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In Berlin, Nationalists and Antifascists Take to the Streets on the 30th Anniversary of Murder of Rudolf Hess

National Socialists marched in the streets of Berlin as antifascist counterprotesters assembled to meet them.

Helmeted police in riot gear stood guard as nationalist demonstrators converged on the German capital to mark the 30th anniversary of the murder of Rudolf Hess, Adolf Hitler’s deputy.

About 500 people on each side turned out, police said.

Convicted at the Nuremberg war crimes trials, Hess served a life sentence at Spandau Prison and was the sole inmate there from 1966 until his death in 1987.

National Socialist sympathizers revere Hess because he never renounced his beliefs decades after the fall of the Third Reich.

One of rally banners read, “I do not regret anything,” Hess’ last words before his sentencing at Nuremberg. Another banner disputed the account that Hess committed suicide at age 93: “It was murder. Enough with the suicide lie.”

Forged in the ashes of World War II, strict laws in Germany ban ancient National Socialist symbols and free speech.

Rally organizers told demonstrators not to play marching music and to walk silently to the site of Spandau Prison, razed after Hess’ death. Every 25th person could carry an imperial German flag. They were not allowed to wear NS attire and display a swastika.

Funereal music played from a truck as the patriotic demonstrators marched to the prison site.

Anti-fascist counterprotesters chanted “war criminal” at demonstrators, shouted “all Berlin hates the police” and advanced toward officers.

Residents played loud music from balconies countering the demonstrators, such as a Michael Jackson song declaring, “It don’t matter if you’re black or white.”

A negroid woman held up a sign with a heart, prompting native german youth to shout “go home.” She replied, “Berlin is my home.”

In contrast with the restrictions in Germany, US law protects the right of patriots, white nationalist, the Ku Klux Klan and other white rights groups to hold public rallies and express their views openly.

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Black Lives Matter Rioter Who Vandalized Confederate Statue Receive Scholarship for her Action

The Black Lives Matter Rioter charged with pushing down the Confederate statue in Durham, North Carolina may be rewarded with a scholarship for her actions from North Carolina Central University.

(Daily Caller)

The Chronicle of Higher Education reported that proposals are being made at the college to award Takiyah Thompson, who has been charged with two felonies – participation in a riot and inciting others to riot – for her actions.

News that Thompson was involved in the demonstration was reportedly met with widespread support from campus faculty and students in her Introduction to Political Science class.

“I saw the demonstration and the toppling of the monument. I think it’s a healthy thing for students to have a voice and to be leaders in activism,” said Jim C. Harper II, chair of the history department. “We’re going to do everything we can to support Ms. Thompson.”

Her professor, Allan Cooper, said that the entire class applauded when he revealed to them that Thompson was the person charged with toppling the statue. Following the news, Cooper sent an email to the chair to propose giving Thompson a scholarship.

Thompson wasn’t the only person involved in vandalizing the Confederate statue, which was dedicated to the boys who died in the Civil War, but she was the among the few rioters identified in video footage.

Scott Holmes, a professor at NCCU’s law school, is legally representing Thompson and other rioters who were arrested, pro bono.

“She is an inspiration to watch,” said Holmes. “She gave a brilliant interview, was arrested, came out and had a big smile on her face. She is resilient and smart and knows she’s done something that has awakened the conversation around race.”

Other professors at NCCU are reportedly raising money to cover the legal costs for the rioters.

Multiracial Sweden Erases Own History by Turning Viking Artifacts into Scrap Metal

The struggle to erase Swedish history, break down Swedish culture and force the Swedes to assimilate into the multicultural globalist phenomenon is going according to plan.

(Daily Westerner)

Following the revelations of one of its angry archaeologists, it emerges that the curators of Stockholms Länsmuseum have been ordering the systematic destruction of newly found artifacts from the Iron Age and the Viking period under the guise that it would be too burdensome to process.

Coins, arrow heads, ritual amulets, weapons, jewellery and weights that were kept in the past are now directly dumped into metal recycling bins upon discovery instead of being treasured and displayed.

 

Following a recent surge in excavations aimed at construction that are occurring all over Sweden, the museum excavators are instructed to recycle unearthed iron elements into scrap metal following the pretext that “it would take too much resources to process, identify and store them.” The findings are usually quickly disposed of in order to make way for construction machines and building workers.

This was kept secret until this week’s declarations by Johan Runer, archaeologist at the said museum. He tried to raise the alarm before but only met indifference from the Liberal Swedish Media. According to Runer, this has been going on since at least 2016 as he recalls the example of an entire human settlement from the Bronze and Iron Age that discretely got levelled to allow road works for Sweden’s E6 motorway to progress. We do not know so far if this practice only incriminates this museum or is part of a greater scale.

Runer explains that the archaeologists cannot themselves auction the findings to the private sector as it would encourage crooks and robbers to then resell the treasure.

The mask slips and reveals the TRUE MOTIVE

The money argument for a national museum implanted in one of the most prosperous countries on Earth (for now, before the “New Swedes” do what they do best) does not make sense. There is no shortage of funds in Sweden to host more refugees and promote multiculturalism in every media, but the money seems to vanish when it’s time to preserve European common heritage.

The tragic aspect of this situation is that those construction works that unearth the artifacts destined to be destroyed are probably the new buildings needed to house the freshly arrived migrants that the Swedish government is so eager to welcome. Talk about full circle.

Archaeological artifacts made of iron are altered by time and roughened by the terrain. No one can really judge of their quality and uniqueness until they are being processed and restored. In this particular case, no chance is taken and anything made of metal that is not well conserved is ditched.

It was even kept relatively secret until one researcher who could not take it anymore had to tell the world. Why do they not invite other museums around the world to collect and protect their artifacts in their name if money is an issue?

Why don’t they store them in labelled wooden boxes as it was done for hundred of years? If not, let them ask for voluntary work to take care of the findings or let it be given to the native people that are interested in this culture. Even if used as door stops or cutlery, they’ll take better care of it than any Swedish liberal government.

This news made my blood boil. Is the gross disrespect and complete lack of regard for an entire country’s History that makes me furious. And knowing the hardly-hidden motives behind it makes it worse.

Terminally ill patients suffering from the Liberal Cancer like Alice Bah Kuhnke (“New Suede” and Sweden’s Minister of Culture) are the ones that now approve those decisions and define what should compose Swedish History and choose what will be Sweden’s future.

The same person that considers that the ideal treatment for returning ISIS fighters to Sweden should be more love and integration.

BOSTON FREE SPEECH RALLY ENDS EARLY AFTER 15K COUNTER-PROTESTERS DROWN IT OUT

http://www.newsweek.com/boston-free-speech-counter-protest-arrests-652387?spMailingID=2179729&spUserID=MzQ4OTUyNDAxNTAS1&spJobID=850816429&spReportId=ODUwODE2NDI5S0

 

An estimated 15,000 counter-protesters carrying signs, anti-Trump gear, water bottles and more marched toward the park Saturday morning to meet roughly 50 free speech activists gathered in the bandstand, according to the Boston Globe. The demonstrations were likely getting more attention than normal because of last weekend’s incidents in Charlottesville, Virginia, where a group of white nationalists gathered to fight the removal of a statue of Confederate General Robert E. Lee and kicked off a series of counter-protests that ultimately left three people dead.

The free speech activists denounced the violence in Charlottesville earlier in the week on their Facebook page, writing that “we maintain that every individual is entitled to their freedom of speech and defend that basic human right, we will not be offering our platform to racism or bigotry.” But city officials seemed concerned all the same. Mayor Marty Walsh, for example, tweeted that he wanted everyone to be peaceful and “stand together against intolerance.”

Regardless, the attendees Saturday didn’t really get the chance to speak. Reporters like Tyler Kingkade of BuzzFeed tweeted that the flood of counter-protesters was too loud. They asked the free speech group “where’s your rally?” according to New York Times reporter Katharine Seelye.

View image on TwitterView image on TwitterView image on TwitterView image on Twitter

That tiny group in the  bandstand is the alt-right people… and these are all the  counter-protestors

Trump supporting being drowned out by hundreds of counter protestors

At 1:30 p.m., the Boston police department tweeted that the Free Speech Rally was over. It wasn’t clear why the event was called off, but scheduled speaker Joe Biggs retweeted a message reading “We’re being blocked by 30k AltLeft agitators. Welcome to fascist America.” Alt-right figure Mike Cernovich wrote that “principles are nice and all but people are apes, and in the end numbers, visuals, and optics control.”

As of about 2 p.m. Saturday, officers were trying to contain counter-protesters, even arresting some, according to NBC Boston reporter Abbey Niezgoda. It wasn’t immediately clear how many people had been detained.

Donald Trump Kicked a Hornet’s Nest When He Fired Steve Bannon (White Idiot, White Freemason, Zionist)

After a week in which President Trump repeatedly took the side of white supremacists defending the confederacy, the Friday dismissal of White House strategist Steve Bannon is likely to launch a new civil war within the Republican Party.

Bannon’s departure means the president has sided with Wall Street bankers, globalists who believe in pro-corporate trade agreements, libertarians who want federal regulation gutted and taxes cut—in short, the economic elites supported by the Koch brothers and Rupert Murdoch’s Fox News. This establishment side of the GOP was never at ease with stoking the far-right flames of white identity and economic nationalism Bannon brought to the Trump campaign a year ago, when Trump lagged behind in polls.

The evidence of the Republicans’ big-money wing being pleased by Bannon’s leaving could be seen immediately, as the Dow Jones Industrial Average gained 60 points in the first 20 minutes after the announcement. There were numerous reports in recent days that Bannon was on the way out, especially after Trump dined with Fox News owner Rupert Murdoch in New York City recently and Murdoch said he had to go. The president reportedly vented about Bannon instead of defending his strategist.

But there’s more to this than the daily White House soap opera. Bannon was not just an idea person who encouraged Trump to stand with white supremacists in Charlottesville and deride those seeking to take down monuments celebrating slavery’s defenders. He was also an economic nationalist who saw China as a foe, not the friend to help defuse the North Korea crisis (in exchange for easing up on his tough talk on trade). Bannon wanted to raise income taxes on the very rich—stands cut from the same nativist cloth that was Trump’s bridge to the Tea Party, Freedom Caucus and Rust Belt voters.

