A General climate of fear: shadows lengthen from the Kremlin
RUSSIA is once again becoming the country it has always been, where the will of the ruler in the Kremlin is the supreme law. President Vladimir Putin is drawing a line under the Gorbachev-Yeltsin era of comparative democracy. In foreign and domestic policies, Putin has been concentrating power into his own hands. The Federal Security Service, or FSB in its Russian acronym, has simply taken over from its predecessor, the KGB, as the arm of state to make sure the ruler has his way. Putin’s term of office ends next year, but yes-men are already proposing to change the constitution in order to extend his presidency.
Elimination of rival claimants to power testifies to this reversion to the past. The lucky ones are able to escape into exile abroad. One such is Boris Berezovsky. Once preeminent among the nouveaux riches oligarchs, he used to be a crony of Putin’s, on whose behalf he acted as a powerbroker. Making his own ambitions too plain, he condemned himself to flight.
In order to break the independence of the huge oil company Yukos, its head was put through a show trial and deported to Siberia; and his deputy was put in a penal colony. Bankers, journalists, businessmen, or even oil technicians are murdered when they venture into public life. Since these killings are neither prevented nor properly resolved, the man in the street attributes them to the Kremlin and the FSB. A general climate of fear takes hold.
Even against this background of suspicion, intimidation, double-crossing, and violence, the death in London last November of Alexander Litvinenko is extraordinary, and will remain a landmark in the annals of crime. For a start, the murder weapon was a novelty, polonium-210, otherwise used only in initiating nuclear weapons. Once ingested, a very small amount is enough to bring bodily functions to a halt. It should work immediately, so fast that the cause of death is a mystery. A particularly fit man, Litvinenko survived long enough for experts to identify the poison. On his deathbed, a tragic and spectral figure who had gone bald and aged prematurely, he wrote an open letter accusing Putin of responsibility for his murder.
Future thriller writers and conspiracy theorists will be taking an interest in the case. Four books are apparently being written already, and Hollywood is planning a movie. Suspects and clues already exist in the world of nonfiction, however. Two ex-KGB agents, Andrei Lugovoi and Dmitri Kovtun, admit to meeting Litvinenko on the day the polonium was administered, and in a hotel bar ideal for the purpose. Moreover, a giveaway polonium trail is traceable in rooms they slept in or visited, and in aircraft they flew on. They claim to be innocent. Kremlin spokesmen, as well as Putin, either sound indignant on their behalf or dismiss Litvinenko as a nonentity. Seemingly protective of the chief suspects, the Russian foreign minister, the prosecutor, and the police authorities combine to impose conditions that block investigation and possible extradition to Britain.
British scientists meanwhile have been able to establish which Russian-government power station produced the polonium. The state is the sole producer, and the costs would have been on the order of $10 million. The polonium can only have been handed out for use officially, or stolen. Scotland Yard detectives have been to Russia and believe they know who did what and when, but they are not saying anything, and perhaps never will.
Like the two men suspected of killing him, Litvinenko was an ex-KGB officer, with the rank of lieutenant colonel. His story was that he had been ordered to kill Berezovsky when Putin finally fell out with the oligarch. Rather than do so, he informed Berezovsky. Paul Klebnikov writes in his book that this was all a fabrication, but at any rate both Berezovsky and Litvinenko ended up in exile in London. There they became friends and associates. Berezovsky is said to have bought the London house in which Litvinenko and his wife Marina lived, and to have financed him as an investigative journalist. Primarily, Litvinenko exposed the barbarity of Russian tactics against the Chechens–the bulk of his work was put out on Chechen websites. With a colleague, Yuri Felshtinsky, he wrote a book, Blowing Up Russia, whose thesis is that the FSB bombed houses in Russia proper only to have a pretext for assaulting Chechnya. Litvinenko further personalized his attacks by describing Putin as a pedophile.
One cheer for the hot new memoir: the uses of George Tenet’s book
FORMER CIA director George Tenet’s new book is the most effective bipartisan initiative of the year. His At the Center of the Storm has been clobbered by the Left and the Right, and rightly so. The Left criticizes him for not speaking up when he was in power if he had so many misgivings about the Iraq War. The Right objects to his after-the-fact criticisms of Bush-administration figures and his neglect of the CIA’s clandestine service–a neglect that played a major role in the intelligence disasters over which he presided. And both Left and Right recoil at Tenet’s self-justification, which is extreme even by the standards of a Washington if-only-they-had-listened-tome memoir.
