West of the Rotunda

Governor Little has a sense of justice. And he’s acting on it. He’s fighting poverty in Idaho, though he doesn’t freely use the term.

This week we remember Martin Luther King. He fought against racial injustice but more, he knew poverty was a millstone around the neck, preventing young children from developing the content of character by which he famously called for us to judge them. But many rise up out of poverty and grow their character, and indeed, grow their wealth. Justice guards that path from poverty.

In Idaho, as well as nationally poverty is defined based on monthly income; this gives us the measure “Federal Poverty Level”. Many dispute these terms, but if you are going to measure something, you need to be consistent. I’ll use it.

If you look at that national designation, Idaho is actually pretty low, with only 11% below 100% FPL, ranking us near the bottom. Nationally, nearly 14% live below 100% FPL. But if you look a little higher, folks making less than 200% of the FPL, we jump up to the top third, with 34% earning less than $2082/month. Nationally, only about 30% earn less than 200% of FPL.

So, Idaho has poverty, but more, we have many folks working hard and not making a lot. We are a low wage state. That pathway out of poverty, guarded by justice is paved with education. Idaho folks would benefit greatly from the opportunity of education, a free, common, uniform education, as our Idaho Constitution guarantees. Our founders knew it; Brad knows it.

And Governor Little knows, for primary education to be valuable and effective, the ability for students to read at grade level when they reach third grade is a key indicator. Most of those that can’t struggle going on in the grades; many of those that can will thrive. He has committed investment toward early reading capabilities. It is a worthwhile investment. And, as always, there is more to do.

The other move Governor Little has made for justice in Idaho has to do with the recently released criminal offenders. Idaho has one of the highest incarceration rates in the country. Over a third of those in the system are there for crimes involving drugs or alcohol. Furthermore, Idaho has the highest recidivism rate (people released, then returned to prison). So, we incarcerate many with fixed sentences for drug violations, and when they are released, they often go back to jail or prison for parole violations.

Reintegrating offenders takes an investment. The recently passed Medicaid Expansion law will help felons in need of medical care, since, odds are they will be working a pretty low wage job that might not offer health insurance benefits. Brad knows this value and knows the investment is worth it.

But Governor Little knows the path for released offenders from the structured chaos of the prison environment to the goal of productive community members would benefit from sign posts; limited structure. He has put funding to operate a community reintegration center in Twin Falls. Low risk offenders will live there in a supervised setting, continuing programs and working in the community before being released.

Work gives more than a paycheck. It’s a place to build relationships, confidence, skills and value. And people need more than money to climb out of poverty.

I appreciate our governor’s commitment to justice. All people deserve our respect and all, under our Constitution have the right of justice. But making positive steps forward take time. And there is more to do.

To quote Martin Luther King:

 If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.

I owe an apology to Bryan Taylor, Prosecutor for Canyon County. I hope this is good enough for him.

Last week I wrote about Canyon County’s Followers of Christ Church and their strong belief in faith healing over medical treatments and how this has led to many documented preventable deaths of children. I referenced a conversation we had, when I asked him if he thought the law should be changed. He pretty much said, “That’s your job.” Meaning, as a legislator who works to write, repeal or revise the laws, that’s what I should have been working on. And he was right.

What I did not reference, but, thanks to the Canyon County Information Officer for supplying it, was a lengthy and detailed, even directive email to me.

Prosecutor Taylor clearly stated: “As a prosecutor, I feel as though it is my responsibility to protect our children.” Then he went on to outline the steps I should follow to change the law that would make “the cleanest” change.

I had discussions in the statehouse but drafted nothing. Today, I apologize for my inaction. But more I apologize for last week mischaracterizing Mr. Taylor’s position.

In 2017 the Idaho Senate took a run at the law. A bill got to the floor of the Senate where it was killed 11-24. Three out of five Senators with some of Canyon County in their legislative districts voted yes. Not a single Senate Democrat supported it. There were complaints it didn’t go far enough.

It’s hard to build coalitions around passionate issues.

