AtomikaLive fast and get fucked or whateverRegistered Userregular
edited March 2011
Hypocrisy of the Right aside, I'm not entirely opposed to medically at-risk patients on taxpayer-funded medical coverage not getting the same priority treatment as the low-risk and/or private-pay patients. Similar policies are already on the books in the UK, and Parliament is currently debating stricter measures that would remove people from NHS entitlement entirely, despite still being taxed for it.
The hierarchy for consideration should (and probably is, we might guess):
- children
- young adults with no significant medical or lifestyle considerations
- middle-aged adults, healthy, who have coverage
- middle-aged adults, healthy, who do not have coverage
- unhealthy or at-risk patients
- the severely elderly
If you're a 3-pack a day morbidly-obese smoker and need medicaid to cover expenses for medical needs you've caused to yourself, I'm not going to be too choked up that you get pushed to the back of the line.
State Representative Anna Tovar, a Democrat and former kindergarten teacher, received two transplants to combat a rare form of leukemia. She says Arizona stands to lose more than $3 million a year in federal matching funds for Medicaid to save $1.4 million a year by restricting transplants
This is the part that really makes someone face palm. Arizona will probably lose more money from federal Medicaid funds than it saves. So not only are they deciding to let these people die slow painful deaths, they're doing it for no reason at all.
Jephery on
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"Orkses never lose a battle. If we win we win, if we die we die fightin so it don't count. If we runs for it we don't die neither, cos we can come back for annuver go, see!".
State Representative Anna Tovar, a Democrat and former kindergarten teacher, received two transplants to combat a rare form of leukemia. She says Arizona stands to lose more than $3 million a year in federal matching funds for Medicaid to save $1.4 million a year by restricting transplants
This is the part that really makes someone face palm. Arizona will probably lose more money from federal Medicaid funds than it saves. So not only are they deciding to let these people die slow painful deaths, they're doing it for no reason at all.
Jephery, why do you want state government to be subservient to the teat of the evil corrupt washington feder--
If you're a 3-pack a day morbidly-obese smoker and need medicaid to cover expenses for medical needs you've caused to yourself, I'm not going to be too choked up that you get pushed to the back of the line.
These people already ARE pushed to the back of the line, but surprise surprise, organ transplants can't work like that in the first place.
Your options are: person dies and you lose the organs, or person dies and you transplant their organs into recipients who are within range.
If you're a 3-pack a day morbidly-obese smoker and need medicaid to cover expenses for medical needs you've caused to yourself, I'm not going to be too choked up that you get pushed to the back of the line.
These people already ARE pushed to the back of the line, but surprise surprise, organ transplants can't work like that in the first place.
Your options are: person dies and you lose the organs, or person dies and you transplant their organs into recipients who are within range.
Yes, but even within the range there's a list of prioritization. Granted, this is fairly a non-issue.
I was mostly commenting on a morbidly-obese 45-year old with myriad medical conditions blaming the government for his impending mortality.
It's not entirely uncommon, though. I've had 6-pack a day smokers tell me they don't take their life-saving medications because they can't afford it. But then again, I'm the kind of person who gets a little pissed that a 6-pack a day smoker has the nerve to seek medical care. Or, like I had earlier this year, the morbidly obese person who passed out at a Ben & Jerry's because his blood sugar was 850.
In fact we should execute people who make poor life decisions, some of their organs might be healthy, if the hospitals were to simply euthanize them for seeking care they could profit!
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AtomikaLive fast and get fucked or whateverRegistered Userregular
In fact we should execute people who make poor life decisions, some of their organs might be healthy, if the hospitals were to simply euthanize them for seeking care they could profit!
does this law do anything to employers of illegal immigrants?
Of course not cause the state needs the labor and they know it.
I don't know if it's already been brought up in the thread since search is disabled but you don't know what you're talking about. Arizona already has a law enacted in 2008 to require E-Verify for all new employees. That same law also addresses employers knowingly hiring illegal immigrants.
Ross, I read the article and just re-read it: Where are you getting the idea that it's "at-risk" patients getting pulled from the transplant list?