Yet there is a kernel of good in Tenet’s book. Underneath the excuse-making and the score-settling, Tenet’s portrayal of the pre-Iraq War intelligence on Saddam Hussein’s weapons programs dispels key contentions of the “Bush lied, people died” crowd. He captures the essential nature of intelligence–that it’s usually fragmentary and uncertain–and reminds us of the post-9/11 environment, in which policymakers were inclined to put the worst interpretation on incomplete information, lest they encounter another nasty surprise. Rather than undermine the case for war, Tenet’s book–no matter how he has tried to market it during high-profile interviews–tends to support it.
Tenet’s book certainly does not deserve three cheers, or even two. But it does deserve one–lonely and perhaps not very enthusiastic–cheer.
In a book that is hard on Bush-administration hawks, Tenet rebuts one of the persistent anti-administration charges, although one that’s never had any evidence behind it: that the Iraq intelligence was skewed in reaction to pressure from Vice President Dick Cheney and others. “Intelligence professionals did not try to tell policymakers what they wanted to hear,” he writes, “nor did the policymakers lean on us to influence outcomes.”
The infamous Downing Street memos from 2002 quote the head of the British Secret Intelligence Service, Sir Richard Dearlove, saying that “intelligence and facts were being fixed around the policy.” The word “fixed” became an obsession of anti-war conspiracy theorists. Tenet explains, “Sir Richard later told me that he had been misquoted. He reviewed the draft memo, objecting to the word ‘fixed’in particular, and corrected it to reflect the truth of the matter.” Dearlove had made the more pedestrian observation that he felt war with Iraq was coming.
Given what we know now, of course, Cheney’s statements circa 2002 appear reckless. But he wasn’t talking in an environment in which U.S. forces had scoured Iraq for WMD and come up empty. His aggressive posture was partly in reaction to the first Gulf War, after which it was learned that U.S. intelligence had badly underestimated how close Saddam had come to building a nuclear weapon. “No doubt that experience had colored the vice president’s view of U.S. intelligence gathering ever since,” Tenet writes, “but it also had a profound impact on my views and those of many of our analysts. Given Saddam’s proclivity for deception and denial, we, too, were haunted by the possibility that there was more going on than we could detect.”
This is one of many passages in which Tenet is more fair-minded than in his book-promotion interviews. To conclude that Saddam wasn’t pursuing WMD, Tenet writes, would have meant ignoring “years and years of intelligence that pointed in the direction of active programs.” In the north of Iraq, a CIA team managed to interview Iraqi military officers prior to the war. According to Tenet, “Every military officer we debriefed told us that Saddam did indeed possess WMD.”
Langley certainly wasn’t doing the work of the neocons. Tenet had doubts about invading Iraq. An intelligence officer named Bob Walpole managed the production of the 2002 NIE and told Tenet, “I just don’t believe in this war.” Even adjusting for his self-interest in explaining away failure, Tenet’s bottom-line judgment about the WMD intelligence sounds about right: “We got it wrong partly because the truth was so implausible.”
Venture Insurance Programs
Venture Insurance Programs, recognized for insuring golf and country clubs since 1993, continues to expand beyond its well-known Preferred Club Program. Today Venture is more than a leading insurance provider to the club industry. Venture is an all-lines insurance product and service provider to several industries, with programs covering hospitality, technology, biotechnology, and community banks-as well as clubs.
“We combine premier products and coverage from multiple carrier groups, with proven in-house and third-party risk management services, to provide brokers with ‘best-in-class’ solutions within the industries we serve,” says Richard Look, director of communications for Venture. “Our underwriting partners include the ACE Group of Companies, Alea North America, Chubb, Discover Re, Hanover, The Hartford, Lloyd’s of London, Seneca, USF&G, and USLI.”
Headquartered in West Chester, Pennsylvania, Venture focuses its program administration on the following areas:
GOLF & CLUB PROGRAMS
To enhance its position as a private, semi-private, and public golf and social club insurer, Venture, in July 2005, added another new and exclusive market with the addition of Hanover Insurance Company. Having earlier earned distinction from the Association of Private Club Directors as Club Insurance Provider of the Year, Venture’s Preferred Club Program is the only multicarrier option available to brokers.Venture Banking(SM), as reported in Rough Notes’ 2004 Target Markets special section, continues as the fastest-growing package within Venture Insurance Programs. This program is specifically designed for commercial banks with assets of less than $2 billion. It contains one of the most comprehensive property, liability, and fiduciary packages available for community banks. Coverage, which is obtainable in all states, is provided through Chubb and The Hartford.
