By MARSHA SHULER
Advocate Capitol News Bureau
The Jindal administration is preparing to hire a firm that will be charged with helping Medicaid patients with diabetes, asthma and congestive heart failure stay out of emergency rooms and hospitals.
The state’s disease management initiative is hung up in the national debate over how to reshape health care.
The state health agency is moving ahead with a program of using $10 million in state and federal funds appropriated during the 2009 legislative session, state Department of Health and Hospitals Secretary Alan Levine said.
The idea is to curb escalating Medicaid costs. Medicaid is the government insurance program for the poor.
“We made the
decision to move this forward because we cannot afford as a state to wait for
Exactly how it will fit in or augment a program that LSU’s hospital division has been operating since the beginning of the decade is unclear.
The LSU program encompasses six disease conditions and specially trained personnel who monitor and educate patients that use system hospitals and outpatient clinics, said Dr. Michael Butler, executive director of LSU’s Center for Health Care Effectiveness and Quality.
According to LSU statistics, the program has saved some $20 million over the years as a result of its work with congestive heart failure, diabetes and HIV/AIDS patients alone because of fewer emergency room visits and inpatient hospital days.
“It’s money we would have had to come up with somewhere or
those people would have been out of luck,” said
The program also
covers asthma patients, cancer screening and chronic kidney disease,
Levine said his agency will be seeking proposals from contractors soon to implement the disease management program that will target Medicaid recipients with chronic conditions. He said his agency used “various pieces of successful programs in several different states to develop our program.”
“We will look at what we are paying out and look at the claims data” to identify high-cost Medicaid recipients who could benefit from having someone help them do the things needed to avoid medical crisis, Levine said.
“Ultimately the consumer decides whether they want to participate,” Levine said.
The most high cost and frequent hospital or emergency room users because of diabetes, asthma or congestive heart failure will be targeted first, he said.
Levine said the state program would expand to other conditions such as hypertension, sickle cell and HIV/AIDS in the future.
The company will have representatives that, for instance, can visit with the patient and his family to educate them about the care plan a physician has ordered, Levine said. And, he said, the representative can track to see if a patient is taking their medication.
The contractor would have access to state health department data on the Medicaid client under the Chronic Care Management Program, Levine said.
“The care manager might look to see if, for instance, they have a script for Albuterol (an asthma medication),” he said.
“If they do, and it was for a 30-day supply, but the care manager notices they hadn’t refilled it after the 35th day, the care manager would call the patient to make sure they are taking their meds, and if not, would find out what the patient needs in order to take their meds,” Levine said.
LSU Physicians Worry about
LSU Physicians Worry about Lake Collaboration | LSU, Our Lady of the Lake Regional Medical Center, Earl K. Long Medical Center, graduate medical education, cooperative endeavor
The advantages of
a proposed deal to make Our Lady of the
Dr. Paul Perkowski, president-elect of the Capital Area Medical Society, said there are a lot of misgivings and misunderstandings about the process for physicians at both hospitals. There are lots of issues to resolve, he said.
For instance, will
question hasn't been answered and that really is the biggest concern of
doctors like us who train residents and medical students," said Perkowski, a surgeon with privileges at both Earl K. Long
There are a number
of other questions, Perkowski said. Will residents
feel as connected to the patients at the
Physicians at both hospitals are in the dark, Perkowski said.
officials at LSU and the
Dr. Richard Vath, the
"What you hear now, I think, is a lot of anxiety about some of the details…and we haven't actually gotten into any of the details," Vath said. "We recognize the devil is in the details, but we have really remained at a very high level conceptually."
Both sides made a conscious decision not to address the impact on individual physicians, individual staff, and individual services, Vath said. The reason people are anxious about the proposal is that they believe the details have been worked out, when in fact they have not.
Vath said the shift from Earl K. Long to the
elements need to be worked out, the
"As far as having those patients treated, it was very important to us that we actually offer the same benefit to those patients that we offer to our current patients," Vath said.
The LSU patients
will not be segregated from the
Vath said having academicians work side-by-side with community physicians is a great opportunity for both.
The LSU doctors
would enhance the
"We saw it again as a nice complement that we would bring to each other," Vath said.
He also said graduate medical education fits well with the community hospital's mission.
