send you our confirmation notification regarding your registration and helpful product use instructions. You will receive these e-mails regardless of your subscription to our newsletter. Furthermore, we will use your data for the following purposes: Measures for the further development of services and products, reporting on the success of the utilised measures in the course of time, testing and optimisation of procedures for requirement analysis, benchmarking, and enrichment of our data, e.g. from publicly available sources or internal market research. We do not share data with third parties. Your data will be stored as long as we maintain a business relationship with you and you have not objected to this data processing. You have the right to object to this data processing, which is based on Art. 6 (1), lit. f, GDPR, at any time, either as a whole or for specific measures. In this case, we will no longer process your data. You may send your objection via e-mail to service@drive-now.com or via regular mail by writing to DriveNow GmbH & Co. KG, Seidlstraße 26, 80335 Munich, Germany. There is also an unsubscribe link in all notifications, which will be considered an objection if activated.
The legal basis for the processing of data after registration for the newsletter by the user is, with the user's consent, Art. 6 para. 1 lit. a GDPR.
We want to regularly send interest-based customised advertisements and/special offers for DriveNow to our customers via e-mail. Special offers also include our DriveNow packages with special cooperation partners, which you can view at: https://www.drive-now.com/de/de/now/partners.
Our goal is to continually improve our DriveNow customer experience and to make it more user-friendly. For the purpose of sending you such advertisements, we will use the e-mail address you specified as part of registration, your name and your date of birth. In order to send you interest-based advertising, we will use automatically generated information transmitted by your computer such as delivery and read receipts for messages, information on your device, your browser, your activities in our website, including the length of your visit on our website and your lease transactions. We will process this information in pseudonymised form. This ensures that our customers exclusively receive e-mail messages that match their interests relating to the advertising and/or special offers of DriveNow. You will receive these notifications regardless of your subscription to our newsletter. We do not share data with third parties. Your data will be stored as long as we maintain a business relationship with you and you have not objected to this data processing. You have the right to object to this data processing, which is based on Art. 6 (1), lit. f, GDPR, at any time, either as a whole or for specific measures. In this case, we will no longer process your personal data. You may send your objection via e-mail to service@drive-now.com or via regular mail by writing to DriveNow GmbH & Co. KG, Seidlstraße 26, 80335 Munich, Germany. There is also an unsubscribe link in all notifications, which will be considered an objection if activated.
The above-mentioned data processing and the associated purposes are part of our legitimate interest on the legal basis of Art. 6 (1), lit. f, GDPR.
We would like to regularly provide interested parties and our customers with advertisements about our products and services about the following products and product categories of our contract partners via e-mail, text message and push. For this purpose, we will use the e-mail address you specified as part of registration, your mobile phone number and your name. Your data will be exclusively used for distributing our newsletter. The identification of your e-mail address and your mobile phone number takes place in a double-opt in process. That means you will receive a separate confirmation e-mail and a 4-digit code via text message after processing your data. You will only start to receive promotional e-mails after clicking on the link included in the e-mail and entering the code contained in the text message. In addition, we will store your IP address and time of registration and confirmation in each case. The purpose of this procedure is to prove your registration and to investigate any possible misuse of your personal data. We do not share data with third parties. Your data will be stored until you withdraw your consent. You have the right to withdraw your consent to this data processing, which is based on Art. 6 (1), lit. a, GDPR, at any time without citing any reasons. In this case, we will no longer process your personal data. You may send your notice to withdraw consent via e-mail to service@drive-now.com or via regular mail by writing to DriveNow GmbH & Co. KG, Seidlstraße 26, 80335 Munich, Germany. There is also an unsubscribe link in all e-mails, which will be considered withdrawal of consent if confirmed.
The legal basis for above-described data processing and the associated purposes is Art. 6 (1), lit. a, GDPR.
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65-1636. Sale of drugs limited to pharmacies; violations; exceptions. (a) Except as otherwise provided in this act, the sale and dispensing of drugs shall be limited to pharmacies operating under registrations as required by this act, and the actual sale or dispensing of drugs shall be made by a pharmacist or other persons acting under the immediate personal direction and supervision of the pharmacist.
(b) The donation, acceptance, transfer, distribution or dispensing of any drug in compliance with the provisions of the utilization of unused medications act and any rules and regulations promulgated thereunder shall not constitute a violation of this section.
History: L. 1953, ch. 290, § 22; L. 1975, ch. 319, § 22; L. 1986, ch. 231, § 24; L. 2009, ch. 48, § 1; L. 2013, ch. 114, § 7; L. 2017, ch. 34, § 5; Apr. 20.


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