Category Archives: Politics

Private vs. Public Budgets

Budgeting is an important concept that is pertinent to any organization. According to Menifield (2009), budgeting is a financial planning function that creates accountability for the funds made available to meet or work towards some goal. In the private sector, budgets create the bottom line, or the amount needed to earn making a profit. In the public sector, however, budgets reflect the accountability and stewardship of tax revenue and its application towards maintaining and improving infrastructure. Although Menifield focuses on public budgets and compares them to private-for-profit business models, many not-for-profit corporations and other philanthropic ventures use budgets to account for funding and spending without focusing so much on profit, much like public budgets (Maddox, 1999). Not-for-profit corporations still need to focus on maximizing funding and reinvesting gains, though — a difference of public budgeting (Maddox, 1999; Penner, 2004). Most important, a budget provides a sense of direction for the organization and should reflect the stated vision and values.

Menifield (2009) describes the primary difference of public versus private budgeting as public budgets are prepared based on organizational needs and the funding for the budget is directed through tax revenue. Private organizations, according to Menifield, do not have the luxury of compulsory funding enjoyed by public organizations and must generate revenue through a prospective business model that maximizes income while minimizing expenditures. Both types of budgeting have intrisic responsibilities inherent to the process, which, if ignored, could result in severe penalties to those responsible.

Additionally, there are functions of government which are served by private contractors. Employing this concept would be rationalized, planned, and tracked by utilizing both private and public budgets — the contractor would utilize an internal budget reflective of private organizations, and the contracting governmental entity would use its public budget to plan and track the contract. Whereas typical criminal justice agencies, such as local police departments, judicial systems, et al., rely on public budgeting, the recent use of private contractors to manage some federal prisons reflect this use of private-public budgeting (Austin & Coventry, 2001; Nelson, 2005).

Budgeting is a form of financial planning. A budget also serves as an important document that can be used to focus an organization towards specific goals and provides overall accountability in financial management.


Austin, J., Coventry, G. (2001). Emerging issues on privatized prisons (NCJ No. 181249). Retrieved from

Maddox, D. C. (1999). Budgeting for not-for-profit organizations. Retrieved from

Menifield, C. E. (2009). The basics of public budgeting and financial management. Lanham, MD: University Press of America.

Nelson, J. (2005). Competition in corrections: Comparing public and private sector operations (IPR No. 11647 [Revised]). Retrieved from

Messaging as an Ongoing Process

Just after midnight on March 24, 1989, the Exxon Valdez ran aground in the Prince William Sound off of the Alaskan coast causing the 36th largest oil spill in history (Baker, n.d.; Fearn-Banks, 2011; Holusha, 1989; Moss, 2010). Though the initial ecological insult was severe, Exxon’s poor response to the emergency is noted as having the most significance (Baker, n.d.; Holusha, 1989). According to Fearn-Banks (2011), the initial public relations response was swift, but the public perception, especially with the obvious absence of CEO Lawrence G. Rawl from the public spotlight, was that the company did not view the incident with the importance that it deserved (Holusha, 1989). “The biggest mistake was that Exxon’s chairman … sent a succession of lower-ranking executives to Alaska to deal with the spill instead of going there himself and taking control of the situation in a forceful, highly visible way” (Holusha, 1989, para. 6). Rawl made comments about being technologically obsolete as a reason for not responding to the incident personally, and in a later television interview, Rawl explained that it was not the responsibility of the CEO to read specific response plans, then he went on to blame the media for the crisis (Baker, n.d.; Fearn-Banks, 2011).

According to Fearn-Banks (2011), Don Cornet, Exxon’s Alaska public relations coordinator, rushed to the scene and instituted a plan focused on the clean-up upon hearing of the incident; however, resources were scarce and the plan was slow to implement. Alaskan oil industry regulations held that the Alyeska Pipeline Service Company, an oil company consortium, was ultimately responsible for the initial response, which was soon taken over by Exxon. It was Alyeska’s involvement in the incident that introduced George Mason, an experienced crisis communications public relations expert for the company that represented Alyeska, into the spotlight. Mason worked with Cornet to streamline the media response and did much to limit the impact of Exxon’s poor media relations, even in light of Rawl’s disastrous commentary. Without the efforts of Mason, Cornet, and a few others, it appears that Exxon’s reputation would have suffered much more.