There was a great
deal of concern after Hurricane Katrina that there would not be enough
physicians to treat patients, Vath said. The
proposal calls for spending $129 million to build additional facilities on
Perkowski said LSU physicians would like to know
that other options are being explored, such as expanding the former
"I think what everyone would like to see, at both facilities, is why this is the best plan, and why this is the only plan for graduate education and indigent care," Perkowski said.
LAFAYETTE – The Louisiana
State Nurses Association, District IV, presented professional achievement
awards to five members of the
Cameron Foreman, RN, nurse educator recognized for his leadership skills, role as a mentor, and unyielding support for students.
Lou Ann Gerard, RN, UMC director of patient relations, was recognized for her nursing expertise and patient advocacy.
Dawn Huggins, RN, BSN, was recognized for her improvement of UMC employee assistance, health and safety programs.
Lisa Judice, RN, BSN, head of nursing for the Intensive Care Unit, was recognized for training UMC staff in post-Katrina kidney transplant services, her service on hospital committees, and development of the ICU Venthilator Care Bundle.
Peggy McCabe, RN, MSN, nurse educator, was recognized for her comprehensive knowledge and teaching of pediatric care.
LSUHSC contributes to research revealing targets to reduce racial disparity in prostate cancer deaths
findings of the North Carolina-Louisiana Prostate Cancer Project reveal
potential new targets for reducing racial disparities in prostate cancer
survival and highlight the importance of the health care delivery system. The study reports differences in physician
trust, access to care, and continuity of care between African American and
Caucasian men which result in advanced prostate cancer at the time of
diagnosis and contribute to the higher death rate among African American men.
The study is published in the early view issue of Cancer online
conducted in depth in-home interviews with more than 1,000
This study examined health care system factors that may influence outcomes. System factors include availability of health care facilities, the services offered at those facilities, the systems in place to trigger appropriate utilization of those services, and clinician time pressures or encounter characteristics may impede their ability to fully address patient needs. Other factors such as provider bias, erroneous stereotypes or lack of understanding of minorities may also influence patient trust, health behaviors, and receptivity toward seeking or utilizing health care services.
“The lack of access to care, lack of a medical home and lack of a relationship with a medical provider may result in a delayed diagnosis that translates to advanced disease and higher rates of death from prostate cancer for African Americans,” notes Elizabeth T. H. Fontham, DrPH, Dean of the School of Public Health at LSU Health Sciences Center New Orleans, who is the principal investigator of the Louisiana portion, and co- principal investigator of the entire study.
In this study, the stage at diagnosis of prostate cancer was similar between African American and Caucasian men, but African American men had more aggressive cancer as measured by Gleason score. Compared with African Americans, Caucasian men exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical visits, and being screened for prostate cancer. African American men were less likely to report prostate cancer screening prior to diagnosis, and men without a prior history of screening were more likely to be diagnosed with advanced stage or high grade prostate cancer than men who reported a history of screening. “Importantly, no differences in prostate cancer stage at diagnosis were observed between men of either race when an established relationship with a healthcare provider existed,” notes Elizabeth T. H. Fontham, DrPH, Dean of the School of Public Health at LSU Health Sciences Center New Orleans, who is the principal investigator of the Louisiana portion, and co- principal investigator of the entire study. “Through an ongoing relationship with their health care provider, patients’ health status and risks are known, trust builds over time when consistent, high quality interactions between patients and providers take place, and patients are more likely to make informed decisions and receive more timely diagnosis and treatment.”
According to the American Cancer Society, prostate cancer has the highest incidence of cancers among US men and is the second most deadly. The prostate cancer incidence rate among African Americans is 55% greater than among Caucasian men, and the African American death rate is two and a half times that of Caucasian men.
The researchers conclude that addressing components of how health care is delivered, including care continuity, has the potential to meaningfully address the mortality disparity observed for prostate cancer.
Funded by the Department of Defense, the North Carolina-Louisiana Prostate Cancer Project is a population-based study of individuals identified shortly after prostate cancer diagnosis designed to produce clinical data and identify racial disparities in prostate cancer, to help determine the best approach to reduce prostate cancer mortality.
Study authors include Dr. Fontham, William Carpenter, PhD, Research Assistant Professor of Health Policy and Management in the University of North Carolina Gillings School of Global Public Health, James Mohler, MD, Chair of the Department of Urology at Roswell Park Cancer Institute, principal investigator of the Consortium, and other researchers at these institutions.