Because there's nothing mentioned in the Reuter's piece about these patients being smokers or anything else.
Ditto.
From the article:
A pacemaker and defibrillator fitted to carpenter Douglas Gravagna's failing heart makes even rising from the couch of his Phoenix-valley home a battle.
But it is not congestive heart failure that is killing him, he says. It is a decision by Arizona Governor Jan Brewer to stop funding for some organ transplants as the state struggles to reduce a yawning budget deficit.
"She's signing death warrants -- that's what she's doing. This is death for me," says Gravagna, 44, a heavy-set man who takes 14 medications to stay alive.
From a medical perspective, Mr. Gravagna is a time-bomb. He would be just about the last to ever get any kind of transplant organ.
By 44 he's already fairly obese, has an AICD installed, and is on a ton of medications, very likely for several conditions. Likewise, most cases of congestive heart failure in people that aren't elderly are brought on by lifestyle-caused illnesses, like obesity, high blood pressure, et al.
For a baseline reference, CHF is fairly common in elderly patients, and can readily be kept in check by inexpensive diuretics. Often by two pills or less.
In fact we should execute people who make poor life decisions, some of their organs might be healthy, if the hospitals were to simply euthanize them for seeking care they could profit!
Don't be a goose.
Hey buddy I'm not the guy that gets offended that a smoker seeks medical care when they need it.
Also, as a formerly obese person myself, I get touchy when people advocate the death of fat people because fuck em they're pigs. I realize you probably don't actually feel that "hey that smoker over there, his wife and kids deserve to be without a husband and father because I hate people with poor decision making skills", I really honestly don't think you believe that, but you come across that way sometimes.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
In fact we should execute people who make poor life decisions, some of their organs might be healthy, if the hospitals were to simply euthanize them for seeking care they could profit!
Don't be a goose.
Hey buddy I'm not the guy that gets offended that a smoker seeks medical care when they need it.
Also, as a formerly obese person myself, I get touchy when people advocate the death of fat people because fuck em they're pigs. I realize you probably don't actually feel that "hey that smoker over there, his wife and kids deserve to be without a husband and father because I hate people with poor decision making skills", I really honestly don't think you believe that, but you come across that way sometimes.
Well, I was being pretty specific. I don't care when a smoker comes into the hospital to get a laceration sewn up, or his appendix removed, or to set a broken bone.
I get sussed when a 3/4/5-pack a day x 20 years smoker comes in because his untreated emphysema is causing him problems.
I'm not going to argue against medical care rationing (in the sense that if you have one organ, and someone with a 90% chance of recovery with it, and someone with a 10% chance of recovery with it, I'd suggest taking the 90% unless they're going to live a healthy life with their current organs for another year or three), but it does amuse me that with all the huffing about death panels deciding who does and does not get care, nobody blinked at Arizona doing that on it's own.
But it's decidedly something that does happen to some extent. You have limited resources, you need to use them effectively. The only mockery I have here is that it's coming from the party who previously was acting like the answer was obviously limitless medical resources and money, and that any other option was completely unacceptable. Turns out when one of your limited resources is "money", they're right quick to say screw it, people should have made better life choices.
The thing is it certainly doesn't sound like it's "life choices". It sounds like "are you poor?" and "do you, through no fault of your own, need an organ transplant?"
"Well too bad sucker!"
Of course the effect probably won't be atrocious, but it's only going to be because specialists, doctors and nurses generally do the best they can with what they have and I suspect will push hard to try and treat everyone like this.
Well yes, the actual rationing should probably done by medical professionals who can actually have the information needed to make rational choices. Again, the group talking about government wanting to step between you and your doctor is first in line to do so. But rationing IS a valid conversation topic in a rational world, even if it's a higher level group saying "X Y and Z are too medically risky to ever do" followed by individual doctor boards saying "due to X circumstances, Z patient should get this organ over Y patient"
Assuming the circumstance isn't "because that dude totally has more money"
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AtomikaLive fast and get fucked or whateverRegistered Userregular
Well yes, the actual rationing should probably done by medical professionals who can actually have the information needed to make rational choices. Again, the group talking about government wanting to step between you and your doctor is first in line to do so. But rationing IS a valid conversation topic in a rational world, even if it's a higher level group saying "X Y and Z are too medically risky to ever do" followed by individual doctor boards saying "due to X circumstances, Z patient should get this organ over Y patient"
Assuming the circumstance isn't "because that dude totally has more money"
Until we have a legitimate socialized medical framework, private hospitals will always choose the paying patient over the non-paying/medicaid patient as long as the two patients are of similar medical need.