I was also informed last week by the Canyon County Information Officer that Canyon County has in fact been doing child fatality reviews for some ten years or so. I have asked for details about how often, who attended, what were the findings, but those details are pending. But digging through press reports suggests it sounds like there could have been some conflict about how child death investigations were handled in Canyon County.

A LA Times article from 2017 described how the Canyon County Sherriff had formed his own unit to investigate childhood deaths. He had concerns that the then-coroner was not doing an adequate investigation. In 2018 Canyon County elected a new coroner.

It would be my hope that persistent investigation of childhood deaths in Canyon County could help bring clarity to this issue. Further, persistent scrutiny maintains focus.  If clarity for a resolution to this issue, as expressed to me by Canyon County Prosecutor Bryan Taylor is found, I would hope such resolve could be communicated to our state legislature. And then some clear action to change the laws must be taken by the Idaho legislature. It’s long past time.

The “cleanest” solution proposed by Mr. Taylor was simple repeal of Idaho Law 18-1501(4):  The practice of a parent or guardian who chooses for his child treatment by prayer or spiritual means alone shall not for that reason alone be construed to have violated the duty of care to such child.

This is in the criminal statutes that define “injury to children” and carries a punishment of jail or prison. Removing this section which protects parents from prosecution would not prohibit the free exercise of faith healing, prayer, or religious practices, all protected by our Constitution. But it would turn up the pressure on parents to consider the children’s well-being.

Maybe Mr. Taylor said it best in that poorly-remembered, unacted-upon email he sent me when I was a State Senator almost five years ago now:

By changing the statute, it does not force an individual who believes in faith-healing to change their beliefs and I don’t think we should ask for that. The First Amendment protects ones right to have whatever religious beliefs they choose, but that right does not include the right to abuse or neglect a child.

Well said Mr. Taylor. I hope you will accept my apology. I wish I had done more.

For the past eight years, advocates have come to the Idaho legislature requesting repeal of Idaho’s “Religious Shield Laws”. Advocates say children are dying because parents refuse life-saving treatment for their children. Religious Shield laws protect parents from prosecution in these instances. And so far, the legislature has done nothing.

Well, not quite nothing, legislative defenders would counter. They had an interim committee meeting. Okay, one meeting, then nothing.

Governor Otter, to his credit did something. He started a Child Mortality Review Team by executive order in 2013. Their reports are available on line. The reports show that 2-5 children in Idaho die annually from treatable diseases where parents refused to seek treatment for religious reasons.

The report doesn’t locate these deaths, but the religious community famous for this is the Followers of Christ Church in Canyon County in southwest Idaho. One Child Mortality Report estimated the death rate for children in the Followers of Christ community to be ten times the rate for the rest of Idaho.

When I was contacted as a new (but not young) Idaho State Senator by advocates for removing the religious shield laws, I wondered what the local authorities thought. I knew they had some recourse. I don’t like solving local problems in the legislature.

I spoke with the then-coroner of Canyon County. My main question, an allegation made by former church members wanting the shield laws removed, was: are all these child deaths being reported and adequately investigated by the county coroner? The allegation was that some dead children had been buried without a birth certificate, without notifying the coroner of a death. Both of these acts are illegal, and not protected by religious shield laws. But the then-coroner assured me she had a “good relationship” with the church community and she had recorded and investigated all the deaths.

To check this out, I got pictures of all the headstones of children in the Peaceful Valley cemetery, where Followers of Christ inter their dead. There were over fifty. I asked the Idaho Department of Vital Statistics to correlate the headstones with death certificates. They reported “near” 100% correlation. So, it looked like, unless there are unmarked graves somewhere else, the coroner did indeed record the deaths. I did not review the adequacy of her investigation.

I also asked the Canyon County prosecuting attorney if he was aware of instances of child neglect or abuse that he had not prosecuted because of the religious shield laws. His lawyerly answer was, “You guys in the legislature make the laws, not me. I just prosecute the laws you make.”

I’m not sure changing the law is a necessary step. If Canyon County cared about child deaths in their community they could form their own Child Mortality review team. They already have a Multidisciplinary Task Force for the Prevention of Child Abuse. Every county in Idaho has one by law. These task forces get together on a regular basis and review all referrals to the Department of Health and Welfare Child Protection Services (CPS) about abuse and neglect. Members of the task force include law enforcement, CPS, school officials, and others. I was a member of our county task force as a physician and as the county coroner.