I appreciate the letter from Dr. C. Ray Halliburton on his wish list for health-care reform.
I don’t think there is anyone with any knowledge of health care who doesn’t think we need reform. The question is how. As they always say, “The devil is in the details.”
I agree with the vast majority of Dr. Halliburton’s wish list and would like to add a few more, if I might.
First, any reform must empower the patient to take responsibility for his/her health-care dollar. We must make the patient part of the decision-making process and tie the patient financially to the process.
To have this disconnect, as the current system is, promotes wasteful and unnecessary spending. No thought is given to, “Do I really need that $2,000 MRI of my back?” It is just done because neither the patient nor the physician has any financial negative incentive. The only program I know of that begins to fill this role is health care spending accounts.
Secondly and probably even more important, make sure whatever Congress saddles us with, its members, too, need to be included in the program. No more special perks and separate insurance programs for themselves. If it is good enough for us, it must be good enough for them. I suspect if we use this as our litmus test, Congress will pass something much more prudent and wise.
Lastly, what I
don’t want is some bureaucrat in
Each and every patient is unique. It is not a perfect science but an art. There is more to treating patients than just pure science. It involves trust and building relationships.
physician, internal medicine
As a professional who was prevented from changing jobs because of health insurance concerns, I am hoping that Sen. Mary Landrieu will reconsider her position on the current health care reform issue.
I knew that my age (62) and a "pre-existing" condition would prevent me from getting affordable health insurance. But this is not even the issue that concerns me most. It is the 46 million without health care.
I am satisfied with my current coverage, but it was achieved through twists and turns and waiting and a complex private bureaucracy that was nearly impossible to negotiate.
I had to spend more than six valuable months of my life to reach a just outcome.
For this reason and many, many others, I support a public option. How can we possibly continue to allow the medical and insurance lobby to prevent this option?
All we have to do is look at what they have "managed" to do, or not do, for the 46 million uninsured. I am appalled at them and at the senator's position.
We have a choice:
private insurance companies who deny basic health and care and coverage vs. a
Medicare-like system that is competitive, affordable, managed and much like
what is available to Mary Landrieu as a
This is not the time to slow down. We have a chance with President Obama and the younger generation moving into power.
There could not be
a more important issue, or a more perfect time to take an honorable (not
political) stand for the people of
Both my husband and I are in our mid-60s and earn an income that is likely to be taxed to fund health care reform.
And why not us?
We have benefited from the opportunities in this country and certainly understand that we have a responsibility to participate in the well being of others.
Developing a swine flu vaccine in time for flu season is a challenge that scientists are struggling to meet, but convincing people that they need to be inoculated is crucial, too.
Given the short time frame, there won't be enough doses for everyone to get a swine flu shot this fall. Health experts are meeting now to figure out who should get the limited supplies. Children likely will be first in line, along with those who have health conditions that put them at higher risk.
An Associated Press poll shows that two-thirds of adults think it's a good idea for their children to be inoculated against the virus, and that's encouraging.
But only one-third of those polled say they're likely to be vaccinated themselves. Adults aren't immune to swine flu, and a sense of complacency could prove to be a public health problem.
The Centers for Disease Control and Prevention say that 40 percent of Americans could contract swine flu this year and next, and hundreds of thousands could die without a successful vaccination drive and other measures.
flu claims about 36,000 lives in the
Health experts are worried about this strain, in part because it has continued to spread during the summer months, which is unusual.
If all goes well with testing next month, swine flu inoculations will be available in October. Those deemed most vulnerable need to take advantage of that protection. And as the vaccine becomes more available, a broader effort to inoculate Americans must take place.
Senate Majority Leader Harry Reid's recent announcement that there will be no final vote on a health care plan before the August recess should be greeted with relief. The key domestic issue of the time deserves more reflection and debate.
We should all agree that we pay too much - at least a third more per capita in combined public and private spending than most other Western industrialized nations - for much too little in the way of public health outcomes.
Up to 50 million Americans have no health coverage. We can debate the reasons, but if those people show up in the emergency room, we're still stuck with the tab.
