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  • Rolling Deposits – Uncovering the Granddaddy of Cash Fraud

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    The Shift Manager of the fast food restaurant sat in his car, under a shade tree in a parking lot. On the floor board are unused disposable deposit bags and a destroyed deposit bag that had been sealed with last night’s closing deposit. The manager had sliced open the deposit bag and the passenger seat is littered with the contents – ones, fives, tens, twenties, and change. He will use one of the unused bags to make a new deposit. The manager counted the funds several times, his stress level mounting. The amount is not enough to match a deposit slip for a deposit dated two days ago. Two days ago? What is going on here? Why did he open a deposit bag today for funds to match a deposit ticket that is two days old? Do you know?

    This is a theft scheme called “rolling deposits” and unfortunately it is not uncommon when retail and restaurant managers prepare deposits and make deposit runs to the bank. The employee steals all or a portion of the day’s deposit and makes up for the stolen cash from the contents of future deposits to cover the thefts. The scheme continues as long as the manager has access to deposits.

    The tell tale sign of the “rolling deposit” theft scam is deposits taken to the bank by a particular manager are consistently validated by the bank several days after they should be. Deposits taken to the bank by the other managers are validated on time. The stress level of the manager who is scheming mounts as the need to match deposit funds with unvalidated deposit tickets becomes increasingly complicated. As in the example above, the deposit the manager opened is not enough to cover the past deposit ticket. The manager will now have to wait to add funds from tomorrow’s deposit to conceal his thefts.

    If the business is using disposable deposit bags and the deposit was prepared by another manager, our shift manager involved in the theft scheme makes the bank run with the deposit. As in the scenario above, the shift manager in order to continue his thefts, must cut open the sealed deposit bag and remove the cash and the accompanying deposit slip.

    With no intervention, these theft schemes can go undetected for a long time and the cash losses can be staggering. Experienced security and loss prevention professionals can easily reveal the fraud with a little investigation. In my experience, the manager conducting the rolling deposit fraud will readily confess when interviewed properly. They are so stressed trying to keep the scheme floating, they are generally relieved that it is over.

    There are tried and true protocols in establishing sound loss control practices to prevent this type of scheme and ways to easily uncover it. If you suspect one of your employees of rolling deposits:

    1. Develop a chart – across the top of the chart list these columns: Date, Shift (deposit), Amount of Deposit, Bag #, Depositor Name, Date of Bank Verification. Make a separate line for each deposit. Down the left side of the chart, list the sequential days of the month. Fill in the corresponding information starting with the first of the month.

    2. Analyze the chart – Look for patterns and discrepancies such as missing disposable bag numbers from the sequence, “leapfrogging” of bag numbers and deposit validations from the bank. Look for a pattern of the same manager taking the deposits to the bank when the discrepancies occur.

    3. Action – Prohibit suspect’s access to deposits. If rolling deposit scheme is occurring, a deposit will soon show excessive shortages or missing altogether. Track the deposit activity for past months to get a better indication when the discrepancies first appeared.

    4. Prevention

    * Require all deposits be sealed in disposable deposit bags

    * Eliminate the vinyl/canvas/zippered pouches

    * Record deposit bag number with corresponding deposit

    * Require depositors to sign for deposits they take to the bank

    * Check all deposit validation dates from the bank with the dates of business

    * Develop strong cash and deposit auditing programs looking for deposit bags and validations out of sequence

    * Have a bank representative notify you of “late” deposits (> 3 days late)

    * Consider SMART safes or armored car service

    Taking deposits to the bank is a common practice for Fast Food (QSR) restaurant and retail management. It is fraught with issues such as time away from management responsibilities in the restaurant or store, exposure to traffic accidents and crime, and this “rolling deposit” theft scheme. Although seemingly the cheapest way of getting funds to the bank, it may be most costly should the manager be seriously injured or killed in a car crash or armed robbery during the transport. Stealing tens of thousands of dollars from deposits may pale in comparison.As new technology is developed, armored cars service becomes more competitive, and ways of banking become more progressive it may be time to rethink how we get our money to the bank and eliminate the exposures to our people and our profits. So what is going here? Why are certain deposits getting to the bank several days late?

    Now you know, and now you can do something about it.

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    Source by Libby Libhart

    Views: 0

  • Should I Still Be Saying "I Love You" To My Separated Spouse?

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    When you are in the middle of a separation that you never wanted in the first place, it can be tempting to want to remind your spouse that they are still married to someone who still loves them very much. I know first hand that there can be a real worry that if they are outside of your presence, they will begin to forget what they loved about you. Or they will find that the phrase “out of sight, out of mind” is actually true.

    So it may be your normal inclination to tell your separated spouse that you love them every time you talk with or see them. And this is absolutely fine – so long as you are getting an enthusiastic response in reply. Unfortunately, this is not always the case.

    A wife might say: “I know that it sounds desperate and needy. But I can not help it. Every time I talk to my separated husband, I tell him that I love him right before we hang up. I have done this for all the years that I have known him and old habits die hard. At the beginning of our separation, this seemed OK. But the last couple of times, I’ve noticed that he has hesitated before he gives a response. Last night, he didn’t say anything in response. I don’t mean to be dense. Obviously, he probably thinks that I am doing something wrong or he doesn’t want to hear me tell him that I love him during the separation. But not saying it feels like a lie. It feels like playing games or holding back. Am I supposed to pretend that I don’t love him? Because I find that ridiculous. I do love him. And it seems silly to me that I am not supposed to say it every day in the same way that I have for many years. Do I have to stop?”

    That is really up to you. I would never tell someone what to do during their marriage or during their separation. I can tell you what came to be my opinion as the result of a similar situation that I was in. But, I know that all situations are different. So I can’t say that what worked for me will work for you.