Venture Insurance Programs has also recently established a new specialty wholesale unit, Venture BrokerageSM. It enables brokers an opportunity to access multiple A rated markets of Monoline Workers Compensation for heterogeneous risks outside of Venture’s traditional industry programs.
INDIANA STRENGTHENS INSURANCE FRAUD LAWS
In May, Governor Mitch Daniels signed HB 1403, which widens Indiana’s anti-fraud dragnet by covering more insurance crimes and imposing harsher penalties. According to the Coalition Against Insurance Fraud, Indiana had some of the nation’s weakest insurance fraud laws.
The Coalition asserts that Indiana’s previous fraud law was so vague that it criminalized only bogus claims. But HB 1403 clarifies that other scams, such as theft of client premiums by agents and sale of fake coverage by phony insurers, are now insurance crimes in Indiana.
Penalties have also increased significantly. The former law imposed only 18 months maximum in state prison plus up to just $10,000 in fines-no matter how large and damaging the swindle. The new bill imposes up to eight years in jail and up to $100,000 in fines, depending on the size of the swindle.
Howard Goldblatt, the Coalition’s director of government affairs, explains that some 46 states have laws which make insurance fraud a specific crime. Strong fraud laws, he says, are crucial tools in a state’s anti-fraud efforts. They can ensure that more fraud cases are tried, increase the rate of convictions, and impose tougher punishment. Prosecutors have more incentive to try cases if strong fraud laws increase the odds of conviction and serious jail time, according to Goldblatt.
Area news
State Farm lowers homeowners and auto rates
Earlier this year, State Farm Fire and Casualty Company reduced rates by an average of six-tenths of one percent for Illinois homeowners policyholders, the result of increased discounts for customers whose plumbing, electrical and heating/airconditioning systems in the home are less than seven years old. State Farm Mutual Automobile Insurance Company has lowered its overall rate level in Minnesota (an average of 4.7%), in Ohio (an average of 1.7%), Wisconsin (an average of 3.7%) and in Indiana (an average of 5.7%).
In Michigan, State Farm now offers the Steer
Clear driver safety program. Completion of the program and meeting additional criteria could result in as much as a 15% discount for drivers who are under 25 years old.
Fox becomes AMS Users’ Group president
Jerry Fox, vice president of James M. King & Associates, Inc., of Bloomington, Minnesota, was elected president of The AMS Users’ Group earlier this year. Since joining The Users’ Group in 1989, he has been involved locally as well as nationally, having served “in almost every capacity, on every committee” according to The AMS Users’ Group. Jerry has received numerous industry honors, including being named “Agent of the Year” by the Minnesota Independent Insurance Association in 2003 for his work in technology education.
Credit scoring allowed
Earlier this year, Michigan Circuit Court Judge James Fisher ruled that the Office of Financial and Insurance Services overstepped its authority because it attempted to rewrite Michigan Insurance Code through administrative rulemaking, according to the Property Casualty Insurance Agents of America. With the ruling, Michigan’s current credit scoring law remains in effect and insurers can continue to use insurance scores only to discount premiums.
Travel insurance gaining in popularity
“The Journey, not the arrival, matters.” These days, however, the preparations for a trip are starting to matter even more to savvy business and leisure travelers.
Traveling is stressful enough without worrying about illnesses or trip cancellations, says Benjamin Rafter, CEO of TravelWorm.com, an online provider of flight, hotel, rental car, tour reservation, and show tickets.
Over the past decade, Rafter has seen a dramatic increase in the number of people purchasing various types of travel insurance, especially for trips overseas or anything involving a complex vacation.
“The number of people buying travel insurance is in the majority at this point,” Rafter says. “It has tripled in the United States in the last 10 years.”
The United States Travel Insurance Association reported that more than 17 million travel-insurance packages are sold annually. Currently, about 30 percent of Americans purchase travel insurance, an increase from 10 percent prior to the terrorist events of Sept. 11, 2001.
Travel insurance ranges from a small package covering trip cancellation and increases from there in complexity, expense, and need into large packages covering medical expenses and emergency transport in foreign countries, Rafter says.
Two-thirds of people are buying the small packages like trip cancellation, for example. If you have to cancel the trip and you have a reason, you are reimbursed the money, Rafter explains.
Some packages that cover unexpected illness as a reason for cancelling a trip are also on the rise.