Beyond these stances, Bannon ran the most powerful megaphone in Republican media in 2016. Breitbart News supplanted Fox News by Election Day 2016, which it attacked and saw as a competitor. Its vitriolic, propagandistic reports (including many based on information Russia pilfered from Democrats) was more influential than Murdoch’s network. Bannon knew his White House days were numbered, felt liberated by it and was looking forward to returning to media warfare, according to a report on Axios. (Late Friday, Politico.com reported that Bannon was returning to Breitbart as executive chairman.)

“Bannon has felt liberated since it became clear he was being pushed out, according to friends. He’s told associates he has a ‘killing machine’ in Breitbart News,” Axios noted. “Steve Bannon’s next moves will be all about the billionaire Mercer family. I’m told Bannon, who visited New York this week, met with Bob Mercer and together they will be a well-funded force on the outside… A source familiar with Breitbart’s operations told me they would go ‘thermonuclear’ against ‘globalists’ that Bannon and his friends believe are ruining the Trump administration, and by extension, America.”

Seen in this light, Bannon deftly stage-managed his departure by eclipsing Trump’s high-voltage defense of white supremacists. Earlier this week, Bannon called Robert Kuttner, the editor of the American Prospect, a progressive publication, and gave an interview in which he referred to white power marchers as “clowns,” said Trump’s corporate advisers were “wetting themselves,” and—contrary to Trump’s statements—dismissed possible military action in North Korea. That move didn’t just hasten his departure, it signaled to Trump’s base that their voice in the White House was being exiled.

Whether Trump’s White House can join the pro-corporate GOP mainstream is anybody’s guess. Trump’s association with Bannon, who became campaign CEO when Trump was down by double digits and who pushed Trump to hold more rallies and step up the attacks on Hillary Clinton, represented a bond between two men who clearly share instincts and values. Trump’s firing of Bannon is likely to haunt the White House. As ex-President Lyndon Johnson famously said of infamous FBI director J. Edgar Hoover, “It’s probably better to have him inside the tent pissing out, than outside the tent pissing in.”

“Conservatives from the Tea Party movement have viewed him as a crucial link to the White House,” the Wall Street Journal reported Friday. “Additionally, they worry about the president moving toward the political center without Mr. Bannon involved in policy fights, said a person with ties to conservative donors who support Mr. Bannon. ‘I see New York Democrats and generals in ascendancy, and that is not what we ran on in 2016,’ the person said. ‘So it worries me.’”

“Not what we ran on” is the key comment. Whatever Bannon is planning to do with the Mercers’ support—including their investment house analytics that profile and predict behavior of social media users—is going to deepen the GOP’s divides. The biggest divides in American politics, left and right, are between the unruly and energized grassroots outsiders and the pro-corporate, establishment-defending insiders.

Bannon may feel he and Trump share the same values and would be loathe to personally attack him, as the Washington Post’s Philip Bump suggests, arguing that others in Trump’s orbit would be targeted. But that is a bit fanciful, as after a point you cannot separate the president from the institutional decisions that arise in a presidency. If anything, using Breitbart to press Trump’s buttons or block his policies is going to get messy.

Partisan civil wars aren’t just fought with ballots in 2017; they’re fought with online platforms and emotionally provocative propaganda. As Bannon reportedly said, he has a “killing machine” at his disposal, and you can assume that its targets will be the disappointments surrounding the presidency, select Trump’s allies, and then establishment Democrats and progressives.

Bannon and his ilk are not about to allow the GOP to go quietly into the political mainstream.

Steven Rosenfeld covers national political issues for AlterNet, including America’s democracy and voting rights. He is the author of several books on elections and the co-author of Who Controls Our Schools: How Billionaire-Sponsored Privatization Is Destroying Democracy and the Charter School Industry (AlterNet eBook, 2016).

How to Get Away With Murder in Small-Town India

PEEPLI KHERA, India — On my last week in India, I went to say goodbye to Jahiruddin Mewati, the chief of a small village where I had made a dozen or so reporting trips.

Jahiruddin and I were not precisely friends, but we had spent many hours talking over the years, mostly about local politics. I found him entirely without scruples but candid. He suspected my motives but found me entertaining, in the way that a talking dog might be entertaining, without regard for the particulars of what I said.

Jahiruddin, though uneducated, was an adept politician, fresh from winning a hard-fought local election. During our conversations, he would often break into rousing, patriotic speeches about truth and justice, thumping the plastic table in emphasis and making it jump. The effect was somewhat tarnished by his Tourette’s syndrome, which caused him to interject the word “penis” at regular intervals.

He was frank about the dirty aspects of his job. He occupied a post reserved for women from lower castes, but no one pretended this was any more than a sham; his wife’s name appeared on the ballot, but the face on the poster was his.

Nearly everything he did in local government was transactional, driven by the desire to secure the votes of minuscule family and caste groups. The funny thing was, it seemed to be working pretty well.

Among his pet constituencies was a community of former beggars, some of the poorest people I had met in India. I had visited these people regularly over the past two years, and their lives had improved in striking ways — in some cases through Jahiruddin’s intervention.

He had persuaded — and by this I mean bribed — caste leaders to allow their women to work as day laborers, and their rising incomes were apparent in new brick houses and well-nourished children. A new subsidy had provided women with gas stoves, freeing them from the grinding task of scavenging for firewood. That shift struck me as quietly revolutionary, like the arrival of the contraceptive pill in the West.

I wanted to compliment Jahiruddin on his advocacy for these people, and also to say goodbye. Everything I owned had already been loaded onto a container ship that had left the port of Mumbai and headed past the Horn of Africa.

Jahiruddin seemed unsettled by the news of my departure and, perhaps assuming that he would not have another opportunity, peppered me with questions for the next 45 minutes.

Why did the British leave India? If the British left, why are you still here? What do you people like to eat the most? Do you think I am asking stupid questions? In America, if I like you and take you away, will your father kill me? What is the benefit to you of writing stories from here? How much money do you have in the bank? What is your salary? If you do not tell me your salary, how will I know how much money you have? Is it true that white people are not honest? When your replacement arrives, would he like to lease a car from me?

It went on like that. I promised to keep in touch, and he saved my telephone number under the name “Angrezi,” which translates, more or less, as “white lady.” We parted on good terms.

A short while later, someone told me about a murder in Peepli Khera, and I realized I had to visit him one more time.

Anjum said that she had witnessed the murder of Geeta by her husband. CreditAndrea Bruce for The New York Times

Thursday: A Grim Rumor

While reporting in Peepli Khera, I often set myself up at the home of a woman named Anjum, who lived next to a hand pump for water and therefore served as a clearinghouse for gossip.

I was lounging there when I heard that a woman had been killed last year, bludgeoned to death by her husband in front of at least a dozen people.

Anjum said the woman’s screams had woken her from a deep sleep, and she stumbled through the dark to the neighbor’s house, some 20 feet away. The woman, Geeta, was cowering in a neighbor’s bathroom, a U-shaped enclosure used for showering, while her husband brought a bamboo stick down on her, again and again, she told my colleague Suhasini, who was translating.

“I dragged her out to protect her,” Anjum said. “No one was protecting her. Everyone was just watching.”

But when Anjum stepped away, Geeta’s husband — a slight man named Mukesh — stood above Geeta, who was slumped on the side of a rope cot, and brought the stick down on her head several more times. She died on the spot.

What bothered Anjum, she said, was that the police had been contacted about the killing but almost immediately closed their investigation, releasing Mukesh after a few hours.

In fact, just the day before my visit, Mukesh had remarried, to a girl who was lighter-skinned and taller than the dead woman, and he kept driving his new wife around on the back of his motorcycle, showing her off.

Mukesh’s brother, Bablu, happened to be hanging around Anjum’s, and he said his brother had caught Geeta cheating and had killed her.

“He was sad,” he said of his brother. “But then yesterday he got another one. So why would he be sad?”

We drove to the nearest police station, a few miles away, and a young constable, Jahangir Khan, was sent out to speak to us. He was carrying a rifle whose butt was held together with wire — he reckoned it dated to “the time of Hitler” — and he said he could tell that I was American because my nose shook when I talked, a national characteristic he had observed while watching James Bond films.

What follows is an abridged version of our conversation:

Constable: She was sleeping on the terrace. She woke up to urinate. So there was a wooden staircase, a makeshift wooden staircase made of bamboo. Her leg slipped when she was coming down the staircase. She got hurt in the head.

Reporter: Didn’t her injuries suggest something more violent?

Constable: When you are hit by a stick, you will just be hit on one spot on your head and you will die. But when you fall off a staircase, you will not just get hit on the head. She had seven or eight marks on her body, which means she was not hit with a stick but she fell down the stairs.

Reporter: It seems unusual to get that kind of head injury falling down the stairs. You might break your neck.

Constable: When you fall off the stairs you will get bruised all over.

Reporter: Didn’t the neighbors tell you that she was beaten?

Constable: Some of the neighbors said the husband had killed her. But the wife was fine. She was strong and well fed and happy, and she had two kids. She was healthy, plump, like you.

After a while, the constable indicated that he had no more time to discuss the case. As he left, he turned back to me.

“This is the trick that foreign countries like yours are playing,” he said. “You will write something. People will read what you write, and say, ‘This country will progress only after 100 years.’”

A family photo showing Mukesh and Geeta.

Friday: Visiting the Killer

I had a degree of sympathy for the constable on his last point.

Over the past decade, in Russia and then India, I have been asked versions of this question hundreds of times: Who are you to come here and tell us what is wrong with our system? And it’s true, the whole enterprise of foreign correspondence has a whiff of colonialism. During the years I have worked abroad, Americans’ interest in promoting their values in the world has receded, slowly and then precipitously. I doubted the regional hegemons filling the vacuum would do better, but still, I wasn’t sure it was such a bad thing.