    But, during my own separation, it eventually became very clear that my husband was not receptive to me acting in the same way that I did while we were still happily married. When I tried to act as if we were any other married couple or that nothing was wrong, he would act distant or he would start to avoid me. If I pushed, it would get even worse and I would have to work very hard to even get him to take my calls. Frankly, there were times when I could almost literally feel him wince when I told him I loved him.

    As hard as it was to accept, I started to realize that if I didn’t change some things, I might be making this situation a whole lot worse. So I made a conscious decision to back off some. Did this mean I didn’t love my husband? No, if anything, I loved him just as much if not more. But I knew that if I was going to have a chance to maintain that love, I was going to have to find the strategy that brought him closer to me rather than pushing further away.

    And when I tried to push my love on to him, this definitely made him pull further away. So, I toned down my demonstrations and declarations of love. I told myself that this was only temporary, but it was difficult. Still, I knew what was most important was my long term goal and not my declarations of love in the moment.

    My backing off did eventually make things better because it eventually made my husband more receptive to me again. And his being receptive to me meant that we got to spend more time together – which never would have happened if I had continued on with my pushing.

    I can’t tell you what will work in your own situation. I can only suggest that if you notice something not working, then it sometimes makes sense to test out something else – if only once. Perhaps next time you talk to your husband and it is time to sign off, you might try something like: “tonight, I’m not going to insist that I love you, even though I do. I sense that it makes you uncomfortable. But I didn’t want you to think that I was angry or anything. I’m just trying to respect your wishes and not push.”

    At this point, your husband could reassure you that the loving phrases are fine. Or, he may not say anything – in which case his silence speaks volumes. If you do decide to back off and you find that the next time you talk, he seems more comfortable, then you may speculate that backing off a little has helped.

    I know that it might seem weird and almost dishonest to hold back with your own spouse. But a separation can be a very fragile time in a relationship – especially when one spouse has asked for space or isn’t sure what he wants. It become my opinion that if backing off a little is what it took for my husband to eventually be available to me, I was willing to pay that price at the time. Because I knew that it was part of a long-term strategy that was going to mean that I wouldn’t have to hold back once we reconciled.

    Today, I tell him that I love him all of the time, so holding off was worth it to me. And I believe it helped. But every situation is different. In some situations, both spouses are perfectly comfortable with still saying they love one another. And that’s wonderful. But it was not my reality. Still, if every one is happy, then I don’t see any reason to hold back.

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    Source by Leslie Cane

    Views: 0

  • Top Network Marketing Company – Why Are the Products So Expensive?

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    I’m sure you’ve heard this question before, Why are top network marketing company’s products so expensive?

    This is one of those ever-present questions that networkers and direct sales people will continue to encounter (probably) forever–and there’s always more to it than meets a simple answer.

    One key is not to side-step it. There are good and genuine reasons for legitimate, premium-priced products–and of course there are over-priced ones as well. Honesty is best, as always, and I’ll endeavor to give you the general truth with my answer to the question.

    Special Products at Special Prices

    First, the products available through top network marketing companies sales and distribution model are mostly what are called “specialty” items. They are higher priced products to begin with, having more costly ingredients and more complex designs or formulas; they are simply more expensive to make and package. Some well-known non-network marketed examples are Clinique makeup and fragrance products, Apple computers, iPods and iPhones, Armani clothing, Mercedes and Lexus automobiles.

    Unless you’re dealing with a scheme or a scam, these premium products outperform their cheaper, off-the-shelf counterparts, giving consumers more and better benefits. Since they have greater value, they cost more.

    If these products are being outsourced by the networking company (produced by a “third-party” vendor/supplier), they tend to be manufactured in smaller production runs that do not allow for all the optimal low-cost advantages of buying and making in the high volumes mass-marketers enjoy. The manufacturing processes are more complex and exclusive. The profit margins are higher. This results in a higher quality product with more attention to detail and quality control.

    The reason manufacturers and marketing companies select network marketing and direct sales is because these higher-priced products are of higher quality, and they therefore require special methods of distribution and sales.

    Simply put, they cannot compete with the lower-priced, lower quality “commodity” products, which are sold based mainly on discounted mass-market pricing and brand awareness alone. Think Wal-Mart and Costco.

    Specialty products are “education-intensive.” They need greater explanation; for example, what formula, ingredients and/or processes makes the product more expensive than those mass-market goods available through direct response marketing (such as the Internet and mail-order) or retail chain store sales. Many require demonstration.

    Mass-market products depend on advertising, promotion and merchandising at “point-of-purchase,” all of which are required to get consumers’ attention, let them know the product exists (to create “trial” especially if it’s “brand” new), and to give them enough compelling reasons to purchase and keep on purchasing.

    Going head-to-head with nationally advertised products, many to most of which are heavily discounted and sold at the lowest price possible, is a tough game for just about all smaller businesses to win. Imagine trying to sell vitamins or nutritional beverages or “prestige” cosmetics against a major manufacturer selling through Wal-Mart, or a natural toothpaste against a tube of Crest® through Kroger or Publix supermarkets.

    Specialty products are perfect for the person-to-person, information-rich education, demonstration and service oriented methods of network marketing.

    And that’s where the important second aspect of network marketing’s “higher price” comes in: the added value which you as a “distributor” add to the specialty products you sell.

    Added Value Added

    Network marketing and direct sales representatives add significant value to the product they sell and they are well paid when they do so successfully.

    We reach consumers with the awareness of new products and services that ads and merchandising–no matter how persuasive or promiscuous–would not be able to reach out and touch. And by virtue of our one-on-one, personal relationship with these buyers, we appeal to them with a level of trust and service no mass-market, retail product advertiser could hope to compete with.

    The extraordinary level of service Network Marketers provide is not available when buying through mail order or retail outlets. It is a real and tangible benefit, part of the product’s value–and its price.