“The highest level of expense will cover medical costs, dismemberment, or death,” Rafter says. “These packages insure that if that happened to you in a foreign country, you would get home.”
Rafter says that the most basic travelinsurance packages cost as little as $20. For example, a basic package might cover a driving trip or a plane flight from Los Angeles to Las Vegas and back home.
Depending on the foreign country and your activities there, complete travel-insurance packages can run into the hundreds of dollars, Rafter says.
He encourages people to examine their activities on their vacation and possible dangers inherent in those activities. “You should look at the cost of insurance as cost of that travel package,” Rafter says. “For 90 percent of people, we are talking about travel insurance under $100 for a weeklong family vacation or couples vacation in the United States.”
Rafter contends that not everyone needs to purchase travel insurance. However, he advises if the cost of the vacation is an investment to you and travel insurance will give you piece of mind, then you should purchase a package.
“It is really counterintuitive to how people think sometimes, because they have already spent so much on a trip and they don’t want to spend an extra $100 on travel insurance,” Rafters says. “However, for 90 percent of people in a position where the vacation is a significant investment, to lose that investment because of illness would be tragic.”
Rafter predicts that the number of people buying travel insurance will continue to increase, due to the increasing volatility of world events and possibilities of family illness.
Currently, about 30 percent of travelers using TravelWorm.com. insure flights and driving trips, 60 percent of travelers insure packages and vacations, and 80 percent of travelers insure safaris and cruises.
Travelers can buy travel-insurance packages from insurance agents and travel agents. Rafter says that most people who buy travel insurance at TravelWorm.com purchase the package from the travel agent that booked their trip.
“It is by far the most convenient way because all travel agencies have partnerships with insurance agencies,” Rafter says.
Rafter hasn’t seen an increase in business travelers buying travel insurance. He says far fewer business travelers use his company’s services than do leisure travelers.
“Business travelers often buy fares that are fully refundable,” Rafter explains. “Their reasons for cancellation are not related to family illness, but instead usually because the meeting got moved to a week later and they just reschedule their flight.”
The Syracuse area is also participating in the increasing trend of buying travel insurance, though travelers mostly buy the costly insurance packages.
Erin Fiorini, a leisure agent with Syracuse-based BTI Travel Consultants for the past two years, says that she encourages the purchase of travel insurance now more than she did when she first started her job.
“I’ve seen a slight increase in the number of travelers buying insurance,” she says. Fiorini says that when people hit a certain price point for their vacations $3,000 and up - the travel agency encourages them to purchase insurance to protect their trip investment.
“Seventy-five percent of our customers buy it at that point,” she explains.
There are currently hundreds of travel insurance plans available - even travelers’ health insurance - but consumers need to be aware of overlapping coverage.
Transportation risk management and insurance—avoiding gaps and traps: risk management
Your camp strategy for managing automobile risks needs review and updating on a regular basis. ACA Standards TR 1-19 forms a solid framework upon which to build your plan. Tailoring your camp’s risk management plan to avoid gaps and traps requires additional work.
Here are some facts and thoughts for you and your staff to consider as part of this process:
* Each camp is different, obviously, with some having little or no transportation risk. However, just about every camp either owns a business vehicle, has employees who use their personal vehicle on camp business, or hires vehicles at some point for use in the business.
* Transportation risks at camp develop out of the ownership and use of automobiles, including their maintenance–and typically include liability from negligent actions, which results in bodily injury to people or damage to your property and to other people’s property. These risks are typically transferred to an insurance company through the purchase of automobile insurance.
No Differences
One faulty assumption some insurance buyers make is that there are no differences in insurance protection offered to customers by various insurance companies. The fact is there can be big differences.
These differences are because of a variety of factors, such as their internal systems and procedures and the risk appetite of the insurance company’s underwriting department.
For example, if you take a long-term lease on a vehicle or buy a vehicle with little or no money down, you could be exposed to financial loss if you have an accident that “totals” the vehicle early in the lease, or loan.
This risk of financial loss can be included in the camp automobile insurance policy through the purchase of an endorsement called “Auto Loan Lease Gap Coverage.” While this endorsement is universally available, some insurers may be unwilling to provide the protection. If you find yourself in this situation, discuss the matter with your insurance broker. Ask your broker to check with your auto insurer to determine if this additional protection is available through your insurance company.