The primary issues identified in Exxon’s response to the Valdez incident, according to Baker (n.d.), are 1) a lack of resources and preparedness for a crisis of this magnitude, 2) failing to commit to prevention efforts in the future, and 3) the perceived indifference to the ecological shock.

According to Holusha (1989), Exxon’s response to the Alaskan spill was immediately identified as highlighting what not to do in responding to a crisis. Holusha compared Rawl’s messaging and response with that of the Ashland Oil spill and the Union Carbide incident in Bhopal, India, in which both CEOs responded immediately, availing themselves to the media to answer questions and respond to scrutiny.

The Exxon Valdez spill was significant, large, costly, and affected many industries and lifestyles in Alaska. Rawl’s response should have been immediate, and he should have taken responsibility to be apprised of all efforts being undertaken to rectify the situation. Legitimizing Rawl’s concerns of being a distraction to local efforts, he could have held frequent press conferences in the mainland United States, which would have limited the media’s need to send so many representatives directly to Alaska. This would have helped to show cooperation with the media as well as allow Rawl to address any concerns that the public might have. The messaging should have been that Exxon will do everything needed to return Alaska back to pre-spill status no matter the cost or manpower required.

Today, social media presents a unique opportunity for companies to address their public. Recently, Connecticut Light and Power utilized Facebook and Twitter, two popular social media programs, to provide real-time updates to their affected customers during a freak early snowstorm that put most of Connecticut without power for weeks (Singer, 2011; State of Connecticut, Department of Emergency Services and Public Protection, 2011). Though there are still concerns that Connecticut Light and Power were unprepared for such a crisis, without the deliberate effort to maintain communication with customers, the corporate image would have been much worse, as Exxon experienced.

It is a common precept in crisis communications that crises will occur and hopes can only be made to minimize their effect (Fearn-Banks, 2011). While preparing for such a crisis, a focus on communication and messaging should be paramount. The more the public trusts that the company will respond to the emergency effectively, the more apt they will be to acknowledge the difficulties involved in such a response. Messaging should be open, honest, and realistic. Every effort to use a multitude of media (e.g. radio, television, print, internet, telephone, et al.) to maintain a sense of transparency should be used to promote messages that accept responsibility and sets realistic goals. These communications, however, should not be unidirectional. A conversation needs to take place where the public can have their concerns and curiosity addressed in a fair and open environment.

By addressing the concerns of all stakeholders in a timely, open manner, corporate images will fare much better even in light of the worst crisis imaginable.


Baker, M. (n.d.). Companies in crisis – What not to do when it all goes wrong: Exxon Mobil and the Exxon Valdez. Retrieved from

Coombs, W. T. (2012). Ongoing crisis communication: Planning managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Fearn-Banks, K. (2011). “Textbook” crises. Crisis communications: a casebook approach (4th ed; pp. 90-109). New York, NY: Routledge.

Holusha, J. (1989, April 21). Exxon’s public-relations problem. New York Times. Retrieved from

Moss, L. (2010, July 16). The 13 largest oil spills in history. Mother Nature Network. Retrieved from

Singer, S. (2011, November 4). CT utility takes heat over winter storm response. News 8 WTNH. Retrieved from

State of Connecticut, Department of Emergency Services and Public Protection. (2011, November 8). Winter storm October 29, 2011 (Situation Report #49). Retrieved from

Impact of Technology: Social Media and Cyberbullying

The advent of the internet and social media allows like minded people to easily seek each other out and share their ideas. As I see a growing trend towards anti-sematism not unlike that of the 1930’s, I begin to draw parallels to that time and imagine sociopolitical paths of the likes we never want to tread. It was for this reason and others that I made a simple post on Facebook and Twitter reading “I support Israel.” This proclamation was made to let my Jewish friends know in no uncertain terms that I would never sway towards anti-Jewish sentiment, and it also made my other friends aware that I would not support them if they should harbor such feelings. There is inherent freedom in the idea of free-flowing information; however, this freedom also comes with responsibility. The same technology that promotes freedom also simplifies efforts to conspire against ideas, governments, and sometimes individuals. It is this conspiracy against individuals that has piqued my interest. The use of the internet (and, other technology, such as cell phones) to conspire against individuals can be seen in the act of cyberbullying.