    For example: Someone tries a network marketing anti-aging health product. It’s personally presented for them–either in person or via mail–with a host of educational material about the product: scientific studies, article reprints, even books or tapes explaining how the product was made, how to use it, its unique features and its benefits.

    Within one to two days, the network marketer again contacts the person to follow up, asking how they are doing, checking to see that their customer is following use directions properly, make recommendations, etceteras. These service calls continue daily, bi-weekly or weekly until the customer is satisfied and happy.

    The network marketer will also continue to send informative and educational material such as updates from scientific literature. He or she will also let the customer know about other products the company offers that this particular customer with his or her unique needs and wants might also enjoy.

    This is an extraordinary level of service that is a real and tangible benefit for the consumer. This kind of personal and knowledgeable attention is not available when buying through the Internet alone, or mail-order or most all retail outlets. It is one of the things network marketers are paid for and it is part of the product’s value–and its price.

    Are there cases where the above education and service are not offered? Of course.

    Are there products that do not have special ingredients or qualities that support a higher price? Sure.

    And are there times when a network marketed product is simply more expensive to pay for the multiple-level commission structure? Yes.

    Back in the early 1950s, a dog grooming service was opened in New York City to serve people living in the exclusive Park Avenue, 70th and 80th Streets area. They charged $25 to shampoo and clip a dog. They had no customers. Then they jacked-up their prices to $250 per visit–and were an instant success. The Cadillac Seville, when first introduced in test-market showrooms priced at under $10,000, bombed; at $14,000 the very same automobile became an instant best-seller.

    Value is a perception. The relationship between quality, benefit and price, i.e., value, is in the mind of the consumer-beholder. Businesses price goods and services according to what the market will bear. Successful marketers come up with just the right mix of value-benefit-price.

    The majority of network marketing direct sales products are of the genuine higher-quality variety, not available in stores, special in ingredients, design and making.

    Most offer the convenience of in-home or on-line ordering and to-the-door delivery. They are also special in terms of…

    Marketing and Customer Service

    The network marketing “sales person” adds value to the product through his or her education, service and sales to the customer.

    All of this has its price. And according to consumer trends and the explosive growth of network marketing direct sales companies and their products worldwide, more and more people every day think it’s worth it.

    What’s the truth about the price of products offered through network marketing? Are they too high? And if so, why?

    The full answer to this one is complicated. If you need a short one, mine is:

    High? Usually, yes.

    Too high? Sometimes… yes, but generally no.

    So, if they are high, why? Let’s start with looking at what kind of products we’re really talking about here.

    The Truth is, Specialty Products Cost More

    Network marketing is predominantly a “specialty products” business: The products we sell most often tend not to be the type you’d find in supermarkets, drug stores or any other mass merchandiser. They are not the kind that combines the lowest possible price for the least acceptable level of quality. For a conventional retail parallel, look at the products in a natural or health food store, beauty salon, boutique or upscale department store.

    Specialty products cost more to make. The ingredients are unique and high quality and production is low quantity–the amounts manufactured usually are not great enough to take advantage of the economies of scale enjoyed by big-time, high-volume, mass-market producers. So these products more expensive–both to make and to buy.

    Also, specialty product makers usually cannot depend on major advertising to increase sales: they don’t have that kind of money. So they have to use more expensive forms of distribution, such as small, individual retail outlets whose profit margins are higher than mass-market stores and chains.

    Profit Margins and Markups

    Here’s an example: a discount chain drug store might be able to markup a bottle of vitamins that normally sells for $3.00 wholesale for less than the normal 33 percent retail profit margin. And, because they buy in large volumes, they’ll get the product for less than $3.00 to begin with.

    A natural or health food store might buy that same product at the full $3.00 wholesale price, and use a markup of 50 percent to get their full 33.3 percent retail profit margin.

    To the consumer, buying at retail, here’s the difference: $3.99 at the drug store and $4.50 at the health food store.

    And then there’s “what the traffic will bear.”

    There are sexy boxes of imported chocolate that go for $38.00 each, and poly-bags of 50 mini Reeses Peanut Butter Cups you can get for less than $3.80. If your taste tends towards expensive, you’ll generally pay more–in “margin” percentages to middle-people and in total dollars.

    Let’s look at a comparison of one single product offered through the conventional manufacturer-to-retailer distribution system and the exact same product sold through network marketing.

    $$$ From Conventional Manufacturer to Consumer

    We know specialty products cost more to make; again, the ingredients are unique and high quality, and the production is low quantity, so they are simply more expensive.

    Manufacturers speak of “Cost of Goods” (CoG): that’s the figure that a product costs the company to make, including overhead, ingredients, packaging and labeling, sales commissions (such as broker’s fees), etc.

    The very minimum a manufacturer needs to sell that product for is double, or a 50 percent margin. Considering that most competitive businesses operate on a six percent pre-tax profit, that leaves them 44 percent to pay for everything else. So, the $2.00 CoG product they make, they sell for $4.00.

    Now, some manufacturers sell direct to retailers–not many, but a few do, and when they do, they’ll take a higher profit margin to pay for the Cost of Sales (CoS).

    However, most manufacturing companies deal through distributors, who charge for warehousing, shipping and selling the products to retail stores. Normal wholesale is a 25 percent markup, which you get by multiplying the purchase price–plus freight if not included–by 1.33. So, our $4.00 item would be sold by a wholesale-distributor to the retailer for $5.32. (Again, plus or not freight costs which can run 10 to 15 percent additional.)

    To achieve a 33.3 percent profit margin, the retailer has a 50 percent mark-up–or higher. Our $5.32 product ends up on the shelf at $7.98.