I started a Child Mortality Review in our county in the early 2000’s when I became aware Idaho was not reviewing child deaths in a systematic fashion. This was before Governor Otters Executive order. The prosecutor, law enforcement, CPS would attend. I would present the case and my findings and ask for their input. Did I miss something in the investigation? Is there something more I should be doing?

If Canyon County elected officials, but more, if Canyon County voters demanded such work from their elected officials, maybe some helpful discussions would occur. As it is, it just looks like Canyon County doesn’t care about preventing children dying because of their parents’ religious beliefs.

I think I just took my Family Medicine Board Certification test for the last time. They didn’t kick me out for my lousy scores, its just things are changing.

Most people (patients) aren’t aware of the hoops and hurdles of medical education. Most MD’s have a four-year undergraduate degree (Bachelors), then complete four years of medical school (where they receive their MD degree). But that’s just a piece of paper you hang on the office wall.

To legally practice medicine in any state you need a license, granted by the Board of Medicine in that state. The Board of Medicine in Idaho is given the power by the Idaho legislature (thus, the people) to grant or remove licenses by statute (Title 54, Chapter 18).

Each state sets its own requirements for Medical licensure and each state enforces this professional monopoly, through the laws enacted by the legislature.

Most states require US MD graduates have some practical training after medical school, called “residency” to get their state license.  You’ve watched Greys Anatomy. I hated that show. Idaho requires US medical school graduates have 1 year of residency training, Washington 2, Nevada 3. But no state requires board certification as a standard for licensure.

So, what the heck is “Board Certification”? It’s another hoop. After you’ve done all those college hoops, National Board exam hurdles, residency requirement hours and hurdles, then, the specialty you choose to join has some more for you.

Since I decided to be a family doctor I thought I should be “Board Certified” in family medicine. I paid the fee ($1850) and took the test. It was a relief to pass, but then when I saw 95% passed I didn’t feel so special. The day long test came up every 7 years for me. I was also required to complete annual self-training requirements to maintain the certification.

Who cares about Board Certification? Not patients; most folks who walk through our office can’t tell an MD from a DO from an NP from a PA. Most pay attention to the practitioner’s demeanor. Still, when polled, 70% of the public will answer “yes” to the question “Is Board Certification an important criterion for choosing a doctor?” Seems a pretty leading question to me.

Board Certification has been used by some hospitals and health care networks to determine who can be employed or work in their facilities.

Insurance companies have used Board Certification status to adjust payment schedules.

Does it matter that 90% of practicing MDs in the US have some sort of board certification?

Since so many of my practicing colleagues have jumped through this hoop, paid the fees, submitted education credits and taken the tests, (and passed) you would think they all agree on the value of making it through the hoop. But for the last ten years there has been grumbling. Many physicians object to the silliness of the day-long multiple-choice test, where a full third of the questions have been shown to have no relevance to current practice. But most point to the lack of evidence for value. There has never been any correlation between performance on certification and clinical quality, even when studied by the national boards themselves.

Such grumbling might be a sign of change. I hope so. A profession questioning its own methods is healthy reflection. Maybe some resolve will come out of it.

From now on, the Family Medicine Boards will offer the old fashioned every 7-10-year day-long test or a quarterly open book test. In addition, I will need to show regular self-education and self-improvement activities. I’ll do my best, but honestly, hoops, at my age, with these knees?

Instead of the national certification, I would hope my patients, my colleagues would respectfully let me know when I mess up and offer me guidance when I stray. Such cultures, such comrades would do more to promote excellence than thousands of hours of tests. I’ll do my best to be part of that change.

Santa’s sleigh circled the dome and found a safe spot to perch. Santa stretched his legs, swung his big belly out and planted his boots in the crusty Boise snow. He patted Dunder’s and Bitzen’s flanks and circled back for his bag. The starry night showed no light in the east as he called to the team, “Take a break you all. This finishes off Idaho, then we sweep down the West Coast. You know the drill.” Knowing there was no chimney, he took the stairs.

