Anti-SLAPP protects doctor for reporting patient-doctor's opioid use to physician treatment authority

Cindy Shebley CC BY 2.0 via Flickr

A doctor who prescribed opioids for a fellow doctor and ultimately reported the patient-doctor for possible impairment by addiction was protected by anti-SLAPP law when the patient-doctor sued, the Massachusetts Appeals Court held in June.

The two doctors' relationships started when the defendant, a primary care physician, prescribed the plaintiff, an ophthalmologist, Percocet, which contains oxycodone, to manage migraines. In time, the defendant became concerned about the plaintiff's ongoing use of opioids. After unsatisfactory back-and-forth with the plaintiff, the defendant reported his concerns to Physician Health Services (PHS), a nonprofit corporation created by the Massachusetts Medical Society, which in turn is a creation of the legislature. The plaintiff ultimately accepted addiction counseling upon PHS recommendation.

The plaintiff sued the defendant for negligence, tortious interference, civil rights violation, and invasion of privacy. The defendant invoked the Massachusetts anti-SLAPP law, and the court dismissed. The Appeals Court affirmed.

I'm on record as an anti-SLAPP skeptic, while acknowledging that anti-SLAPP laws sometimes facilitate a sound outcome. To my satisfaction, the Massachusetts law is narrow in some key regards, including the requirement that a defendant's conduct must be substantially related to a petitioning to governmental officials. In June 2021, I wrote about the failure of an anti-SLAPP defense when the Appeals Court opined that defendants' alleged extortive expression was not sufficiently closely related to the zoning disposition with which the defendant was alleged to have sought to interfere.

In the instant case, the Appeals Court had little trouble determining that the defendant's reports to PHS were substantially related to government petitioning. Physician peer reporting is required by law upon reasonable belief in a violation of regulation. And it was understood, the court reasoned, that reporting to PHS, which specializes in treatment for drug and alcohol impairment, was an intermediate step that would result in reporting to the state licensing authority if the matter could not be resolved.

"It follows, therefore, that the defendant's communication to PHS regarding his concern about the plaintiff is protected," the court wrote, "unless the plaintiff can show either that the defendant failed to act in good faith or that he had no reasonable belief that the communication furthered the purpose of PHS."

The case is Berk v. Kronlund, No. 22-P-4 (Mass. App. Ct. June 14, 2023) (FindLaw). Justice Kenneth V. Desmond Jr. wrote the opinion of the unanimous panel that also comprised Justices Wolohojian and Blake.

Opioid settlement disbursements must be transparent, state high court rules in row over nonprofit foundation

The nonprofit foundation responsible for disbursing hundreds of millions of dollars of opioid settlement money in Ohio is subject to state freedom of information laws, the state supreme court ruled Thursday.

Big money is flowing out of opioid settlements, such as the $10 billion deal struck by pharmacies CVS and Walgreens. Ohio will see some $450 million of that money, Emily Field reported for Law360 (limited free access). At least half of it will be disbursed by a nonprofit organization that state and local governments created for the purpose, the OneOhio Recovery Foundation.

A representative of Harm Reduction Ohio (HRO), another nonprofit organization, concerned with preventing overdose deaths, was shown the door at a OneOhio meeting not open to the public. OneOhio subsequently refused to reply to record requests under the Ohio public records act (PRA).

That will change now, as the Ohio Supreme Court ruled unanimously that OneOhio is the functional equivalent of a public entity, the test for bringing quasi-private actors within the scope of the PRA. To determine functional equivalence, the court explained, a totality-of-the-circumstances, multi-factor test asks:

(1) whether the entity performs a governmental function,
(2) the level of government funding, 
(3) the extent of government involvement or regulation, and 
(4) whether the entity was created by the government or to avoid the requirements of the Public Records Act.

The burden of proof is "clear and convincing," which is no low hurdle. 

The factors are common in functional equivalence tests in state sunshine laws in the United States. The devil is in the application. Characteristically, HRO and OneOhio posited very different analyses.

Though the multi-factor test makes no one factor dispositive, funding often proves controlling in cases such as these, even to the point that some states employ a disjunctive formulation along the lines of "state funding or state power." Here, the parties looked at the problem from differing angles. HRO characterized the money under the control of OneOhio, an entity created by government, as public money. OneOhio rather looked to the source of the money, private corporations, and to the ultimate beneficiaries, private-person recipients of state aid.