Even so, the need for change doesn't translate into a need for reckless speed. We have questions to answer:
# Louisiana Gov.
Bobby Jindal's administration has proposed
expanding the number of uninsured
# We know the
# U.S. Sen. Jim DeMint, R-S.C., has described health care as a political opportunity to hurt President Barack Obama, casting the senator's sincerity into doubt. But DeMint also argues that the government is artificially raising insurance costs by preventing real interstate competition. Meanwhile, insurers that compete to administer large group plans - including those that cover employees in many states - certainly aren't holding the line on costs. Who's right? We need to know whether government is artificially raising premiums.
# The same forces that make American health care more profitable also fund medical research and development, creating the breakthroughs that cure diseases and extend lives here and abroad. If we reduce those costs, are we risking the advances that keep us healthy?
We know, as the president says, that an aging population threatens to drive government spending far beyond sustainable levels. That's a good argument for doing health care right, not for undue haste.
by Amber Sandoval-Griffin
incremental improvements over the past few years,
More troubling, analysts see harder times ahead thanks to the still-lurching economy, the study says.
The data book, the
20th annual report on child well-being compiled by the Annie E. Casey
Despite the low
surprising is the child poverty rate," said Laura Beavers, National KIDS
COUNT coordinator in
Since 2000, Lousiana's teen birth rate has improved, meanwhile,
dropping from 62 births per 1,000 females ages 15 to
19 in 2000 to 54 per 1,000 in 2006. In this area,
"This is a concerning trend because we know . . . as the economy worsens, teen birth rates do tend to rise," said Teresa Falgoust, KIDS COUNT coordinator for Agenda for Children.
Falgoust said that some experts theorize that as the economy has slumped, the incentive to delay child-bearing seems to be disappearing. But she says they will not understand the shift fully until more data is released.
Other areas of
The child death rate also improved dramatically, falling from 297 child deaths in 2000 to 219 child deaths in 2007.
But Falgoust is troubled by forecasts for increased child poverty, which in turn is likely to affect the other indices.
"Almost all of these indicators are affected by poverty," Falgoust said. "That's really the one indicator that drives everything else, so when we see that indicator rising it really concerns us about the overall well-being of children."
By Karina Donica
The Louisiana Department of Health and Hospitals has announced a series of local events to inform parents of uninsured children about resources available to insure their little ones.
The back-to-school enrollment drive is designed to provide information on the Louisiana Children's Health Insurance, known, as LaCHIP. The LaCHIP Affordable Plan and Medicaid programs are available to children age 19 and younger.
"We certainly encourage parents, caregivers and grandparents to apply. If there is a need, your needs can be met with health insurance coverage through these programs," said Lester Turner of LaCHIP.
Turner said while
many parents have taken advantage of the insurance programs available, there
are still many uninsured children in
By the end of June, there were as many as 24,000 Rapides Parish children under the age of 19 under some type of public insurance program. According to a two-year-old estimate, as many as 1,800 to 2,000 children are uninsured in Region 6, Turner said.
Turner said it's especially important to get the word out due to economic uncertainties of the times. Many families may have found they are no longer covered due to layoffs or other situations, he said.
"When those circumstances occur the Medicaid program and the LaCHIP program is there," to help, Turner said.
Some of the events will be held starting Saturday and run through Aug. 8 at different locations, including the Alexandria Zoo, New Haven Baptist Church in Colfax and the Winn Parish Health Unit.
In order to reach as many uninsured children as possible, LaCHIP officials said they are expanding hours of operation for its toll free number -- 1-877-252-2447 -- from 7 a.m. to 7 p.m., Aug. 3 through Aug. 7.
Region 6 Administrator and Medical Director Dr. David Holcombe, whose office is also disseminating information about health insurance, said the events are a great opportunity for local families.
The statistics of children's health coverage have come a long way in the past few years, Holcombe said, but there is room for improvement.
"I encourage (parents) if they have children who are eligible to certainly sign them up."
Holcombe also invites parents to vaccinate the children during the upcoming vaccination drive. Dates for that drive will be forthcoming, he said.
The LaCHIP program is for families with income at or below 200 percent of the federal poverty level -- or about $3,675 per month for a family of four, officials said in a press release.
With the LaCHIP Affordable Plan, families with income between 200 percent and 250 percent of the federal poverty level -- up to $4,594 for a family of four -- may purchase health coverage for a $50 monthly premium, plus co-payments.
Each event will feature information about various health coverage programs. Applications will processed on the spot, including for program renewals. There is no penalty if you don't qualify.