It's the hand of the market, and private hospitals have to stay in business, too. Not fair, but not particularly illegal, so you know where the corporations are going to fall on that choice.
As a rule, doctors care about things in this order:
- maintenance and protection of licensure
- swift reimbursement for services
- peer review
- consistent employment
- helping patients
Actually you skipped one; it should read "Taking care of all the above smoothly enough to leave enough time for 9 holes a day" right before "helping patients".
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ElldrenIs a woman dammitceterum censeoRegistered Userregular
Actually you skipped one; it should read "Taking care of all the above smoothly enough to leave enough time for 9 holes a day" right before "helping patients".
That's far, far less true than his list.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
Actually you skipped one; it should read "Taking care of all the above smoothly enough to leave enough time for 9 holes a day" right before "helping patients".
I'd actually disagree on that one. One thing I'll never knock doctors for is how many hours per week they work and take call.
Most I know work, on average, 60 hours a week, and do so at all kinds of random hours. One day a doctor will work a 7a-7p shift, two days later he's working 7p-7a. There are several reasons I didn't go to medical school as my family expected, and one of them was looking at doctors' lifestyles. It's the textbook example of having a ton of money to spend and no time to spend it.
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ElldrenIs a woman dammitceterum censeoRegistered Userregular
Actually you skipped one; it should read "Taking care of all the above smoothly enough to leave enough time for 9 holes a day" right before "helping patients".
I'd actually disagree on that one. One thing I'll never knock doctors for is how many hours per week they work and take call.
Most I know work, on average, 60 hours a week, and do so at all kinds of random hours. One day a doctor will work a 7a-7p shift, two days later he's working 7p-7a. There are several reasons I didn't go to medical school as my family expected, and one of them was looking at doctors' lifestyles. It's the textbook example of having a ton of money to spend and no time to spend it.
You forgot the 7a-7a
But seriously: Most doctors don't play golf, and many are workaholics for whom "leisure time" is an imposition foisted on them between calls.
Actually you skipped one; it should read "Taking care of all the above smoothly enough to leave enough time for 9 holes a day" right before "helping patients".
I'd actually disagree on that one. One thing I'll never knock doctors for is how many hours per week they work and take call.
Most I know work, on average, 60 hours a week, and do so at all kinds of random hours. One day a doctor will work a 7a-7p shift, two days later he's working 7p-7a. There are several reasons I didn't go to medical school as my family expected, and one of them was looking at doctors' lifestyles. It's the textbook example of having a ton of money to spend and no time to spend it.
You forgot the 7a-7a
But seriously: Most doctors don't play golf, and many are workaholics for whom "leisure time" is an imposition foisted on them between calls.
I will confirm this. Even when my parents started in private practice in Australia, they started out working 8am-7pm 7-days a week.
Doctors work fucking hard either out of habit, necessity or enablement, I may never know.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
Doctors work fucking hard either out of habit, necessity or enablement, I may never know.
It's one of the few hourly-wage jobs where you can make a shit-ton of money. I figure that's the primary impetus right there.
As well, you don't work for anyone but yourself, so you can do rotations at several hospitals at once. Most specialists in urban areas have attending and consulting privileges at at least four or five hospitals.
It is just anecdotal, but I know several people who have been in car accidents involving people in the country illegally. In every case they did not have a drivers license or insurance and in all but one case they were at fault. Having a group of people driving without insurance might be a problem here in Arizona.
Doctors work fucking hard either out of habit, necessity or enablement, I may never know.
It's one of the few hourly-wage jobs where you can make a shit-ton of money. I figure that's the primary impetus right there.
As well, you don't work for anyone but yourself, so you can do rotations at several hospitals at once. Most specialists in urban areas have attending and consulting privileges at at least four or five hospitals.