HRO had it right, the court decided. The analysis was bolstered by the inescapable conclusion that OneOhio was created by state and local governments through a memorandum of understanding specifically about how they would handle the money. OneOhio tried to resist the fourth factor by articulating it as conjunctive, thus, requiring an intent to evade the PRA. But the court had none of it.

Another somewhat superfluous argument by OneOhio merits mention. The foundation argued that subjecting it to the PRA would makes its funds vulnerable to raiding for other purposes by the legislature. Neither here nor there, the court opined. I suggest moreover that OneOhio's PRA accessibility is the result not the cause of its public status.

What's interesting about the argument from a tort perspective, though, is that OneOhio pointed to the example of tobacco settlement money. The Ohio executive and legislature responded to the 2008 financial crisis by diverting $230m in proceeds from the 1998 Master Settlement Agreement with Big Tobacco to unrelated purposes, namely, balancing the budget and fostering job creation. The Ohio Supreme Court upheld the diversion against constitutional challenges in 2010.

The application in the states of functional equivalence and similar tests to extend sunshine laws to quasi-private actors is highly variable, as much a function of the eye, or prejudices, of the beholder, as of any mathematical formula. That makes it difficult to extrapolate from the Ohio case beyond Ohio.

Still, I find this case offering a compelling analysis to access the infamously secret records of university foundations in other states. Those records, too, often are secreted upon the rationale that the funds originate with private donors. Consistently with the instant case, but not representing a majority rule in the states, the Ohio Supreme Court sided with a newspaper in 1992 in granting PRA access to the donor rolls of the nonprofit University of Toledo Foundation.

The instant case is State ex rel. Harm Reduction Ohio v. OneOhio Recovery Foundation, No. 2023-Ohio-1547 (May 11, 2023).

Opioids, coronavirus add up to dangerous interaction

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Purdue Pharma will plead guilty to criminal charges in the marketing of OxyContin, the Justice Department (DOJ) announced yesterday.  Meanwhile, addiction and coronavirus are dangerously interrelated, Dr. Joseph Grillo warns.

DOJ settled with Purdue Pharma in civil and criminal investigations, and with Sackler family shareholders in civil investigation.  Purdue will admit that it conspired to defraud the United States by misleading and impeding enforcement by the Drug Enforcement Administration for almost 10 years.  Purdue also will admit to conspiring to violate the Federal Anti-Kickback Statute with inducements to doctors to prescribe opioids for almost eight years.  (Purdue Plea.)

On the civil side, Purdue will settle, without admission, allegations of false claims to federal healthcare programs, of improper inducements to prescribing doctors, and of improper contracts with fulfilling pharmacies.  The government will have an unsecured claim on $2.8bn in Purdue's bankruptcy.  (Purdue Settlement Agreement.)  Purdue shareholders in the Sackler family will pay $225m in settlement of allegations that they approved an intensified opioid marketing program.  (Sackler Settlement Agreement.)

The settlements do not resolve state claims.

Opioids have taken more than 450,000 American lives since 1999, The New York Times reported yesterday, citing CDC research.  COVID-19 deaths now exceed 220,000, according to the CDC.

In 2020, the coronavirus pandemic nudged the opioid epidemic out of the number one spot for enemy of public health.  But the two are hardly mutually exclusive.  Addiction, of all types, interacts with the threat of coronavirus in a mutually exacerbating feedback loop.  Joseph Grillo, M.D., J.D., and an alum of my torts class, raised a warning flag on his blog yesterday.

"Two great epidemics of our generation are intersecting in ways that are additively deadly, and which highlight the urgent ways we must respond to some of the underlying fault lines in our society that are worsening both crises," Dr. Grillo wrote.

Read more about substance use disorders (SUD) and coronavirus at A Pandemic Within a Pandemic, Joseph Grillo, M.D. Medical Legal Consulting, Oct. 21, 2020.

Talk traces 'nuisance' from King Henry I to COVID-19

Yesterday I had the privilege to present in a lecture series (virtually) at Jagiellonian University (UJ) on the tort of nuisance in American common law.  I sketched out the historical background of nuisance relative to the recent lawsuit by the State of Missouri, against the People's Republic of China, alleging public nuisance, among other theories, and seeking to establish responsibility and liability for the coronavirus pandemic.  Here is a video (CC BY-NC-SA 4.0) of the presentation, also available from Facebook, where the lecture streamed live.  A narrative abstract is below the video.

