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jesse-pinkman123 · 3 years ago

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Levodopa Market Size, Share, Outlook, and Opportunity Analysis, 2019– 2027

Levodopa Market by Application (Parkinson’s disease and Dopamine Responsive Dystonia), by Drug Type (Rytary, Duopa, Sinemet, Canamet, and Others), by Distribution Channels (Hospital Pharmacies, Retail Pharmacies, and Online Pharmacies) and by Geography (North America, Europe, Asia Pacific, Latin America, Middle East, and Africa) - Size, Share, Outlook, and Opportunity Analysis 2018 – 2026.

Levodopa or L-Dopa is a chemical building-block that converts into a dopamine in body. Dopamine is the chemical messenger released in brain. It mediates pleasure, cognition, and memory functions. Nearly all patients receive the dopamine precursor levodopa, which adequately control symptoms of Parkinson's disease (PD) at early stage of the disease. Carbidopa is often included with levodopa-containing drugs in order to boost its efficacy by slowing down the metabolism of dopamine.

Levodopa Market Driver

Development of novel formulations and efficient drug delivery methods for levodopa are expected to drive growth of the levodopa market. For instance, a clinical study for gastric retentive Accordion Pill, an immediate drug release formulation by Intec Pharma Ltd., is ongoing in clinical phase III and is expected to complete in September 2018. Accordion Pill is a Carbidopa/Levodopa (AP-CD/LD) combinational oral drug delivery system, which is designed to improve the efficacy and safety of existing CD/LD drugs by utilizing an efficient gastric retention and specific release mechanism.

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Moreover, Impel NeuroPharma Inc. is conducting phase II clinical study for INP103, a drug-device combination product containing a drug component, L-dopa, and device component I231 Precision Olfactory Delivery (POD) device. The study is expected to complete in November 2018.

Furthermore, advancement in diagnosis of Parkinson's disease (PD) progression is expected to boost growth of levodopa market. For instance, a clinical study conducted by Washington University School of Medicine, for measuring PD progression both by using Magnetic Resonance Imaging (MRI) and by controlled dose of levodopa for discovering suitable biomarker of PD is currently in clinical phase I and is expected to complete in February 2019.

Levodopa Market Restraint

Shortage of drug supply in the market due to delay in manufacturing and supply of levodopa is expected to hamper levodopa market growth. For instance, Merck Sharp & Dohme Ireland (Human Health) Ltd. in September 2018, anticipated stock shortage of some Sinemet (Carbidopa/ Levodopa) products in the Irish market in near future due to global manufacturing delays in production and demand for resupply of these products.

Levodopa Market – Regional Analysis

On the basis of region, the global levodopa market is segmented into North America, Latin America, Europe, Asia Pacific, Middle East, and Africa.

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North America is expected to dominate the global levodopa market, owing to approval of new products by the U.S. Food and Drug Administration (FDA). For instance, in 2015, FDA approved an extended-release oral formulation of Levodopa/Carbidopa called Duopa, manufactured by AbbVie Inc., in the U.S. market. Duopa is a gel formulation of Carbidopa/Levodopa enteral suspension and is administered using a small, portable infusion pump that delivers Carbidopa and Levodopa directly into the small intestine, which continuously release over 16 hours in the body.

Europe region is expected to witness significant growth in levodopa market due to involvement of key players for marketing novel formulations in European region. For instance, Acorda Therapeutics, Inc., in March 2018, submitted a Marketing Authorization Application (MAA) to the European Medicines Agency (EMA) for INBRIJA, an investigational inhaled levodopa treatment for symptoms of OFF periods (OFF symptoms implies recurrence of symptoms such as rigidity, and tremors after long period of levodopa use) in people with PD taking a Carbidopa/Levodopa regimen.

Furthermore, in November 2015, Impax Laboratories, Inc. received European Commission (EC) marketing authorization for NUMIENT (Levodopa and Carbidopa), a modified-release oral capsule formulation for the symptomatic treatment of adult patients with Parkinson's disease in Europe region.

The key players operating in levodopa market include, Taj Pharmaceuticals Limited., Guangzhou HanFang Pharmaceutical Company Limited, Poulvet.com, Teva Pharmaceutical Industries Ltd., UBM, Zhejiang Wild Wind Pharmaceutical Co., Ltd., and SWAPNROOP.

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tajagroproducts · 4 years ago

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sarabarratt · 4 years ago

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Alendronate Market : Opportunities, Demand and Forecasts, 2021-2027

In the latest report, with a graph of the Alendronate market, the assessment bases fundamentally available examples, demand reach, and future odds of this territory over the gauge time period. Besides, the report gives a nitty gritty measurable outline as far as patterns portraying the geographic chances and ventures of driving business investors.

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Alendronate Market

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Postmenopausal Osteoporosis

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Alendronate Market

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vaibhavilatane · 4 years ago

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Drinking Water Cable Market (covid-19 update) upcoming business reports on size, shares, stocks and many more | forecasting report 2026

Drinking Water Cable market

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Key Player Mentioned: Jazz Pharmaceuticals, Shire, Kyowa Hakko Kirin, Qianhong Bio-pharma, Taj Pharmaceuticals, Mingling Pharmacy, SL Pharmacy, United Biotech, Medac GmbH

Product Segment Analysis: Escherichia coli, Erwinia Chrysanthemi, Pegylated

Application Segment Analysis: Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia

Regional Segment Analysis: North America (U.S.; Canada; Mexico), Europe (Germany; U.K.; France; Italy; Russia; Spain etc.), Asia-Pacific (China; India; Japan; Southeast Asia etc.), South America (Brazil; Argentina etc.), Middle East & Africa (Saudi Arabia; South Africa etc.)

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shrikrisharathod · 5 years ago

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Global Fluvoxamine Maleate Market to Witness Robust Expansion Throughout the Forecast Period 2019 | Top Leading Vendors like Ltd, Caraco Pharmaceutical Laboratories, Apotex

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Key Players Mentioned: Solvay Pharmaceuticals, Manus Aktteva Biopharma LLP, Caraco Pharmaceutical Laboratories, Ltd, Reid-Rowell Inc., Mylan N.V. All Rights Reserved, Actavis Elizabeth, Ani Pharms, Apotex, Ivax Sub Teva Pharms, Abbott Laboratories, Jazz Pharms, Synthon Pharms, Tocris, Taj Pharmaceuticals Ltd API Request Sample @t: https://introspectivemarketresearch.com/request-samples.php?_id=&_sid=379

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loyallogic · 5 years ago

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Handling of Hazardous Substances and Legal Provisions

This article is written by Himank Dewan, a 5th-year student at Bharati Vidyapeeth Deemed to be University, Pune. This article talks about what are the different hazardous substance in the world which is destroying the community and the people in it. It will also be talking about the different legal provision and the step to prevent the destroying the community by these hazardous substances.

Introduction

Are you aware that India ranks 177 out of 180 on the Environmental Performance Index 2018, which has plummeted 36 points from 141 out of 180 from 2016? It is in the bottom five of the Environmental Performance Index, which is a disgrace to the country’s image. Taj Mahal is considered as one of the seven marvels of the world but if you look at its condition now. A monument which was famous for its beauty is now turning yellow due to environmental pollution which is a result of human action.

Let us explore the different hazardous substance and their legal provision.

Statutory Provision

As per Section 2(e) of the Environmental Protection Act, 1986 “Hazardous Substance” has been characterized as “an element or preparation which, by reason of its synthetic or physic-synthetic properties or managing, is a danger to cause harm to individuals, other existing animals, flora, microorganisms, other belongings or the earth”.

Harmful and Other Wastes (Management and Transboundary Movement) Rules, 2016

These principles are the essential guidelines which address the supervision of harmful waste in India. They were set up under the Environment (Protection) Act, 1989, which gives the Central Government the capacity to “acknowledge all such measures as it might consider essential or convenient for the purpose of protecting and improving the quality of the environment and counteracting, controlling and abating ecological pollution”. These standards were endorsed after the Bhopal Gas Tragedy Case to counteract further such cases.