Another difference may involve the scope of the liability protection provided by automobile policies. Some insurance companies want to limit protection to only those automobiles listed (scheduled) on the policy. Others are willing to provide liability protection for any auto. These differences are not obvious to buyers, but are apparent to insurance brokers and advisors. Assuming your camp qualifies, it is better to purchase a policy providing liability protection for any auto.
Suspension of Liability and Physical Damage Insurance
Nearly every camp has vehicles, which are “laid up” or suspended at some point during the year. The primary risk management concern here relates to preventing the use of these vehicles when they are not insured. A secondary concern is to protect them against physical damage when they are “laid up.” In some states, license plates must be surrendered before an insurance company will suspend liability insurance. Other states may not require this. In jurisdictions without a license plate surrender regulation, there is a real risk a vehicle could be operated without liability insurance protection if you have scheduled automobile liability insurance.
To prevent use of these uninsured vehicles, some directors remove the plates from each vehicle, even though the law doesn’t require this. Others put signs on the vehicles not currently insured to notify caretakers and other staff that the vehicles should not be used. How do you manage this risk? Another potential problem involves continuing physical damage insurance on vehicles stored for the winter months. If you aren’t sure how you are managing these risks, review the issues with your insurance brokers and advisors.
Coverage Territory
Some camp directors are under the mistaken impression they have automobile insurance for all of their automobile-related risks wherever their business takes them. This is not so. The automobile insurance policy limits the territory within which coverage is provided as follows:
The coverage territory is:
a. The United States of America;
b. The territories and possessions of the United States of America;
c. Puerto Rico;
d. Canada; and
e. Anywhere in the world, if:
1) An auto of the private passenger type is leased, hired, rented, or borrowed without a driver for a period of thirty days or less; and
2) The insured’s responsibility to pay damages is determined in a suit on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico, or Canada or in a settlement the insurance company agrees to.
There is no insurance protection for automobile accidents outside this coverage territory. This means no insurance coverage for vans hired with, or without drivers outside the policy coverage territory; nor would there be coverage if you drive your own vehicles into Mexico, for example. If your camp has programs operating outside of this coverage territory consult with your insurance advisors to determine how your automobile risks outside the coverage territory can be properly insured.
Employees’ interests–and in some cases volunteers who regularly drive their vehicles on your business–may be insured on your policy on a secondary basis. Including employees and volunteers as insured requires an endorsement. When included, the endorsement makes your camp automobile liability coverage in excess of the employee’s or volunteer’s policy when they are on your business. These endorsements are for liability insurance only.
Camp hired automobile exposures usually involve renting vehicles from major rental companies for short periods–often while owners, staff, or volunteers are away on business. There is liability and physical damage risk in these situations, too.
Each state has different laws, which govern short-term rentals of automobiles. Some states make the renter primarily responsible for the liability and physical damage insurance on the rented vehicle. This is okay if the individual renting the vehicle owns a vehicle that is insured under a personal auto policy with liability and physical damage insurance. If you don’t own and insure a personal auto, there could be a coverage gap.
One solution to this gap is to purchase an endorsement to your business automobile policy called “Employee-Hired Autos.” This endorsement extends the liability insurance in your business automobile policy to individual employees who rent a vehicle in their own names while on your business. Damage to the rented vehicle while in your care and control may also be provided by your business auto policy by purchasing hired car physical damage insurance.
There are other noninsurance solutions to this physical damage risk, such as renting the vehicle with a credit card that includes collision damage waiver benefits. These should also be explored as part of your risk management process. Choose the risk control and risk financing methods that work best for your business.
This discussion was intended to increase your awareness of some potential gaps and traps in transportation risk management. To get the most out of this information, plan to spend some time before next summer reviewing your risk management plans. Talk with your insurance advisor about these issues and any other issues you may uncover. Remember that the management of risk is never finished, because risk is constantly changing.
Woman heads to India to promote cheap health care
Ever since learning about India in high school, Ann Rogan wanted to travel there. Now she works there for a company selling medical care and other products to villagers.
For half of the six months between January and June, the 24-year- old lived in a room with cement floors and a mosquito net — “It was a great room” — and spread the word about inexpensive health insurance and medicinal prescriptions, and convinced local salesmen to sell her company’s products.
Rogan returned when her visa expired. But six weeks later, on Thursday, she left again — this time for a full year.
“It’s what I’ve wanted to do,” she said.
Rogan grew up in Livermore and went to school in Hayward. In high school she learned about India’s religions of Buddhism and Hinduism. Based on what she learned, she became a vegetarian.
Her father, John, said she began her various volunteer work projects around this time, and what she learned in high school formed her ideas and thinking that led to where she is now.