The Tort of 'Nuisance' in American Common Law:

From Hedge Trimming to Coronavirus in 900 Years

Nuisance is one of the oldest civil actions in Anglo-American law, dating to the earliest written common law of the late middle ages.  Nuisance for centuries referred to an offense against property rights, like trespass, interfering with a neighbor’s enjoyment of land.  But a nuisance need not be physical, and colorful cases have addressed nuisance achieved by forces such as sound, light, and smell.  In recent decades, nuisance has undergone a radical transformation and generated a new theory of civil liability that has become untethered from private property.  State and local officials have litigated a broad new theory of “public nuisance” to attack problems on which the federal government has been apathetic, if not willfully resistant to resolution, such as climate change and the opioid epidemic.  Just last month, the State of Missouri sued the People’s Republic of China, asserting that COVID-19 constitutes a public nuisance.  Emerging from understandable frustration, public nuisance nevertheless threatens to destabilize the fragile equilibrium of state and federal power that holds the United States together.

Here are some links to read more, as referenced in the presentation:

• Oral argument in Oakland v. BP (9th Cir. argued Feb. 5, 2020)
• Complaint in Missouri v. PRC (E.D. Mo. filed Apr. 21, 2020) (item 1)
• The English Game (Netflix 2020)

Here is a two-minute video (CC BY-NC-ND 4.0) of only my PowerPoint (no audio), if you want an idea about the course of the talk:

The four-part lecture series, "American Law in Difficult Times," comprises:

Paul Kurth: The American Low-Income Taxpayer: Legal Framework and Roles Law Students Play
May 12, 18:00
Event - Video

May 19, 18:00
Richard Peltz-Steele: “Nuisance” in American Common Law Tort: COVID-19 as a Public Nuisance?
Event - Video

May 26, 18:00
Susanna Fischer: Art Museums in Financial Crisis: Legal and Ethical Issues Related to Deaccessioning
Event - Video

June 2, 18:00
Cecily Baskir: American Criminal Justice Reform in the Time of COVID-19
Event - Video

Here is the lecture series invitation (Polish) from the American Law Students' Society (ALSS) at UJ, via Facebook:

Here is an "about" from ALSS and partners:

❖ ABOUT AMERICAN LAW IN DIFFICULT TIMES:

The American Law Program (Szkoła Prawa Amerykańskiego) run by the Columbus School of Law, The Catholic University of American [CUA], Washington D.C., and the Faculty of Law and Administration, Jagiellonian University, Kraków, as well as the American Law Students’ Society (Koło Naukowe Prawa Amerykańskiego) at the Jagiellonian University, Kraków, sincerely invite you to participate in a series of four one-hour online open lectures and discussion sessions delivered by professors from the American Law Program.

The lectures will be devoted to a variety of legal issues mainly relating to COVID-19 difficulties facing people and institutions, for which legal solutions may be useful.

The lectures will be available through Microsoft Teams as well as a live-stream via Facebook. Participants willing to participate through Microsoft Teams are kindly asked to provide the organizers with their e-mails no later than 6 hours before the commencement of the lecture, by e-mail to kn.prawaamerykanskiego@gmail.com.

Your participation in all four lectures will be certified by the American Law Students’ Society. Only those participants who provide the organisers with their name, surname and e-mail will be granted such certificates.

I am grateful to Jagoda Szpak and Agnieszka Zając of ALSS at UJ; Wojciech Bańczyk, Piotr Szwedo, Julianna Karaszkiewicz-Kobierzyńska, and Gaspar Kot at UJ; and Leah Wortham at CUA.  The lecture series is sponsored by, and I am further grateful to, the Koło Naukowe Prawa Amerykańskiego (ALSS), Szkoła Prawa Amerykańskiego (School of American Law), and the Ośrodek Koordynacyjny Szkół Praw Obcych (Coordination Center for Foreign Law Schools) at the Uniwersytet Jagielloński w Krakowie (UJ in Kraków), and to CUA.