List of things that Generate Hazardous Waste

Here is a list of few substances which produce Hazardous waste and which infects the environment in a ruthless manner:

Petrochemical procedures and pyrolytic tasks.

Raw petroleum and production of natural gas.

Cleaning, draining and upkeep of petroleum oil stockpiling tanks including ships.

Refining of oil or pre-preparing of utilized oil or reusing of waste oil.

Industrial operations utilizing mineral or engineered oil as lubricant in hydraulic systems or other applications.

Secondary generation and/or industrial use of zinc.

The primary generation of zinc or lead or copper and other non-ferrous metals aside from aluminium.

Secondary manufacturing of copper.

Optional manufacturing of lead.

Creation as well as industrial use of cadmium and arsenic and their compounds.

Production of essential and optional aluminium.

Metal surface treatment, such as drawing, recolouring, cleaning, arousing, cleaning, degreasing, plating, etc.

Creation of iron and steel including other ferrous amalgams (electric heater; steel rolling and finishing mills; Coke broilers and by products of plant).

Solidifying of steel.

Production of asbestos or asbestos-containing materials.

Generation of caustic soda and chlorine.

Production of mineral acids.

Generation of nitrogenous and complex composts.

Production of phenol.

Creation and additional use of industrial solvents.

Production and/or modern utilization of paints, colours, lacquers, varnishes and inks.

Creation of plastics.

Production and modern utilization of pastes, organic cement, cements and tars.

Creation of canvas and textiles.

Industrial generation and formulation of wood preservatives.

Production and industrial utilization of engineered dyes, dye-intermediates and pigments.

Generation of a natural-silicone compound.

Production/formulation of medications/pharmaceutical and health care product.

Creation, and formulation of pesticides including stock-piles.

Leather tanneries.

Electronic Industry.

Pulp and Paper Industry.

Treatment of harmful chemicals and wastes.

Sterilization of utilized for the treatment of hazardous wastes/chemicals.

Air/Gases, Water and Wastewater from the process and common effluent treatment plants (CEPTS) must be refined and treated properly according to the procedure laid down by the government of India.

Organic compounds/ solvents have to go through the purification process.

Waste treatment process which is dangerous, For eg. pre-paring, incineration and concentration.

Ores containing heavy metals such as Chromium, Manganese, Nickel, Cadmium etc. must go through chemical processing.

These are a few things which are depleting our environment and which is causing a lot of imbalance for all living creatures. Various things have been mentioned under the Schedule of the Hazardous and Other Waste Management and Trans-boundary Movement) Rules, 2016.

Responsibility for Proper Management of Harmful and Other Wastes

According to Section 4 of the Hazardous and Other Wastes (Management and Transboundary Movement) Rules, 2016, these are the process that needs to be followed by various people for proper management of Hazardous Waste:

Occupier:

They should pursue anticipation, minimization, reuse, recycle, recuperation, utilisation including co-handling; safe disposal

They ought to have a safe and environmentally sound management of harmful waste.

An authorized user will receive the harmful waste created in an establishment or it will be discarded according to the authorised disposal facility.

In accordance with the guidelines laid down, the occupier’s establishment will transport the waste produced to an authorised actual user or to an authorised facility.

Storage and removal facility will be provided to the operator of that facility with such explicit data as may be required for safe storing and disposal as may be required by those who expect to get harmful waste treated and disposed of by the administrator.

They will take all the steps while managing hazardous waste to-

Provide people working on-site with appropriate training, equipment and the information necessary to ensure their safety.

Contain contaminants and anticipate accidents and confine their consequences on human beings and the environment.

State Government:

Approval of State Government to ensure earmarking and allocation of industrial space or recycling shed, pre-processing and utilization of harmful waste in the current and upcoming industrial park has been done for the Department of industries in the State or any other government agency.

Labour department in the State or any other government agency approves in such regard by the State Government shall-

Assist the advancement of groups of workers to facilitate setting up such facilities;

Ensure, acknowledge and enlistment of workers involved in recycling, pre-processing and other utilisation activities;

To ensure the well being and health of workers involved in reusing, pre-processing and other utilisation annual monitoring must be taken;

Development exercises for the labourers engaged in recycling, pre-processing and other utilisation for the development of industrial skills;

Integrated plans for effective implementation of the provisions and submit an annual report to the Ministry of Environment, Forest and Climate Change, in the Central Government is required to be done by the State Government.

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Procedure for Treatment, Storage and Disposal

According to Section 16 of the Hazardous and Other Wastes (Management and Transboundary Movement) Rules, 2016 the proper procedure for treatment, storing and removal facility of hazardous and other waste is as follows:

The State government, occupier, operator of a facility or any association of occupiers will uninhibitedly or mutually or severally be held answerable for the identification of destination for establishing the workplace for treatment, storing and removal of the harmful and other waste.

According to the technical procedure issued by the Central Pollution Control Board, the operator of ordinary office or occupier of the captive facility, will plan and set up treatment, storing, and removal facility which will get an endorsement from the State Pollution Control Board for structure and configuration in this regard.

Monitoring and setting up the task of common of the task of the common, or captive treatment, storing and removal facility as per the guidelines laid down by the State Pollution Control Board.

Monitoring and setting up and the task of the common or captive treatment, storing and removal facility shall be done by the State Pollution Control Board.

According to guidelines or standard operating procedures issued by the Central Pollution Control Board, the operator of regular facility or occupier of a captive procedure will be in charge for the safety and ecological sound operation of the facility and its closure and post-closure phase.

Records of harmful and other waste dealt by the operator of common facility or occupier of a captive facility are required to be maintained under Form 3.

An Annual return under Form 4 is required to be filed by the operator of common facility or occupier of a captive facility on or before the 30th day of June following the financial year to which the returns relate to them in the format given to them by the State Pollution Control Board.

Bhopal Gas Tragedy Case

Facts

In the year 1984, India witnessed one of its most terrifying and devastating industrial disasters. In 1970 an American Enterprise, Union Carbide Corporation (UCC) established a pesticide plant in a densely populated region of Bhopal due to its central location and transportation network. The site was supposed to be used for light industrial and commercial activity. During 1984 the company was manufacturing Selvin at one-quarter of its capacity due to decreased capacity. UCIL had made arrangements to transport it to a different country due to its low decreased production. Due to low profits the company was ignoring safety standards, which the government was aware of, which further lead them to be reluctant to impose strict control.

On 3rd December 1984, massive amounts of Methyl isocyanides had engulfed the city which resulted in a loss of life for both humans and animals on a massive level. This resulted in huge loss of life and the hospital were packed with both dead bodies and clueless patients and Doctors who were not at all aware of the cause of death nor were they aware of any treatment which was not shared by the UCC group which had claimed trade secrecy as an excuse.

After the incident, UCC distance itself from its Indian subsidiary and tried to invade itself from the liability by transferring the blame on them.

The gas leak affected the lives of many, it led to various ocular, respiratory, gastrointestinal, reproductive and neurological disorders among the people. The most affected were the pregnant women who had to abort their babies, or had premature delivery or to infants with foetal abnormalities.

The grievance was also inflicted on the environment. Even after the death of so many people, the company refused to take active responsibility and restore health environment. During its production year, the company dumped a huge amount of contaminated waste outside and inside the plant site. Almost all the contamination still remain in the plant site. These waste have degraded slowly and have polluted the soil and groundwater. This threatened a lot of people and will keep on spreading until it is properly disposed of.