Meg Farris / Eyewitness News
Video: Watch the Story
Most people don't get a warning of the danger that lies ahead, but one Northshore mother did.
Becky Winchell, 42, can't believe she is back to her normal active routine, a routine that involves a regular tennis match. Just two days after Easter, something felt terribly wrong.
"It is the worst headache you've ever experienced. I mean it's an incredible amount of pain," said Rebecca "Becky" Winchell.
"We went from a nice evening to hell within a minute," said her husband Andy Winchell.
Fluid rushed to her head, and with a stiff neck, blurred vision and vomiting, she was rushed to the E.R. But Becky Winchell said in a head scan, using no contrasting dye running through her vessels, things looked okay. She was sent home.
"Two hours later I woke up and it was the same feeling and I just told my husband, 'We've got to go back' and that's when they ordered a spinal tap. And when they did the spinal tap, they realized there was blood in my spinal fluid," said Becky Winchell.
Becky Winchell was
"If the aneurysm ruptures 30 percent of patients do not make the hospital. That's the bad part. Another 30 percent will succumb to their aneurysm even though they make the hospital. They will either die or have a very bad outcome," said Dawson, an LSU Health Sciences Center Neurosurgeon and Radiologist who is a member of the Culicchia Neurological Clinic.
"This is actually a relatively small aneurysm in a terrible place," added Dr. Dawson while looking at Becky Winchell’s brain scan.
There were two choices: brain surgery to clip off the protruding bubbled area of the artery or the less invasive coil method, without ever opening up the skull. Three-dimensional imaging was crucial to see through all the overlapping and twisting of vessels and exactly how to get to it.
But now the latest technology makes the coil method even better. It has a hydrogel coating that is secreted, soaking up water swelling and filling up the empty space between the metal wires, making the seal in the bubble even stronger for the rest of her life.
people were very skeptical that this was going to work," said
People are born with a weak spot in a blood vessel. It usually takes 40-60 years for problems to show up. High blood pressure and smoking increase the risk. Many don't get a warning as Becky did.
"I'm more patient in traffic and if I lose a tennis match I'm like, 'It was fun who cares.' You know, nothing, the line in the grocery store doesn't bother me as much," said Becky Winchell.
"We don't take things for granted. Don't sweat the small stuff and we plan on traveling a lot more," said Andy Winchell.
Now Becky Winchell is an advocate of trusting your instincts about your health.
"When you really think something is wrong, you need to say 'Look something is wrong, I don't want to leave,' " she said.
And she believes her second trip back to the E.R. is the reason she has a second chance to be with her seven children.
There are no routine, inexpensive screenings for aneurysms. If you have two or more immediate, blood relatives who have had this condition, you are at higher risk.
By MICHELLE MILLHOLLON
Advocate Capitol News Bureau
A week after rallying around the private health insurance industry, Gov. Bobby Jindal Monday talked up the privatization of unspecified state services.
Jindal mentioned privatization several times as a way to cut costs. His audience was a commission that began work this week on devising ways to streamline state government. The overarching goal is to help the state grapple with huge budget shortfalls.
The governor asked the Commission on Streamlining Government to be bold.
“It is absolutely critical that the commission not just result in a study that sits on a shelf,” he said.
The commission — made up of legislators, business leaders and others — must submit recommendations to the governor and other state officials by Dec. 15.
In a rare visit to a legislative committee room, Jindal addressed the commission that he wanted created. The governor made it clear how he thinks state government can be streamlined: Privatize some state services.
The governor said the state will have to cut costs as revenue shortfalls continue.
The Division of Administration is projecting a $1 billion to $1.9 billion budget shortfall in coming years, partly because of an increase in the state’s share of costs for the Medicaid program for the poor and uninsured.
The budget crunch already is forcing public colleges and universities to lay off select employees and furlough many others.
The governor said he wants state agencies to look for services that can be handled by the private sector.
His stated philosophy on the role of private companies in serving the public is thrusting him into the national spotlight.
Jindal is critical of a proposal before the U.S. Congress that could pit the federal government against private companies in providing health-care coverage.
The governor recently penned a Wall Street Journal opinion piece in which he predicted a public option plan would drive private plans out of business.
“The government plan will become so large that it will set, rather than negotiate, prices,” Jindal wrote.