SCOTUS, climate change, drug addiction, immigration highlight law and policy issues at UMass colloquium

Today at the Fifth UMass Interdisciplinary Legal Studies Colloquium in Boston, scholars talked about a range of intriguing work, from politics to climate change to drug legalization, being done across the University of Massachusetts campuses—Amherst, Boston, Dartmouth, and Lowell, and Law (at Dartmouth) and Medical (at Worcester).  Here’s a taste.

View of Boston from One Beacon Street today.  "Back Bay is called 'Back Bay' for a reason," UMass Dartmouth Professor  
Chad McGuire said, referring to reclaimed land that is threatened by rising sea levels.

Law and Policy Inside the Beltway
Panel 1—Moderated by yours truly

Queer Sacrifice in Masterpiece Cakeshop, Jeremiah Ho, UMass Law.  Professor Ho explicated his theory of “interest convergence,” and how a lack thereof explains the result in the U.S. Supreme Court’s recent decision in the LGBTQ-rights cakeshop case.  His research shows how images—sometimes literally—of gay identity have informed public and judicial perception of LGBTQ rights cases.  Three more cases lie on the horizon, in the Court’s next term, Ho said, so stay tuned.   Meanwhile preview his "Queer Sacrifice" work, just out in the Yale Journal of Law and Feminism, at SSRN.

Can Presidents Influence Public Attitudes Toward the Supreme Court? Evidence from a Survey Experiment, Paul M. Collins, Jr. (blog), Department of Political Science, UMass Amherst.  Collins’s long-term research digs deep into how statements and action by the President of the United States exert influence over public perception of the U.S. Supreme Court and its decisions.  What the President says matters; consider, Collins proffers, the White House has a whole office dedicated to SCOTUS spin.  Collins also notes that low public knowledge of the Court is a factor in allowing public opinion to be influenced by forces external to the Court.  I can’t help but think about the Court’s intransigence on cameras and public access.  Anyway, Collins has discovered that the public is more easily influenced on “low salience” issues, but less so on “high salience” (I’d say “hot button”) issues, such as immigration.

On the Supreme Court of the United States of America (and Congruent Agencies and Ministries in the Term of President Donald Trump), Judge Francis Larkin, UMass Law.  Judge Larkin shared observations of recent events in President-Court interaction.  He recalled FDR’s Court-packing plan, relative to its recent resurgence in politics (e.g., WaPo).

Forcing Disclosure, Justine Dunlap, UMass Law.  Professor Dunlap is looking at mandatory disclosures under Title IX, especially faculty duties.  She observes that the evolution of Title IX over recent decades, under administrations from both sides of the aisle, have fairly sought to respond to a real problem of unredressed sexual harassment and assault on college campuses.  But the responses have not always been well tuned.  And mandatory reporting, however well intentioned, can put faculty in the impossible bind of having to betray student trust.  (Professor Julie Baker in Q&A aptly noted also that the consequences of ill-tuned reporting schemes for accused perpetrators are not always conducive to dispute resolution or justice.)  Dunlap talked about a system being implemented at the University of Oregon that contemplates a third class of potential “reporter”—rather than all or nothing, a “student-directed reporter.”

Recovery, Resiliency, and Equality in Economic Development
Panel 2—Moderated by Professor Justine Dunlap, UMass Law

Opening for Business: Tax-Haven Economy and the State of Exception in Puerto Rico, Jose Atiles, Department of Political Science, UMass Amherst.  Professor Atiles is working on Puerto Rico and U.S. development strategies.  He explained that there are two prevalent approaches to development policy concerning the island, one the “blank canvas” approach, which encourages recovery investment on the selling point that, more or less, my words: there’s nothing there at present; two the “PR is open for business” approach, which seeks to exploit the island’s legal status as a tax haven.  Both of these representations are animated by a “neoliberal-colonial rationality,” and that troubling mindset is reflected in the law that facilitates these strategies.

I’m reminded of the colonial terra nullius doctrine with respect to the blank canvas, and the local-policy-characteristic Everett casino debate with respect to “open for business.”  Puerto Rico and its people are not our offshore plaything.  In Q&A, I asked Atiles what it would take for us to start thinking about PR more like we do Missouri.  Statehood and independence each have advantages and drawbacks, which he explained summarily; what won’t save PR, he said, is the status quo.