Judgement

In the Year 1986, the Union of India filed a complaint in the Hon’ble District Court of Bhopal in September seeking an interim compensation of Rs. 3.5 Billion, however, the Madhya Pradesh High Court diminished it to Rs. 2.5 Billion. UCC again appealed to the Hon’ble Supreme Court. The court ordered UCC to 470 Million Dollars (approx. 750 Crore Rupees) ‘in full settlement of all claims, rights and liabilities related to and arising out of the Bhopal gas calamity. In terms, all civil proceedings were concluded and criminal procedures were suppressed.

In the year 2010, Seven former representatives, including the former UCIL director, were convicted in Bhopal of causing death by negligence and sentenced to two years imprisonment and fine of 2000$.

Views

The basic negligence on the part of the company, that they had not provided proper training or had provided any safety equipment to the workers. They were not keeping a regular tab on the work or on the machinery which was being used. Due to the low sales of the company was trying to neglect things which were a safety concern for everyone. During the internal inquiry, it was found out that most of the safety systems were not working properly. This proved that UCC was only interested in the declining profits which led them to neglect the wellbeing of workers and the people near the plant, who were all killed mercilessly in an accident and negligence on the part of the Company.

It was due to this accident that the government of India felt the need to provide environment laws to protect the wildlife from this evil humanity, it was also during this time that the government also provided us with Hazardous and other waste rules, 1987.

Even after many years of the disaster, the waste is still lying around the site which polluting the soil and groundwater, which is causing a problem to the environment and the people living there. Earlier the government was not able to decontaminate the place properly as they did not have the proper procedure or methods to do so, and the company was hiding behind legal framework wherein they refused to share the information of the plant as part of their trade confidentiality.

Amendments

Over the years there have been many developments in the industry which may have led to an increase in the different types of products being introduced and being used in the development of a new product due to which there might be an increase in new types of Hazardous and Other Waste. Here are some of the major Amendments which have been made to protect the Environment. These Amendment of 2016 are as follows:

The ambit of the Rules has been extended by including ‘Other Waste’.

Waste Management grading in the procedure of priority of prevention, minimization, reuse, recycling, recovery, co-processing; and safe disposal has been incorporated.

All the procedures under the rules for permission, import/export, filing of annual returns, transportation, etc. have been re-examined altogether, demonstrating the stringent methodology for the management of such harmful and other wastes with a simultaneous simplification of procedure.

The fundamental responsibility of framework to shield the wellbeing and environment from waste handling industry has been recommended as Standard Operating Procedure (SOPs), explicit to waste type, which must be complied by the stakeholders and guaranteed by SPCB/PCC while conceding such authorisation.

The system has been simplified to unite all the approvals as freedom for setting up of harmful waste disposal facility and import of different wastes.

Streamlining and authorization procedure for co-handling of harmful waste to recoup energy and put on discharge standard premise rather than on a trial basis.

Co-preparing a particular mechanism over disposal for utilization of waste as a significant asset, or for recovery of energy has been given.

Streamlining by rearranging the record-based procedure by rethinking the list of waste regulated for the procedure for import and export of waste under the rules.

Exemption from the need of obtaining Ministry’s authorization for the import of metal scrap, paper waste and different categories of electrical and electronic hardware for reuse.

Endorsement of Standard Operating Procedure(SOPs) specific to waste type for the essential need for infrastructure to safeguard the wellbeing and environment from the waste-production industry.

Introduction to the duties of the State Government for environmentally stable supervision of harmful and other waste is as follows:

Setting up/Designating specified space or shed for the purpose of reusing, pre-processing and other utilization of harmful waste.

To ensure the safety and health of workers and attempt industrial skill development.

To enlist the workers associated in recycling, pre-processing and other utilization exercises.

To form a gathering of workers to empower setting up such facilities.

Assessment of list of techniques generating harmful waste considering inventive headway into the venture.

Reconsidering the list of waste and concentration limits according to international standard and drinking water standard.

The accompanying items have been blocked for import:

Waste edible fats and oils of animals, or vegetable cause;

Household waste;

Basic Care Medical equipment;

Tyres for direct reuse reason;

Solid Plastic wastes including Pet bottles;

Waste electrical and electronic gathering scrap;

Other chemical wastes especially in solvent structure.

Sanction by the State government to submit a yearly report to the Ministry of Environment, Forest and Climate Change and also to set up an integrated arrangement for viable execution of these provisions.

Submission by the 30th September of every year which contains a yearly inventory of waste generated, waste reused, recouped, utilised including co-processed should be done by the State Pollution Control Board.

Amendments in the year 2019

Solid plastic waste has been rejected from import into the country including in Special Economic Zones (SEZ) and by Export Oriented Units (EOU).

Exporters of silk waste have now been given prohibition from requiring authorisation from the Ministry of Environment, Forest and Climate Change.

Electrical and electronic assemblies and segments manufactured in and exported from India if found damaged can now be imported back into the nation, within a year of export, without obtaining consent from the Ministry of Environment, Forest and Climate Change.

Ventures which do not require consent under Water (Prevention and Control of Pollution) Act 1974 and Air (Prevention and Control of Pollution) Act 1981, are now exempted from requiring approval under the Hazardous and Other Wastes (Management & Trans-boundary Movement) Rules, 2016, provided that hazardous and other wastes generated by such enterprises are handed over to the lawful actual users, waste collectors or disposal facilities.

Other Legislation for Environment Protection

Ministry of Economic Environment was established in the year 1985, it is the apex body which provided rules and regulations for protecting the environment. It has laid down many statutory rules to protect the environment those are:

The National Green Tribunal Act, 2010

The Air (Prevention and Control of Pollution) Act, 1981

The Water (Prevention and Control of Pollution) Act, 1974

The Environment Protection Act, 1986

Hazardous Waste Management Regulations

E-Waste (Management and Handling) Rules, 2011

Batteries (Management & Handling) Rules, 2001

The Wildlife Protection Act, 1972

The Forest Conservation Act, 1980

Public Liability Insurance Act, 1991

The Biological Diversity Act, 2002

Coastal Regulation Zone Notification

Conclusion

It is not easy for people to cope with the Bhopal Gas Tragedy, they still feel for their loved ones. They are still not able to live a proper healthy life, still children are being born with diseases and complaint it is hard for them to live. Every industry should follow these safety protocols to dispose of these hazardous waste, they should make sure that no other person is affected by these harmful waste.

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myabhijitr · 5 years ago

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Levodopa Market - Size, Share, Outlook, and Analysis by 2018-2026

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expertofmarketinsights-blog · 6 years ago

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Levodopa Market Positive Long-Term Growth Outlook 2018-2026

Levodopa Market Driver

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Competitive Landscape

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demondeanismybaby · 8 years ago

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Stood Up Again, ... wait.

Pairing: AgentSmith!Sam x reader, mentions of OMC

Word count: 2533

Warnings: Fluff, one night stand, semi public sex, unprotected sex, generally smuttiness

Summary: After getting stood up by your boyfriend, and questioned by the FBI you are thinking your life is getting a little off track, but maybe things could all work out in the end.

A/N: I thought about this one shot, there is not enough of Sam having one night stands, he should do that more according to me. For Smut Appreciation Day.

You fiddled with the pages of the wine list, glancing down at various French vineyards, before looking over at the frosted glass entrance. Bryan was supposed to meet you there at 8, you thought it was strange he picked out such a nice restaurant, but you were telling yourself not to overthink it. Valentines day was next weekend, maybe he was just trying to step up his game.

You tapped on the screen of your phone, 8:47pm, and there were no missed calls or texts. After you had called him, and gotten his voicemail, and sent a text twenty minutes ago you could feel the strange emptiness in your stomach, something awful was going on.

“Excuse me, Y/F/N, Y/L/N?”

You felt the slight touch on your shoulder, hope swelling, only to immediately crash at the strangers voice. You moved a little in your chair, so you were able to face him, “Yes?”

He flashed an official looking FBI badge at you, increasing your dread about Bryan, “I need to ask you a couple of questions.” He didn’t wait on you to say yes or no, just sat across from you, and you felt his knees bump against yours at the intimate table.