Cyberbullying, according to Bill Belsey, the award winning author of the website “involves the use of information and communication technologies such as email, cell phone and pager text messages, instant messaging, defamatory personal Web sites, and defamatory online personal polling Web sites, to support deliberate, repeated, and hostile behavior by an individual or group, that is intended to harm others” (as cited in Li, 2007, p. 1779). Li (2010) goes further to include “exclusion” to this list. Exclusion is the specific and intentional exclusion of an individual from an online group. Further, Li (2007) hypothesizes that internet users are socially isolated and inept. This is certainly not the case. Li also discusses demographic differences in both victims and bullies, but the evidence from other studies prove confounding to any hypothesis regarding specific demographics (Schneider et al., 2011; Slonje & Smith, 2008; Smith et al., 2008; Smith, Mahdavi, Carvalho, & Tippett, 2006). Children do not seem either savvy enough or willing enough to block these communications as they happen (Smith et al., 2008). Further, children and adolescents are not emotionally stable enough to make this type of rational decision when confronted with cyberbullying; however, they also do not seem prepared to become emotionally stable enough to deal with typical adolescent musings when they become persistent, such as rumors posted to a website.

There is a real problem with social media and cyberbullying, but we need to call it as it is: bullying. By attaching the prefix cyber- to the act, we acknowledge the sophistication needed to perpetrate this type of bullying, which might egotize the bully. Most communities respond to cyberbullying by focusing on the technology used to perpetrate the bullying; however, it is more important to focus on the motivations and the social intolerances involved in bullying in general. By losing sight of the cause and focusing on the vehicle, no one will be able to overcome this problem, which is inherent, though sometimes magnified, in normal social adjustment and development of children and adolescents. Communities that wish to address cyberbullying would do well to educate the students about social responsibility, the rights and responsibilities of civic duty, and the different levels of appropriateness of various forms of communication.


Li, Q. (2007). New bottle but old wine: A research of cyberbullying in schools. Computers in Human Behavior, 23(4), 1777-1791. doi:10.1016/j.chb.2005.10.005

Li, Q. (2010). Cyberbullying in high schools: A study of students’ behaviors and beliefs about this new phenomenon. Journal of Aggression, Maltreatment, and Trauma, 19(4), 372-392. doi:10.1080/10926771003788979

Schneider, S. K., O’Donnell, L., Stueve, A., & Coulter, R. W. S. (2011). Cyberbullying, school bullying, and psychological distress: A regional census of high school students. American Journal of Public Health. Advance online publication. doi:10.2105/AJPH.2011.300308

Slonje, R. & Smith, P. K. (2008). Cyberbullying: Another main type of bullying? Scandinavian Journal of Psychology, 49(2), 147–154. doi:10.1111/j.1467-9450.2007.00611.x

Smith, P. K., Mahdavi, J., Carvalho, M., Fisher, S., Russell, S., & Tippett, N. (2008). Cyberbullying: its nature and impact in secondary school pupils. Journal of Child Psychology and Psychiatry, 49(4), 376–385. doi:10.1111/j.1469-7610.2007.01846.x

Smith, P. K., Mahdavi, J., Carvalho, M., & Tippett, N. (2006, July). An investigation into cyberbullying, its forms, awareness and impact, and the relationship between age and gender in cyberbullying (Report to the Anti-Bullying Alliance, Brief No. RBX03-06). Retrieved from

