Faced with tough choices, Italy is prioritizing young COVID-19 patients over the elderly. That likely 'would not fly' in the US.

Paramedics in a tent set up outside the hospital of Cremona, Italy, on February 29.

Claudio Furlan/Lapresse via AP

• Epidemics force medical professionals to make tough choices, including which lives to save first. 
• In Italy, where more than 9,000 people have been diagnosed with COVID-19, doctors are prioritizing the young and otherwise healthy patients over the older people who are less likely to recover.
• A NYC medical ethicist told Insider the medical community in the US would also have to make decisions about who to prioritize if hospitals become overwhelmed.
• Choosing patients simply based on their age, however, "would not fly," he said.

With the number of coronavirus patients rising every day, the medical community in New York City is discussing what to do if hospitals in the US become overwhelmed.

In Italy, where more than 9,000 people have been diagnosed with COVID-19, doctors are scrambling to secure resources and treat patients. They have been forced to prioritize the young and otherwise healthy.

"It's very hard to just prioritize the young over the old. That would not fly in the US," Arthur Caplan, the head of the division of medical ethics at NYU School of Medicine in New York City, told Business Insider. "People would protest the idea that young lives are worth more inherently than older lives."

Caplan said hospitals, like NYU's Bellevue Hospital, have already begun discussing how to ration scarce resources if need be. While there hasn't yet been a hospital committee meeting that addressed which patients would get priority in treatment, he expects that to come up down the line.

Those conversations, which will likely vary by hospital and region, should touch on not just the age of the patients but also their health and a number of other factors, Caplan said.

"If you had, let's say, an ICU that was overwhelmed, you're probably going to try and give some extra attention to healthcare workers because you need them to deliver care," he said. "The rationale isn't that they're more worthy; it's that they can contribute in the longer run to saving more lives."

When a medical center discharges a coronavirus patient, it would make sense for healthcare workers to consider whether the person is homeless before doing so, he said, because they might not have somewhere to safely self-quarantine and recover.

Arthur Caplan.

NYU School of Medicine

In a crisis, hospitals try to "maximize the chance of saving a life and make sure that we save the most years of life," Caplan said.

"In that way, younger people tend to have a huge priority, but not exclusively," Caplan said.

In fact, most people who are young with the coronavirus won't even be treated in US hospitals because they will likely recover at home.

"So what we're really talking about is the very sick young versus the sick elderly, who we know aren't likely to do well," he said. "It's not like every young person is going to get ahead of every old person."

The coronavirus is far from the first time that hospital workers have had to grapple with which patients to treat at the expense of others.

In New York, there are guidelines on how to allocate ventilators during a flu epidemic, Caplan said.

"They suggest that you may take someone who is desperately ill and not likely to live off that ventilator and put someone else with a much better chance on," Caplan said. "I'm not against that, but I will tell you that doctors hate to do that because they don't want to abandon their patient."

That is a topic that will likely also have to be addressed when hospital committees meet to come up with coronavirus policies, Caplan said.

While it's important to have conversations about how to ration resources, Caplan is concerned that not enough people are thinking about how to share resources among institutions.

"I've been complaining that we also need a strategy for sharing. So if NYU Bellevue ... got overwhelmed, how do we direct patients to other hospitals in New York City or the VA?" he said. "You need to be thinking about that right now because the better solution to shortage is sharing, not rationing."

The coronavirus outbreak has killed more than 4,000 people and infected over 116,000, with the majority of cases in China. It has spread to more than 100 countries.

The US has confirmed 28 coronavirus deaths: 23 in Washington state, two in Florida, two in California, and one in New Jersey.

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Faced with tough choices, Italy is prioritizing young COVID-19 patients over the elderly. That likely 'would not fly' in the US.

Maine High Court Hears Considering Sanctions Against Former Probate Judge

The state’s highest court heard oral arguments Friday morning as the justices consider issuing a $10,000 fine and barring former York County Probate Judge Robert M.A. Nadeau from sitting on the bench again.