Starting his spiel, you quickly became disinterested it had nothing to do with your fiance, then you heard the soft ding and snatched up your phone. Your blood boiled as you read it, he wasn’t coming, so sorry, late night at work, the same excuses except this time you were left eating fancy salad and drinking imported wine instead of a beer and wings.

“Miss?” A giant hand crossed over the words on your phone, and you were snapped out of your jilted musings to be reminded it wasn’t the only thing on your plate.

Trying to force an apologetic smile, wondering if you looked a little like you were drunk as the edge of your mouth twitched, “sorry, long day, I didn’t catch what you were saying.”

He was a little apprehensive, you could see a slight frown and a worried shimmer in his eyes, “I was saying my name is Agent Smith, we are currently looking into a case involving Meyer Pharmaceuticals, and I was wondering if you could tell me anything about their day to day operation.”

Briefly focusing on his question, “why would you want to talk to me about it? I am an intern the only thing I do there is make copies and get coffee.” You weren’t angry he wanted to talk to you, but you really didn’t see why he wanted to get the interns opinion, you were underpaid, overworked, and no one there even called you by your name. You doubted that you could crack open an FBI investigation on the place.

“What I am looking for is information about a,” he pulled out a small black notebook, “Carla Tillman.”

“Carla? She is the office manager,” you racked you head for anything he would find substantial but you were blank, only petty things came to mind like her weird obsession with tiny ceramic unicorns, or the way her perfume was always so heavy it made you gag when you went to grab whatever copies she needed made, “what is it that you want to know about her?”

He kept asking you questions, stuff that didn’t seem all that important, and you kept checking your phone as you gave brief answers growing angry again at being left here while your boyfriend hadn’t even asked if you had made it home. Then Agent Smith asked you something that distracted you completely.

“So if you don’t mind me asking, is this normally the type of place you come by yourself?”

“No, actually I got stood up,” and even though you tried to keep out the bitterness you couldn’t help but add, “again.”

He blushed a little at your answer, “I’m sorry to hear that,” then he smiled, it was dazzling the way it changed his whole personality and you noticed how handsome he was, “he must be an idiot.”

You thought it was weird how quickly the conversation changed after that, you started just chatting asking you about you about your job, what kind of places you did normally hang out at, you noticed he didn’t really open up himself but occasionally he would let something slip about his brother or how much he loved to read. As he called over the waiter, it had been almost two hours, and you felt a little disappointment. You were silently delighted when he dropped his own card down on the bill he winked, “it’s on Uncle Sam.”

Grasping your purse as you stood up to leave, you hesitated for second, then you forced yourself to do something crazy. Pulling out a company card, with your own cell number scribbled at the bottom, you slid it into his hand as he offered one last shake before leaving.

“If you stay in town for a while, maybe you could give me a call.” You knew you should feel guilty even mildly flirting with another guy, but you doubted anything would come from it, his mouth opened in silent surprise but he quickly changed it into a smile and nodded.

It had been two days of looking at your phone every chance you got, because a lot had changed. You had left the dinner with Agent Smith, you never did find out his first name, and you had called Bryan. There was obviously no answer so when you heard his bland voicemail you had told him you were done, no more waiting on him or being stood up, he had tried to get you to change your mind but it was over.

Something about the ease that you were able to imagine being with someone else that night, even a stranger, was enough to make you aware that you needed more. Even though you doubted the FBI let their agents go out with people they questioned after the way you had gotten along so well you were still hopeful.

“Y/n, can you put down the phone.”

Shoving it quickly out of sight, you focused on what you were supposed to be doing, “Yeah sorry, family things.” Carla didn’t look fooled. Then the look morphed into a glare as your phone started ringing.

“I’m going to go get the rest of those papers off your desk,” you dashed out of the copy room and as you got around the corner of the row of cubicles, you answered without even a cursory glance at the number.

“Hello?”

“Miss Y/L/N?”

Your cheeks hurt as the muscles strained because of the huge smile at the voice on the other line, he had decided to call you after all, even though as you continued to talk you were getting a little less excited since it was obviously a work thing. He wanted to come over to see the offices and would you be able to show him around. You let him know you only had access to the office section of the building, it was mostly cubicles where people called different hospitals to try and get them to stock the pharmaceutical companies medications, but that you would be happy to.

Standing out near the employee entrance to the side of the building, you shifted your weight, you had been running a little late to meet him and now you didn’t see anyone else around. Maybe he had decided he couldn’t wait on you. When you saw his tall frame coming around the building though you relaxed and waved to catch his eye.

He hurried his pace and beamed at you as he pushed his hair back out of his face. “Y/n thanks for doing this.”

“No problem, hey can I ask what your first name is?”

He hesitated, you thought maybe you were crossing a line, then he stammered out, “it’s Sam.”

You pulled a face.

“What?”

“Your name is Sam? Sam Smith? Like the singer.”

He laughed, it shook his whole body, and he balanced himself on his knees with the force of it. You weren’t really sure why it was so funny but his energy was so inviting you found yourself wanting to join in. Eventually he calmed down, “Sorry my name is actually Samuel but I go by Sam, I guess I never made the connection.”

“Well lets show you around Sam.” You swiped your ID badge over the small black panel and then when the tiny light went from red to green, you swiftly pushed open the door.

Sam’s company made up for the boring tour you were giving, he was making little jokes about the various things that were bland to you seeing them every day, he made you giggle and snort as you tried to keep quiet so you didn’t draw too much attention to the two of you.

It wasn’t exactly the Taj Mahal so in about fifteen minutes you had wandered through the areas you were allowed access to, and you pulled open the last door. Inside was a small table that had a jar of pens, papers, a hole punch on it. Opposite the copier, it was only slightly better lit that the average closet or coffin but you liked it anyway. It was where you went to escape your annoying co-workers.

“I doubt the ax murderer has any secret plans for these safety scissors,” you said picking up a pair to snap at him menacingly, “I just like it in here.”

He was looking out into the hallway, not really acknowledging you, which kind of stung. Then he stepped forward shutting the door, you stomach clenched at the scent of his cologne it wasn’t pungent but his closeness had it wrapping around you, but as he leaned closer you thought maybe he was going to tell you something secret about the case and figured you should focus.

“About the other night,” you felt the warmth against your ear as he spoke, “you should know I won’t be in town long we’ve almost finished the case.”

You turned to look at him, but you misjudged his closeness and you felt the hard knock and water crept into your eyes as your nose smacked into the back of his head, “God sorry,” you said as you watched him start rubbing the spot you had hit.

“No problem,” he hair covered his face, so you had no way to gauge his expression, his shoes were suddenly very interesting apparently.

A second later the sting had gone away so you reached for him, “well that’s too bad, about leaving soon I mean.”

His gaze snapped up at that, pausing on where your hand rested against him, then locked onto your eyes. Deciding to be a little bolder, you typically were a long term relationship kind of girl, you added, “I was wanting to see about giving the whole rebound thing a try since I am officially single.”

He started to press in closer to you, pausing briefly, but when you didn’t back away he was on you. Turning you, you felt a sting as your tailbone hit the hard edge of the table, it was cramped. He was clearly aware of your location though because instead of trying to undress you he just lifted your skirt and pulled your panties halfway off, to steady yourself you pushed against his chest, but he planted his hands on your waist and set you on the edge of the table. You felt papers sliding onto the ground and underneath you, and you held off the urge to start laughing.

The sound of his zipper, had you panting in an instant, being at work where anyone could walk in and see you was intoxicating. He was standing a little away from you and you were drawn to where he was working himself.

“Touch yourself,” his voice was strained.

You knew without glancing up he was watching you, so you wet your fingers before sliding them against yourself. He let out a small groan as you lifted you skirt a little more and tried with your panties twisted up around you to spread your knees.