In high school she volunteered for Meals on Wheels, and at McGill University in Montreal, she was the local chapter president for the Habitat for Humanity.
“As a parent, you’re apprehensive (about her safety), but I feel good because of who she is as a person,” John Rogan said. “She’s trying to make the world better for people.”
Her 17-year-old brother Patrick said he will miss Ann during important events, such as his and his sister’s graduations, but that the family does not question her choices.
“Obviously, we are all going to miss her — but I’m happy that she’s doing it for something she loves to do,” he said. “It’s something she thinks is extremely important and I’m happy for her.”
She graduated from McGill in 2005 with two degrees, including international development with a focus in southwest Asia, and started saving up for a trip there.
“I didn’t know what I wanted to do … but it had to be self- sustaining,” she said.
That’s why volunteering would not work, she said.
Rogan knew a person in the Bay Area who worked for Drishtee, a for-profit firm with a goal to change the village dynamic in India, helping small villages become independent from the overcrowded cities and offering inexpensive medical services.
The company works with local kiosk operators and encourages them to sell Drishtee’s products — from batteries to health insurance. That way villagers don’t waste time traveling to the cities and have the products they want delivered to where they live.
The kiosk operators become the “nucleus of the village,” where people go to have their needs met.
The headquarters of the company in India are outside of New Delhi in a city called Noida in the state of Uttar Pradesh.
One of her tasks is to work with the kiosk operators and convince them to sell Drishtee products.
Another was to teach villagers about preventive health care and to sell them cheap health insurance — which proved to be a major failure during Rogan’s first stint. Villagers “didn’t have faith” that paying money now would protect them when they need care in the future.
“The fear was, ‘I pay a doctor when I’m sick. Why should I pay when I’m perfectly healthy?’” she said.
She had to find local doctors who would travel with the team to various villages to set up short-term — usually four hours at a time — clinics and offer cheap care and medicinal prescriptions.
Finding doctors was difficult, she said, because seasoned doctors had their own offices and villagers didn’t trust young doctors.
Once, Rogan said, she was given the name of a doctor and the village he lived in, but no phone number. So she embarked on a two- hour rickshaw ride with an interpreter, asking villagers if they knew the man.
“Without a doctor, everything falls apart,” she said.
On days the clinics were held, her team would drive around a village for several hours with a loudspeaker, saying that medical service would be available at a specific time at a certain location - - usually by a house of worship or a busy tea stand.
They would then set up the clinic; a tent, and wait for the customers to show up.
She also spoke to local doctors about what types of ailments were common in the area — usually diarrhea caused by food and water contamination, malaria, gastrointestinal infections and anemia.
Prescriptions were sold for 40 rupees — about $1. The patients would then go to a local chemist and have the prescriptions made.
“In the beginning, in four hours we would have three patients; it was slow,” she said.
But the popularity of the clinics grew to about 30 patients during a four-hour span.
In villages farther away from New Delhi, her job was tougher.
“I was the only female out there,” she said. “One time I was asked, ‘Why are you doing a man’s job?’”
This time Rogan said she will work and live in a different town now, in the Etah District near the Ganges River, which has about 2,000 villages.
Critical illness policy with a hidden trap
A critical illness claim may go before the European Court of Human Rights because good faith was not enough for a policyholder to win pounds 28,000 she felt she was entitled to. Alison Ridgway decided to buy a house in 1999, four years after a divorce and once she had finally saved enough by living with her parents to put down a deposit.
The 40-year-old planning officer from Fareham, Hampshire, was advised, like most people, that it was a good idea to take out insurance to cover her mortgage. She chose a critical illness policy from Friends Provident. The policy undertook to pay off her mortgage in the event that she contracted one of a number of serious illnesses which could have meant she was unable to work to make repayments.
The house buying went smoothly, and Ms Ridgway moved into her one- bedroom maisonette in February 2000. When most people would have been settling in, Ms Ridgway was given sad news. At a hospital appointment two days after moving house, she was told test results from a biopsy of a lump on her breast showed she had breast cancer, and not just the benign lump she had hoped for.
Ms Ridgway, who was only 38 when diagnosed, said: “I was gobsmacked when they found something was wrong. I was not in a high- risk category. There is no history of breast cancer in my family.”