The Committee on Judicial Responsibility and Disability recommended the sanctions, the harshest the Maine Supreme Judicial Court could hand down short of disbarment, for what it says are five violations of the Code of Judicial Conduct.

Cabanne Howard, executive secretary and counsel to the committee that investigates and recommends sanctions for Maine judges, outlined the five violations to start the hearing.

Nadeau faces the proposed sanctions for actions he took in November 2012, when he directed probate court staff not to appoint certain attorneys to litigants who qualified for indigent legal service, for ordering a lawyer to destroy an email deemed a public document, and for ordering the removal of a lawyer from three cases to which she had been assigned.

The committee also found that in April 2015, Nadeau changed the entire probate court schedule without consulting staff just hours after the commissioners turned down his request for more court days and a raise. During subsequent probate court hearings, he also told litigants who complained about scheduling to contact the County Commissioners to urge them to increase funding for the court.

“The motive was retaliatory to the County Committee for denying his raise,” Howard said. “This was all the cases pending in his court. Everybody got hurt in these delays.”

Nadeau, 62, who lost his bid for re-election in a three-way race last year, has been sanctioned twice previously for violating the code of conduct for judges.

He first was suspended from the bench in 2007 for a week without pay for lying about his opponent in his 2004 re-election bid. He was suspended for 30 days without pay last year for statements he made in a 2013 letter to the attorney representing his former girlfriend in a protection from harassment matter.

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Maine High Court Hears Considering Sanctions Against Former Probate Judge

Warning: Guardianship Can Take A Toll On Advisor’s Psyche

There are favors a financial advisor can safely do for a client or a client’s family without a second thought.

Becoming a guardian is not one of them.

“Becoming a guardian is not a role to be accepted without a considerable amount of thought no matter how well you know the person or his or her family,” said Sally Hurme, author of several books on guardianship for AARP and the American Bar Association.

The danger is not being threatened with fines or jail for alleged or real misdeeds. Chances of that happening are slim because court oversight of guardians tend to be frail and the individual being protected is usually too weak of body and mind to complain to the authorities.

Instead, the hazard for a financial advisor taking on the responsibilities of guardianship is being swept up in a whirlwind of uncertainties, unfamiliar duties and family feuds.

Even something as seemingly simple as getting the bank records of the senior under a court-approved guardianship arrangement may not be simple.

With a court order, getting the records may take two minutes at one bank and two days at another, said Hurme, a lawyer who once served as the public member of the CFP Board’s Discipline and Ethics Commission.

Her advice: go to a branch manager. Don’t ask a teller.

She cautioned that if the senior is running out of money, a court can reduce the fee a guardian gets.

One often aggravating and time-consuming duty the courts often don’t compensate a guardian for: hours on the phone and in meetings with family members at each other’s throats.

The starting point for becoming a financial guardian (called guardian of the estate or a conservator) or having full responsibilities for an incapacitated individual (guardian of the person) is the courts.

And that is where the problems often begin.

“One of the problems is the duties of a guardian and oversight can vary widely even locally. Even in a single county one judge may not check a guardian’s annual reports, another judge might require a lot of documentation of a guardian’s activities and have an auditor,” said Brenda Uekert, director of the Center for Elders and the Courts of the National Center for State Courts.  (Click to Continue)

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Warning: Guardianship Can Take A Toll On Advisor’s Psyche

Mike Hubbard's lead defense law firm withdraws from case; judge issues gag order

The judge in House Speaker Mike Hubbard's ethics case today allowed Hubbard's lead defense firm to withdraw from the case and issued a gag order, telling lawyers on both sides not to talk to the media.

Also, one of Hubbard's remaining attorneys told the judge the defense would not be ready in time for the March 28 trial date.

Lee County Circuit Judge Jacob Walker approved the motion to withdraw by the firm White Arnold and Dowd.