As soon as you started to work you noticed the echos, his hand on skin and as you got going your own slickness, then he came closer.He tugged at your wrist and then capturing it brought your fingers to his lips, his tongue swirled along them, when he released you he felt him pressing into you.

Shifting down a little you tried to make it easier for him. That’s when you felt him enter you, the pace he set was quick and the table under you kept knocking against the wall, you didn’t even care if anyone heard though because you could felt him run a finger over you clit and electricity shot through you.

“God,” you couldn’t even remember his name, “ Agent, feels so good.” Barely able to make the words leave your mouth past your clenched teeth.

He rested his head on you, nipping at your clavicle. You felt his head damping the sweater you were still wearing. You tangled your hand in his hair and the other wrapped around his upper arm for purchase and you began to rock your hips.

Picking up the pace you knew he was close, he was pulling up and his eyes locked on yours, putting your hand between your bodies you were able to frig your self. You were right on the edge and then you were tightening around him, heat was rolling through you.

Suddenly he pulled out and you knew he was ready so you scuffled off the table and onto your knees his free hand steadying you while you got down.

“Stick your tongue out,” he was panting it but you got the idea.

You opened your mouth wide and closed your eyes and waited and then he was pushing the tip of himself against your lips and you were flooded with the deep tang which you swallowed down.

He was still breathing heavy, and you knew as you stood up and tried to straighten yourself that if anyone saw either of you, it was going to be more than obvious what you just finished. His suit was wrinkled and dark with sweat and you could feel the weird way your hair was standing as your tried to smooth it with your palm.

“So, Smith,” his last name was still all you could think of, “you should probably get back to work.” You giggled there were no hard feelings it had been a good time for both of you.

He beamed at you, his teeth were showing, “I finished the case the other night.”

“Really?” You face must have shown your shock because he started to laugh.

“Yeah I just wanted to see you again,” he said after calming, “I wasn’t expecting this though, my partner is going to give me a hell of a time.”

“Well, you always have my number if you are ever back in town.” You had no expectations, you didn’t even really mind that this was a one time thing, you were looking forward to having more fun experiences now that you were single.

Turning towards the door you were stopped by his giant arms wrapping around you, it was sweet and you got the feeling if he didn’t have this type of job he wouldn’t be the kind of guy to watch a chick walk out after a quicky, “I really hope I get a chance to use it.”

#sam x reader #sam x you #smut appreciation day 2017 #spn smut #spn fanfic #spn #my writing #FBIagent!sam

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vsplusonline · 5 years ago

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India braces for more coronavirus cases, but experts fear an epidemic

New Post has been published on https://apzweb.com/india-braces-for-more-coronavirus-cases-but-experts-fear-an-epidemic/

India braces for more coronavirus cases, but experts fear an epidemic

India is bracing for a potential explosion of coronavirus cases as authorities rush to trace, test and quarantine contacts of 31 people confirmed to have the disease.

It is screening international travelers at 30 airports and has already tested more than 3,500 samples. The Indian army is preparing at least five large-scale quarantine centers.

For weeks, India watched as cases of COVID-19, the disease caused by the virus, multiplied in neighboring China and other countries as its own caseload remained static — three students evacuated from Wuhan, the disease epicenter, who were quarantined and returned to health in the southern state of Kerala.

READ MORE: Coronavirus cases top 100,000 worldwide, sparking global economy concerns

Prime Minister Narendra Modi’s government said last week that community transmission is now taking place. India has shut schools, stopped exporting key pharmaceutical ingredients and urged state governments to cancel public festivities for Holi, the Hindu springtime holiday in which people douse each other with colored water and paint.

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Modi canceled travel plans to Brussels for an India-EU summit amid a rising caseload in Belgium, and tweeted that he would not attend any Holi festivities.

3:44 COVID-19: PAHO prioritizes Haiti, Venezuela, migrant populations for coronavirus support

COVID-19: PAHO prioritizes Haiti, Venezuela, migrant populations for coronavirus support

Experts fear these precautions won’t be enough for India’s beleaguered, under-funded and under-staffed health system to stave off an epidemic. Here are their foremost concerns:

Too few labs, not enough hospitals

As the virus spread globally, India began bolstering its ability to test and detect the virus. While the National Institute of Virology at Pune remains the main testing facility, the government has identified 35 additional labs for testing.

But concerns remain over India’s overstretched health infrastructure — a single state-run hospital for every 55,591 people on average and a single hospital bed for every 1,844 people. India needs about 10 times more doctors to meet the norms prescribed by the World Health Organization, a shortfall of at least 500,000 doctors.

READ MORE: China sees cautious return to work after weeks of disruption due to COVID-19

Experts fear that an epidemic would cause other routine health care functions to suffer.

“Everything will become about COVID-19. And other routine services like immunization or taking care of maternal mortality would be affected,” said Anant Bhan, a global health and policy expert.

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Health care inequality

India’s health performance, an index that includes access to primary care, maternal mortality rates and child health, runs the spectrum, with some states outperforming others by almost 2.5 times, according to the government-run think tank NITI Aayog.

The best performer was Kerala, the small state that found and treated India’s first three cases. The worst was Uttar Pradesh, a state with roughly the population of Brazil that has detected at least six cases. Kerala has a doctor for approximately every 6,000 people, while Uttar Pradesh has one for every 18,000 people. The inequalities are further pronounced between urban and rural areas, with the bulk of the available beds concentrated in India’s cities.

India spent an average of $62.72 per person on health care in 2016, according to WHO, compared to China’s $398.33.

READ MORE: U.S. stocks open sharply lower, bond yields sink over brewing coronavirus worries

Inequalities could make prevention even harder. In places with limited access to clean water, washing hands to prevent the spread of the virus is difficult, said Dr. Gagandeep Kang, a microbiologist who heads India’s Translational Health Science and Technology Institute.

Retired virologist and pediatrician Dr T. Jacob John said these inequalities aren’t just a reflection of not spending enough on health care, but also of not knowing where to spend.

“The last time a needs-based survey was done for India’s health care was in 1946,” he said, adding that the country’s “health management system is very inadequate for India’s existing problems, let alone new ones.”

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Quarantine millions

India’s health minister told Parliament that the “need of the hour” is to contain viral clusters, to prevent and break chains of transmission. But in India, with a population of 1.4 billion, that is far from easy.

Take the city of Agra, famous for the Taj Mahal, where six Italian tourists tested positive for the virus. Apart from the 40,000 tourists who visit the monument each day, the city has a population of more than 4 million, with nearly 3,000 people crammed into every square mile. Following WHO advice, the Indian government has told people keep a distance of at least six feet from others.

But “anywhere you’ve a dense population, all the issues of social distancing become challenging,” Kang said.

1:56 Coronavirus outbreak: WHO praises role of women in fighting COVID-19

Coronavirus outbreak: WHO praises role of women in fighting COVID-19

Short on medicines

With the virus lockdown in China resulting in shortages in India, the government halted the export of 13 key drug ingredients and the medicines made from them on Tuesday.

Although India is the world’s primary supplier of generic drugs, it relies on China for nearly 70% of the active pharmaceutical ingredients it uses for making medicines.

READ MORE: Do you think you have coronavirus symptoms? Here’s who to call first

India has said it has enough stocks, but the government’s minister for chemicals and fertilizers told Parliament that there remains “an apprehension” that supplies of ingredients from China would be disrupted if the epidemic continues.

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Long-term response

On Thursday, Health Minister Harsh Vardhan met the management of India’s top private hospitals to ask them to work with the government in dealing with the outbreak, and urged them to “prepare a pool of beds.”

Kang said India’s current approach, which is focused on travelers, might restrict some cases. But eventually, it will have to expand testing to limit the spread of the disease within the country, Kang said. The question, she said, is whether authorities want to do that now, or at the height of an epidemic.

