Segregated Healthcare in New York City

August 16, 2010 by astofsky

N-Map is assisting New York Lawyers for the Public Interest and their clients, Bronx Health REACH on the very challenging and complex issue of segregation of heathcare services in New York City.

The basic problem is this: many large private hospitals in New York City accept money from the state and federal government, and are thus required to treat Medicaid patients as well as patients with private health insurance.  Sounds like a reasonable tradeoff, right? However, many of these hospitals have two separate systems: one for patients with private insurance and one for patients on Medicaid.  This two systems are wildly different in quality.  The main hospitals provide some of the best healthcare in the world, and patients are treated by attending physicians, while the clinics tend to be much poorer: overcrowded, with long wait times, and staffed by overwhelmed residents and interns.  Heath outcomes – the key metric in determining quality of care – are wildly different.

The systems leads to perverse results like a person who happens to have private insurance heading to the hospital to get treated for bronchitis, while someone with breast cancer has to wait 5 months for a diagnosis at a clinic, during which time that cancer has a chance of metastasizing.

And guess what? In NYC, there is a strong correlation between type of health insurance and race.  Go into the clinic, and almost everyone is a person of color.

Obviously, this is not the same kind of intentional discrimination that we saw in the Jim Crow South – no one thinks that racism is the motivating factor here – but a number of communities in the city see the echoes of Jim Crow in this unjust system.  Intentional or not, race cannot be a determining factor in how long it takes to have a tumor looked at. And that, of course, can mean the difference between life and death.  In the aggregate, this has enormous impact on a community that is already facing a major health crisis (by one measure, the Bronx is the least healthy of New York’s 62 counties).

We are helping NYLPI and Bronx Health REACH generate media to support their campaign to change the laws on this issue to guarantee access to quality care to all New Yorkers, regardless of their kind of insurance or the color of their skin.  We will be posting media soon.

Second Circuit Rules on the Crude Case

August 4, 2010 by astofsky

The Second Circuit has ordered Joe Berlinger, the director of the documentary Crude to hand over some, but not all, outtakes from the movie.  Berlinger declares victory and Chevron now has ammunition to delay the the case for many months, if not years.

You can find the order here.  It is short, so I will copy the text:

Pending further order of this Court, respondent Joseph Berlinger is directed to comply forthwith with the District Court’s order, to the following extent:

1)    Berlinger shall promptly turn over to the petitioners copies of all footage that does not appear in publicly released versions of Crude showing: (a) counsel for the plaintiffs in the case of Maria Aguinda y Otros v. Chevron Corp.; (b) private or court-appointed experts in that proceeding; or (c) current or former officials of the Government of Ecuador.

2)    Material produced under this order shall be used by the petitioners solely for litigation, arbitration, or submission to official bodies, either local or international.

3)    Berlinger’s reasonable expenses of sorting and duplication of footage, incurred in complying with this order, are to be reimbursed by Chevron.

4)    Any disputes related to the performance of this order shall be directed to the district court for resolution.

Opinion to follow.

Presumably, we’ll see the the opinion shortly, but my sense is that the court managed to successfully thread the needle, balancing the Journalists’ privilege with the Federal Courts’ presumption of robust discovery, set forth most clearly in FRCP Rule 26(b) (why do I always mix metaphors when writing about law?).

All of this may be much ado about nothing.  We’ll find out when we hear whatever arguments Chevron makes with the footage — but regardless of the outcome of those arguments, this is a huge tactical victory for them.  They’ve layered a lot of uncertainty and delay into the current state of play, which will certainly help them in settlement negotiations.

I stand by my analysis of the district court’s original opinion — be very very careful if you are going to commission a video in the context of litigation.  And please, call N-Map before you start rolling.

A Conversation With Haitian Grasroots Women Leaders

August 4, 2010 by astofsky

Last week, one of N-Map’s partners, and fellow technology/human rights upstart, Digital Democracy, organized an extraordinary event in New York City — a live conversation with grassroots leaders from Port au Prince.  The event was part of the launch of a major initiative that we are undertaking with Digital Democracy, along with the Institute for Justice and Democracy in Haiti, the Bureau des Avocats Internationaux, and Madre, to help grassroots women’s organizations fight against gender based violence after the earthquake.  The IJDH has already done extensive work on the rape epidemic — you find their report here.