Hubbard had filed a motion giving his consent to the withdrawal.

Mark White has served as the main spokesman for Hubbard's defense. The firm did not give a reason for the withdrawal in the motion filed Dec. 31 or in court today during a short hearing.

Deputy Attorney General Michael Duffy told the judge that criminal procedure rules require lawyers to disclose their reason for withdrawal in cases in which a trial date has been set.

White disputed that, saying the reason for withdrawal was protected by attorney-client privilege.

White said information about the reason for withdrawal should be given to the judge in private, with the prosecution excluded.

Walker met in his chambers with the defense team for a few minutes before granting the motion to withdraw.

Prosecutors did not object to the withdrawal but said they did not want the trial delayed.

The judge asked Hubbard attorney Lance Bell, who remains on the case, if the defense would be ready for trial by March 28. Bell said they would not.

Walker had earlier postponed the trial from October to March at the defense's request and over the objections of the prosecution.

Before issuing the gag order this afternoon, the judge went over what happened Dec. 31, when Deputy Attorney General Matt Hart sent the motion to withdraw by Hubbard's lawyers to a reporter, even though it was filed under seal.

Walker later unsealed the motion, except for an attached exhibit that included the names of four grand jury witnesses.

Hart sent an email to the court and the defense apologizing after he said he realized the motion was sealed. Hart said the motion with the sealed exhibit was posted on Bill Britt's Alabama Political Reporter website for several minutes.

In issuing the gag order, Walker said he learned that the sealed exhibit was posted on the Internet before it was scanned into Alacourt, the website for public posting of court documents.

Walker said pretrial publicity can cause trials to be delayed if the court believes there is a need for a "calming down period."

The defense has sought dismissal of the case for prosecutorial misconduct and has previously accused prosecutors of leaking grand jury information. Hubbard attorney Bell filed a new motion on Wednesday asking the court to allow the defense to question Hart in a deposition.

Prosecutors filed an opposing motion saying that Hart's mistake had been acknowledged and that Hubbard's lawyers had made a comparable mistake in September when they failed to properly redact sealed information from a court filing.

Prosecutors also said disclosure of the names of four grand jury witnesses previously provided to the defense does not equate to revealing grand jury matters, although they said they would comply with a previous court order to keep grand jury witnesses' names under seal.

Walker scheduled a Jan. 26 hearing on defense request to depose Hart.

White and law partner Augusta Dowd talked to reporters after the judge approved their motion to withdraw. That was before Walker issued the gag order.

"I don't think you can have a better friend than Mike Hubbard," White said, choking up slightly. "I don't think there's been a person in my 42 years of practice who has been treated more cruelly and unfairly by the attorney general's office than Mike Hubbard."

White declined to say if the reason for withdrawal was related to Hubbard's ability to pay legal fees, saying he was obligated under rules of attorney-client privilege not to discuss that.

He referred to the reason for withdrawal as "a conflict of interest" but did not say what that meant.

Hubbard has paid the firm, at least partly, with campaign finance funds. Those payments total $256,475 since December 2013. But those payments have tapered off, with only $35,000 of that total paid since the start of last year.

White said his firm would fulfill its obligation to help the defense team through the transition.

White said the attorneys remaining on Hubbard's defense team were outstanding lawyers.

White said the case would not have been ready for trial had his firm remained on the case because of the number of pending motions.

A grand jury indicted Hubbard in October 2014, charging him with 23 felony ethics counts of using his public offices for personal gain.

He has pleaded not guilty.

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Mike Hubbard's lead defense law firm withdraws from case; judge issues gag order

Judicial conduct panel wants Flagstaff judge suspended

PHOENIX (AP) — A Flagstaff judge should be suspended for 90 days without pay for using government resources in his 2014 re-election bid, campaigning on government property and confronting a court employee who apparently supported his opponent, according to a recommendation from the state commission that oversees discipline for judges.