    Now, this is the minimum scenario–not what normally happens except in the more strongly competitive markets. It’s not the least bit unusual to find the manufacturer selling that $2.00 CoG product for $5.00 or $6.00… the distributor working on 35 percent instead of 25 percent… and a retailer – especially from a specialty market segment–look for a 50 percent profit (i.e., a 100 percent markup), instead of “only” one third.

    And if all of that were true, the retail price of the product through that sales and distribution system would be more like $14.95.

    $$$ In Network Marketing Direct Sales

    Let’s work this one backwards (because that’s how most of the numbers are figured for your commissions).

    If the networking company’s product sells to consumers for $15.00 it will have an average retail commission to the networker of from 20 percent to 40 percent. So, using a 30 percent retail commission, the company’s “wholesale” price to the mlm distributor will be about $10.50.

    Let’s say that your company pays out a full 50 percent in “downline” or organizational commissions. That means that the company’s lowest from-the-warehouse price for the product would be half of wholesale, or $5.25.

    That’s right in the ballpark for specialty manufacturing, distribution and sales.

    It’s a Question of Value

    There is also a greater value, beyond the “specialty products” issues of ingredient quality, cost of manufacture and so forth and that’s the education, information and service delivered by the person-to-person distribution network.

    Learning the product’s proper use, additional uses, history, all about the ingredients, etceteras, is all part of its value. And products offered through word-of-mouth network marketing have more of this “added value” than any others.

    This last point begs the question:

    “Are products purchased through network marketing higher priced to make up for the compensation or commission payments to distributors and their networks?”

    Can they be? Yes.

    Are they… usually? No and Yes.

    In an authentic, intelligent, sincere and sensible network marketing direct sales company, one that’s well-managed and directed… a company that understands that the financial health and well-being of the men and women in the field MUST lead their mission, decisions, strategy, policies and procedures… no.

    But that new ostentatious corporate headquarters in the prestige location… corporate jet… an army of “distributor service” personnel… rock concert “conventions”… $50,000 “big name” keynote speakers… resort vacations and incentive cruses to exotic locations paid for by the company… luxury car allowances… are all expenses that need to be paid for. Where does that money come from?

    Directly (in terms of potential commissions that will not be paid out to people) or indirectly (in over-priced products and/or inflated charges for marketing materials, self-replicating websites, business building tools and trainings), the money comes from only one place… the men and women in the field.

    “So… do network marketed products cost more?” Sometimes yes and other times no.

    Can they be more expensive than similar items of equal value offered in a conventional market such as a retail store? Yes, they can.

    In fact, you can find numerous examples of both conventionally retailed products and networking products of similar sizes, shapes and qualities at prices that vary by as much as 30 to 40 percent or more.

    The only sure rule in product pricing the world over is, “What the traffic will bear…” No matter what distribution and sales route the product travels. It’s not so much a game of “Let the Buyer Beware,” as it is and always will be…

    “Let the Buyer Be Aware.”

    Factor in the at-home shopping convenience… the customer service… the satisfaction guarantee… personal attention… education and information–and in today’s increasingly competitive global marketplace, the “aggressive pricing” posture being taken by more and more networking companies around the world–along with the generally superior quality of the products available through network marketing and direct sales…

    … and I believe a growing number quality-conscious consumers will agree with me, top network marketing company’s products represent outstanding value.

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    Source by John Milton Fogg

    Views: 0

  • Finding Your Wealthy Place

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    How is your life today? Does it reflect that you are a child of God? Does it reflect the wealth of your heavenly Father? God said in Deuteronomy 28:3, “Blessed shalt thou be in the city, and blessed shalt thou be in the field.”

    There is what is called a wealthy place. God wants to bring you into your own wealthy place. Once you are in such a place you will not ask yourself if you have found it. You will experience it when you are in the city and when you are in the field. It works everywhere. It works in the city and in the field. In other words, whether you are a doctor, lawyer, school teacher, minister, business person, or you have some other vocation.

    Remember that yesterday we talked about leaving all for Jesus? You started coming out of the practices that God does not like. Why? God wants to take you into that place. You cannot win the world and win God’s Kingdom at the same time. One must drop. Genesis 12:1 says, “The LORD said to Abram: Leave your country, your family, and your relatives and go to the land that I will show you.” You are expected by God to leave certain practices in life. That will be your expression of faith in Him. That is what Abraham did. So forsaking certain things as you obey God will lead you to the place God destined for you.

    “Thou hast caused men to ride over our heads; we went through fire and through water: But thou broughtest us out into a wealthy place.” (Psalms 66:12).

    You might have gone through the fire or water, but finally the Lord is bringing you into this wonderful place in Jesus Name. That is the place of plenty. It is God’s will that you come out of the tight spot financially. We do not serve a careless God. He does not take you out of Egypt and throw you into a wilderness and then leave you there to die. The wilderness is just a pathway to your wealthy place. So do not worry about what is happening in your life now. You are just passing through. Never think the wilderness is your destiny. Never think you should die there. No, No! Fix your eyes into your wealthy place. See God taking you through. Listen to Him. Obey Him.

    I believe the following verse in Psalms is a prophetic word to the Body of Christ for this hour concerning finances.

    Thou shalt arise, and have mercy upon Zion: for the time to favour her, yea, the set time, is come. (Psalm 102:13). Note that Zion refers to the Church. God favors those who believe Him.

    When is the time to arise? The time is now. Do not stay in the wilderness till you die. If you have not yet found your wealthy place, arise now! Ask God to show you where or what is your wealthy place. He is a faithful God. He is always true to His Word. Therefore believe Him and act according to His instructions. He will speak to you in Jesus Name!

    Blessings!

