Taking Back What’s Theirs: The Recess Appointments Clause, Pro Forma Sessions, and a Political Tug-of-War

This Note surveys the current landscape of the Recess Appointments Clause. With the recent recess appointments of Richard Cordray to direct the Consumer Financial Protection Bureau (CFPB) and three other individuals to join the National Labor Relations Board (NLRB), came an influx of old—and new—controversy over the President’s recess appointment authority. This Note explores interpretational issues that have surrounded the Clause since its inception, as well as novel issues that have arisen with the Congress’s use of pro forma sessions in an attempt to block recess appointments and derail the executive’s agenda. The conflict over control of the appointments process is at its peak, as exemplified by the current litigation seeking to invalidate President Obama’s most recent recess appointments. This Note examines the varied interpretations of the Clause, the current litigation and potential dispositions, the increasing congressional trend of using the appointments process as an obstructionist device, and the possible state of both the CFPB and the Recess Appointments Clause after litigation. Ultimately, this piece proposes a modified functionalist standard by which the validity of recess appointments should be judged. That is, if the Senate is in a truly functional recess for a period of longer than three days, then the President should be able to make a valid recess appointment. Additionally, this three-day rule can be broken in the event of an emergency that renders the Senate unable to advise and consent to a nominee at a time when a recess appointment is necessary for the uninterrupted functioning of the government

Transportation Barriers to Healthcare in Adults 65+ in the Greater Burlington Area

Introduction. Missed appointments often lead to poorer health care outcomes for patients and pose a major economic burden on medical centers. Transportation is an obstacle to accessing medical care for elderly patients in Vermont and results in delayed medical appointments. Methods. We surveyed senior citizens in Chittenden county to determine both the type of transportation barriers and medical care missed due to the lack of transpor- tation. An original survey assessing the impact of transportation to health care was distributed in person and through an online platform. Participants were asked to identify the following in the past year: how often transportation was an issue for healthcare, specific barriers to transportation, and which specific health care appointments were missed due to lack of transportation. Ninety-six surveys out of a total of 251 collected were included in the analysis. Respondents were grouped into either having high transportation barriers, n=43, (always, often, sometimes had issues in the past year), or low transportation barriers, n=53, (rarely had issues). Results. The high barriers group reported more missed appointments, with eye appointments being the most frequent, and depended more on other modes of trans- portation. The low barriers group was able to drive themselves to their appointments more often. Conclusion. The results suggest a trend between barriers to transportation and a lack of access to healthcare appointments. Although more than half of the survey respondents indicated that they do not currently experience transportation barriers, many expressed concern about the transportation difficulties they could encounter in the future.https://scholarworks.uvm.edu/comphp_gallery/1263/thumbnail.jp

Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records

Background Missed appointments are a common occurrence in primary care in the UK, yet little is known about the reasons for them, or the consequences of missing an appointment. This paper aims to determine the reasons for missed appointments and whether patients who miss an appointment subsequently consult their general practitioner (GP). Secondary aims are to compare psychological morbidity, and the previous appointments with GPs between subjects and a comparison group. Methods Postal questionnaire survey and prospective medical notes review of adult patients missing an appointment and the comparison group who attended appointments over a three week period in seven general practices in West Yorkshire. Results Of the 386 who missed appointments 122 (32%) responded. Of the 386 in the comparison group 223 (58%) responded, resulting in 23 case-control matched pairs with complete data collection. Over 40% of individuals who missed an appointment and participated said that they forgot the appointment and a quarter said that they tried very hard to cancel the appointment or that it was at an inconvenient time. A fifth reported family commitments or being too ill to attend. Over 90% of the patients who missed an appointment subsequently consulted within three months and of these nearly 60% consulted for the stated problem that was going to be presented in the missed consultation. The odds of missing an appointment decreased with increasing age and were greater among those who had missed at least one appointment in the previous 12 months. However, estimates for comparisons between those who missed appointments and the comparison group were imprecise due to the low response rate. Conclusion Patients who miss appointments tend to cite practice factors and their own forgetfulness as the main reasons for doing so, and most attend within three months of a missed appointment. This study highlights a number of implications for future research. More work needs to be done to engage people who miss appointments into research in a meaningful way

Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. Participants: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments

Assessing Causation in Breast Implant Litigation: The Role of Science Panels

In two recent cases, federal judges appointed panels of scientific experts to help assess conflicting scientific testimony regarding causation of systemic injuries by silicone gel breast implants. This article will describe the circumstances that gave rise to the appointments, the procedures followed in making the appointments and reporting to the courts, and the reactions of the participants in the proceedings

The Productivity Effects of Extension Appointments in Land Grant Colleges

A key piece in understanding the link between the extension and research missions of Land Grant universities is to understand the role of faculty with (and without) extension appointments within agricultural colleges. This article provides a comparative empirical portrayal of the primary activities of agricultural college faculty, and demonstrates the basic vitality of extension professors within the Land Grant system. Professors with smaller extension appointments are heavily engaged in the major research efforts of their universities at even greater levels of production than professors without extension responsibilities. Professors with heavy levels of extension appointments experience increasing tradeoffs between core extension activities and research outputs and graduate training. Professors with no extension appointments engage substantively in extension activities and frequently have links to core extension clientele.

Executive Order, May 1, 1927

Appointments made to be members of the Armory Boar