The seven-member panel of the Commission on Judicial Conduct also recommended that Flagstaff Justice of the Peace Howard Grodman be removed from the state Judicial Ethics Advisory Committee. Grodman's lawyer, Bob Van Wyck, said he has already done so.

The opinion obtained Friday by The Associated Press is preliminary and came after a hearing last month. The commission can change it following a response from Grodman that is due Sept. 8. But Van Wyck said he has no plans to ask for a revision "because we quite frankly trust the commission."

The Arizona Supreme Court will have the final say and can modify or accept the recommended penalty, which at most would include removal from office.

Charging documents accused Grodman of violating judicial ethics by sending expletive-filled emails referencing his opponent from his official email account. He also used the account to seek endorsements and permission to post campaign signs and posted photos on his campaign website while wearing his judge's robes. In addition, he blocked his opponent in the primary election from hearing cases in justice court, where the opponent was an acting judge, and he illegally posted campaign material at a U.S. Post Office.

Grodman formally acknowledged many of the acts in advance of the hearing, but he called them poor decisions that he is sorry about making. He disputed an allegation that he intentionally failed to disclose to the commission that he had been disciplined by the presiding judge for his conduct. The commission didn't believe his testimony that the non-disclosure was inadvertent.

He was seeking a lower penalty during the hearing.

The commission found that even if Grodman's "initial ethical missteps could be attributed to ignorance of code-based campaign restriction (a doubtful proposition given his service on the Judicial Ethics Advisory Committee), respondent ignored numerous entreaties by court staff and the presiding judge to stop his behavior," according to the panel's decision. "Even a cursory review of the code and relevant judicial ethics advisory committee opinions would have alerted (Grodman) to the impropriety of his actions."

Grodman was first elected as a judge in the Flagstaff Justice Court in 2010 after being a practicing lawyer for 27 years. He currently serves on the state Judicial Ethics Advisory Committee. His biography says he has taught business law and ethics at Northern Arizona University.

Justice courts handle low-level criminal matters such as drunken-driving cases as well as civil matters like evictions.

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Judicial conduct panel wants Flagstaff judge suspended

Three-judge panel to hear ethics case against Tulare County judge

Tulare County Superior Court Judge Valeriano Saucedo

A panel of judges appointed by the state Supreme Court will meet April 6 in Fresno to hear evidence against Tulare County Superior Court Judge Valeriano Saucedo, who is accused of violating judicial ethics.

Saucedo, a judge since 2001, allegedly accused his court clerk in an anonymous letter of having an affair and then gave her thousands of dollars worth of gifts.

The three-judge panel will report its findings to the Commission on Judicial Performance. If the commission finds clear and convincing evidence of wrongdoing by Saucedo, it could remove him from office or impose lesser discipline.

The hearing will be held at the Fifth District Court of Appeal and is open to the public.

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Three-judge panel to hear ethics case against Tulare County judge

NY: A Judge's Status Robed in Silence

 

The newest judge on the court's fourth floor is Barry Kamins, a man with as prestigious a resume as any in the New York state court system. But his future is also uncertain: Kamins is currently being investigated by the state Commission on Judicial conduct for a range of possible ethical violations.

A recent New York City Department of Investigation report that examined Charles J. Hynes's campaign spending and other conduct during his failed bid for a seventh term as Brooklyn District Attorney found that Kamins had been providing legal and political advice to Hynes over many months. The report revealed that Kamins, then the supervising judge for all of Brooklyn, recommended staff, prepped Hynes for debates and even provided extra legal advice dealing with active cases being handled by Hynes' office.

Following the June 3 DOI report, Kamins was removed from his senior position. But 10 weeks later, he is back on the bench hearing disputes over property values and deciding foreclosure cases.

David Bookstaver, the spokesman for the New York State Court system, said that, by law, a judge can only be removed or otherwise disciplined by the Commission on Judicial Conduct.