A “Least Regrets” Framework for Coastal Climate Change Resiliency Through Economic Development, Chad McGuire and Michael Goodman, College of Arts and Sciences, UMass Dartmouth.  Professor McGuire continues his renowned work on environmental conservation and climate change, and now he’s brought public policy numbers wizard Professor Goodman (also president of the UMass Dartmouth Faculty Senate) onto the team to look at the economics.  They’re attacking the problem of aligning shorter-term economic incentives with the longer-term public interest in saving the human race from extinction.

I just saw Dan Gardner on The Daily Show talking to Roy Wood Jr. (video embedded below) (let me remind everyone that I shook Roy’s hand in East Providence) talking about how our “caveman” brains don’t well process the threat of climate change because it’s too abstract, that we need more urgent messaging.  McGuire and Goodman have it.  As I’m wearing a sweater in May, McGuire observed: “Spring has become less of a thing, and winter moving into summer is becoming more of a thing.”  We’ve lost 15-30 days of winter in New England, he shows with data, and seasonal transitions are becoming more abrupt.  Then he directs us toward the view of Boston from our huge glass windows here in the 32nd floor of One Beacon Street.  “Back Bay is called ‘Back Bay’ for a reason,” McGuire said.  Boston sits on filled-in bay.

At lunch, McGuire told me about rubber buffers that run through Boston streets to absorb shifts in the aqueous earth beneath.  And he told me about the latest alarming findings from the Ross Ice Shelf.  Our society has invested a great deal in developing low-lying land, and we’re going to have reconcile that policy with our climate game.

Human Rights Responses to Economic and Social Inequalities—A Book Proposal, Gillian MacNaughton, School for Global Inclusion and Social Development, UMass Boston.  For my money—both figuratively and literally—Professor MacNaughton’s work is what we need to save humanity from catastrophe—after and assuming we figure out how to survive climate change.  MacNaughton takes what we know and bemoan about inequality of wealth and opportunity in the United States and runs writ large with the problem.  As she wrote in her abstract: “The Global Wealth Report 2017 reveals that the wealthiest 1% of the global population owns 50% of global assets, while the poorest 50% owns less than 1%.”  Building on the U.N. Sustainable Development Goals, she plans to propose putting some punch behind international treaty guarantees of social and economic equality, such as we might start to address this problem on the global level.  I’ve often lamented that our increasingly disparate economic stratification will be our undoing in the United States if we don’t address it.  It’s worth being reminded how much more desperate the situation already is worldwide.  See also Professor MacNaughton's recent co-edited book, Economic and Social Rights in a Neoliberal World (Cambridge University Press 2019).

Drug Use and Abuse, and the Criminal Justice System
Panel 3—Moderated by Professor Julie Baker, UMass Law

Is Marijuana the Gateway Drug? Maybe Not, But Its Legalization Could Be, Nikolay Anguelov, College of Arts and Science, UMass Dartmouth.  Professor Anguelov is known to many of my readers and former students as the author of the 2015 book, The Dirty Side of the Garment Industry: Fast Fashion and Its Negative Impact on Environment and Society (CRC Press) (Amazon).  I have heard him speak many times to awestruck and sometimes squirming audiences about the connection between their affordable clothing and Bangladesh waterways poisoned with dye and arsenic.  Anguelov is more recently author of From Criminalizing to Decriminalizing Marijuana: The Politics of Social Control (Lexington Books 2018) (Amazon).  Anguelov is now fine-tuning his formidable research into marijuana use.  His early data invite the conclusion that legalization—which I as a libertarian have favored—might be contributing to the opioid epidemic at least by “contributing to the cultural normalization of drug use and experimentation.”  Ruh-roh, Shaggy.  This is going to require further research, and I’m anticipatorily squirming in my H&Ms.

Recovery Coaches in Opioid Use Disorder Care, Matthew Maughan, UMass Medical.  When opioid addiction turns to recovery, attorney Matthew Maughan is the policy guru to turn to.  Informed by his multifaceted experience and research, he explained the role and peculiar success of the “recovery coach.”  It might be awkwardly unorthodox in terms of developing a large-scale model, but sometimes a block grant for an activity tailored to a person’s specific needs offers the best hope for recovery and might as well be cost effective.  Maughan recounted the story of a recovery accomplished through mental clarity achieved on the water on a kayak, under the guidance of a recovery coach.  That’s got to cost less than any bill I’ve ever gotten from a medical clinic.