She had an operation at once to remove the lump and, as soon as she returned from hospital, contacted Friends Provident so that she could claim on her policy for a sum in the region of pounds 28,000. After initially sounding positive about paying out, Friends Provident changed its mind and told Ms Ridgway that the company would not be able to honour the agreement because she had not kept them fully informed about the state of her health. Ms Ridgway recalls her reaction was “extreme shock, not a good reaction”.
The problem, Friends Provident explained, was that between taking out the critical illness policy in November 1999 and making it active when she actually moved in February 2000, their customer had gone to the doctor and not informed them about it. Ms Ridgway went because of a cold, but in a routine check her doctor found a lump which she said should be checked in hospital. She had the lump tested in hospital in January 2000 and had her diagnosis on 21 February, just after her critical illness policy came live with the move to the new home.
Ms Ridgway says she did not inform Friends Provident of the trip to her doctor or hospital test because she was given the impression that it was very unlikely that there was something wrong. She says of her doctor, who supports her dispute with the insurance company: “When I went to see her she assured me she was convinced it was nothing but she was referring me to hospital as a matter of course.”
Friends Provident takes a very different view. Graham Aslet, Friends Provident’s appointed actuary, says: “We ask for full information from a customer which is up to date until the point we go on risk [when the policy comes into force]. The onus is on the customer to tell us everything.”
Ms Ridgway says - and Friends Provident accepts this - that she did not deliberately try to mislead the company. She says: “I don’t think people inform their insurer every time they go to the doctor for a cough or cold.” She also points out that her policy says customers should inform the company when they have been diagnosed with an illness. Ms Ridgway feels she did this because, while the tests took place before she moved, the diagnosis came after the policy was in force. Friends Provident disagrees, and says application forms and letters remind customers that they must tell the company about a change in their health.
Mr Aslet says this is sometimes overlooked. “Our policy is to put customers back in the position they would have been in if they had got it absolutely right. So if they haven’t told us about a trivial thing, it is not a problem. In some cases the new information would have made the policy more loaded, so we recalculate the claim.”
Unfortunately, in Ms Ridgway’s case, Friends Provident says it would not have been able to continue with its promise to offer her critical illness cover until it knew the outcome of her breast cancer tests.
Ms Ridgway describes the last two years, when she has had to deal with chemotherapy and frequent checks for fresh signs of cancer as well as battles with Friends Provident, as “absolute hell”. After being off work for six months she felt she could not afford to live on half-pay and, because she was also unable to claim critical illness compensation, she had to return to work.
Ms Ridgway’s MP, Sir Peter Lloyd, and the broker who arranged her cover support her argument that she acted in good faith and is entitled to her claim. Sandy Dawson, from the broker Roy Sansom, says that if Ms Ridgway had suspected she had breast cancer, she could have brought her move forward so her visit to the doctor came after the policy went live.
Livermore woman will advocate for health care in India
LIVERMORE — Ever since learning about India in high school, Ann Rogan wanted to travel there. Now she works there for a company selling medical care and other products to villagers.
For half of the six months between January and June, the 24-year- old lived in a room with cement floors and a mosquito net — “It was a great room” — and spread the word about inexpensive health insurance and medicinal prescriptions, and convinced local salesmen to sell her company’s products.
Rogan returned when her visa expired. But six weeks later, on Thursday, she left again — this time for a full year.
“It’s what I’ve wanted to do,” she said.
Rogan grew up in Livermore and went to school in Hayward. In high school she learned about India’s religions of Buddhism and Hinduism. Based on what she learned, she became a vegetarian.
Her father, John, said she began her various volunteer work projects around this time, and what she learned in high school formed her ideas and thinking that led to where she is now.
In high school she volunteered for Meals on Wheels, and at McGill University in Montreal, she was the local chapter president for the Habitat for Humanity.
“As a parent, you’re apprehensive (about her safety), but I feel good because of who she is a person,” John Rogan said. “She’s trying to make the world better for people.”
Her 17-year-old brother Patrick said he will miss Ann during important events, such as his and his sister’s graduations, but that the family does not question her choices.
“Obviously, we are all going to miss her — but I’m happy that she’s doing it for something she loves to do,” he said. “It’s something she thinks is extremely important and I’m happy for her.”
She graduated from McGill in 2005 with two degrees, including international development with a focus in southwest Asia, and started saving up for a trip there.
“I didn’t know what I wanted to do … but it had to be self- sustaining,” she said.
That’s why volunteering would not work, she said.
Rogan knew a person in the Bay Area who worked for Drishtee, a for-profit firm with a goal to change the village dynamic in India, helping small villages become independent from the overcrowded cities and offering inexpensive medical services.