Pretty much what I knew, though I have to give allowance for other motivations outside my 2nd hand experience of the field. The ability to continue working for more money is one of the primary benefits of the "high earning" professions really - the hourly rate sucks, but the potential for continued profit is the benefit.
I'll chime in with the "doctors work a shitload", but I grew up in the military medical system, where there isn't much of a profit motive for the doctors. One of the reasons my parents had problems retiring and going into private practice was the sudden addition of "sure we can cure that, this is what it will cost" as opposed to "sure we can cure that, come in on tuesday"
I'd always though it was more about the stage of the career - initially soul-crushing 60 to even 80 hour weeks sometimes, but reduced workloads as you get further in. All varying by specialty, etc. It was mostly an off-the-cuff joke though.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
I'd always though it was more about the stage of the career - initially soul-crushing 60 to even 80 hour weeks sometimes, but reduced workloads as you get further in. All varying by specialty, etc. It was mostly an off-the-cuff joke though.
Except that most doctors don't seem to view it that way. Many of them see their situation and go, "Damn, I gotta work 80 hours a week to pay off my hundreds of thousands of dollars in student loans. But if I pay them off and STILL work 80 hours a week? Boom."
No shit: I know an ER doctor who owns a 10,000 sq.ft. house in a fairly pricey part of Dallas. He works at least 80 hours a week to maintain it. 80 hours a week means that, after sleeping, you have approximately 4 hours to yourself everyday to eat, dress, bathe, and do anything else.
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lonelyahavaCall me Ahava ~~She/Her~~Move to New ZealandRegistered Userregular
edited March 2011
My mom's an RN, my dad's a CFNP, so not quite a doctor. But he pretty much runs his own practice through a larger medical group. Dad goes into work around 6am (after an hour commute) and leaves work around 6pm, if he's lucky. It's a good job and he seems happy (although he hates the computer stuff and the files on computer, etc. But he enjoys his patients (for the most part) and his staff (when they're not being psychotic). But the hours are killer.
But then, dad was one of those who while working for the 'free' clinic at the beach would gladly accept fresh fish from the Islanders in exchange for medical services. They didn't have the money to pay, but they had fish from the Bay, pulled in that morning. And he had no problem taking the medicaid, medicare, illegals, whatever. Still really doesn't. He's one of the physicians who's of the opinion 'if you're hurt, i'll take care of you the best I can'. Legal, Illegal, Poor, whatever, a hurt person is still a hurt person.
I love my dad. I hate his hours that he works, and I'm getting worried about his health and the effect of all this on him, but he does good work for good reasons.
To put it another way, yes, I realize that the fact that they stand out (due to language and skin tone) is part of the reason why this particular immigrant-hate-fest has bubbled up to claim it's spot among some of the great immigrant-hate-fests that give our country's history such a cheeky irony. But that, in no way whatsoever, makes any point that you think it makes.
So, is there a way to lower the actual cost of the transplant procedures? It seems from a labor point of view having too few trained doctors, surgeons and nurses working too many hours to pay off enormous debts from their training may be increasing the costs.
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He's a shy overambitious dog-catcher on the wrong side of the law. She's an orphaned psychic mercenary with the power to bend men's minds. They fight crime!
but..with transplants, you can only lower it so far. It takes a big deal of very well trained people to pull off.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
Because Arizona never struggles to not be not awesome for very long . . . .
Female judge tells female sexual assault victim who was again sexually assaulted by the officer that responded to her 911 call that the original sexual assault (and subsequent assault) was her fault because "bars are dangerous."
Because Arizona never struggles to not be not awesome for very long . . . .
Female judge tells female sexual assault victim who was again sexually assaulted by the officer that responded to her 911 call that the original sexual assault (and subsequent assault) was her fault because "bars are dangerous."
This female judge was appointed by Jan Brewer (naturally) and is most likely a mormon, so to her drinking in a bar is tantamount to whoring it up. I believe she also mentioned being in a grocery store past 10pm is equally inviting sexual assault.