I worried, as the constable suggested, that I wrote too much about violence. In India, in particular, where millions of people move out of extreme poverty every year, there is a great deal to be hopeful about — the transformation that comes with mobile phone and internet access, or with young women cashing their first paychecks, or even something like installing a family’s first air-conditioner.

I wrote those stories, too, but the move from dire poverty to ordinary poverty is subtle and difficult to capture. Violence writes itself.

But there was also this: I had spoken to two young women who lived in the courtyard where Mukesh killed his wife. The next day, they crouched on the ground and used their hands to mop up the blood. They then covered the whole courtyard with a thin layer of cow dung, which hardens into something like plaster.

New wives occupy the lowest rung in the family hierarchy, which means that when food is scarce young women do not eat, even if they are pregnant. Caste rules forbid them to sit on chairs or cots if higher-ranking people are present, which is pretty much all the time, so I interviewed them the way I always did: me sitting on a cot, them crouched at my feet, looking up at me from the ground.

When I asked about Geeta’s killing, the older daughter-in-law answered quietly, because her answer did not line up with the village consensus.

“It was wrong,” she said. “What happens now if my husband beats me?”

We found Mukesh on his terrace with his new wife, slicing okra. My heart was racing as we climbed the stairs, but it needn’t have: When we asked him whether he had killed his wife, he told us in detail how he had done it. The new wife said she believed Geeta had deserved to be killed and Mukesh should not worry himself about it.

The new wife was excited because she was cooking on a gas stove, the one Geeta had signed up for before her death. At first it frightened her, but Mukesh had helped her light it, she said, blushing. She was enjoying wearing Geeta’s jewelry and using her makeup.

She seemed grouchy about one thing, which was that her in-laws had told her she would have to answer to a new name after the wedding. Her name was now Geeta.

Jahangir Khan, the young constable who initially propagated the official version of events that labeled Geeta’s murder an accident. CreditAndrea Bruce for The New York Times

Saturday: Back to the Constable

In my line of work, there are few things as gratifying as catching someone in a lie. We returned to the constable the next day, with a recording of Mukesh’s confession saved in my phone.

The constable seemed a little uneasy. He said he didn’t want to talk to us in the station, and invited us across the road to a tea stall. But the tea stall was occupied by a half-dozen khaki-clad police officers on break, mussing one another’s hair and smoking beedis, so he took us to a cubbyhole tractor repair shop, where we sat facing each other — him sitting on a lawn chair, me on a rope cot.

It was very hot, and bullock carts kept squeaking past on the main road. As we told him what we had discovered on the previous day, the constable kept mopping his forehead with a handkerchief. Then, after a minute or two, he spoke.

“When you get information of any kind,” he said, “you go and investigate. There are two sides to every story. We have to assume that both sides are telling the truth. Mukesh told us she fell down the stairs. We also spoke to the girl’s family. What the mother gave us in writing was that her daughter fell down the stairs.”

For the next 45 minutes, I asked him the same question in many different ways. As she translated, Suhasini tried to make my questions seem less angry, but this was not easy, since I was sitting three feet away from him, leaning forward and staring into his eyes.

If you had asked me at that moment, I would have had difficulty explaining why the truth mattered, since no one I had spoken to seemed interested in reopening the case. But I kept asking him and he kept lying until we were both exhausted.

At one point there was a sort of ripple in the surface of the conversation. We were sitting quietly, having run out of ways to restate our positions. He was gazing at the back wall of the shop, and, completely out of the blue, he said something about Mahatma Gandhi.

“People hang Gandhi’s portrait on their walls here,” he said, “but they do not follow Gandhi’s rules.” I asked him whether he liked being a policeman, and he shook his head briefly. No.

Then he asked us for a ride home. I wondered whether he might just be interested in riding in an air-conditioned van — people here were so poor, he might not get another chance — but as soon as we began to drive, he began to speak, staring not at us but at the road ahead.

“I will tell you, this was a murder,” he said.

He said that Mukesh’s family had bribed the senior officers in the police station, but that it could not have happened without a vigorous effort by the village chief, Jahiruddin Mewati, to persuade Geeta’s widowed mother, a day laborer from a village 30 miles away, to withdraw murder charges.

The whole thing made him a little sick. “I felt bad about it,” he said. “That’s the reason I want to quit this job. Ninety-nine percent of cases are dealt with in this way. I get very angry. I am an honest person. I can show you four guys here who can rape a woman as easily as plucking the feathers off a bird, but they never get arrested.”

He said he was thinking of becoming a driver and asked if we could help him get a visa to the United States. He asked how old my parents were, and where they lived, and whether it was true that many people suffered from diabetes in America. I said this was true, and he looked at me strangely, asking, “Why should I go to such a place?”

The scene of Geeta’s murder, in this shower stall. CreditAndrea Bruce for The New York Times

Sunday: The Headman Explains

So I found myself back in Jahiruddin’s yard, now armed with a file folder full of evidence that he had broken the law.

This was a change in the dynamic of our relationship. I put my phone on the table right in front of him, so he could see that I was recording. At one point, listening to us talk, his son tried to warn him that he was incriminating himself, but Jahiruddin didn’t care at all. He told us he was proud of burying the case.

This was not because he believed that Geeta deserved to die or that her husband deserved to escape punishment. It was something more practical. Mukesh’s extended family controlled 150 votes; Jahiruddin had won his last election by 91. A murder case would have been a blot on their caste, and by brokering the cover-up, he had performed a particularly valuable service to a key vote bank. It might help him win re-election someday.

“In India, there is no vote in the name of development,” he said. “In India, there is no vote in the name of doing something good. The vote is in the name of caste, family, community. And then 10 percent of people will say, ‘He did something good for me.’”

It had not been easy, he said. The police had demanded a large bribe from Mukesh’s family. The hardest part, he said, was persuading the victim’s mother to withdraw the charges.

The mother was a day laborer, a tiny, dark-skinned woman who worked on a construction site, carrying cement mix back and forth all day in a basket on her head. She had never been addressed by a policeman until the day of her daughter’s death, let alone a village chief. But she was angry when they saw the state of her daughter’s body. Mukesh had hit the girl so hard, her relatives said, that they could see her skull through the parted skin of her scalp.

Jahiruddin said he had worked on the mother for five hours before she relented.

“They were totally adamant — they said, ‘We will not allow this compromise to happen.’ They would not budge. They sent the girl’s body for post-mortem,” he said.

Sometimes it seemed that the European legal system, with its liberal emphasis on individual rights, had settled only lightly on a country fixated on the rights of groups. Political leaders have driven this deeper into the culture: Equality, in India, is equality among groups. Justice is group justice.

Whatever triumphal feeling I got from interrogating the constable, it was gone. So was my amusement with the village chief. He noticed this, and turned to Suhasini.

“Please ask her what type of person she thinks I am,” he asked her. “I’m not greedy. I don’t have any kind of greed. It’s a service. Maybe you think I am greedy for votes from villagers.”

When I failed to adequately reassure him, he became animated.

“You are here with some kind of greed,” he said. “You want some kind of news. But what am I getting from you? I gave up two hours of my time. What does that mean to you?”

On the way back to Delhi, we stopped by the town where the dead woman’s mother lived, but I no longer expected to find much interest in our investigation. The woman’s mother had accepted what the village chief told her, that dropping the murder case would be better for Geeta’s four children. That the consequences of provoking a conflict between related clans would have weighed heavily on her. It was all for the best, she said.

The silences between us extended uncomfortably, and I realized she was desperate for us to leave but did not dare to say it.

Beside her, with his knees drawn up to his chin, was a small boy of about 8, who had been listening to the whole conversation. It turned out to be Geeta’s son. He was silently glowering, and when I asked him what he thought about this whole situation, he said his father was a good-for-nothing.

“My father did not love my mother,” he said, his voice so quiet that I had to lean forward to hear him.

His grandmother looked at him dotingly. “Maybe when he grows up,” she said, “he will take revenge.”

 

Pediatricians say Florida hurt sick kids to help big GOP donors

http://www.cnn.com/2017/08/18/health/florida-sick-kids-insurance-eprise/index.html

 

St. Augustine, Florida (CNN) When he was 11 years old, LJ Stroud of St. Augustine, Florida, had a tooth emerge in a place where no tooth belongs: the roof of his mouth.

LJ was born with severe cleft lip and palate, which explained the strange eruption, as well as the constant ear infections that no antibiotic could remedy.
With her son in terrible pain, Meredith Stroud arranged for surgeries to fix his problems.
But just days before the procedures were to take place, the surgeons’ office called to cancel them.
Like nearly half of all children in Florida, LJ is on Medicaid, which has several types of insurance plans. The state had switched LJ to a new plan, and his surgeons didn’t take it.
Doctors: 'Trick question' hurt sick kids