"Right now there is no mechanism to keep him from the bench. This isn't subjective, it's the constitution," Bookstaver said. "There is a process."

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A Judge's Status Robed in Silence

Alabama Federal Judge Mark E. Fuller Stripped of His Caseload, But Not His Salary!

An Alabama federal judge stripped of his caseload following his arrest on domestic violence charges in Atlanta will continue receiving his annual salary of nearly $200,000.

Federal rules on judicial conduct and discipline don't include a provision for withholding the pay of U.S. District Judge Mark E. Fuller of Montgomery, and the court system can't quit paying a judge just because he was arrested, said judicial ethics expert Russell E. Carparelli. A circuit judicial council is looking into whether Fuller should be disciplined.

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Judge in Siegelman, Scrushy trials keeps getting $200,000 salary after domestic violence arrest

Circuit Judge Mike Maggio Cuts Deal on Judicial Ethics Probe

Judge Mike Maggio

Circuit Judge Mike Maggio of Conway, who continues to draw more than $140,371 a year pay while not hearing any cases since the beginning of an ethics probe, has agreed to a settlement of his case before the Judicial Discipline and Disability Commission.

In it, he admits violations of ethics rules and agrees never to seek office again as judge. He  will be able to be paid for the rest of this year, which means he can continue to accrue retirement benefits. But he'll be suspended from acting as judge. He's done as a judge.

Each additional year of service qualifies a judge for pay equal to 3.2 percent of the salary of the office at retirement. Maggio, 53, took office as circuit judge in 2001, appointed to a vacancy by Gov. Mike Huckabee. He was elected twice. A judge must be 65 to take retirement benefits unless 20 years have been served.

Here's the lengthy findings of violations and agreed punishment.
Multiple complaints were merged to produce some core findings of violations, all related to his prolific postings as "geauxjudge" on an LSU fan website, tigerdroppings:

* He breached confidentiality in the case of an adopting mother, actress Charlize Theron, by revealing she'd adopted a child in Faulkner County.

* He had misused social media to the detriment of the judiciary by comments easily traced to a sitting judge. Ironically, some included pronouncements on poor judicial behavior by others. Some of his comments were posted while he sat on the bench hearing cases.

* He tried to clean up the record — thus removing evidence — after the news broke.

* He made improper comments as a sitting judge. The volume of comments suggested more than a problem of taste and decorum, the report said. "It adds up to demonstrate someone who is unfit for the bench." The record included sex jokes about bipolar women; blow jobs as wedding gifts; incest references; referring to teenagers' sex with teachers as trophy hunting, and remarks about how women make divorce decisions on emotion rather than common sense. He made jokes about the names of black people and derogatory remarks about gay people and Mexicans. Pages 3-6 of the report are a mind-numbing illustration of Maggio's lack of fitness to serve.

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Mike Maggio Cuts Deal on Judicial Ethics Probe; Will Never be Judge Again

Judge Mike Maggio Appears Before Ethics Commission

The Arkansas judge who made national headlines this spring faced the Arkansas Ethics Commission on Friday in a confidential hearing regarding campaign contributions.

Maggio's name hit headlines after blogger Matt Campbell linked the judge to questionable comments on an online sports forum, including disclosing confidential details of an adoption by celebrity Charlize Theron. 

 

That triggered an investigation by the Arkansas Judicial Discipline Commission. Maggio withdrew from the appeals court race and apologized for a lapse in judgment.
 

Campbell later highlighted thousands of dollars in campaign contributions made to Maggio's campaign from political action committees that were linked to a nursing home owner who had been a defendant in Maggio's court.
 

That led to additional investigations by the Judicial Discipline and Arkansas Ethics Commissions. 

 

In March, the daughters of Martha Bull filed paperwork with the Arkansas Judicial Commission. Those papers outlined the timing of thousands of dollars in contributions to Judge Maggio's appeals court campaign. The paperwork triggered a Judicial Discipline investigation, but the Ethics Commission also confirmed it was investigating the donations. 