It was an incredible event.  Digital Democracy are amazing organizers in addition to innovative activists, and managed to get over 70 people to attend the event, on a steamy, rainy weekday afternoon.   We used everyday technology — Skype — to listen to three courageous Haiti women tell their stories, to to have the opportunity to ask them some questions.

More below the fold.

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The Importance of New Media Advocacy Tactics: The Crude Case

June 18, 2010 by astofsky

The legal controversy surrounding the documentary film, Crude, is fascinating.   The basic facts are as follows: Chevron has been in litigation against a coalition of indigenous groups for destruction of their lands in Ecuador and Peru.  The main case is Aguinda v. Texaco, and it is one of the biggest and most significant environmental justice cases to be litigated under the Alien Tort Claims Act (please forgive the lack of citations — it’s just too late on Friday…).

The film’s website is here, and the trailer is here:

I am probably botching the explanation slightly, but here goes.  Plaintiffs’ counsel asked a prominent filmmaker, Joe Berlinger, to make a movie about the situation surrounding the case, in order to create more public awareness of the issue.  It looks like plaintiffs’ counsel worked with Mr. Berlinger in shaping some of the content of the movie and might have engaged in some ethically borderline practices in connection with the filmmaker (I am very skeptical, but you can see the allegations in the district court’s opinion here).

Chevron made a really big deal about this, arguing that the content of Mr. Berlinger’s raw footage could impact the case — a lot of this argument has to do with some pretty obscure issues relating to the proper forum for the litigation.  The judge agreed with Chevron and ordered Berlinger to turn over all of his raw footage.  That’s right all of it – 600 hours, much of it presumably obtained though months of work building trust with his subjects.  The second circuit has granted a stay and will hear Berlinger’s appeal.  Those of us who have worked for the Courts of Appeals know that Berlinger has a tough road ahead.

The merits of the case have been thoroughly debated, but I would like to raise a different point.  The situation the Berlinger and Plaintiffs’ counsel (not to mention the Plaintiffs!) find themselves in shows why lawyers (not to mention the judiciary) need to have a better understanding of video and new media.  This is one reason why N-Map’s work is important: we are developing an understanding of the many pitfalls involved in using video and other media in legal advocacy — as important as knowing how to use media to get a good result is when to not use it at all.

Some thoughts on the tactical issues that this case brings to light (note that this are taking the allegations in the district court’s opinion as true ), below the fold.  Dissenting opinions are welcome! Please comment:

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Justice in Mississippi – Katrina Recovery (Part 3 of 3)

May 27, 2010 by astofsky

Yes, that’s right.  Katrina recovery.  It’s still going on after all these years.  Katrina raises so many issues that it can be hard to decide what to focus on.  We chose the Katrina Cottage issue in part because it just seems so absurd — a solution to the housing crisis which has been going on for half a decade is sitting right in front of our eyes, but is still not being used.  It is the same toxic combination of cruelty and incompetence that has characterized so much of governments’ (federal, state, and local) response to Katrina.

Justice in Mississippi – South Delta Regional Housing Authority (Part 2 of 3)

May 27, 2010 by astofsky

This story in this piece — about a abusive quasi-public housing authority — is important for lots of reasons, but I will emphasize two:

1) It really illustrates the importance of housing as a fundamental human right.  As you will see in the video, so many other fundamental rights depend upon having a safe, healthy, and stable place to live.

2) It also shows the power of community lawyering.  MCJ has managed to mobilize and channel both the frustration and anger, but also to generosity, creativity, and committment of this community, towards the cause of the case.   It’s inspiring.

Here it is:

Justice in Mississippi – Payday Lending (Part 1 of 3)

May 18, 2010 by astofsky

We just finished producing three short videos with the Mississippi Center for Justice, which profile several of the many problems that the Center is tirelessly working to fix.  I have been working with the Mississippi Center for Justice in some form for most of my legal career, so I can say first hand that they are some of the most committed and creative lawyers working today.  The Center’s primary goal is as ambitious as it is necessary: to end structural racism in Mississippi.  To support these efforts, we have made short videos on three key issues: payday lending, public housing, and Katrina recovery.  I will post the videos and brief discussions in this and two following posts.