I remember a sign somewhere at a rally that said "We teach Don't get raped, not Do not rape." And this horrible judge seems to really take that to a stupid place.
I would like some money because these are artisanal nuggets of wisdom philistine.
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The hierarchy for consideration should (and probably is, we might guess):
- children
- young adults with no significant medical or lifestyle considerations
- middle-aged adults, healthy, who have coverage
- middle-aged adults, healthy, who do not have coverage
- unhealthy or at-risk patients
- the severely elderly
If you're a 3-pack a day morbidly-obese smoker and need medicaid to cover expenses for medical needs you've caused to yourself, I'm not going to be too choked up that you get pushed to the back of the line.
This is the part that really makes someone face palm. Arizona will probably lose more money from federal Medicaid funds than it saves. So not only are they deciding to let these people die slow painful deaths, they're doing it for no reason at all.
"Orkses never lose a battle. If we win we win, if we die we die fightin so it don't count. If we runs for it we don't die neither, cos we can come back for annuver go, see!".
Jephery, why do you want state government to be subservient to the teat of the evil corrupt washington feder--
HUUUUNGGGGGGHAGHERG *painful twitching*
oh god I couldn't even make it through the joke.
These people already ARE pushed to the back of the line, but surprise surprise, organ transplants can't work like that in the first place.
Your options are: person dies and you lose the organs, or person dies and you transplant their organs into recipients who are within range.
Because there's nothing mentioned in the Reuter's piece about these patients being smokers or anything else.
Yes, but even within the range there's a list of prioritization. Granted, this is fairly a non-issue.
I was mostly commenting on a morbidly-obese 45-year old with myriad medical conditions blaming the government for his impending mortality.
It's not entirely uncommon, though. I've had 6-pack a day smokers tell me they don't take their life-saving medications because they can't afford it. But then again, I'm the kind of person who gets a little pissed that a 6-pack a day smoker has the nerve to seek medical care. Or, like I had earlier this year, the morbidly obese person who passed out at a Ben & Jerry's because his blood sugar was 850.
Don't be a goose.
I don't know if it's already been brought up in the thread since search is disabled but you don't know what you're talking about. Arizona already has a law enacted in 2008 to require E-Verify for all new employees. That same law also addresses employers knowingly hiring illegal immigrants.
See: http://en.wikipedia.org/wiki/E-Verify#Arizona and http://www.azcentral.com/arizonarepublic/business/articles/1128biz-sanctions101-CP.html
Ditto.
From the article:
From a medical perspective, Mr. Gravagna is a time-bomb. He would be just about the last to ever get any kind of transplant organ.
By 44 he's already fairly obese, has an AICD installed, and is on a ton of medications, very likely for several conditions. Likewise, most cases of congestive heart failure in people that aren't elderly are brought on by lifestyle-caused illnesses, like obesity, high blood pressure, et al.
For a baseline reference, CHF is fairly common in elderly patients, and can readily be kept in check by inexpensive diuretics. Often by two pills or less.
Hey buddy I'm not the guy that gets offended that a smoker seeks medical care when they need it.
Also, as a formerly obese person myself, I get touchy when people advocate the death of fat people because fuck em they're pigs. I realize you probably don't actually feel that "hey that smoker over there, his wife and kids deserve to be without a husband and father because I hate people with poor decision making skills", I really honestly don't think you believe that, but you come across that way sometimes.
Well, I was being pretty specific. I don't care when a smoker comes into the hospital to get a laceration sewn up, or his appendix removed, or to set a broken bone.
I get sussed when a 3/4/5-pack a day x 20 years smoker comes in because his untreated emphysema is causing him problems.
But it's decidedly something that does happen to some extent. You have limited resources, you need to use them effectively. The only mockery I have here is that it's coming from the party who previously was acting like the answer was obviously limitless medical resources and money, and that any other option was completely unacceptable. Turns out when one of your limited resources is "money", they're right quick to say screw it, people should have made better life choices.
"Well too bad sucker!"
Of course the effect probably won't be atrocious, but it's only going to be because specialists, doctors and nurses generally do the best they can with what they have and I suspect will push hard to try and treat everyone like this.
Which is really what makes it all the worse.