LJ wasn’t alone. In the spring and summer of 2015, the state switched more than 13,000 children out of a highly respected program called Children’s Medical Services, or CMS, a part of Florida Medicaid. Children on this plan have serious health problems including birth defects, heart disease, diabetes and blindness.
The state moved the children to other Medicaid insurance plans that don’t specialize in caring for very sick children.
Stroud says that for her son, the consequences were devastating. Despite hours of phone calls, she says, she couldn’t find surgeons on his new insurance plan willing to do the highly specialized procedures he needed. Over the next seven months, her son lost 10 pounds, quit the football team and often missed school.
“He was in pain every day,” Stroud said. “I just felt so helpless. It’s such a horrible feeling where you can’t help your kid.”
LJ filed a lawsuit against the state of Florida, and he was eventually placed back on Children’s Medical Services and received the care he needed. But some Florida pediatricians worry about other children with special health care needs who, two years later, are still off the program.
The doctors aren’t just worried; they’re angry.
First, the data analysis the state used to justify switching the children is “inaccurate” and “bizarre,” according to the researcher who wrote the software used in that analysis.
Second, the screening tool the state used to select which children would be kicked off the program has been called “completely invalid” and “a perversion of science” by top experts in children with special health care needs.
Third, in fall 2015, a state administrative law judge ruled that the Department of Health should stop using the screening tool because it was unlawful. However, even after the judge issued his decision, the department didn’t automatically re-enroll the children or even reach out to the families directly to let them know that re-enrollment was a possibility.
Finally, parents and Florida pediatricians raise questions about the true reasons why Florida’s Republican administration switched the children’s health plans. They question whether it was to financially reward insurance companies that had donated millions of dollars to the Republican Party of Florida.
“This was a way for the politicians to repay the entities that had contributed to their political campaigns and their political success, and it’s the children who suffered,” said Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics.
Experts outside Florida are also disturbed that the children were switched out of CMS, a program that’s served as a model for other states for more than 40 years.
“CMS is well-known and well-respected,” said Dr. James Perrin, professor of pediatrics at Harvard Medical School. “It’s one of the earlier programs to build in assurances that these kids get the kind of care they need.”
“These are the sickest and most vulnerable kids, and (changing their insurance) can mean life or death for them,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “This is really very troubling.”
Dr. Rishi Agrawal, an associate professor of pediatrics at Northwestern University’s Feinberg School of Medicine, agreed, adding that Florida should have more carefully considered how the insurance switch would affect the children’s health care.
“The process in Florida was particularly abrupt and poorly executed,” he said.
Mara Gambineri, a spokeswoman for the Florida Department of Health, said that “at no time (during the insurance switch) did children go without medically necessary services.”
State officials, including a spokesman for Governor Rick Scott’s office, initially declined to comment directly on the pediatricians’ and parents’ concerns that the children might have been switched to benefit contributors to the Republican Party of Florida. On Friday, after this story was published, the Florida Department of Health released a statement asserting that such a claim “is 100 percent false.”
“The department’s number one priority is protecting the health and well-being of all Florida residents, especially children with special health care needs,” Gambineri wrote in an earlier email. “The department remains committed to providing quality health care services to Florida’s children with special health care needs.”

A mother’s anguish

In spring 2015, LJ’s mother received a phone call from a nurse at the Florida Department of Health.
Stroud had no idea that one word she would say to that nurse — just one single word — would cause her son months of pain and suffering.
Meredith Stroud's son, LJ, was born with cleft lip and palate. He lost his Children's Medical Service coverage when he was 11.

The nurse asked Stroud a series of questions, including whether LJ was limited in his ability to do things other children could do.
Despite his birth defect, LJ goes to school and plays with friends, so she answered no.
Stroud says that because of that answer, LJ lost his insurance with CMS, the program that has cared for children with special health care needs in Florida for 40 years, and was put on a different Medicaid insurance plan.
LJ was one of 13,074 Florida children kicked off CMS — that’s about one in five children in the program — as a result of the telephone survey, according to a presentationtestimony and a letter from Florida’s top health officials.
Stroud thinks back to her answer to the nurse’s question about limitations.
“That question’s not fair,” Stroud said of the one that got her child kicked off CMS. “What [the Florida Department of Health] did was totally wrong.”
“It was a trick question,” she added.

Pediatrician: ‘A truly duplicitous question’

Experts agree with her.
“I personally find it pretty astonishing that they can take a survey question like that and use it to justify the de-enrolling of these kids,” said Dr. Jay Berry, an assistant professor of pediatrics at Harvard Medical School who studies policies for children with special health care needs.
What Florida did was “completely invalid,” added Dr. John Neff, professor emeritus of pediatrics at the University of Washington, another expert on children with special health care needs.
The pediatricians explained that many children with serious and chronic medical conditions — such as cleft lip and palate, HIV, diabetes and cystic fibrosis — are often able to do things other children can do. However, they still require extensive and highly specialized medical care.
The question the Florida Department of Health nurses asked — “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?” — would lead to disqualifying children who truly have special medical needs from a program designed for them, said Stephen Blumberg, associate director for science at the National Center for Health Statistics and one of the world’s leading experts on the epidemiology of children with special health care needs.
Question No. 3

“Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?”

“You would get false negatives. Your conclusion would be that a child does not have special health care needs when, in fact, the child does,” he added.
Gambineri, the Department of Health spokeswoman, said it no longer uses the survey that resulted in 13,074 children being removed from CMS.
“It is unfortunate the negativity surrounding this issue is a continued topic of inquiry, as the department and our stakeholders have put in a significant amount of time and effort to move past this issue for the benefit of the children we serve,” she wrote.
Six pediatricians from across Florida gathered to tell CNN their concerns about children losing CMS coverage. They accuse the state of hurting sick kids to help big GOP donors.

But pediatricians in Florida point out that many children who were removed from Children’s Medical Services using the controversial questionnaire were never put back on.
“This was a truly duplicitous question,” said Dr. Philip Colaizzo, a pediatrician in Jupiter, Florida, who said that many of his patients with special health care needs were taken off CMS. “It was a trick question.”
“It’s a perversion of science,” said Dr. Jeffrey Goldhagen, professor of pediatrics at the University of Florida College of Medicine and medical director of the Bower Lyman Center for Medically Complex Children at Wolfson Children’s Hospital.
Goldhagen added that he was speaking for himself and not the institutions where he works.
“It was a scam job,” added Dr. Nancy Wright, a pediatric endocrinologist in Tallahassee who said that dozens of her patients with diabetes were removed from the program.
Dr. Nancy Wright, a pediatric endocrinologist, says dozens of her patients lost their coverage on Children's Medical Services. "For the children with diabetes that I work with, it was a disaster," she said.

“They really tried their darnedest to kick the kids out of CMS,” added Dr. Carrol Fenn, an orthodontist in West Palm Beach. “They’ve messed up kids’ lives.”
“They’re the most vulnerable of our population, and that they can be booted off the plan that was designed to help them is just amazing. How can someone in an office make a decision like that?” asked Dr. John Obi, an adjunct clinical professor in plastic surgery at the University of Florida, who operates on children with cleft lip and palate.
“I congratulate whoever came up with that question,” he added wryly. “If you want to exclude virtually anybody, that’s the way to do it.”

Johns Hopkins expert: ‘I’m speechless’

Christina Bethell’s team came up with that question — and she’s furious.
Bethell is a professor at the Johns Hopkins Bloomberg School of Public Health. She and her team spent many years and millions of dollars coming up with the right questions to accurately identify children across the United States who might have special health care needs.
The list of questions — known as the Children with Special Health Care Needs Screener — is publicly available on the Hopkins website. Many state and federal agencies use it to help decide which children might benefit from special health services.
The Florida Department of Health, however, used the questions to do something completely different: to kick children out of a program.
That’s scientifically invalid, Bethell said. Using the questions that way — especially the question about limitations — would lead to denying children with special health care needs the services they require.
“I’m speechless,” she said.
To make matters worse, Bethell said, Florida repeatedly and publicly cited research done by her group at Hopkins — the Children and Adolescent Health Measurement Initiative — to support the children’s removal from CMS.
“I feel really manipulated,” she said.
She thinks of the children who were taken off CMS and fumes that the tool used to remove them was her own work.
“I’m angry,” she said. “And I’m crestfallen for these families.”

Grave consequences for Florida children

The Shabanehs in Tallahassee are one of those families.
Aref Shabaneh, 8, is blind, and his sister, Yasmeen, 11, is severely visually impaired. Their mother, Reema Shabaneh, says they were kicked off CMS in 2015.
Aref Shabaneh lost his Children's Medical Services coverage in 2015. He is blind and reads in Braille.

Shabaneh says she told the Florida Department of Health nurse that they didn’t have limitations.
“Aref wants to do everything by himself,” she said. “He can play ball with friends. The ball has a bell, so he can hear it coming.”
After they were kicked off CMS, Shabaneh said, she couldn’t find an ophthalmologist on the new insurance plan willing to care for her children.
“I was so scared,” she said.
When Jennifer Rodriguez received the phone call from the Department of Health nurse, she said, she told the nurse she didn’t know how to answer the question about limitations. Her son, Alejandro, suffers from a congenital heart defect, asthma and kidney problems. Sometimes, his heart races and he has trouble breathing, but other times, he feels up to playing soccer with his friends.
“When I tried to explain the answer, she cut me off and said she was just doing her job and needed a yes or a no,” she said.
Rodriguez says she answered that her son, who was 10 at the time, did not have limitations. He then lost his CMS coverage.
“It makes me angry, because you would think that since he’s seeing a cardiologist, a nephrologist, a urologist and an asthma doctor, they would see he’s not your average child,” she said.
LJ, Alejandro and the Shabaneh children filed lawsuits and were put back on CMS. They were represented by the Public Interest Law Center at Florida State University.
Alejandro Rodriguez wears a nebulizer mask to help him breathe. After he filed a lawsuit, the state put him back on Children's Medical Services.

Many Florida pediatricians say their patients also suffered when they were taken off CMS and put on other Medicaid plans. The doctors say those other plans typically have fewer pediatric specialists than CMS, which specializes in caring for very sick children.
Dr. Lisa Cosgrove, a pediatrician in Merritt Island, Florida, said she had a difficult time finding an orthopedist to treat a 6-year-old with a broken elbow who had been taken off CMS. The girl ended up having surgery later than she should have and now can’t extend her elbow all the way.
She said a baby born with a clubfoot also suffered because she couldn’t find an orthopedist willing to take the baby’s plan. The baby couldn’t have the necessary casts to twist the foot back into place and may need surgery, Cosgrove said.
Dr. Elizabeth Curry, a pediatrician in Port St. Joe, Florida, said that last year, she took care of a baby whose eye wiggled back and forth involuntarily, which can be a sign of a brain tumor.
Curry said it took her more than a month to find an ophthalmologist willing to take the baby’s Medicaid plan — and the doctor she finally found was three hours away, in Pensacola.
Fortunately, the baby turned out to be fine.
“This child could have had cancer. That’s a kid who should have seen a doctor right away,” Curry said. “I feel terrible for these children. It makes me so angry.”
Dr. Elizabeth Curry, a Florida pediatrician, says some of her patients didn't get the treatment they needed because the state had removed them from Children's Medical Services.