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titheguerrero · 7 years ago

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A Higher Impunity - How Can we Reduce Health Care Leadership's Impunity When the President Claims His Own Impunity?

Impunity: an Introduction We believe that unaccountable leadership is a major cause of health care dysfunction. Impunity is an extreme form of unaccountable leadership. We have noted that despite numerous legal settlements made by health care organizations of alllegations like fraud, bribery, and kickbacks, almost never do top leaders who presided over these actions face any negative consequences. Lack of deterrence caused by such impunity appears to be a major cause of the epidemic of continuing unethical behavior, crime and corruption on the part of large health care organizations. How executives got to the point of having such impunity has never been clear. Timidity and lenience by regulatory agencies and law enforcement seem to be factors. For example, in 2014, we noted that Attorney General Eric Holder had previously been reluctant to go after big organizations because of the economic consequences of their failure:

The attorney general angered many last year when he reiterated those concerns at a congressional hearing, admitting 'that the size of some of these institutions becomes so large that it does become difficult for us to prosecute' because of the potential nasty economic effects of a major company failure.

In general we have seen much tougher enforcement directed against relatively small health care players than against bigger ones. For example, we noted in 2014 that settlements by Merck, Eli Lilly, Takeda, and Teva, all large pharmaceutical companies, allowed the companies to pay fines to settle allegations that they pushed dangerous products, while none of the executives who authorized, enabled, or directed these actions faced negative consequences. In contrast, at that time, the CEO of a relatively tiny Sheffield Pharmaceuticals was convicted of a felonious wastewater discharge (see this post). However, this rationale does not address the failure to pursue enforcement actions against organizational leaders who who enabled, authorized, directed or implemented misbehavior. It is not that there are no good legal tools available to do so. We wrote in 2012,

As we noted here, a Supreme Court case from 1943 empowered the government to seek penalties against responsible corporate officers (the "responsible corporate officer doctrine") who were in a position to stop a fraud that resulted in a guilty plea or conviction, particularly for the selling of misbranded or adulterated drugs into interstate commerce under the US Food and Drug Act. Despite a threat made in 2010 by the chief counsel of the Inspector General's office of the US Department of Health and Human Services to use such legal authority to "get high level executives out of companies," nothing of the sort has happened.

Later, in 2015, under the previous administration, there was a tiny sign of progress against impunity. Then, Attorney General Holder authorized the creation of a Corporate Strike Force to take strong actions in response to health care corporate fraud. However, last year the Trump administration gutted even that small effort (look here). Why are efforts to reduce the impunity of health care corporate leaders going backward? It may be because the very top leadership of the current administration, that is, the President himself, has long personally enjoyed his own impunity. Examples of Donald Trump and Family's Apparent Impunity Before He Became President As a wealthy businessman, Donald Trump and his family were often linked to apparently illegal activities, but seemed to avoid any intensive investigation, much less negative consequences. A 2016 Politico article cataloged Trump's ties to organized crime, and found "Some of Trump’s unsavory connections have been followed by investigators and substantiated in court; some haven’t." Also,

Trump’s career has benefited from a decades-long and largely successful effort to limit and deflect law enforcement investigations into his dealings with top mobsters, organized crime associates, labor fixers, corrupt union leaders, con artists and even a one-time drug trafficker whom Trump retained as the head of his personal helicopter service.

We have found numerous examples, whic are below listed chronologically according to the time of occurrence of relevant events. Trump Accused of Lying to Federal Investigators about his Mafia Connections in the 1980s A WNYC piece from October, 2016, was based on an interview with a federal prosecutor who had investigated organized crime in the 1980s,

Attorney Kenneth McCallion was one of the federal prosecutors involved in that investigation. He says there appeared to be a sweetheart deal between the Teamsters Local 282 and Trump, where Trump would get a promise of cooperation from organized labor—including breaking up any strikes by minority workers—in exchange for no-show jobs, a lucrative concrete contract and a luxury apartment for the union president's girlfriend. 'After we indicted them, the Teamster leaders called a citywide strike, but there were two job sites they exempted from that. One was Trump Tower and the other was Trump Plaza,' McCallion said. Yet despite this, Trump was never prosecuted. 'Even though Donald Trump lied to law enforcement about his relationship and lying to federal agents is a federal crime, he basically got a pass at that point,' he said.

Trump Accused in Legal Papers of Accepting Kickbacks, but the Charges were not Investigated The 2016 Politico article also noted:

[An associate of a convicted racketeer] in court papers accused Trump of taking kickbacks from contractors, asserting this could 'be the basis of a criminal proceeding requiring an attorney general’s investigation' into Trump. Trump then quickly settled, paying the woman a half-million dollars.

No further investigation ensued. After a Judge Found that he Conspired to Violate Fiduciary Duty and Committed Fraud, Trump was able to Settle with Details Sealed Again in Politico,

In 1991, a federal judge, Charles E. Stewart Jr., ruled that Trump had engaged in a conspiracy to violate a fiduciary duty, or duty of loyalty, to the workers and their union and that the 'breach involved fraud and the Trump defendants knowingly participated in his breach.' The judge did not find Trump’s testimony to be sufficiently credible and set damages at $325,000. The case was later settled by negotiation, and the agreement was sealed.

It is not clear that Trump was personally responsible for paying whatever the settlement entailed. No criminal charges apparently followed. Applying for a Casino License, Trump Failed to Disclose he was Under Grand Jury Investigation, but Later Kept his License As also reported by Politico, when Trump was trying to obtain a license for a New Jersey gambling casino,

Trump was required to disclose any investigations in which he might have been involved in the past, even if they never resulted in charges. Trump didn’t disclose a federal grand jury inquiry into how he obtained an option to buy the Penn Central railroad yards on the West Side of Manhattan. The failure to disclose either that inquiry or the Cody inquiry probably should have disqualified Trump from receiving a license under the standards set by the gaming authorities.

But it didn,'t. And despite the fact that

Once Trump was licensed in 1982, critical facts that should have resulted in license denial began emerging in Trump’s own books and in reports by Barrett—an embarrassment for the licensing commission and state investigators, who were supposed to have turned these stones over. Forced after the fact to look into Trump’s connections, the two federal investigations he failed to reveal and other matters, the New Jersey Division of Gaming Enforcement investigators circled the wagons to defend their work. First they dismissed as unreliable what mobsters, corrupt union bosses and Trump’s biggest customer, among others, had said to Barrett, to me and other journalists and filmmakers about their dealings with Trump. The investigators’ reports showed that they then put Trump under oath. Trump denied any misconduct or testified that he could not remember. They took him at his word. That meant his casino license was secure even though others in the gambling industry, including low-level licensees like card dealers, had been thrown out for far less.

Trump's Casino Company Paid Multiple Fines for Violating Regulations, but Trump was not Personally Sanctioned An Atlantic article from January, 2017, stated,

Trump has been repeatedly fined for breaking rules related to his operation of casinos. In 1990, with Trump Taj Mahal in trouble, Trump’s father Fred strolled in and bought 700 chips worth a total of $3.5 million. The purchase helped the casino pay debt that was due, but because Fred Trump had no plans to gamble, the New Jersey gaming commission ruled that it was a loan that violated operating rules. Trump paid a $30,000 fine; in the end, the loan didn’t prevent a bankruptcy the following year. As noted above, New Jersey also fined Trump $200,000 for arranging to keep black employees away from mafioso Robert LiButti’s gambling table. In 1991, the Casino Control Commission fined Trump’s company another $450,000 for buying LiButti nine luxury cars. And in 2000, Trump was fined $250,000 for breaking New York state law in lobbying to prevent an Indian casino from opening in the Catskills, for fear it would compete against his Atlantic City casinos.

Also, while Trump was attempting a hostile take-over of a rival casino,

the Federal Trade Commission fined him $750,000 for failing to disclose his purchases of stock in the two companies, which exceeded minimum disclosure levels.