Wall Street Bombing of 1920: Terrorism and its Victims

In my search of a terrorist act, I hoped to find an example that was both pertinent in history and applicable today. With the growing “Occupy Wall Street” movement of anarchists, communists, socialists, and other anti-capitalists focusing their attention on the “evils” of Wall Street bankers, I am reminded of a similar set of circumstances that occurred in 1920 as the same groups of anti-capitalists focused themselves on Wall Street and for much the same reason. Unfortunately, the 1920’s protest resulted in the most fatal act of terrorism on U.S. soil at the time. According to Gage (2001), Kengor (2011), and the New York Times (“Explosives,” 1920; “Havoc,” 1920), on September 16, 1920, a horse-drawn carriage was driven down Wall Street and parked in front of the offices of J. P. Morgan bank. A few minutes later, a large explosion occurred killing 38 people and injuring 400 others. The scars of this attack, attributed to Italian Galleanist anarchists, can still be seen today as pockmarks in some of the local buildings.

“It would seem at times as if the whole world is one madhouse” (as cited in Gage, 2001, para. 12). This quote from the New York Call seems to summarize terrorism as it occurs on U.S. soil. However, those who are directly affected might have a more acute perception of the ordeal. By definition, terrorism instills terror, an acute fear reaction associated with daily living, and provides for more intense and prolonged psychological effects, such as insecurity, social disruption, anger, uncertainty, and loss of control, compared to disasters of other etiologies (Roberts & Yeager, 2009). However, according to DiMaggio and Galea (2007), most of the population appears to cope appropriately after such an event. When focusing on at-risk groups that might fail to cope, the literature describes females, those with previous psychiatry, and those directly involved, whether victim or rescuer, to be more apt to progress from a lesser acute stress phase to a more significant post-traumatic stress disorder. Though DiMaggio and Galea promote these as potentially useful triage markers, they admit that “many questions remain to be answered about how best to utilize health care resources in response to terrorism” (p. 157).

As much as I wish not to consider the possibility of another bombing on Wall Street this year or next, I know that it remains a real possibility. I am encouraged in the growth of victim awareness and crisis intervention that has occurred over the last few decades that might blunt the psychological effects of another terrorist event.


DiMaggio, C. & Galea, S. (2007). The mental health and behavioral consequences of terrorism. In R. C. Davis, A. J. Lurigio, & S. Herman (Eds.), Victims of crime (3rd ed.; pp. 147-160). Thousand Oaks, CA: Sage.

Explosive stores all accounted for. (1920, September 17). The New York Times, pp. 1, 3. Retrieved from

Gage, B. (2001, September 17). The first Wall Street bomb. History News Service. Retrieved from

Havoc wrought in Morgan offices. (1920, September 17). The New York Times, pp. 1, 4. Retrieved from

Kengor, P. G. (2011, November 8). In 1920, U.S. saw the carnage of class warfare. USAToday. Retrieved from

Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University.

Effects of Victimization

Selye (as cited in Roberts & Yeager, 2009) presents stress as natural component of life. Feelings of anxiety or memories of that anxiety are what drive us to fulfill our needs. This is where stress is important to the natural development. As we develop, we face many discomforting scenarios that we learn to avoid (e.g. hunger, cold, burns, pain; and later, losses of loved ones, debt, material losses, et al.). These stressors are learned and we live life trying to avoid them for the most part, and, according to Roberts and Yeager (2009), healthy stressors exist also, such as buying a home, the birth of a child, and others.

It is when stressful situations are too overwhelming to cope with that stress becomes a problem. Overwhelming stress can lead to crisis, acute stress disorder, or post-traumatic stress disorder (Roberts & Yeager, 2009). The key to dealing with stress is to have a positive outlet or sense of control over the stressors.

A study by Taylor (1995) shows that increases in crime, or at least the perception of crime, in a community leads to community decline; however, as this decline manifests, community participation grows to help to stop or slow the decline. This is possibly more akin to piling trash in the corner, then realizing one day that it is time to bring it all to the dump. The stress of living in a declining community is compounding until the community member finds a healthy outlet to alleviate the stress (help with clean-up efforts) or finds a negative outlet, contributing to the decline of the community. Positive outlets within a declining community allow the community members to take responsibility, once again, for the state of their environment, and thereby, relieving the stress of living amongst a declining community.