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    Source by Elphas Sipho Mdluli

    Views: 0

  • Department Administrator Interference in the Doctor-Patient Relationship

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    I contacted a resident doctor in Internal Medicine at a teaching hospital and asked if he would be interested in becoming my primary care physician (PCP). My note briefly described my background in health outcomes research and two of my prescription drugs. He wrote back that he would be honored to be my PCP, and came across as professional, humble, and sincere. A new doctor-patient relationship was formed, and I contacted my existing doctor’s office to arrange for my medical records to be transferred, which immediately informed that office that I must be dissatisfied and going to a new doctor. I also shared with the resident doctor confidential information from my medical records and a copy of one of my professional presentations at a health care conference.

    A department administrator then contacted me to say the resident doctors are not available every day of the week for clinic and are not even here when they do their ICU rotation. Also, the Internal Medicine department protocol would not allow the resident doctor to write me a drug prescription for off label use. Finally, she was concerned that in the past I have ordered and correctly interpreted my own blood tests. The administrator’s attitude reflects one of the chief complaints Americans have with the health care system: the system is coming at them and requiring them to get health services in some predefined structure to which the facility is accustomed but which eliminate any potential for individualized treatment according to individual patients’ needs.

    Apparently the administrator did not spend enough “careful consideration” to get her facts straight. I do not need to see my PCP daily or even monthly. My track record shows I saw my existing doctor once in a calendar year, and the prior doctor before him I saw once in a 15-month period. So the administrator based her decision on her own ignorance of the facts.

    She also misstated facts concerning off-label prescriptions for drugs by resident doctors. One of the drugs we are talking about is Clomiphene. Both a resident doctor and an attending faculty physician at the teaching hospital advised me that they would be willing to write me (off-label) prescriptions for this drug, and the attending physician did indeed phone in a prescription for one of the drugs at my request. Similarly, the Dept. of Obstetrics and Gynecology (OB-GYN) advised me that their doctors, both resident and attending, have prescribed Clomiphene to patients. Therefore, residents in Family Medicine and OB-GYN (both primary care departments) can write prescriptions for Clomiphene, but “protocol” prevents residents in Internal Medicine (also primary care) from writing off-label prescriptions. What kind of a cockamamie rule is that? What, the residents in Internal Medicine are too dumb or too naive to understand off-label benefits of medicines?

    Finally, I had planned for my resident PCP to order and interpret blood tests each time I visited him. The administrator could have learned that fact if she had bothered to call or write me before jumping to conclusions and interfering in my doctor-patient relationship. I strongly reject the Director’s paternalistic view of medicine in which she feels she has to protect resident doctors from patients who order or interpret their own blood tests. These resident doctors are young professionals who have completed their medical degrees; they don’t need paternalistic oversight from a department administrator telling them who they can and cannot invite to be patients.

    Apparently, an overwhelming number of patients who visit this teaching hospital’s doctors want to be told what to do and how to feel. I am the exact opposite; I take personal responsibility for and manage my own health, which is strongly advocated under health care reform. Having a more equal, collaborative relationship with my PCP works for me, and that seems to be the true reason for the administrator’s interference. Studies show that medical malpractice rates drop with a non-paternalistic model of health care services. That fact of reducing litigation risks is pushing more health care systems across the country to migrate to a non-paternalistic model.

    LEGAL ANALYSIS

    I. Formation of Doctor-Patient Relationship

    The first question to address is whether, based on this fact pattern, a doctor-patient relationship was formed. When I gave the Internal Medicine resident doctor confidential information on two off-label drugs that I take, that act would be analogous to a prospective client approaching a lawyer with facts about his case to see if the lawyer will assist him. Contacting a lawyer this way does not create an attorney-client relationship. However, the lawyer is under an ethical duty to protect the confidentiality of the information shared by the prospective client. Similarly, the resident doctor was under an ethical duty to keep the information I shared with him confidential.

    When a lawyer responds to a prospective client, “I agree to take your case,” or “I will be your lawyer,” or words to that effect, then an attorney-client relationship is created, and the protection afforded to the client’s information rises to the level of constitutionally protected attorney-client privilege. In this case, when the resident doctor responded that he would be honored to be my PCP, we have offer and acceptance forming a contract. The offer-acceptance could be construed as my offering to be his patient, which he accepted, or his offer to be my PCP, which I accepted.

    But offer and acceptance are only two of the three required elements to form a contract. The third essential element is exchange of consideration, expressed in Latin as the quid pro quo. In this case, there were several separate exchanges of consideration that complete the formation of a contract and thereby render it enforceable in a court of law. Consideration is defined as some act or some transfer of an item from one party to the other, for which the receiving party had no legal right to otherwise obtain that consideration. There is no requirement that the consideration have intrisinc value. For example, the transfer of a scrap piece of paper can constitute valid consideration that renders a contract binding and enforceable.

    The initial disclosure of confidential information from my health history amounts to sufficient consideration. Second, the fact that both I and the doctor each began pursuing scheduling an appointment for me to see him is also consideration: neither of us had a prior legal right entitling us to that action by the other person. Third, when we continued to correspond after offer and acceptance, with additional information being shared back and forth, further consideration was exchanged. My sending the resident doctor a copy of one of my professional presentations was a fourth example of consideration. Finally, my request that my medical records be transferred to the resident doctor’s clinic constituted an obvious legal detriment based on reliance rendering the contract enforceable.

    If a lawsuit were filed for enforcement of this contract, I am confident that the plaintiff would overcome any attempt to dismiss the lawsuit by the teaching hospital’s attorneys based on the absence of a contract. Defendant might attempt to argue that no contract could be formed, because the resident doctor is not licensed. According to the website http://medical-dictionary.thefreedictionary.com/resident+physician, a “resident physician is a graduate and licensed physician receiving training in a specialty, usually in a hospital.” The resident’s licensing status would not prevent the formation of an enforceable contract, as we have in this fact pattern, for treatment in the supervised residents’ clinic.