The governor said he wants his cabinet secretaries to identify programs, functions and activities that can be privatized or outsourced.
He said he has also asked his cabinet to:
* Identify a core vision for changes.
* Differentiate between what they are required to do and what they are doing.
* Define non-core activities.
* Identify outdated activities.
* Identify underperforming programs.
* Identify duplication and overlap with the private sector.
The commission is supposed to recommend ways to reduce state government costs as it reviews agencies.
As an example, Jindal pointed to the
The center now is a female re-entry program operated by Madison Parish Sheriff Larry Cox.
The shift occurred because the center was proving to be too costly, Jindal said.
The commission of nearly a dozen members will split into subcommittees to study various aspects of state government.
The commission’s chairman, state Sen. Jack Donahue, said it is not fair to cut every agency by an equal percentage because there is no strategy in that.
Donahue, R-Mandeville, said he hopes the commission produces a pile of information on curtailing costs.
Only some of it is likely to be palatable, he predicted.
Most of the meeting focused on compiling a list of questions that commission members want answered.
State Rep. Jim Fannin, D-Jonesboro, wants to know what other states are doing to privatize and outsource.
State Treasurer John Kennedy wants to investigate the layers of management at each state agency.
The commission will meet again Aug. 11.
Reported by Crystal Price
The Annie E. Casey
Only half of
"People will put off a lot of visits because they feel like they can't afford it," says Anatole Karpovs.
Doctors believe the greatest concerns for improving child health care in our city are cost and prohibitive insurance policies.
"A lot of times there are middle class families who cannot afford to be insured, so they take a risk," says Karpovs. "Because if there is a catastrophic injury or illness, they're going to spend a lot of money out of pocket."
The costs of immunizations and vaccines can be up to $300 for uninsured patients.
"I really feel there must be ways to reduce some of those costs or to control them," says Karpovs.
Karpovs thinks patients might not completely trust their children's pediatricians when it comes to vaccines.
"They don't want to believe or they think pediatricians are biased," says Karpovs. "But we're really pushing this for a good reason, to prevent some serious childhood illnesses."
Doctors say the main way to prevent long term illnesses is to keep your child immunized and healthy in their early years.
"These things dovetail into adulthood and then you save a lot of money, not only that but misery in the long term" says Karpovs.
Re: "Boundaries set on N.O. tobacco sales," Metro, July 24.
I'm glad to see efforts to stem the flow of cigarettes into the hands of minors. Perhaps there should be the same energy put into keeping sodas, candy, chips and fast foods out of the hands of children as well.
harmful, and so are these other items.
There are already laws on the books that should prevent a business from selling cigarettes to minors. That law needs to be enforced.
Let's take action to further prevent our children from making unhealthy, life-threatening lifestyle choices. Help our children learn to eat better and we may be able to save generations from obesity, diabetes, hypertension, and heart disease.
By Bill Barrow and
Amber Sandoval-Griffin, Staff writers
A lawsuit seeking
to block the state from closing
Court Judge Sidney Cates IV granted the state's request to move the case
Zanders told the media before the hearing -- originally scheduled to consider plaintiffs' motion for a preliminary injunction -- that he did not want to get bogged down in a dispute over venue. "The lack of adequate health care for the mentally ill patients in this area is far too critical to waste precious time arguing over where this case should be heard," he said.
--- Denial of rights claimed ---
The lawsuit, filed against Gov. Bobby Jindal, state Health Secretary Alan Levine and other state officials, contends that closing the hospital would deny several legally protected rights of the facility's patients and employees.
state agencies typically are heard in the 19th Judicial District, based in
the state capital. With Cates' granting of the venue change, the
Jindal proposed as part of his February budget
recommendations closing NOAH and moving its inpatient operations to the
--- Jindal defends plan ---
Some mental health advocates in the city have decried the move, though the Jindal administration cast the plan as a redistribution of resources that does not cut services to the region. The administration also has said that the money the Legislature directed to NOAH is not sufficient to keep it in operation, with the state asserting that the per-day cost of inpatient care is significantly lower at the Mandeville hospital.
Those claims figure prominently in the defendants' response to the lawsuit because state law prohibits a preliminary or permanent injunction against a public office or agency if the court order would force deficit spending.
Zanders disputes that keeping NOAH open would force deficit spending, calling it "a political argument, not a legal argument."
State Budget Fight Ends, Federal
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