But, what happens when a person feels no control or ability to control their environment, such as a child? Kilpatrick, Saunders, and Smith (2003) explored the impact of violence and victimization on adolescents across the nation. Unlike adults who might have more opportunity to feel safe in the face of violence and have more options to redirect the stress, children are limited in their ability to react. They have yet to learn strategic coping mechanisms required to deal with stress productively. Kilpatrick, Saunders, and Smith show that “victimization in early childhood and adolescent years is the root of many problems [, such as PTSD, substance abuse, and delinquent behavior,] later in life” (p. 1). What is unclear, however, is the proximate cause of the cyclic phenomenon of violence.

As the studies suggest, violence (within the environment) begets violence (in the individual, especially children and adolescents). As children of violence mature through their environment and as they tend toward violence, they contribute to the environment of others by fulfilling what some might deem as their destiny. This, though, is shown to be untrue in many as not only can an individual contribute negatively to an environment, but many, even those touched by violence, find means of contributing positively, even if as an outlet for the stressors of such an environment. Being a product of one’s own environment does not dismiss the notions of self-reliance and personal responsibility. These ideals are the cornerstone of social change.


Kilpatrick, D. G., Saunders, B. E., & Smith, D. W. (2003, April). Youth victimization: prevalence and implications. Retrieved from

Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.

Taylor, R. B. (1995). The impact of crime on communities. Annals of the American Academy of Political and Social Science, 539(1), 28-45. doi:10.1177/0002716295539001003

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.


Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.

Future Threats

Aside from hoax attacks, where credible threats occur based on purposeful counter-intelligence efforts of terrorists, I suspect large-scale events to be the modus operandi of terrorists in the next decade. According to LaFree, Yang, and Crenshaw (2009), anti-U.S. terrorists have ample intent on attacking the U.S. on our soil; however, this would be a huge and logistically complicated undertaking. For this reason, any future organized act of terror on U.S. soil will be designed to be significant, causing extreme loss of life or toppling a significant structure or both.

Biologic weapons would be the choice for terrorists who wished to inflict harm to the greatest amount of people, though releasing biologic material lacks the sudden impact usually sought, and weaponized biologics are not easily grown or economical (Levitin, 2005). Chemical weapons are typically easier and cheaper to manufacture, though they lack effectiveness and tend to merely create a scare of equivalent magnitude of a hoax (Levitin, 2005). Aside from basic explosives, this leaves the radiologic threat, a threat that I believe, coupled with a significant target, will cause devastating effects not unlike 9/11.

A dirty bomb is a conventional explosive used to disseminate radiologic materials over an area. I foresee a coordinated attack on the financial districts of the U.S. using dirty bombs. The bombs would, first, cause physical destruction to the buildings causing immediate disruption of the financial sector of the U.S. economy, along with a large death toll. Second, the radiation dispersed over the area would cause difficulty in cleaning up the area, inhibiting recovery and further impacting the financial markets.

A law enforcement response to such an attack would certainly be large in scale. The local police department would be first to respond, along with state police, then the WMD Coordinator at the local FBI field office would be apprised of the situation. As responders start arriving on scene, personal radiation detectors would start to tone indicating the release of radiologic material. This further information would prompt the WMD Dictorate in Washington, D.C., to order a full asset response by the FBI and other federal terrorism partners (e.g. the Joint Terrorism Task Force). The response to this type of incident should be trained on in cooperative exercises involving all levels of law enforcement. Additionally, personal radiation detectors (and other detectors) should, at a minimum, be placed in police vehicles for early warning of environments immediately dangerous to life and health. Adequate training, equipment, and preparation are the only ways in which to prepare for responding to large-scale terrorist attacks.