    In court, we would pose a series of questions: 1) Is the resident a graduate of a medical school? Yes! 2) Was our conversation focused on health care treatment? Yes! 3) Does the resident see other patients (whether supervised or unsupervised) in the resident clinic? Yes! 4) Are the resident’s services billed to the U.S. government and to private insurers as the services of a doctor (not a student or a doctor’s aide)? Yes! 5) Did we both use the term PCP in describing our relationship? Yes. 6) Did the resident undertake to assist me in obtaining a medical appointment to see him? Yes! With these answers, any court of law is going to recognize if it looks like a duck, swims like a duck, and quacks like a duck, then it is a duck. Therefore, the defendant’s argument on licensing will be viewed as a red herring and will fail. In a similar vein, courts have noted “it is axiomatic that a doctor-patient relationship may arise from, briefly exist, and be limited by the unique circumstances presented in a transfer situation.” Sterling v. Johns Hopkins Hosp., 145 Md. App. 161 (Md. Ct. Spec. App. 2002). It does not matter how long the doctor has been seeing patients or how brief the contact with any given patient, a doctor-patient relationship can be formed.

    Selection of a PCP and other medical decisions are “core” private decisions. A fundamental tenet of privacy jurisprudence, as it has been applied to other types of personal matters, is that the individual most directly concerned is entitled to make and implement the protected decision autonomously and free from paternalistic government intrusion. See, e.g., Zablocki v. Redhail, 434 U.S. 374, 54 L. Ed. 2d 618, 98 S. Ct. 673 (1978) (decision to marry); Moore v. East Cleveland, 431 U.S. 494, 52 L. Ed. 2d 531, 97 S. Ct. 1932 (1977) (decision to live with extended family members); Griswold v. Connecticut, 381 U.S. 479, 14 L. Ed. 2d 510, 85 S. Ct. 1678 (1965)(reproductive choice). I would argue that the constitutional right to privacy also protects autonomy in selecting a PCP among a wide choice of available doctors, selecting which medications I want prescribed, and choosing what lab tests I want to order myself to monitor my health.

    In 2005, the Supreme Court of Arkansas provided the best statement in American jurisprudence on the elevated status of the doctor-patient relationship. The court noted the relationship of doctor-patient is unique. “The loss of this relationship, even temporarily, causes irreparable damage to the doctor and the patient. There is no adequate remedy at law because the loss is a loss of a one-time opportunity.” Baptist Health v. Murphy, 362 Ark. 506 (Ark. 2005)

    The court noted that the hospital had violated the Arkansas Department of Health rules and regulations for hospitals by failing to enforce policies that protected the doctor’s selection of patients and the patient’s choice of a physician. “We interpret this to mean that an otherwise qualified doctor must be granted access to his patient for the purpose of treating his patient, if that is what both the doctor and the patient want. Or, stated another way, a hospital cannot deny the services of a physician of the patient’s choice if the patient is already being seen by physicians at the hospital. Baptist Health v. Murphy, 362 Ark. 510-511 (Ark. 2005)

    Based on reading Baptist Health, I will now forward a copy of this article to the state Department of Health to determine whether the teaching hospital violated any of my state’s regulations requiring Tennessee-licensed medical centers to have policies or bylaws that respect the patient’s right to select his own physician. If so, then the teaching hospital is violating those regulations.

    II. Tennessee’s Tortious Interference Statute

    Tenn. Code Ann. § 47-50-109 is captioned, “Procurement of breach of contracts unlawful – Damages.” The administrator tortiously interfered in my doctor-patient relationship and prevented the resident doctor from performing his services under our contract. She therefore procured a breach of that contract. The administrator will argue that she was merely performing her duties, but that is no excuse for interfering in an existing doctor-patient relationship.

    Although Tennessee jurisprudence does not have a case on point, courts across the country have taken a dim view and expressed disapproval of employer interference in the doctor-patient relationship. For example, the U.S. Supreme Court stated, “The ethical objection has been that intervention by employer… makes a tripartite matter of the doctor-patient relation. Since the contract doctor owes his employment and looks for his pay to the employer… rather than to the patient, he serves two masters with conflicting interests.” United States v. Oregon State Medical Soc., 343 U.S. 326, 329 (U.S. 1952).

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    Source by Michael Guth

    Views: 0

  • How to Cut 3 Pounds in an Hour Before a Wrestling Match

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    Amateur wrestling, high school and college, besides being an extremely physical strength and skill dependent sport, is a game of weight. To posses the strength of a 160 pound person, but physically confront, by wrestling, a person with the strength of a 145 pound person, by dropping weight in order to equal your opponent, is normal practice. There’s nothing illegal about it, we’re not talking steroids or some physical enhancing drug. We’re talking controlling your body to reach goals your mind has set.

    Besides, there is a science to dropping weight. Do it incorrectly or too quickly and you will not only lose your advantage, you’ll give your opponent a huge advantage by dehydrating and losing strength. You’ll enter the match tired and sluggish, the exact opposite effect you were striving for.

    Let’s get one thing straight before we begin, you can not lose 3 lbs of body fat in 1 hour, not unless you cut an appendage off and that’s not an option. However, you can lose 3 lbs of overall body weight by losing water weight. Remember Biology 101, the body could be consisted of 75% water, depending on the person’s physical make up. The fatter the person the greater the difference in water weight than a muscular person, for example.

    So what we really are attempting to do is rid the body of water (fluid), which will translate into less body weight. So how do we safely do this?

    The first matter we must address is our diet, and I’m not talking just eating healthy, I’m talking eating sodium free. Salt, is the number one reason a healthy person retains water. There are other health reasons which cause the retention of water, but those do not apply in our case.

    Therefore, if we eliminate as much salt from the body as possible, the body’s resistance to losing fluid decreases making it easier to pass water weight through perspiration.