Locating Cannabis Equity: Defining Areas Impacted by Drug Criminalization, Michael Johnson, Professor and Chair, McCormack Graduate School, UMass Boston, and Jeffrey Moyer, doctoral candidate in public policy, UMass Boston.  Moyer is working with Professor Johnson to study the intersection of enforcement and anti-discrimination.  Specifically, he asks whether the Massachusetts “Cannabis Control Commission’s use of a race-neutral variable is effective in selecting areas disproportionately impacted by criminalization.”  Part of the work has entailed mapping all drug arrests, which generates some compelling graphics when overlaid with demographic data.  I am reminded of being a journalism intern at WJZ-TV in Baltimore in the early 1990s, when we made an analog map—this was when we were still working on DOS-based computers—literally putting color pushpins in a map of Baltimore to look at the coincidence of murders with factual and demographic elements.  That was a time when we were first talking about the problem of race and policing “where the crime is.”  We also walked five miles to school, uphill both ways.

Moyer shows analysis of geographic data on police enforcement, obtained in part through a public record request.

To Plea or Not to Plea: A Virtual Simulation of Plea-Bargain Scenarios, Miko M. Wilford, Psychology Department, UMass Lowell; Annabelle Frazier, doctoral candidate in applied psychology, UMass Lowell; Kelly Sutherland, doctoral candidate in applied psychology and prevention science, UMass Lowell.  With doctoral candidates on a new applied psychology track at UMass Lowell, Professor Wilford is taking a behavioral look at plea bargaining, that irksome feature of the criminal justice system that we don’t like to talk about, even while we know it results in some guilty pleas calculated to avert draconian outcomes (my take).  Really they’re looking at the research of plea bargain research, trying to refine how we learn about people's decision-making processes in these high-stakes circumstances.  Perhaps no surprise once you think about it, it is difficult to simulate having so much at stake with volunteers in psychology-lab experiments.  The team is working on new, high-tech models using animations to engender empathy and generate better results.  See more at the project website, Pleajustice.org.

Personal Rights at the Borders

Panel 4—Moderator: Misty Peltz-Steele, UMass Law

Controlling Asylum: A Genealogical Analysis of Gender and Race Intersectionality, Phil Kretsedemas, College of Liberal Arts, UMass Boston.  Professor Kretsedemas is studying the status of domestic violence survivors and Latin American asylum seekers relative to Matter of A-B, an AG-Sessions opinion “that dramatically curtails asylum protections for survivors of domestic violence, and for many other people who have been persecuted by non-state actors.”  A U.S. District Court has lately pushed back on Sessions’s conclusions, Kretsedemas said, as he investigates the problem from critical dimensions of gender and racial equality.  Kretsedemas’s approach is further informed by comparative law, as he draws on parallel legal perspectives from foreign tribunals, including the U.K. House of Lords, and from parallel cultural perspectives, such as Guatemalan views on gender roles within families.  Present policies, focusing for example unduly on familial cohesion, have gravely injurious impact, for example failing to protect women from female genital mutilation.  Kretsedemas locates these policies in a context that includes family separation, though the latter issue has garnered greater public attention.

Troubling Bodies: The Office of Refugee Resettlement and the Unaccompanied Pregnant Teen, Shoshanna Ehrlich, College of Liberal Arts, UMass Boston.  Also examining a perhaps under-recognized issue within our vast immigration policy debate, Professor Ehrlich is studying the federal government’s “literal refusal to release [young women] from . . . custody so they may access abortion care,” plainly violating their civil rights, Ehrlich asserts.  Even the U.S. Government waived argument in the courts as to whether the teens involved here enjoy U.S. constitutional rights.  Yet in government memos discovered in ACLU litigation, Ehrlich shared in her presentation, Scott Lloyd, director of the Office of Refugee Resettlement (ORR), opined that abortions desired even by teens impregnated by rape are not in the young women’s best interests.  Lloyd was removed from his post and “transferred to HHS’s Center for Faith and Opportunity Initiatives,” Rolling Stone reported in November 2018.  He was later summoned to testify in Congress about family separations, Politico reported in February 2019.  Ehrlich told of interviewing parents the government separated from their children, and the trauma that resulted, wondering how the government could at the same time justify refusing abortions on the rationale that mothers should not be separated from their unborn children, despite their personal circumstances and decisions.