Mississippi is certainly one of the most beleaguered states in the Union.  Even now it is facing new crises on multiple fronts, between tornadoes and massive oil plumes just hitting the barrier islands south of Gulfport.  Given these almost cataclysmic events, it can be hard to think of something as mundane as payday lending stores as devastating — but they are.

These establishments charge a 572% interest rate for very short-term loans to low income people to help them cover their basic expenses until their next paycheck.  This has the effect of sucking large amounts of income away from people and communities who are already desperately poor.

The video explains in more detail, but my perspective is simply that that this is a deeply dishonorable business.  It is taking advantage of the duress of the desperately poor to squeeze as much money as possible out of them. Obviously there are situations where high interests rates are necessary in the case of higher risk debt – but there can be no excuse for 578% interest rates to anyone, particularly when the majority of those people have had little to no financial education.

Here’s the video.  As always, we welcome feedback and discussion.

Wikipedia and Human Rights

May 11, 2010 by astofsky

Early in N-Map’s formative stages, I had planned on setting up a human rights law wiki.  The idea was to create a practice-oriented collaborative tool to help public interest lawyers around the world share information, advice, strategies, and arguments more effectively.  The wiki would centralize the information in a more user-friendly way than does the gargantuan top-down behemoths, Lexis and Westlaw.

Hmm.  As I write this, it still sounds like a pretty good idea.  It still might happen.  However, my recent explorations of Wikipedia have changed my thinking about how to best make use of the scarce time that lawyers have to contribute to social media.

It turns out the Wikipedia’s content on human rights and human rights law is in pretty bad shape, and needs a lot of improvement.  The content writers at Wikipedia’s Human Rights Project have done a great job of starting debate on the topics, but the entire field could stand a great deal of improvement.  Given that Wikipedia has become the world’s leading source of encyclopedic information (over 9 million views of the English language edition per hour, as of January 2010), I thought that it would be a far better use of our community’s time to improve the wiki that everyone is already reading instead of starting from scratch.

Thus, the nascent N-Map Wikipedia Project.

The task is daunting.  As many of you now, Wikipedia has split itself into a variety of subject groupings, called WikiProjects.  Each of those projects has a listing of articles relevant to their subject area, ranked in importance (i.e., top, high, mid, low).  Each of these articles is given a quality rating from Wikipedia’s universal quality scale.   For normal articles, this scale starts at a “stub,” then moves to a “start,” followed by C, B, “Good,” A, and then Featured Article, or “FA.”  Every article of any importance should strive for at least “A,” if not FA status.  Articles are periodically reassessed to determine if their quality has changed.

The Human Rights WikiProject identifies 39 top importance articles, and 340 high importance articles.  Of the top importance articles, there are no FA or A rated articles, and just 4 “Good” rated articles.  That is appalling.  The majority are C and below.  Of the high importance articles, all but one are B or below.

More details below the fold — if you don’t have time to read on but are interested in joining an effort to improve Wikipedia’s human rights content (and thus the world’s knowledge of human rights law and history), please email me.

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The Plight of Women After the Earthquake

April 21, 2010 by astofsky

Posted below is the video that we just produced with Partners in Health and the Institute for Justice and Democracy in Haiti to raise awareness about the problem of gender based violence and sexual exploitation after the earthquake.  I find this movie to be extremely powerful and disturbing.

The women who speak in the video are extraordinarily brave.  Let’s do what we can to ensure that they, and all other women in areas affected by the earthquake, are adequately protected from violence.   Please sign the petition encouraging the International Community to take strong action to protect the basic safety of women.

I wanted to send a special thanks to Harriet Hirshorn, who shaped and edited this video.  Please take a look at some of her other amazing work here and here.

http://www.vimeo.com/11091051

Conditions in Port au Prince

March 31, 2010 by astofsky

Posted below is the video that we just produced with Partners in Health and the Institute for Justice and Democracy in Haiti to raise awareness about worsening conditions in the hundreds of Internally Displaced Persons camps in and around Port au Prince.

Please  sign the petition that the IJDH has organized to persuade the international organizations to start delivering aid faster and more efficiently to the thousands of Haitian people that desperately need it.