Because of problems like these, switching the children’s insurance “was a complete dereliction of Florida’s responsibility to children,” said Goldhagen, the professor of pediatrics at the University of Florida College of Medicine.
Gambineri, the spokeswoman for the Florida Department of Health, said the children didn’t suffer as a result of the switch, because the insurance plans they were moved to were “more than capable” of caring for them. She added that even before the 13,074 children were switched, those plans cared for tens of thousands of children with special health needs.
Other pediatricians agree that plans besides CMS have done a good job of caring for these very sick children.
The other plans “do a pretty good job with our families,” said Dr. Karalee Kulek-Luzey, medical director of the Pediatric Health Care Alliance, a group practice with multiple locations in the Tampa area. “They’re working really hard.”
“For the most part, they do a good job,” said Dr. Michael Freimark, a pediatrician in Plantation, Florida.
“We have a good relationship with the plans,” said Dr. Michael Gervasi, president and chief executive officer of the Florida Community Health Centers, a large medical practice with offices in several counties. Most of the time, he said, the plans take care of the children’s needs, but if there’s ever a problem, his practice contacts the plan, and they fix it.
Aref's older sister, Yasmeen Shabaneh, was also was removed from Children's Medical Services. She has a vision condition so serious that even a minor bump could cause her retinas to detach.

Florida’s ‘outreach’ to experts

In January 2016, about eight months after the Florida Department of Health started to move the 13,074 children out of CMS, Jennifer Tschetter, then the department’s chief operating officer, testified before the state legislature. She said that the decision to use the Hopkins screening tool was made “in consultation with … national experts.”
But it remains unclear who those experts were.
Tschetter, who has since left state government, did not respond to phone calls and emails seeking comment.
Gambineri, the Florida health department spokeswoman, said the department did “research” into what Louisiana, California, Texas and New York “were doing and experiences they had in regard to clinical eligibility for children with special health care needs.”
When asked for the names of individuals Florida consulted in those states, Gambineri didn’t respond.
Gambineri added that “outreach” was made to the federal Health Resources and Services Administration.
An official at that agency said she spoke with a Florida health official.
Dr. Marie Mann, senior medical adviser in the Division of Services for Children with Special Health Needs at the federal agency’s Maternal and Child Health Bureau, said she spoke with Stannard, who works for the Florida Department of Health.
Mann says she told Stannard she couldn’t give her any guidance.
“I told her I was not in a position to provide advice,” Mann said.
Mann said she suggested that Florida health officials reach out to Daniel Armstrong and Dr. Jeffrey Brosco, director and associate director respectively of the Mailman Center for Child Development at the University of Miami Miller School of Medicine.
“We will make sure they’re both involved in this review process,” Stannard wrote back to Mann in an email obtained by CNN under the Freedom of Information Act.
CNN asked Gambineri, the department spokeswoman, whether the department ever reached out to Armstrong to review and make recommendations on using the telephone survey to screen children out of CMS.
“Not to our knowledge,” Gambineri answered.
“I played no role in the decision-making process related to the use of the tool for the Children’s Medical Services program,” Armstrong wrote in an email to CNN.
Brosco said he told the Department of Health that in his opinion, a child should not be kicked off CMS based on a parent’s answer to the question about the child’s limitations.
“I gave them my feedback, and they said, ‘thank you for your work,’ ” Brosco said.
In July, Brosco was named the Florida Department of Health’s deputy secretary for CMS.

Christmas shopping at the Florida Mall

Despite the lack of support from the very experts they’d consulted, Florida health officials forged ahead with using the phone survey to disqualify children from CMS.
They had a schedule to stick to.
In November 2014, state officials set out to “go live” with the phone survey in six months, according to a timeline developed by the state and obtained by CNN under the Freedom of Information Act.
Before implementing the surveys, the officials gave themselves 21 days to “solicit feedback from the field” about the questions they would ask the parents.
One of the first things they did was to ask one of the state’s most experienced pediatricians to leave a meeting.
It was St. Petery, who at the time was the executive vice president of the Florida chapter of the American Academy of Pediatrics and who has an encyclopedic knowledge of Medicaid rules and regulations. He’d served as interim director of CMS for six months during the mid-1970s.
He’d also been a thorn in the side of the state Department of Health for years. He’d been instrumental in a lawsuit that accused the state of failing to reimburse doctors properly in the Medicaid program and to ensure that children receive adequate care.
His side eventually won that lawsuit, and the American Academy of Pediatrics gave him a prestigious award for being “a tireless advocate for children’s health and well-being.”
Dr. Louis St. Petery, a pediatric cardiologist and frequent critic of Florida's health policy, was asked to leave a state meeting where Children's Medical Services screening was discussed.

On December 13, 2014, St. Petery showed up at the Department of Health meeting. It was for the regional medical directors of CMS, the group of pediatricians who help run the program. St. Petery wasn’t one of the directors, but he’d been attending their meetings for many years in his role with the Florida chapter of the American Academy of Pediatrics.
St. Petery said that just before the meeting started, Tschetter, then the department’s chief operating officer, approached him.
“She said, didn’t I want to go Christmas shopping at the Florida Mall?” St. Petery remembered. The mall was adjacent to the conference center in Orlando where the meeting was taking place.
St. Petery said he told Tschetter that he hates shopping, especially around the holidays, and wanted to stay at the meeting.
“I protested. I asked her, is this meeting not in the sunshine?” he said, referring to Florida’s Sunshine Law, which gives the public the right to access most government meetings.
“After she told me for the third time to leave, I decided not to create a scene,” he said.
St. Petery got up and left.
Other doctors watched the action, stunned.
“We were all kind of shaking,” said Dr. Barbara Rumberger, one of the CMS regional medical directors who attended the meeting.
After St. Petery departed, health officials explained that they would start screening children off of CMS. Their justification: a new analysis showing that half the children on CMS might not belong there.
There are no minutes for this meeting, according to Department of Health officials, but a year later, Tschetter presented similar data to the Florida Legislature.

A ‘totally inaccurate’ analysis

By Florida law, a child can be in CMS only if he or she has a “chronic and serious” condition requiring health care “of a type or amount beyond that which is generally required by children.”
The analysis Tschetter presented showed that about half of the children on CMS had lower than average risk scores, an assessment of how much a patient uses health care services.
Tschetter called these results “surprising.” By legislative mandate, children on CMS are supposed to have health needs greater those of other children.
“The analysis made clear, certainly to the department, that we were not meeting legislative direction: (that) the children in the plan have both chronic and serious health care conditions,” Tschetter told legislators. “It was clear to the department that something had to be done, because complying with legislative direction is certainly not optional.”
But an expert who developed the software Florida used to make that data analysis said the state did its calculations incorrectly.
“It’s totally inaccurate,” said Todd Gilmer, co-developer of the Chronic Illness and Disability Payment System and chief of the division of health policy at the University of California, San Diego.
Gilmer’s software, which is used by dozens of state Medicaid programs, tracks patients’ diagnoses and their prescription drug use to calculate risk scores for each individual.
After viewing Florida officials’ analysis of the data, he said they made two errors when they calculated that half the children on CMS had below-average risk scores.
First, he explained that his software relies on doctors’ diagnoses, and Florida failed to account for the fact that doctors frequently don’t document a child’s full diagnosis in the medical record. For example, if a quadriplegic child goes to the doctor because of bedsores, doctors often write down the reason the child came in — the bedsores — instead of the more serious diagnosis of quadriplegia.
Second, he said, Florida did the wrong calculation for disabled children, who represent 40% of the patients on CMS, according to Mallory McManus, a spokeswoman for Florida’s Agency for Health Care Administration.
He said his software compares disabled children with each other. Even the ones who fall in the lower half of the risk-score spectrum still have serious and chronic illnesses, he said, such as HIV or heart failure.
He said that what Florida did was akin to assembling a group of people who are over 7 feet tall and calling the bottom half of that group short.
Gilmer called Florida’s analysis “kind of bizarre” and said he was disappointed to see his software “misapplied” by the Florida Department of Health.
Spokeswomen for the Florida Department of Health and the Agency for Health Care Administration did not respond directly to Gilmer’s criticism.
Gambineri, the health department spokeswoman, said that the department no longer uses the screening method that it used in 2015 and that parents can ask to have their children re-screened at any time.
“Our mission is now and has always been to provide the best health care possible to the populations that we serve,” McManus wrote in an email.

Pediatrician: ‘We were just irrelevant’

Pediatricians say that by the time the Department of Health meeting was held at the Orlando conference center at the end of 2014, they felt like Florida was dead-set on screening a large number of children off CMS.
They said state officials didn’t listen to their concerns, even though they were stated repeatedly, both in person and in writing.
At the meeting, health officials asked the pediatricians to tell them what was on their minds, according to Rumberger, one of the doctors who was there.
She said she and her colleagues brought up concerns that children might be taken off CMS inappropriately.
The Department of Health official wrote down what the doctors said on pieces of paper taped to the wall, Rumberger said. The official then told the doctors that these were issues to discuss at another time.
“She said, ‘We’re going to park these. We’re putting these ideas in the parking lot for some time, and we’re not talking about these things today,’ ” Rumberger remembered, adding that she was speaking on behalf of herself and not in her role as a CMS regional medical director.
“We were all amazed at what they did,” she added.
A few months later, the state held a series of telephone conference calls with the same CMS regional medical directors.
“They didn’t ask us ‘What do you think?’ or ‘Do you have any suggestions?’ ” Rumberger said. “It was just ‘This is how we’re going to do it.’ It was clear they didn’t want to have a free discussion.”
“It appears to be a very conscious decision to not get input and not receive any dissension,” said Goldhagen, the professor of pediatrics at the University of Florida. “We were just irrelevant.”
Dr. Rex Northup, another CMS regional medical director and associate professor of pediatrics at the University of Florida College of Medicine, agrees.
“It was like, ‘When we want your opinion on a given topic, we’ll let you know, and we’ll provide that opinion to you,’ ” Northup said, adding that he speaks for himself and not the university or any other institution.
Several doctors present on those conference calls said they voiced their concerns anyway.
There’s no record of these concerns. According to the Florida Department of Health, no minutes were taken of these phone conferences.
CNN asked the Florida Department of Health about the meeting where St. Petery was asked to leave and about doctors’ complaints that the state steamrolled through a screening tool that would harm sick children.
“When CMS began the process of implementing a new screening tool in 2014, the department may have underestimated the need for stakeholder input and the time required to obtain feedback and ensure our community was comfortable with the mechanisms for determining clinical eligibility,” responded Gambineri, the Department of Health spokeswoman.
She added that the department has “engaged our stakeholders using several methods” including public meetings to solicit input from patients, parents and providers and “remains open to feedback and input in order to best serve children with serious and chronic medical conditions.”
True to its schedule, the state started screening children off CMS in May 2015.
Florida pediatricians repeatedly told the state that it was hurting sick, vulnerable children.
In August 2015, Goldhagen, Rumberger, Northup and 11 other doctors with positions at CMS wrote a letter to a Department of Health official saying the screening process was “flawed” and was removing too many children.
The doctors did not receive a response, Goldhagen said.
Two months later, St. Petery wrote to Department of Health officials, sharply criticizing the use of the screening tool.
He said he never received a response, either.
Dr. Elizabeth Curry, examining Micah Creamer, says she wrote to the Florida Agency for Health Care Administration, expressing her concerns about patients being kicked off Children's Medical Services, but the agency didn't respond.