The company works with local kiosk operators and encourages them to sell Drishtee’s products — from batteries to health insurance. That way villagers don’t waste time traveling to the cities and have the products they want delivered to where they live.
The kiosk operators become the “nucleus of the village,” where people go to have their needs met.
“The kiosk operators decide which goods (they) want to sell,” she said.
The headquarters of the company in India are outside of New Delhi in a city called Noida in the state of Uttar Pradesh.
One of her tasks is to work with the kiosk operators and convince them to sell Drishtee products.
Another was to teach villagers about preventive health care and to sell them cheap health insurance — which proved to be a major failure during Rogan’s first stint. Villagers “didn’t have faith” that paying money now would protect them when they need care in the future.
“The fear was, ‘I pay a doctor when I’m sick. Why should I pay when I’m perfectly healthy?’” she said.
She had to find local doctors who would travel with the team to various villages to set up short-term — usually four hours at a time — clinics and offer cheap care and medicinal prescriptions.
Finding doctors was difficult, she said, because seasoned doctors had their own offices and villagers didn’t trust young doctors.
Once, Rogan said, she was given the name of a doctor and the village he lived in, but no phone number. So she embarked on a two- hour rickshaw ride with an interpreter, asking villagers if they knew the man.
“Without a doctor, everything falls apart,” she said.
On days the clinics were held, her team would drive around a village for several hours with a loudspeaker, saying that medical service would be available at a specific time at a certain location - - usually by a house of worship or a busy tea stand.
They would then set up the clinic; a tent, and wait for the customers to show up.
She also spoke to local doctors about what types of ailments were common in the area — usually diarrhea caused by food and water contamination, malaria, gastrointestinal infections and anemia.
Prescriptions were sold for 40 rupees — about $1. The patients would then go to a local chemist and have the prescriptions made.
“In the beginning, in four hours we would have three patients; it was slow,” she said.
But the popularity of the clinics grew to about 30 patients during a four-hour span.
In villages farther away from New Delhi, her job was tougher.
“I was the only female out there,” she said. “One time I was asked, ‘Why are you doing a man’s job?’”
This time Rogan said she will work and live in a different town now, in the Etah District near the Ganges River, which has about 2,000 villages.
Off-Label Prescribing of Erythropoiesis-Stimulating Proteins in US Hospitals
This study quantifies and describes off-label prescribing of currently marketed erythropoiesis-stimulating proteins(ESP): epoetin alfa and darbepoetin alfa. Methods: A retrospective database study examined on-label, off-label supported, and off-label unsupported ESP treatment of anemia in 464,834 inpatients. Findings: Epoetin was used in 97% of the patients studied from January 2002 to June 2004. ESPs were prescribed on-label in 48% of patients primarily for chronic kidney disease and nonmyeloid cancers. Off-label supported use was seen in 38% of patients mainly for unlabeled chronic kidney disease indications and anemia associated with critical illness. Off-label unsupported use occurred in 14% of prescriptions for cardiovascular, pulmonary, pediatrics, and other conditions. Differences in prescribing were associated with hospital, physician, patient, clinical, and drug variables. Conclusions: Off-label ESP drug use appears to be widespread and associated with many factors. It may be evidence based, since most is associated with conditions supported by the medical literature.
Learning Objectives :
Upon completion of this article, participants should be able to
* Describe the prescribing of erythropoiesis-stimulating proteins in on-label, off label, and off-label unsupported treatment settings
* Discuss the impact of these uses on the patient population
Target Audience
This article is designed for physicians, pharmacists, nurses, other health care professionals, journalists, researchers, health care insurers, and policy makers.
In the past decade, innovations in biotechnology have lead to breakthrough therapies for numerous medical conditions. Biotechnology drugs are created using cellular attributes such as DNA and proteins from yeast, bacteria, and mammals to develop and manufacture new therapies. Biotech drugs have been used successfully to treat millions of patients for uses approved by the Food and Drug Administration (FDA), including cancer, osteoporosis, hepatitis C, and multiple sclerosis. At the same time, advances in medical knowledge and practice associated with biotech drugs have resulted in extensive off-label use.
Off-label medication use occurs when physicians prescribe drugs for indications not approved by the FDA. Off-label prescribing occurs whenever drugs are used at different doses, via different routes of administration, or in patient populations other than those specified by FDA-approved labeling. Off-label prescribing of any FDA-approved drug is considered acceptable practice as long as physicians deem it medically appropriate.