Trump and Family were Accused of Self-Dealing and Accepting Illegal Donations while Operating the Trump Foundation, but were not Individually Penalized Also reported by the Atlantic,

The [Trump] foundation appears to have broken IRS rules on 'self-dealing” by paying to resolve the legal disputes as well as buying a portrait of Trump and a Tim Tebow helmet that went back to the Trump family. In November, in tax filings posted online, the Trump Foundation said it had violated self-dealing rules in 2015 and in previous, indeterminate, years. On the donation, Trump and Bondi both say there was no quid-pro-quo, but the donation was an illegal one for a charitable nonprofit, and the foundation had to pay a $2,500 fine. Liberal watchdog group Citizens for Responsibility and Ethics in Washington charges other laws may have been broken as well. New York Attorney General Eric Schneiderman has reportedly launched an investigation into the foundation. Schneiderman has also informed the foundation that it is in violation of rules on fundraising and ordered it to quit. Trump has announced plans to shutter his foundation, but reportedly cannot do so while it is under investigation.

Yet so far no person has been charged with any related violations. Note that it appears that Trump may have had leverage on Mr Schneiderman, who has now resigned (see below). Although there were reports in 2017 that the Foundation was going to shut down, as of March, 2018, according to an article in The Hill, the ranking Democratic member of the House Oversight and Government Reform Committee was still trying to get records related to the self-dealing described above from the leadership of the apparently still existing foundation (look here). Trump's Taj Mahal Casino Was Fined for Breaking Rules about Money Laundering, but Trump Paid no Penalties A May, 2017, CNN story stated,

The Trump Taj Mahal casino broke anti-money laundering rules 106 times in its first year and a half of operation in the early 1990s, according to the IRS in a 1998 settlement agreement. It's a bit of forgotten history that's buried in federal records held by an investigative unit of the Treasury Department, records that congressional committees investigating Trump's ties to Russia have obtained access to, CNN has learned. The casino repeatedly failed to properly report gamblers who cashed out $10,000 or more in a single day, the government said. Trump's casino ended up paying the Treasury Department a $477,000 fine in 1998 without admitting any liability under the Bank Secrecy Act.

There is no record suggesting anyone looked into Trump's involvement with these violations. Note that

The 1998 settlement was publicly reported at the time, and the Associated Press noted it was the largest fine the federal government ever slapped on a casino for violating the Bank Secrecy Act.

However,

But key details of the casino's cash reporting violations are missing from the publicly released documents, including the identities of the gamblers and casino employees involved in the transactions.

Then, in 2015, FINCEN publicly announced:

The Financial Crimes Enforcement Network (FinCEN) today imposed a $10 million civil money penalty against Trump Taj Mahal Casino Resort (Trump Taj Mahal), for willful and repeated violations of the Bank Secrecy Act (BSA). In addition to the civil money penalty, the casino is required to conduct periodic external audits to examine its anti-money laundering (AML) BSA compliance program and provide those audit reports to FinCEN and the casino’s Board of Directors. Trump Taj Mahal, a casino in Atlantic City, New Jersey, admitted to several willful BSA violations, including violations of AML program requirements, reporting obligations, and recordkeeping requirements. Trump Taj Mahal has a long history of prior, repeated BSA violations cited by examiners dating back to 2003. Additionally, in 1998, FinCEN assessed a $477,700 civil money penalty against Trump Taj Mahal for currency transaction reporting violations. 'Trump Taj Mahal received many warnings about its deficiencies,' said FinCEN Director Jennifer Shasky Calvery. 'Like all casinos in this country, Trump Taj Mahal has a duty to help protect our financial system from being exploited by criminals, terrorists, and other bad actors. Far from meeting these expectations, poor compliance practices, over many years, left the casino and our financial system unacceptably exposed.' Trump Taj Mahal admitted that it failed to implement and maintain an effective AML program; failed to report suspicious transactions; failed to properly file required currency transaction reports; and failed to keep appropriate records as required by the BSA. Notably, Trump Taj Mahal had ample notice of these deficiencies as many of the violations from 2012 and 2010 were discovered in previous examinations.

Again, there is no record of any negative consequences for Mr Trump Trump Made False Statements Under Oath, but was not Charged with Perjury A Mother Jones article published February, 2016, recounted that in connection with a libel suit Mr Trump filed against journalist Timothy O'Brien alleging O'Brien under-reported Mr Trump's wealth,

In 2007—two years before a New Jersey judge tossed out the case—Trump was questioned during a deposition. Over the course of the two-day-long interrogation, Trump was forced repeatedly to acknowledge having made false statements. And at one point, a lawyer for O’Brien and his publisher asked Trump a straightforward question: Have you ever before associated with individuals you knew were associated with organized crime?' Trump, who was testifying under oath, answered, 'Not that I know of.' That was a clear and unequivocal response. But it was not true. Two years earlier, O’Brien had interviewed Trump and specifically asked him about Sullivan and Shapiro. O’Brien, now an editor and writer at Bloomberg, has provided Mother Jones with a transcript of the interview, and it conclusively shows that Trump believed that these two men were associated with organized crime.... Trump: They were tough guys. In fact, they say that Dan Sullivan was the guy that killed Jimmy Hoffa. I don’t know if you ever heard that. O’Brien: I have heard that. And that he was, you know…

Also,

Trump: I just was able to handle them. And I, really, I was able to handle them. I found Sullivan to be the tougher of the two. I started hearing reports about Sullivan, that he killed Jimmy Hoffa….

Also,

O’Brien: What was Shapiro like? Trump: He was like a third-rate, local, real estate mob guy. Nothing spectacular. And I, you know, I got lucky. I heard a rumor that Sullivan, because Sullivan was a great con man, I heard a rumor that Sullivan killed Jimmy Hoffa. And because I heard that rumor I kept my guard up. You know, I said, 'Hey, I don’t want to be friends with this guy.' So here was Trump connecting Sullivan to the Hoffa murder and calling Shapiro a 'mob guy.'

The same article also asserted that Trump lied in a deposition about knowing and working with Felix Sater, who who "had once been involved in a Mafia-linked stock swindle," and who "had worked with the Trump Organization." Ivanka Trump and Donald Trump Jr Escaped Indictment for Fraud As reported by the New Yorker in October, 2017, despite considerable evidence that the two children of Donald Trump had misled potential buyers of Trump SoHo condominiums, Cyrus Vance, the Manhattan District Attorney overruled his staff by halting an investigation of them in 2010. Later, the Trumps' attorney, Marc Kasowitz, made a large donation to Mr Vance's campaign. Trump University Settled Fraud Allegations, Trump Not Charged As reported by the New York Times in 2017, "the final settlement of allegations that 'Trump University students had been cheated out of thousands of dollars in tuition through high-pressure sales techniques and false claims about what they would learn" was approved by a judge. Litigation about these allegations had gone on for years, but after his election in November, Mr. Trump reversed course and agreed to pay $25 million to resolve the litigation. He did not admit fault, and he maintained in posts on Twitter after the settlement announcement that he "did not have the time to go through a long but winning trial on Trump U." The settlement resolved lawsuits brought by the Attorney General of New York, Eric Schneiderman, among others. However, Mr Trump was never charged with a crime by Mr Schneiderman among others. There is some reason to think Mr Trump took actions to ensure his impunity. According to Bloomberg on May 11, 2018,

Back in 2013, Donald Trump was exploring a presidential run. His Trump University was in the crosshairs of New York’s crusading attorney general. Around the same time, Trump and his personal lawyer got an interesting piece of information: Eric Schneiderman, the AG, was accused of sexually abusing two women.

The details of the accusations were not made public at that time, but later,

Trump took aim at Schneiderman in a tweet on Sept. 11, 2013, that also referred to New York politicians who’d resigned over allegations of sexual misconduct, Anthony Weiner and Eliot Spitzer. 'Weiner is gone, Spitzer is gone -- next will be lightweight A.G. Eric Schneiderman. Is he a crook? Wait and see, worse than Spitzer or Weiner,' Trump tweeted.