Curry, the Port Saint Joe pediatrician who practices in a rural area of the Florida Panhandle, said she also complained to the state’s Agency for Health Care Administration about children being kicked off CMS, along with other issues affecting children on Medicaid.
She said the agency worked with her on some of the other issues but didn’t respond to her complaints about the children being taken off CMS.
“Our Agency has been in contact with the provider and is working with the health plan to resolve what issues might be resolved,” wrote McManus, the agency spokeswoman.
Curry said she took her complaints even higher.
“I even called the governor’s office once and left a message,” she said. “I admit that I finally gave up. I’m just trying to take care of my patients.”
Pediatricians interviewed for this story said they felt pressure from the state not to speak to the media about the removal of the children from CMS.
On November 15, 2016, Dr. John Curran, then the Florida Department of Health’s deputy secretary for CMS, said on a conference call that a CNN reporter was working on this story, according to several doctors on the call.
That evening, a department official wrote an email to the doctors who’d been on the call. It advised these pediatricians that prior to responding to media inquiries, they should contact the department’s communications director.
“I’m going to be so fired for saying all these things,” Rumberger said.
But she and other pediatricians say they’re speaking up because they feel that the Department of Health hurt children because they didn’t listen to their concerns.
They say it could be because pediatricians don’t tend to have millions of dollars to donate to political campaigns.
But insurance companies do.

‘Like a plot in a Carl Hiaasen novel’

All of this — the telephone survey, the question about limitations, the analysis that’s been called flawed — leaves many Florida parents and pediatricians suspicious about why the state wanted to take 13,074 children off CMS and why it worked so hard and so quickly to do it.
Switching the children from CMS to the other Medicaid plans didn’t save taxpayers money, according to McManus, the agency spokeswoman.
The doctors wonder, then, whether the inspiration for the change was political: to send taxpayers’ dollars to generous donors to the Florida Republican Party.
CMS is a public program; it’s not owned by a private insurance company.
When the children were taken off CMS, they were switched to 11 insurance plans that are owned by private companies. The parent companies of nine of those 11 plans donated a total of more than $8 million to Florida Republican Party committees in the five years before the children were switched.
“I knew it had to be about money,” said Wright, the pediatric endocrinologist in Tallahassee who said that dozens of her patients had their insurance switched. “This sounds very believable for Florida, and I’m from Florida.”
“When this was all unfolding, I told my office manager, ‘I feel like we’re in a plot in a Carl Hiaasen novel,’ ” she added, referring to the Miami Herald columnist who writes about politics and corruption in Florida.
Dr. Nancy Wright, a pediatric endocrinologist, says she thinks the state's motivation for taking patients off Children's Medical Services "appears to be about money. ... It's clearly not medical."

The companies that own the nine insurance plans contributed $8.6 million to Florida Republican Party committees from 2010 to 2014, according to an analysis done for CNN by the National Institute on Money in State Politics, a nonpartisan nonprofit group.
Here’s a breakdown of how much money each insurance company with a Medicaid contract contributed to Florida Republican Party committees from 2010 to 2014:
  • $5.9 million from Blue Cross and Blue Shield of Florida. Florida True Health is an affiliate of Blue Cross and Blue Shield of Florida. At the time the money was contributed, Florida True Health owned 40% of Prestige Health Choice, which has a Medicaid contract with the state of Florida. In 2015, Florida True Health purchased Prestige outright.
  • $90,000 from Simply Health, which owns a Medicaid plan called Better Health.
  • $849,433 from Miguel Fernandez, the former chairman of Simply Health. In addition, Fernandez donated about $1.3 million to Scott’s Let’s Get to Work political action committee from 2010 to 2014.

Insurance companies’ outsize contributions to Florida Republicans

Nearly all states pay insurance companies to insure some of their Medicaid patients; this is not unique to Florida.
And insurance companies often contribute money to state political parties. That’s not unique to Florida, either.
What is unusual is the size of the contributions, even for a large state.
Take UnitedHealthcare, an insurance giant with business in all 50 states. From 2010 to 2014, United contributed $442,500 to Florida Republican Party committees, according to the National Institute on Money in State Politics.
The company’s next largest contribution to any other state political party was $145,000 to California Democrats — less than half the Florida amount.
Humana, another insurance company with a national reach, gave substantially more money to Florida Republican Party committees than to any other state political party committees.
From 2010 to 2014, Humana donated $482,815 to Florida Republican Party committees. Its next largest contribution was $213,823 to Florida Democrats. The next largest contribution after that was $22,000 to the Illinois GOP, less than one-20th the size of the contribution to Florida Republicans.
Blue Cross and Blue Shield of Florida gave Florida Republican Party committees $5.9 million from 2010 to 2014 and gave Florida Democrats $1.8 million. The next largest contribution after that from any other Blue Cross and Blue Shield company in the United States was $730,696 from Blue Shield of California to Democrats in that state — about one-eighth the size of the contribution to Florida Republicans.

Florida’s payments to the insurance companies

Nearly all states pay private insurance companies monthly premiums to insure Medicaid patients. It’s become big business.
The Florida Department of Health declined to say how much it paid the private insurance companies to insure the 13,074 children when they were switched out of CMS.
“If they got 13,000 new kids, (it’s) that times however many dollars per member per month,” St. Petery said. “I think that’s a lot of money when you start talking about that many kids.”
LJ Stroud sued the state of Florida to be put back on Children's Medical Services. He has now had the procedures that he needs.

These children came from CMS, a Medicaid program for sick children, and the state pays insurance companies more money to care for such children.
This is how it works, according to McManus, the spokeswoman for the Florida Agency for Health Care Administration.
Florida takes a look at all the people who’ve signed up with an insurance company and calculates a risk score for that group based on factors such as the age of the enrollees in the plan and their health conditions.
A plan with the lowest risk score has a “typical population” and might be paid a rate of, for example, $320 per person per month, McManus said. A plan with sicker enrollees might have a risk score that’s twice as high and so would be paid $640 per person per month, she added.
The numbers can get even higher from there.
“The state will pay a pretty good rate for these children,” said Agrawal, the pediatrician at Northwestern who studies health care systems for children with special medical needs.
“They could get paid thousands more per month for a child with serious medical needs,” said Steve Schramm, founder and managing director of Optumas, a health care consulting group.
“The enhanced reimbursement may be 10 times what the insurance companies get for a well child,” said Goldhagen, former director of Florida’s Duval County Health Department.
Yasmeen Shabaneh sued Florida and was placed back on Children's Medical Services.

Sick children are, of course, also costlier for insurance companies because they need more care. But insurance plans monitor that care to manage costs.
“Plans have gotten very sophisticated in their ability to manage very sick kids, so their willingness to take very sick kids is great,” said Jeff Myers, president and CEO of Medicaid Health Plans of America, an industry group representing insurance companies.
Pediatricians questioned whether such outsize political donations were an attempt to gain influence and favor with Florida’s Republican administration, which orchestrated the transfer of the children out of CMS and to the private companies.
“It certainly raises a lot of suspicion and concern,” said Northup, the associate professor at the University of Florida College of Medicine.
“Why would they make contributions in the hundreds of thousands and the millions to Florida Republicans? Why would they be so uniquely committed to Republicans in Florida? It gives one pause,” he added. “If you follow the money, at the very least, it’s worrisome.”
“It’s the left-hand-washing-the-right-hand kind of business,” said Dr. Joseph Chiaro, who was Florida’s deputy secretary of health from 2005 to 2011. “It breaks my heart.”
Six Florida pediatricians gathered in Orlando to tell CNN their concerns. They practice in rural, suburban and urban areas. Some of them are Republicans, and others are Democrats.
They said they feared that big donors had influence on the state’s decision-making process and that in many cases, the children suffered as a result.
“I don’t see this in writing anywhere, but my impression is, this was a way for political payback at the expense of the sickest of the Medicaid children,” St. Petery said.
“It just comes back to money or power. It’s not about health care for the children,” said Wright, the pediatric endocrinologist in Tallahassee.
“Just follow the money,” said Colaizzo, who runs a rural health care clinic in Pahokee, Florida.
State leaders “don’t give a damn about the kids. They don’t give a damn about the families,” said Dr. Marcy Howard, a pediatrician in Crystal River, Florida.

State officials and insurance companies respond

State health officials did not respond directly to the pediatricians’ concerns that campaign contributors had influence over Republican leadership’s decision to take the children off CMS.
“The Statewide Medicaid Managed Care program was designed to provide comprehensive care to recipients through high quality health plans with a payment structure designed to ensure that plans paid an appropriate rate based on the health conditions of those enrolled in their plan,” McManus, a spokeswoman for the Florida Agency for Health Care Administration, wrote in an email.
“The program currently covers more than 2 million of Florida’s children, offers the strongest provider network and access standards in program history, and provides families with a choice of high quality, nationally accredited plans so that they can choose the plan that best suits their needs, including specialty plans for those who qualify.”
Alejandro Rodriguez also sued the state of Florida and was placed back on Children's Medical Services.