LaFree, G., Yang, S., & Crenshaw, M. (2009). Trajectories of terrorism: Attack patterns of foreign groups that have targeted the United States, 1970-2004. Criminology & Public Policy, 8(3), 445-473. doi:10.1111/j.1745-9133.2009.00570.x

Levitin, H. W. (2005). Debunking myths: How law enforcement can help diffuse the public’s fear. On the Beat. Retrieved from

Fear of Terrorism

As terrorism becomes more prevalent within a society, concerns about the psychological effects are brought to the forefront. The psychological effects of terrorism, in general, should have an impact on the ability of law enforcement and the public to interface appropriately. A recent study by Bleich, Gelkopf, and Solomon (2003) of the psychological effects of terrorism on the public in Israel showed surprisingly low levels of post-traumatic stress disorder symptoms despite high incidences of direct exposure to terror events. This study demonstrated that, although up to a third of the respondents acknowledged a “limited sense of safety and substantial distress [they] reported adapting to the situation without substantial mental health symptoms and impairment, and most sought various ways of coping with terrorism and its ongoing threats [, possibly linked to] processes of adaptation and accommodation” (p. 619). The study found that the most effective and widely used coping mechanism was checking on the well-being of friends and family. As people tend to cope well with trauma, attitudes towards protective measures seem to acquiesce for the common good, and this can be assistive to law enforcement.

One of the protective measures people tend to adopt that would help law enforcement is a sense of hypervigilance (Bleich, Gelkopf, & Solomon, 2003). Hypervigilance allows the people to be more attentive to things out of the ordinary (e.g. unattended packages, suspicious loitering, anxious mannerisms of others, et al.). This promotes a line of communication with law enforcement not only regarding terrorism but for other criminal activity, also.

Another protective measure, which goes towards acquiescence, is the ability of the people, in general, to accept an increased presence of law enforcement in their daily lives. When faced with a proximal event, the bulk of the citizenship contend that it is, indeed, a function of government to protect the masses from further harm, and these citizens tend to accept limits on personal liberty for perceived increases in security (Klein, 2007). This is a double-edged sword, however. People tend to want to return to a normal state of affairs (Bleich, Gelkopf, & Solomon, 2003). Though an increased police presence is initially welcomed and embraced, the people will eventually resent the loss of liberty and require law enforcement presence to recede. How this occurs will either enhance or detract from the ongoing relationship with law enforcement. An example of this is easy to see when considering both local law enforcement and the federal effort of the Transportation Security Administration (TSA). Local law enforcement seems to have decreased their presence, at least in my area, and are respectfully viewed as helpful, whereas the TSA, an agency that continues to irrationally impede on liberty, is viewed negatively by the traveling public.

Law enforcement is a service-based industry where the public is the customer. Police need to understand both the rights and the fears of the people in order to maintain the appropriate level of service, which waxes and wanes.


Bleich, A., Gelkopf, M, & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. Journal of the American Medical Association, 290(5), 612-620.

Klein, L. (2007). Civil liberties and national security in the post 9-11 era: State power and the impact of the USA Patriot Act. Conference Papers – American Sociological Association, 1-8.


Challenges in Developing  Standards

The U.S. health care industry is contemplating the implementation of pay-for-performance reimbursement schemes in order to increase quality and safety in the delivery of health care. Pay-for-performance is a business model that combines reduced compensation for those who fail to meet standards and bonus payments for those that meet or exceed the stated expectations, but the results of such programs, thus far, is mixed (Baker, 2003; Campbell, Reeves, Kontopantelis, Sibbald, & Roland, 2009; Lee & Ferris, 2009; Young et al., 2005). The introduction of pay-for-performance models is primarily to provide relief from other, more extreme, reimbursement models, such as fee-for-service (which rewards overuse) and capitation (which rewards underuse), and with rising health care costs, a diminishing economy, and the increasing number of Americans lacking adequate health insurance, its introduction to the U.S. health care system could not be more timelier (Lee & Ferris, 2009).

The impetus of contemporary pay-for-performance schemes is derived from a report from the Institute of Medicine (2001). This report argued that current reimbursement schemes fail to reward quality in health care and may possibly create a barrier to innovation (Baker, 2003; Young et al., 2005). There are many international supporters of health care pay-for-performance, especially in England where the National Health Service employs pay-for-performance to keep costs under control while attempting to provide for quality and safety in the delivery of primary health care (Baker, 2003; Campbell et al., 2009; Young et al., 2005). However, the adoption of pay-for-performance seems to face many challenges.