He slipped a little on the marble floor; the bag on his back shifted and a box toppled out and over the rail. He followed it’s fall and listened for breakage. It dropped to the main floor and thudded. Santa harrumphed, “Must be those socks for Speaker Bedke,” he muttered.

He stopped outside the JFAC analysts’ offices up on the fourth floor. He knew from the book they’d all been nice, none naughty, so they were all getting new sharp pencils. He gave the one in charge of the prison budget a red one, just as his little joke.

Down the winding stairs he first dropped the big box of chocolates for the Senate staff. Then in front of the Majority office he had to place his finger by his nose and ponder. He had a couple lumps of coal to give out, and the Treasurer had suggested the Speaker and Pro Tem in her letter to Santa, but he didn’t think he should pick sides, since they had both suggested the coal (or worse) for her. So, he picked his smallest slightly wrinkled Washington apple, left it there and then strolled over to the Minority side. He left them a bright new dog leash.

His bag was half full as he swung east to the House side and he offloaded the bigger box of chocolates for their staff. On Speaker Bedke’s desk he left a note to look downstairs for his present. On the Minority side he left a small bag of peanuts, honey roasted.

The second floor was easier as the bag got lighter. The Secretary of State got boot polish, the Attorney General a new tie (black and gold). The Lieutenant Governor got a small pink purse.

By the time he got to the west Governors wing on the second floor the lumps of coal were banging together in the bottom of his bag. But his book said the governor’s staff had been very good, so they got free Boise parking passes.

Governor Little had also been good, the book said, so the lumps of coal stayed in the bag. It was against his good judgement but he left a Copenhagen can top with the Idaho seal on it for the chief executive.

Just as he was leaving the Governor’s office he heard footsteps behind him. The security guard called, “Hey!” and Santa swung around. He was holding Bedke’s crumpled package. “You drop this?” he asked.

“Why yes son, I did.” Santa reached out and took it from the young man. “Thank you,” he said and twinkled his eyes.

“You about done ‘cause I gotta lock up this wing?” the young man asked.

“Just a couple of lumps of coal to give out.” Santa sighed.

“Let me, I’m doing my rounds, just tell me where.”

Santa flipped through his book. “Well, I guess it will be for two of the Senators or Representatives down in the basement.” He said still counting all the tally marks. As he took out the coal from his bag he fumbled and they fell to the floor, breaking into many pieces.

“Oh dear.” Santa pouted his rosy lips.

“It’s OK. This way I’ll have enough for everybody.” The young security guard smiled as he collected the shards. “And don’t you worry. If I run out I know how to make more. That’s how we do things around here.”

“Merry Christmas son.” Santa smiled. “And Merry Christmas to you.”

It has been heartening for me to see a local uproar involving our school district that didn’t have to do with a levy, teacher pay or athletics. Our little dust up has to do with “Mastery Based Learning”.

I’m not a professional educator, though some of my patients are sometimes disappointed that educating them about their body or their disease can be my main focus. “Can’t you just give me something for this Doc?”

The first time I heard about Mastery Based Learning was back after the LUNA Laws got repealed in 2012. After their defeat, Governor Otter engaged a task force of education folks to give him some recommendations for Idaho education. Recommendation Number One (of twenty) was to institute Mastery Based Learning in Idaho. A fellow State Senator, a retired educator, who had served on the task force, muttered under her breath to me, “I don’t know about this Mastery Based stuff” as she shook her head. I asked about her reservations. “It’s going to be a lot of work for teachers. And we aren’t going to pay them any more for it!”

If you are wondering about just what exactly this shift in learning is, there are plenty of resources. I would encourage you to read some, but not on Facebook. You wouldn’t be considered mastering the subject with that research. I suggest Idaho Education News; they have a few great reporting pieces.

Let me see if I can summarize. Students advance based on their demonstrated mastery of specific learning goals.

Under the current system, a student takes a year of Algebra 1, then moves on to a second year of Algebra 2. Under Mastery Based Learning, if a student demonstrated mastery of Algebra 1 in December, they could start Algebra 2, maybe completing it by June.