CNN reached out to officials at all nine insurance companies. Two responded.
“WellCare contributes to a variety of organizations that shape health care policy, including the Florida Republican Party committees, the Democratic Party committees and those without political affiliation,” wrote Alissa Lawver, a spokeswoman for WellCare. “The company also discloses and publicly reports all political contributions on its website above and beyond the requirements of state and federal law. As a provider of managed care, WellCare is committed to partnering with the state of Florida to provide access to quality, affordable health care solutions for the state’s most vulnerable populations. We maintain a robust provider network and offer comprehensive care management services to create personalized, coordinated care plans to help improve and maintain the health of families and children across the state.”
She added that WellCare has accountability to Florida’s Agency for Health Care Administration, “which provides careful oversight of the state’s Medicaid program to ensure all members, including children that transitioned from Children’s Medical Services, receive access to the right care, at the right time and in the most appropriate setting.”
Ethan Slavin, a spokesman for Aetna, said the company makes “donations to campaigns for both major political parties to support and address issues that impact our customers and members.”
He added that “we are required to meet state rules and regulations regarding our network of health care providers and are consistently compliant with those requirements” and that “we regularly work with our members, health care providers and the state of Florida to move children with special health care needs into the Children’s Medical Services program, when appropriate and in the best interest of our members. Our integrated care management program regularly identifies these children and assists in this process.”
Miguel “Mike” Fernandez, founder and former chairman of Better Health, said he had contributed several million dollars to both Republicans and Democrats. He added that states move Medicaid patients into the care of private companies so they can “move the risk off their financial books.”

A victory for Florida families

Many pediatricians use strong language to describe their anger and frustration with the Florida Department of Health and what it did in 2015 to the 13,074 children.
“This has just been a nightmare, and we’re still experiencing the fallout,” said Dr. Toni Richards-Rowley, treasurer of the Florida chapter of the American Academy of Pediatrics.
“It’s disgusting,” said Cosgrove, the pediatrician in Merritt Island. “It’s all about money and not looking out for the children.”
“Honestly, it makes me want to puke,” said Lida Sarnecky, nurse manager of the team at the University of Florida that takes care of children with cleft lip and palate.
“In my heart, what I want to do is go down to Governor Scott’s office and ask him, ‘What if this were your child or grandchild who couldn’t receive the care they needed? How would you feel then?’ ” she said.
By June 2015, some Florida parents had had enough.
Five children, including Alejandro Rodriguez, and Yasmeen and Aref Shabaneh, sued the state Department of Health to get it to stop using the telephone questionnaire to take patients off CMS, claiming that the state Department of Health hadn’t gone through formal rulemaking procedures.
The children won.
The state didn’t fight the ruling. Instead, it came up with a new way to screen children for the program — one that doesn’t rely on a telephone survey and takes into consideration a child’s diagnosis.
Aref Shabaneh lost his Children's Medical Services coverage when his mother told the state he didn't have limitations. "Aref wants to do everything by himself," she said.

Many parents and pediatricians assumed the state would soon reach out directly to parents to let them know they could reapply to have their children put back on CMS.
They were very wrong.
Five months after the judge’s decision, St. Petery, the Tallahassee pediatric cardiologist, implored the secretary of the Department of Health to reach out to parents.
To St. Petery, the reasoning was obvious: A judge had said that the state had violated the law. Reaching out to the parents was a way of correcting wrongdoing.
The state had a notice on its website about the ability to be rescreened for CMS, and at a meeting with state legislators, a department official had given out a phone number parents could call. But St. Petery knew that busy parents of very sick children might not attend official state meetings or notice pages on government websites.
“I would hope that you would consider notifying each of the parents of those 13,074 children that the tool by which their child was screened out of CMS has been declared invalid, and that they have the right to appeal that decision,” St. Petery wrote to Dr. John Armstrong, then secretary of the Department of Health and the state surgeon general.
Armstrong wrote back that doing so would violate federal regulations, since the children had been switched to other Medicaid insurance plans.
“Federal regulations prohibit direct marketing to children currently being served by another managed care plan,” he wrote back to St. Petery.
CNN was unable to reach Armstrong for comment. Gambineri, the Florida Department of Health spokeswoman, said he “is no longer employed by DOH.”
Not satisfied with Armstrong’s response, St. Petery sought help from US Rep. Kathy Castor, a Democrat from Tampa. Castor took his concerns to the federal Centers for Medicare and Medicaid Services.
On March 23, 2016, an official at that agency sent an email to Justin Senior, then the Medicaid director at Florida’s Agency for Health Care Administration. CNN obtained the email under the Freedom of Information Act.
In that email, the federal official explained to Senior that federal regulations do not prohibit Florida from reaching out directly to families.
“To clarify, 42 CFR 438.104 does not prohibit marketing,” wrote Jackie Glaze, associate regional administrator for the Division of Medicaid and Children’s Health at the Centers for Medicare and Medicaid Services, citing a federal regulation.
More than a year later, on July 24, 2017, the Florida Department of Health sent a letter to parents letting them know that their children could be screened to get back on CMS. The letter was sent to 6,081 parents whose children were removed from CMS and put on another Medicaid plan and were still on that plan and financially eligible for Medicaid, according to Gambineri, the Florida health department spokeswoman.
That letter was sent nearly two years after the judge’s decision. Pediatricians say they’re angry it took that long to directly let parents know about the possibility of getting back on CMS.
Gambineri said there was concern that parents might get confused.
“It was originally thought to be, and still is considered a risk, in terms of confusion and disruption to families, to send a letter because they have had rescreening available since 2015,” Gambineri said a few months before the letter was sent out.

Nelson Mandela and Mr. Rogers

Now that LJ Stroud is back on CMS, he’s a happy, strapping 13-year-old who loves to play football and horse around with his brother and sisters in the family’s backyard in St. Augustine.
But his mother looks back on the dark days in 2015, after her son was switched off CMS, when she says he would lie on the couch in pain, unable to get the surgeries he needed.
It’s not just her son’s physical pain that makes Stroud angry; it’s his emotional pain.
Since LJ Stroud was placed back on Children's Medical Services, he's been able to play football again.

When LJ was on CMS, Stroud says, he received excellent care and was a contented, well-adjusted child, never thinking of himself as different despite his birth defect.
But she says that when he was in pain because he couldn’t have surgery, he started to feel sorry for himself.
” ‘Why did God make me this way?’ ” she says he asked. ” ‘Why can’t I be like my brothers and sisters?’ “
When she hears about how top Florida officials have spoken with pride of what they did to her son and to more than 13,000 other children, she becomes livid.
Last year, Armstrong, then Florida’s surgeon general and secretary of health, made a presentation to the Florida Children and Youth Cabinet, a panel created by the state Legislature to promote children’s welfare.
Declaring that the Department of Health “cares about every child in Florida,” Armstrong explained how the state removed the 13,074 children from CMS.
Armstrong’s presentation quoted two great advocates for children, Nelson Mandela and Fred Rogers.
First, he quoted Mandela: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”
And he quoted Fred Rogers, the star of the children’s television show “Mister Rogers’ Neighborhood”: “Anyone who does anything to help a child in life is a hero to me.”
Stroud struggles for words to describe what she thinks of Armstrong quoting these two champions for child welfare.
“It’s just — it’s just disgusting,” she said. “I feel my blood boiling just thinking about it.”

Boy, 13, who had heart transplant dies on 1st day of school

GOSHEN, Ohio — A 13-year-old boy who received a heart transplant months ago has died on the first day of school.

WCPO-TV in Cincinnati (http://bit.ly/2fQHKL5 ) reports Peyton West died Thursday. His family says he was born with hypoplastic left heart syndrome and needed three open-heart surgeries before his fifth birthday. He had to have a transplant when his health deteriorated in March.

Peyton’s father says he seemed fine Thursday. He smiled for a photo that morning before leaving their home in Goshen, about 31 miles (50 kilometers) northeast of Cincinnati.

On the way to school, Peyton told his father he didn’t feel right. He was taken to a hospital, where he died. His family says they still don’t know what happened.

The Defenders Sets Up A Daredevil Season 3 ‘Born Again’ Storyline

http://comicbook.com/marvel/2017/08/19/daredevil-season-3-born-again-netflix

 

Facing the evil of The Hand is a challenge that will change each respective member of The Defenders by the time the Marvel Netflix miniseries ends. But for Matt Murdock/Daredevil, the battle will be especially personal.

As we learned in Daredevil seasons 1 & 2, Matt Murdock’s life has been heavily affected by The Hand’s war with their sworn enemies, The Chaste – including Daredevil‘s mentor, Stick. Matt has been investigating The Hand’s threat to NYCever since he first suited up – and in The Defenders, he’ll have to deal with the added pain of seeing The Hand bring back Elektra as the soulless killing machine known as The Black Sky.

With Daredevil season 3 already set for production in the fall, the next chapter of Matt Murdock’s story is set for some drastic changes – and The Defenders sets up one particularly good storyline for season 3 of Daredevil to tell.

SLIDE 1/6

Born Again

Daredevil Season 3 Born Again

“Born Again” is a 1986 Daredevil comic book storyline by Batman: Year One team Frank Miller and David Mazzucchelli. The main thrust of the story is that Matt Murdock has his secret identity sold to Wilson Fisk/Kingpin by someone close to him (Karen Page), allowing Fisk to systematically dismantle Murdock/Daredevil in both his costumed and personal lives.

The story is famous for the very deep and introspective character story it tells about Matt Murdock/Daredevil, who is pushed to the bring of his sanity by what The Kingpin does to him. It’s also famous for invoking a lot of religious iconography that has to do with Daredevil – and the contradictory existence he lives as a devout Catholic, and son of a nun. The story also sees Murdock battling both a violent Daredevil impostor and a supervillain named Nuke, and it had the controversial (and Frank Miller signature) arc of making Karen Page into a drug-addicted former porn actress.