    Perspiration if you recall, is the body’s natural function to cool itself when temperatures rise above normal. Therefore, we must create heat to raise the body’s temperature and force it to cool itself by perspiring.

    There are probably many different methods, some complex such as water pills which causes a person to continually urinate, to rid the body of fluid, but we’ll use an old tried and true method. Sweating.

    Dress yourself in warm clothing such as sweat shirts and sweat pants. You notice I use the plural form of shirts and pants because you will put on layers of these clothes, at least two layers and three if possible.

    Be sure to wear a hat of some sort, preferably a winter sock hat, as the body gets rid of a tremendous amount of heat through the head. We don’t want that to occur in this situation. We want to retain as much internal heat as possible.

    Exercise vigorously for at least 10 minutes. This can be jogging, either in place or around the gym, jumping jacks, what ever you find comfortable, but which will work up a good sweat.

    After creating a good sweat, lay down and have someone wrap you in a blanket or wrestling mat. This will cause the body temperature to remain high after exercising, which will continue to extract fluid through perspiration.

    After 20 minutes, unclothe and weigh in. You most likely have lost more than three pounds, but if not, you still have time to redress, with dry clothes, and repeat the procedure.

    As with any drastic or sudden body change, there are dangers associated with this procedure. Never perform this procedure alone. Always have a coach or an wrestler with quick access to the coach, with you at all times. After making weight, re-hydrate with drinks such as Gatorade which are high in electrolytes.

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    Source by Jim Bain

    Views: 0

  • A Healing Heart, Positive Attitude, And Open – Mind

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    There is no such thing, as an accurate, crystal – ball, when it comes, to foreseeing, one’s health, and happiness. However, most experts agree, one’s attitude, focus, self – confidence, and willingness to consider options, and alternatives, with an open – mind, enhances one’s possibilities, and potential! Are you someone, who considers, obstacles, as problems, or, simply, as challenges, to overcome? Do you believe in yourself, and that you’ll succeed, or focus on the negatives? Do you prefer to try to get along with others, and proceed through life, with genuine empathy, with a so – called, healing hearth, or are you confrontational, adversarial, and polarizing? With that in mind, this article will attempt to, briefly, consider, examine, review, and discuss, how these things, coincide, with one’s overall health.

    1. Healing heart: Those who proceed, through life, with a true, healing heart, often, enjoy living, more, and enjoy more moments, than those, who lack this quality! Those who seek to bring people together, for the common good, generally, minimize undesirable, unnecessary stresses, and tensions. When you are happy, you are usually healthier! How will you proceed, to enjoy things more, and look for the good, in people, rather than being, judgmental, and confrontational, towards others?

    2. Positive attitude: How strong one’s will, to live, is, often dictates, his enjoyment, satisfaction, and how, he handles, stresses and strains, and life’s challenges! Are you able to handle disappointments, by converting, lemons, to lemonade? Will you do, what benefits you, by believing in your ability, etc, and proceeding, in a more satisfied, happier, and, this, often, healthier way? If you think you can, you will, and if you believe you can’t, you won’t. However, generally, either way, you’ll be correct, so, which do you think, is the more effective, better way, to live?

    3. Open – mind: There is no such thing, as a, one – size – fits – all, way, of living, and/ or believing. However, those who are able to maintain an open – mind, and consider the possibilities, options, and alternatives, your little struggles, will not become expanded, and, you will consider, the best way, to proceed. When one follows a system, based on overall, wellness, rather than limiting himself, to only, conventional remedies and approaches, often, experiences, far more unnecessary challenges, and issues!

    If you maintain a healthy heart, a true, can – do, positive attitude, and have a real, consistent, open – mind, you will probably enjoy a healthier life! Are you prepared, to do, what is in, your own, best interests?

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    Source by Richard Brody

    Views: 1

  • Heal Yourself With Water – The Water Cure

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    Most people have figured out by now that medicine does not cure disease. Medicine isn’t necessarily bad; it just isn’t necessary. Do not let your fear of disease make you forget that humanity wasn’t exactly dying off when pharmaceutical companies saw a financial opportunity and exploded onto the scene. You need to know the facts; then, if you still choose to be ill, it will truly be a “free choice,” and not one born of the absence of awareness.

    You are mostly water. You are made of cells (30-50 trillion of them); and they are mostly water. You need to replenish the water in your body in order to keep it fresh and clean, so that you can stay fresh and clean – healthy. Water cleans you, nourishes you, energizes you, cools you, lubricates you, supports and sustains you, and is truly most of what you are. And water is simply Hydrogen and Oxygen; both of which are atoms – which are simply Energy. You are Energy; but between pure Energy and the form you have currently assumed, there is water.

    When I say, “Water,” I do not mean to say, “Coca cola, Gatorade, Milk, Diet Coke, Orange juice, Beer, or any other liquid solution; these do not clean and support your body. These substances add chemicals to your body which alters the way you feel. Drinking water helps cleanse these chemicals and other toxins from your body returning you to your natural state of health – a state which most Americans have truly not seen since they were very, very young (if then!).

    It is estimated that most Americans are chronically dehydrated. How do you know if that’s you? If you don’t drink 2-3 liters of pure water each day (an estimated one-half your body weight, in ounces), you are most likely dehydrated. Even if you do, you may still be dehydrated depending on your weight and the amount of other solutions, salts, and sugars in your diet. You are mostly water; and good health is primarily predicated on the maintenance of your water level and the cleanliness, or purity, of the water in your body. If the water is heavily-laden with suspended materials, you are toxic. If you are toxic, you are sick, overweight, or on your way to both of these conditions. There are no other options; and there is no escaping this simple reality.