Of course, the corollary is also true. If a student doesn’t master the concepts of Algebra 1 by June, they may be spending some extra time in the summer, or coming fall accomplishing that. Or, if they had mastered their English goals early, they could take some time from there to invest in their Algebra deficiencies.

Like I said, I’m not an expert in education matters. As it turns out, from my limited research, there’s not complete agreement on the value of Mastery Based Learning. Maybe except in the Idaho legislature. Both the Senate and the House passed unanimously and Governor Otter signed House Bill 110 in 2015, codifying Recommendation Number One of Otter’s Education Task Force. The change in student evaluation was rolled out in 19 incubator districts a few years ago. My local district was one of those incubators.

But my retired educator colleague foretold the rub. When the legislature saw a $1.4M price tag for expanding Mastery Based Learning to all districts in 2018, they killed it. But then they voted to approve expansion to all districts in 2019, as long as there was no cost to the state. Can you see where there might be some pain here? It is standard operating procedure for the Idaho Legislature to demand a change in policy but refuse to pay for such effort.

I can imagine some teachers resisting this change. It is work to do things different than before. Especially if one is comfortable that what one has been doing has brought success. Add to that, it’s more work with the same pay.

Some parents and students argue that the Mastery Based system makes students unengaged in learning if all they have to do is demonstrate mastery on a simple test. Such a concern for student laziness, or complacency is merited, but I would argue we see enough of that now under our current grade-inflated system.

In short, I’m happy our community is engaged about education and talking about it. We all have so much to learn.

I went to a public forum on Federal lands in Idaho a few years back that the Idaho legislature sponsored. It was a traveling interim committee meeting the legislature set up to consider just what the Idaho legislature should do to take back federal lands. It was Sagebrush Rebellion 2.0. The meeting was in my district back when I was a State Senator. I was amazed at the turnout. I never got that many people to show up at a town hall meeting I held. I was also surprised to see a sheriff’s deputy standing by the door. It seemed a pretty dry presentation to me. But then I noticed the guy next to me had a side arm. And then I noticed quite a few in the folding chairs around me. I hadn’t brought mine; hadn’t felt the need.

My church wants to pass a resolution that our church premises should be a “gun free zone”. I’m not opposed to it. I just don’t understand why we need such a statement. I think my fellow congregants believe such a statement might help quell the mass shootings we hear about in the media. I don’t. It just seems like common sense to me. But then, maybe common sense needs some support nowadays.

I think we all need to start thinking differently.

I see a gun as a tool, like a chainsaw. Both have their purpose. Both are incredible innovations our modern minds and industrial technologies have developed. Both can be misused. Both can be used for powerful purposes. Both have the power to cause lethal harm to oneself or others. Both have a specific function. One cuts so fast it has made getting firewood almost fun. The other directs a projectile with more accuracy and power than a human arm could hope to throw. And that can be fun.

But we have very different feelings about these two tools, don’t we?

If you saw a guy walking down the street with a chainsaw on her shoulder, would you be afraid? Or would you think them a bit silly? How about if the guy had an AR15 on her shoulder? Would you be afraid or think them a bit silly?

My liberal friends find guns threatening and react with umbrage, indignation, anxiety, outrage and fear. But I think that reaction is just what the idiot with the AR15 wants. She’s not going to use the gun, just like the idiot with the chainsaw wouldn’t fire it up on Main Street. When an idiot postures, sometimes the best reaction is to laugh at their folly.

But we can’t help reacting, can we? It is just such reaction, such a visceral response we need to learn how to avoid. Such a reaction gets us hooked to FOX News, CNN, or whatever click bait we fall for. Such reactions make us a tool of these powerful media machines we give so much of our money to. It’s time to look at the idiots and laugh.

But be alert.

Laughing at the guy with a chain saw might be a little easier than laughing at the guy with a semi auto. The guy with the chainsaw can’t kill you from across the street.

I don’t know of any school massacres that have happened with chainsaws. But they have been stars in some horror movies. We don’t live in a movie, or do we?

Tools have their purpose, as do people. It’s time we started reacting to the people around us and not just the tools they carry. Have we become a society that can’t know the people among us?

Banning tools won’t change people. People change people.

Be a people, not a tool.