Daredevil Born Again

In the end, Matt Murdock assumes a new identity and works as a diner chef, content to live with Karen and fight crime as Daredevil. The Kingpin, meanwhile, is left fully exposed as the criminal he is, with empire cracking and crumbling around him.

The ending of The Defenders Netflix miniseries certainly leaves Daredevil in a place where “Born Again” could be the season 3 story arc – as the clues have been laid out pretty clearly.

Sister Maggie

Daredevil Season 3 Born Again Sister Maggie

 The Defenders ends with the reveal that Daredevil survived the bombing of The Hand stronghold at Midlands Circle, even though his friends and fellow Defenders teammates all think he’s dead. Matt Murdock is seen lying in a bed all bandaged up, with a nun holding vigil over him. As Matt begins to stir, the Nun says “Get Maggie, he’s waking up.”

This “Maggie” in question is Sister Maggie, who actually Matt Murdock’s mother. She’s well-known in the comic book mythos, and is an iconic part of the “Born Again” storyline and artwork (check her out in the artwork for the storyline, seen above). 

Maggie is an integral part of “Born Again”: after being nearly killed The Kingpin, Daredevil is nursed back to health by Maggie – who reveals herself to be his estranged mother. 

SLIDE 3/6

Skeletons In Karen’s Closet

Karenatoldjob

Karen Page has gotten a much different depiction in the MCU than she did on the comic book page. In comics, she started out as something of a wholesome (if not generic) love interest – before creators like Frank Miller put her through the ringer. However, Karen Page in the MCU has hinted at already having a dark past when we meet her – and that certainly seems to be the case when she executed Kingpin’s henchman, James Wesley, in season 1.

The events of “Born Again” unfold because of Karen Page being on a serious downward spiral of addiction, selling Matt’s secret out, and funny enough, her MCU counterpart is poised for a similar arc after the events of The Defenders.

On the one hand, Karen is poised to take on the role that reporter Ben Urich plays in “Born Again,” as Urich becomes a target of Kingpin in the comic book story. Unfortunately, in the MCU, Fisk as already brutally murdered Ben Urich for such a transgression, but Karen has now taken his place as an investigative reporter, and could serve that role in the story.

 

On the other hand, Karen is currently torn apart from thinking Matt Murdock is dead after The Defenders, and that mourning could lead her to a dark place where drinking and/or drugs make her make a terrible mistake of spilling Daredevil’s secret.

With the secret of Wesley’s death (and other skeletons) still hanging over her as well, Karen is poised to have as tragic an arc in the MCU “Born Again” as she did in the Marvel Comics version.

SLIDE 4/6

The King Returns

The Kingpin Wilson Fisk Daredevil Season 3 Born Again

A pivotal scene in Daredevil season 2 took place when Matt Murdock went to see Wilson Fisk in prison. During that scene, Fisk violently manhandles Murdock while telling him in no uncertain terms that, when he gets out, he is going to break both Matt and Foggy for helping put him away

With the time that has passed since Daredevil season 2 (like the construction of Midlands Circle and the entire events of The Defenders) it would make sense if Wilson Fisk came out of prison at the start of season 3, and got to work dismantling Matt Murdock’s life – only to learn that Murdock and Daredevil are one and the same. That would be a great way to adapt the Kingpin’s “Born Again” story for the MCU. 

SLIDE 5/6

The Nuke Is Lit

Will Simpson Nuke Daredevil Season 3

As stated, “Born Again” sees Daredevil finally don his costume again after a spiritual and exsetential crisis – just in time to battle the supervillain known as Nuke, who was set loose by The Kingpin to terrorize Hell’s Kitchen.

Well, the Marvel Cinematic Universe has already introduced its version of Nuke, in the form of “Will Simpson,” the NYPD officer who goes mad from combat-enhancing drugs during the events of Jessica Jones season 1. When last we saw Will, he had gone full crazy on Jessica and her friend Trish Walker, forcing the girls to put him down hard. He was left unconscious in Jessica’s apartment, until he was taken away by Doctor Kozlov and IGH, the special forces program that created the combat enhancer soldiers. 

Having Will Simpson return as an enforcer for The Kingpin would give Marvel Comics fans a nice Easter egg – and Daredevil a great new foe, who could also offer opportunity for a cameo from Matt Murdock’s new friend, Jessica Jones. 

SLIDE 6/6

Deadly Imposter

Daredvil Born Again Imposter

On stage of Kingpin’s plot in the Daredevil “Born Again” storyline is drawing Daredevil out by releasing a violent mental patient and dressing him up as Daredevil, to wreak havoc.

Matt Murdock shows up to battle the impostor and defeats him before the madman can hurt either Foggy or Karen, as Kingpin intended.

With the MCU Daredevil believed to be dead after the events of The Defenders, it would be plausible that Wilson Fisk (skeptical that Daredevil is really gone) would sponsor an impostor who could discredit Daredevil’s legacy, and possibly draw the hero out. And it would be very cool to see two Daredevils going at it in an epic battle sequence, midway through season 3. 

Samsung’s Galaxy Note 8: What It Needs to Win

Next week, Samsung executives will take the stage at a press event in New York to unveil the next generation of the Korean company’s supersize Note smartphone. This isn’t gonna be just any old product launch; a lot is riding on this particular phone. Samsung almost had a winner on its hands with the Note 7, a feature-packed phone that dazzled critics —  until it turned into a literal garbage fire. Now, Samsung seeks to recapture the pre-recall magic with the Note 8.

Concept Credit: Benjamin GeskinSamsung faces two hurdles with this launch. First, the infamous recall has made the Note a punchline, and the company needs to turn that around by executing its next Note perfectly. The second challenge is timing: The Galaxy Note 8 is heading to market just weeks before Apple takes the wraps off its 10th anniversary iPhone, and the buzz surrounding that device is already deafening.

So what can Samsung do to take on Apple and prove to the world that the Galaxy Note 8 is a must-have? We have some ideas.

Be flawless

Samsung has mostly recovered from the dragging its reputation took last year. The company apologized for the Note 7 debacle and hired independent investigators to figure out why the batteries were exploding. The company then committed to more stringent standards to prevent future disasters, including an eight-point battery safety check for every phone. Though people still joke about the Note 7, no one expects Samsung’s future devices to catch fire, especially after the Galaxy S8‘s smooth launch earlier this year.

Only time will tell if there are any huge issues with the Note 8.

“If Samsung stays core to quality, to great execution and delivery of this product, I think they can definitely go head-to-head with the new iPhone,” said Roberta Cozza, research director at Gartner, who analyzes the personal technology industry.

Credit: Evan Blass/TwitterCredit: Evan Blass/TwitterOnly time will tell if there are any huge issues with the Note 8. But in addition to delivering a flawless phone, Samsung needs to innovate. The Note lineup is where the company tends to level up with cutting-edge features. The S8 incorporated some of the Note 7’s technology, like the iris scanner, and now the Note 8 needs to push it forward.

“Last year, the [Note] 7 really raised the bar as far as what the Note represented as a phone,” said Carolina Milanesi, principal analyst for market research firm Creative Strategies. “It was all about the bigger screen, and then the [S] Pen was really a differentiator. Last year, we saw that this was a broader device, and it became the flagship product for Samsung. It was a shame that … they ended up recalling the phone and not actually taking advantage of the broader appeal of the device. This year, that’s what they need to build on and make the device a more all-around flagship product.”

Sell the story

The Note 8’s long-rumored dual-lens camera would be one example of innovation — sort of. Samsung wouldn’t be the first smartphone-maker to incorporate two rear lenses. The Note 8 wouldn’t even be the first Android phone to include a dual-lens system, and that technology is already surfacing in budget Android phones such as ZTE’s $130 Blade Z Max.

According to a new SurveyMonkey study of 1,000 smartphone owners, 45 percent of people who currently own a Samsung device said they would think about buying a Note 8.

So Samsung needs to be clear about how the Note 8’s camera will make a difference. Apple used the iPhone 7 Plus’ dual-lens camera with portrait mode to convince people they needed a larger, more expensive phone, Milanesi said. Samsung could do the same.

Bixby on a Galaxy S8. Credit: SamsungBixby on a Galaxy S8. Credit: SamsungSamsung also needs to improve its personal assistant, Bixby, which stuttered at launch and has failed to impress. Cozza said Samsung needs “to build experiences around their devices” and “articulate the value” of what it’s offering. The company obviously knows how to cram every hot new feature into its flagship devices, but illustrating scenarios in which those features would be useful for the average consumer and marketing the hell out of them? Not so much.

Appeal to fans

Because of itssize, price and stylus integration, the Note 8 will be a niche device, analysts say. As such, Samsung’s core market for the device is its existing fans and people looking for a larger premium Android phone. The Note 8 is rumored to have a 6.3-inch display.

According to a new SurveyMonkey study of 1,000 smartphone owners, 45 percent of people who currently own a Samsung device said they would think about buying a Note 8. Even people who bought the Note 7 — who might be expected to feel burned by the company (literally or figuratively) — are willing to give the company another chance, as 80 percent still consider the company reliable.

Galaxy Note 7. Credit: Jeremy Lips/Tom’s GuideBut the Note isn’t a “churner device,” Milanesi said. In other words, it’s not  a phone that could convince people to switch operating systems — especially not with the iPhone 8 around the corner.

“It’s still going to be hard for Samsung to win over iPhone users,” she said. “There are still a lot of jokes about explosions and how hot they [Note 7 phones] get. The Apple core base take advantage quite glibly of instances that Apple competitors are faced with. I see this as more of an opportunity … to put more pressure on [Google’s upcoming second-gen] Pixel to come out and raise the bar.”

Google’s Pixel and Pixel XL smartphones offer what most consider a purer version of Android, as close to stock as you can get, but they’re close to a year old and lack many of the hardware and software features Samsung has added to its phones over the last 18 months. Samsung might not appeal to iPhone users or Android purists with the Galaxy Note 8, but the company could win in other ways by redeeming its Note brand and moving the smartphone industry forward. Your move, Google.