    “But I don’t like drinking plain water!” I hear it all the time; but what most people have been conditioned to Not Realize is that this statement is only an indicator light that you are addicted to the flavoring and chemicals in the beverages you do consume. In the absence of true awareness, what we LIKE is what we choose. If I told you that drinking coffee would make you explode, and then the guy next to you took a big drink of coffee and exploded, I bet you a dollar you’d put your coffee cup down. But what if it took 20-years for you to explode? Would you start drinking water instead of coffee today, or would you put it off hoping you could quit nineteen-years from now and be none the worse for wear?

    I know the things we drink taste good; and I’m not saying that they are “bad.” But there is an obvious effect from the chemicals in the things we drink; and you are definitely not doing yourself any favors by not drinking enough water. I am not necessarily trying to change anyone’s ways; but some of you do indeed want to feel better and have simply never been told anything other than what you’ve been told – none of which contained the answers to your problems, or you wouldn’t have them right now. If you want different, you must think and do different; and yet most people simply can not do this – and don’t even realize it.

    In the Declaration of Independence, there is a line which reads: “…and, accordingly, all experience has shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.” I realize that words do not teach, and that you can lead a horse to water, but you can not make that horse drink water when it could have a Diet Coke instead; but maybe nobody ever told you what happens when you don’t drink enough water, so here goes…

    If you do not drink enough water, you could quickly experience any of the following, in any combination: Dyspeptic pain, Colitis pain, False Appendix pain (of course the surgery will be real…), Hiatus Hernia, Rheumatoid arthritis pain, Low back pain, Angina, Headaches (one of the first signs of dehydration), Stress, Depression, Asthma, Allergies, Excess body weight, High blood pressure, High cholesterol, Diabetes, Fainting, Insomnia, and many other serious and not-so-serious symptoms. If you have any of these symptoms or conditions, they could have been brought on by not drinking enough water; and some of them could be caused by the drugs you are taking for problems you could be drinking water to get rid of. Yes, there is a good chance you are treating “thirst” with prescription drugs that only “clog your filters” (liver and kidneys) and give you the added bonus of “side-effects” which could actually kill you. I’ll just have the water, please…

    The bottom line is that you are water and need to renew yourself daily. Failure to do so is typically the result of ignorance and addiction; one of which should have been remedied by the last paragraph. Chronic (constant/ongoing) cellular dehydration is a painful way to die prematurely of outward symptoms and manifestations which have, until recently, been thought to be diseases of “known” and unknown origins. Until you are properly hydrated and oxygenated, you have absolutely no way of knowing what is causing your pain and illness, regardless of what you have been told about your health up to this point. You are water. You have a choice. What kind of ending do you want for your story?

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    Source by Pete Koerner

    Views: 0

  • My Drug, My Bread And My Appetizer

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    Your love letters are my appetizer

    Your guffawing is my drug

    And you’re my daily bread chaser…

    Ha ha, you swear… I’m your ladybug,

    Who you’d always keep fuller,

    But now you swell…It’s you I brag!

    Gotcha! My appetizer, I grab you first

    Here are those words that you burst:

    MY LOVE

    I miss you, I miss you so much

    I cannot wait to be with you…

    And kiss you and hold you in my arms.

    I have so many love and hugs to give you

    My love for you and my feelings are present

    And it’s growing and glowing every day.

    Each day I would discover you,

    Each day you are different,

    Each day you are beautiful,

    Each day everything is all new…

    Each day my love for you would remain

    Very strong that I’d have it hard to contain!

    Each day I love you with all my heart!

    And I promise we will never be apart…

    Oh, I am sick of love for you

    Henceforth, today

    If you want to hurt me, you can…

    I am at your knees!

    I am your love on the altar of sacrifice.

    If you had ever had wished…

    You can tear my heart at every moment,

    And I am not afraid to love you,

    You are someone special and different…

    With you my scars have been healed

    And all my fears have vanished…

    I already know that I will share much with you,

    I already know I am going through a lot with you,

    I already know I will stay with you

    until the end of my days…

    My heart and my mind are wide open for you…

    Oh, my love is open at great day for you!

    I love you deeply…I believe in you

    Forever, with grace…

    Yes! Truly these words are MY APPETIZER

    Next you’d enhance my day with a booster…

    Because you’d let me eat you any time I’d plea

    Likewise you’d never ever want to leave me

    or look your way out, ‘coz with me you feel free

    Hahaha, we’d always find our days end with glee!

    Ah! MY BREAD, you’d give me all the nutrients I need

    As we breathe together with our true loving seed.

    When I drink you up MY DRUG, my master

    Like cocaine, Oh my… you got me so addicted

    I wouldn’t have a day without your dopey laughter

    You’re my heart-sore…you got me so captivated.

    “Yes, hear me all my dear Folks!

    Take delight in my Chef’ stroke…

    He’d bake faces- a wry face, a wince, a glower

    So that with him, I wouldn’t ever get bore

    Though I would try his glances to ignore

    Still here I am, I crave for him! Even I’d get sour

    With all of the sound of his freaky snore…

    Hehehe… Very strange! Because those lion’s roar

    Would only sound-like the jazz music I adore…

    And with it, never would give me a bit of a bother

    So funny…I’d sleep deeply sound and even soar…

    In the morning I would rush up to the platter

    When I’d hear the wake up call of a rooster

    But never from the clinch of my sweet and wild boar

    You bet, I’d yearn for him more… he’d pet me to endure…”

    Gosh! You spoil me with your French kiss

    With all of your love appetizer to taste…

    As much as I could have you all embraced

    You’re all mine to feel full and be blazed!

    You always give me the best of your all,

    All the fun and laughter that I needed

    My love, you’re my drug, and my soul

    You alone I would ever get me addicted…

    Every day with you is an awe-inspiring ball

    With all of your love recipes I would deserve,

    Oh, my daily bread you’re unique from them all,

    I would have you always loved and preserved…

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    Source by Abeille Amore

    Views: 0