 

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Judge Mike Maggio Appears Before Ethics Commission

Lawyer ethics violations in New York are punished too slowly and inconsistently handled, study finds

A study of lawyer discipline cases in New York has found that punishment is slow and sanctions for similar conduct are inconsistent.

New York University law professor Stephen Gillers studied lawyer discipline cases dating to 1982 and read 577 court opinions imposing sanctions in the last six years. He found several instances of unacceptable delays and disparity in punishment in courts in different parts of the state, the New York Times reports in an op-ed.

In upstate New York, appeals courts rarely explain decisions on sanctions, and often they don’t follow earlier precedents, the story says.

“Perhaps most troubling,” the Times says, “is the overall lack of transparency that pervades the system. Unlike 40 other states, New York does not inform the public of pending charges against lawyers. It is also unnecessarily difficult to learn when a lawyer has been officially sanctioned.”

The Times includes some examples of problematic cases. One lawyer accused of stealing client funds was allowed to continue practicing for three years before he was disbarred. In another case, a lawyer received a two-and-a-half year suspension for filing false documents, making false statements and improperly notarizing a client’s signature. But a different lawyer accused of similar conduct received only a formal rebuke.

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Lawyer ethics violations in New York are punished too slowly and inconsistently handled, study finds

NY: Twenty Judges Reprimanded in 2012

Three judges were removed from office last year and another 11 resigned after investigations by the state Commission on Judicial Conduct found the jurists had breached their ethical or legal responsibilities.

The agency, which oversees the state court system, received 1,785 complaints about judges suspected of misconduct in 2012, leading to 460 preliminary inquiries, 182 full-fledged investigations and 20 reprimands, the group disclosed in an annual report Thursday. That’s up from 14 reprimands in 2011.

In addition to the judges who left office after charges were brought against them, nine judges were censured and three were publicly admonished after the commission determined they’d abused their power.

“It’s fair to say that any number of disciplines against judges is too many, to the extent that it reflects misconduct being committed by those who have an ethical obligation to uphold the highest standards,” commission administrator Robert Tembeckjian said. “But given that there are 3,500 judges in the court system, the number who are disciplined really doesn’t reflect a systemic ethics problem among the judiciary.”

Although there were more reprimands in 2012 than the previous year, more judges resigned in 2011, when fifteen jurists stepped down from their posts. There were also more complaints filed in 2011 compared to last year. There were 1,818 complaints in 2011.

The commission may discipline judges but does not have the authority to request that cases be reopened, should it appear that a judge’s ethical or legal breach jeopardized a case. Tembeckjian said a party in the case would have that option.

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Twenty Judges Reprimanded in 2012

DOJ, D.C. Bar Counsel at Odds in Ethics Case Against Ex-Prosecutor

A clash between the U.S. Justice Department and the D.C. Office of Bar Counsel over a former federal prosecutor's alleged ethics transgression is playing out in front of a Washington attorney ethics board.

Andrew Kline, a former assistant U.S. attorney in Washington, is challenging an ethics committee's conclusion in March that he didn't play by the rules in a shooting case when he kept certain information to himself that the victim had earlier provided to police.

The Justice Department is backing Kline in the dispute, pending before the D.C. Court of Appeals Board on Professional Responsibility. DOJ lawyers argue that the hearing committee too broadly interpreted a prosecution conduct rule, opening the door for ethics cases and "unwarranted sanctions" against prosecutors. Kline is no longer in government service.

The D.C. Office of Bar Counsel this month filed a response to Kline and DOJ, which submitted an amicus brief in the case supporting the former assistant U.S. attorney. You can read bar counsel's brief here and the DOJ brief here.

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DOJ, D.C. Bar Counsel at Odds in Ethics Case Against Ex-Prosecutor