Mr Schneiderman never brought criminal charges against Mr Trump. Could it be that he was made aware that Trump had information about Schneiderman's sexual behavior that he could use against him? This month, the allegations of his sexual misconduct were finally made public and he then resigned. The settlement, again absent any charges against Mr Trump, was approved in March, 2017. Summary of Trump's Pre-Presidency Impunity While Trump's firms have had to pay multiple fines for breaking rules and laws, and Trump and the immediate family members who work with him in the Trump Organization were credibly accused of multiple types of wrong-doing, including various apparent crimes, neither Trump nor his family members were ever indicted, or apparently investigated for crimes. President Trump's Arguments That He Has De Jure Impunity Since he was elected, President Trump and his proxies have asserted he now has de jure impunity that seems to go well beyond the sort of de facto impunity he enjoyed as a wealthy and powerful businessman and celebrity. Note that none of these statements attempted to deny that he had or would violate laws. They were all assertions that President Trump is not subject to the rule of law. Examples appear again in order of apparent occurrence. Trump Said He is Not Subject to Laws on Conflicts of Interest. As reported by CNN in November, 2016:

Donald Trump said on Tuesday that he faces no legal obligation to cut ties with his businesses, even as he described how winning the presidency has made his brand 'hotter' and acknowledged advancing his business interests during a conversation with a British politician. 'The law's totally on my side, the president can't have a conflict of interest,' Trump said in an interview with New York Times editors and writers. Trump said he was surprised by how little was legally required of him. 'In theory I could run my business perfectly and then run the country perfectly. There's never been a case like this,' he said. 'I'd assumed that you'd have to set up some type of trust or whatever and you don’t.'

Yet,

It’s true that federal conflict-of-interest laws exempt the president, and he’ll have the power to change White House ethics rules. But there remains a constitutional ban on accepting payments from foreign governments, as well as anti-corruption laws against bribery and fraud.

Trump Stated His Personal or Family Finances Cannot be Subjects of Investigation In an interview with the New York Times in July, 2017, he responded to a question:

SCHMIDT: Last thing, if Mueller was looking at your finances and your family finances, unrelated to Russia — is that a red line? HABERMAN: Would that be a breach of what his actual charge is? TRUMP: I would say yeah. I would say yes. By the way, I would say, I don’t — I don’t — I mean, it’s possible there’s a condo or something, so, you know, I sell a lot of condo units, and somebody from Russia buys a condo, who knows? I don’t make money from Russia. In fact, I put out a letter saying that I don’t make — from one of the most highly respected law firms, accounting firms. I don’t have buildings in Russia. They said I own buildings in Russia. I don’t. They said I made money from Russia. I don’t. It’s not my thing. I don’t, I don’t do that. Over the years, I’ve looked at maybe doing a deal in Russia, but I never did one. Other than I held the Miss Universe pageant there eight, nine years [crosstalk]. SCHMIDT: But if he was outside that lane, would that mean he’d have to go? [crosstalk] HABERMAN: Would you consider—— TRUMP: No, I think that’s a violation.

A typical interpretation of this rather incoherent response was in The Hill,

President Trump warned special counsel Robert Mueller from investigating his family’s finances beyond the scope of the probe into ties between his administration and Russia in an interview with The New York Times on Wednesday. 'I think that’s a violation. Look, this is about Russia,' Trump told the Times. Trump during the interview said he wasn’t ruling out firing Mueller as special counsel on the probe into Russian meddling in the presidential election. He did not say that he would order the Justice Department to fire Mueller or under what circumstances he would fire him, but he indicated Mueller investigating his family's finances would cross a line.

Trump's Attorney Argued that a President Cannot be Charged with Obstructing Justice An article in Axios from December, 2017, strated

John Dowd, President Trump's outside lawyer, outlined to me a new and highly controversial defense/theory in the Russia probe: A president cannot be guilty of obstruction of justice. The 'President cannot obstruct justice because he is the chief law enforcement officer under [the Constitution's Article II] and has every right to express his view of any case,' Dowd claims.

However, a Washington Post article published on May 18, 2018, stated that Mr Trump's current attorney is not so sure about that,

But apparently [current Trump laywer Rudy] Giuliani disagrees. Trump's own lawyer said Friday that his client is not immune from charges of obstructing justice — which is clearly the most troubling part of special counsel Robert S. Mueller III's investigation for Trump personally. While Trump hasn't been directly linked to potential collusion with Russia, he has taken many actions as president that have caught Mueller's attention and could feasibly be seen as trying to influence the course of the investigation. So whether Trump can technically obstruct justice at all is a key point, and it's one Giuliani just conceded.

Trump's Attorneys Argued He Is Immune from Civil Court Proceedings while President They had argued that he has immunity from lawsuits as President, but as Reuters reported this month,

A New York state judge on Tuesday said U.S. President Donald Trump must face a defamation lawsuit by a woman who accused him of sexually harassing her after she appeared on his former reality TV show. The decision by Justice Jennifer Schecter of the New York state court in Manhattan in favor of California restaurateur Summer Zervos, a former contestant on NBC’s 'The Apprentice,' raises the prospect that Trump might have to answer embarrassing questions in court about his behavior toward women. She rejected Trump’s claim that he was immune from being sued, finding 'absolutely no authority' to dismiss litigation related 'purely to unofficial conduct' solely because he occupied the White House. 'No one is above the law,' the judge wrote.

Trump's Attorney Asserted He Cannot be Forced to Testify in Court As reported by Reuters two days ago, on May 17, 2018, President Trump's current lawyer Rudolf Giuliani:

told Fox News Thursday morning not just that the special counsel cannot indict President Trump but that Mueller’s team cannot even subpoena the president to appear before a grand jury. Giuliani’s theory is that if the president cannot be prosecuted, he cannot be called to testify in an investigation of his conduct. 'We’re pretty comfortable, in the circumstances of this case, they wouldn’t be able to subpoena him personally,' Giuliani said. 'They could probably require documents to be produced. That’s what was required of Nixon. We’ve provided 1.4 million documents. They probably could require you to testify in a civil case, possibly even as a witness in a criminal case, but they can’t require you to testify in what would be your own case.'

However,

I talked Thursday to eight lawyers who’ve been involved in previous probes of U.S. presidents. Every one of them said Giuliani’s theory is incorrect. Some of them had quite strong words. George Conway wrote the Supreme Court briefs for Bill Clinton accuser Paula Jones in the case that led to a unanimous ruling from the justices that the Constitution does not shield presidents from testifying in certain civil suits. He said Giuliani’s assertion that President Trump cannot be subpoenaed is 'drivel.' Lawrence Robbins, who represented White House officials in the Whitewater investigation, said Giuliani’s theory is 'facially preposterous.' Solomon Wisenberg, who worked on the Whitewater probe of Clinton, called the theory 'delusional.'

Summary Unaccountable leadership, particularly leadership with impunity, has been a major feature of modern US health care, and probably explains the continuing bad behavior, including criminally bad behavior and outright corrupt behavior ongoing in US health care organizations. While the US government began to address impunity in the last few years, those efforts have apparently halted during the current Trump regime. Given President Trump's long record of personal impunity during his career as a wealthy and prominent businessman, and his assertions that as President he is above the law, that should be no surprise. Yet, true health care reform requires well-informed leaders who uphold health care professionals' values, put patient's and the public's health ahead of all other considerations, avoid self-interest and conflicts of interest, are honest and ethical, and surely are not corrupt. They need to work in the context of a government that is of, by and for the people, not of, by and for a demagogic leader. In these times, true health reform is not possible under the current president. We will watch health care dysfunction continue to grow, and patients' and the public's health continue to decline until someone new takes the oath of office. Article source:Health Care Renewal

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