Assuming the circumstance isn't "because that dude totally has more money"
Until we have a legitimate socialized medical framework, private hospitals will always choose the paying patient over the non-paying/medicaid patient as long as the two patients are of similar medical need.
It's the hand of the market, and private hospitals have to stay in business, too. Not fair, but not particularly illegal, so you know where the corporations are going to fall on that choice.
As a rule, doctors care about things in this order:
- maintenance and protection of licensure
- swift reimbursement for services
- peer review
- consistent employment
- helping patients
That's far, far less true than his list.
I'd actually disagree on that one. One thing I'll never knock doctors for is how many hours per week they work and take call.
Most I know work, on average, 60 hours a week, and do so at all kinds of random hours. One day a doctor will work a 7a-7p shift, two days later he's working 7p-7a. There are several reasons I didn't go to medical school as my family expected, and one of them was looking at doctors' lifestyles. It's the textbook example of having a ton of money to spend and no time to spend it.
You forgot the 7a-7a
But seriously: Most doctors don't play golf, and many are workaholics for whom "leisure time" is an imposition foisted on them between calls.
I will confirm this. Even when my parents started in private practice in Australia, they started out working 8am-7pm 7-days a week.
Doctors work fucking hard either out of habit, necessity or enablement, I may never know.
It's one of the few hourly-wage jobs where you can make a shit-ton of money. I figure that's the primary impetus right there.
As well, you don't work for anyone but yourself, so you can do rotations at several hospitals at once. Most specialists in urban areas have attending and consulting privileges at at least four or five hospitals.
Pretty much what I knew, though I have to give allowance for other motivations outside my 2nd hand experience of the field. The ability to continue working for more money is one of the primary benefits of the "high earning" professions really - the hourly rate sucks, but the potential for continued profit is the benefit.
Except that most doctors don't seem to view it that way. Many of them see their situation and go, "Damn, I gotta work 80 hours a week to pay off my hundreds of thousands of dollars in student loans. But if I pay them off and STILL work 80 hours a week? Boom."
No shit: I know an ER doctor who owns a 10,000 sq.ft. house in a fairly pricey part of Dallas. He works at least 80 hours a week to maintain it. 80 hours a week means that, after sleeping, you have approximately 4 hours to yourself everyday to eat, dress, bathe, and do anything else.
But then, dad was one of those who while working for the 'free' clinic at the beach would gladly accept fresh fish from the Islanders in exchange for medical services. They didn't have the money to pay, but they had fish from the Bay, pulled in that morning. And he had no problem taking the medicaid, medicare, illegals, whatever. Still really doesn't. He's one of the physicians who's of the opinion 'if you're hurt, i'll take care of you the best I can'. Legal, Illegal, Poor, whatever, a hurt person is still a hurt person.
I love my dad. I hate his hours that he works, and I'm getting worried about his health and the effect of all this on him, but he does good work for good reasons.
And arizona sucks.
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Just saying
Because holy shit. I thought 2009 and 2010 were bad, but they have literally lost their godamn minds this year.
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In what context do you mean?
Oh shitz nm I found better cliche.
To put it another way, yes, I realize that the fact that they stand out (due to language and skin tone) is part of the reason why this particular immigrant-hate-fest has bubbled up to claim it's spot among some of the great immigrant-hate-fests that give our country's history such a cheeky irony. But that, in no way whatsoever, makes any point that you think it makes.
To be fair, you were arguing with Hedgie, another guy a lot of us never want to find themselves agreeing with.
but..with transplants, you can only lower it so far. It takes a big deal of very well trained people to pull off.
Female judge tells female sexual assault victim who was again sexually assaulted by the officer that responded to her 911 call that the original sexual assault (and subsequent assault) was her fault because "bars are dangerous."
This female judge was appointed by Jan Brewer (naturally) and is most likely a mormon, so to her drinking in a bar is tantamount to whoring it up. I believe she also mentioned being in a grocery store past 10pm is equally inviting sexual assault.
I remember a sign somewhere at a rally that said "We teach Don't get raped, not Do not rape." And this horrible judge seems to really take that to a stupid place.
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