One challenge to pay-for-performance implementation concerns the effectiveness in the overall continuity of care. Campbell et al. (2009) conducted an analysis of the effect of pay-for-performance in England and found that, although implementation of pay-for-performance in 2004 resulted in short-term gains in the quality of care, the improvements receded to pre-2004 levels. Beyond the pay-for-performance standards, though, the quality of care in areas not associated with incentives declined. Cameron (2011) reports on a recent study of the effectiveness of pay-for-performance on hypertension – the study shows no improvement in any measure including the incidence of stroke, heart attack, renal failure, heart failure, or combined mortality among the group (Lee & Ferris, 2009). McDonald and Roland (2009) describe these effects on other aspects of care as unintended consequences detrimental to health care quality and safety as a whole.

Another significant challenge to pay-for-performance implementation is ensuring that certain patient populations continue to be able to access appropriate care (McDonald & Roland, 2009). Under some pay-for-performance schemes, practices with a sicker patient demographic (i.e. geriatrics, oncology, neonatology, etc.) will suffer economically despite providing a higher level of care than their counterparts in family medicine or other more generalized practices. Specific concerns address a physicians ability to choose not to treat patients due to their non-compliance with medical orders (McDonald & Roland, 2009). Equity and access cannot suffer under a just reimbursement model, just as physicians with a sicker demographic should not suffer.

Identifying a reliable standard of measure in health care quality proves difficult. Earlier methods, such as those developed by Campbell, Braspenning, Hutchinson, and Marshall (2002), initially appeared sound, but ineffective methods and unintended consequences were soon identified (Cameron, 2011; Lee & Ferris, 2009; McDonald & Roland, 2009). More recent work by Steyerberg et al. (2010) shows that new approaches are on the horizon and that pay-for-performance may still remain a viable scheme, providing the measures and standards are, in fact, legitimate and accurately identify improved quality without detracting from other aspects of heath care. Steyerberg et al. identifies novel approaches to prediction models that may help to standardize measures in pay-for-performance schemes to be more realistic and reliable without causing many of the unintended consequences of earlier plans.

As we become more technologically advanced and find ways, albeit expensive, to cure and treat diseases that until now were intractable, we must address the ethics surrounding the provision of this care as a system of management. By combining the whole of health care into the ethics discussion, we opt to leave no one wanting for care, but we now have to address the problem of paying for the expensive care that we have all but demanded. Pay-for-performance, though not perfect, shows much promise in keeping health care costs manageable. However, we must strive to identify those patients and practitioners that lose out under this system of reimbursement and strive to identify just and ethical means of repairing the scheme. Though, we should first answer the question: is health care a right or a privilege?


Baker, G. (2003). Pay for performance incentive programs in healthcare: market dynamics and business process. Retrieved from

Cameron, D. (2011, January 27). Pay-for-Performance does not improve patient health. Harvard Medical School News. Retrieved from 012611_serumaga_soumerai/index.html

Campbell, S. M., Braspenning, J., Hutchinson, A., & Marshall, M. (2002). Research methods used in developing and applying quality indicators in primary care. Quality and Safety in Health Care, 11(4), 358–364. doi:10.1136/qhc.11.4.358

Campbell, S. M., Reeves, D., Kontopantelis, E., Sibbald, B., & Roland, M. (2009). Effects of pay for performance on the quality of primary care in England. New England Journal of Medicine, 361(4), 368-378. doi:10.1056/NEJMsa0807651

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from

Lee, T. H. & Ferris, T. G. (2009). Pay for performance: a work in progress. Circulation, 119(23), 2965-2966. doi:10.1161/CIRCULATIONAHA.109.869958

McDonald, R. & Roland, M. (2009). Pay for performance in primary care in England and California: comparison of unintended consequences. Annals of Family Medicine, 7(2), 121–127. doi:10.1370/afm.946

Steyerberg, E. W., Vickers, A. J., Cook, N. R., Gerds, T., Gonen, M., Obuchowski, N., … Kattane, M. W. (2010). Assessing the performance of prediction models: A framework for traditional and novel measures. Epidemiology, 21(1), 128–138. doi:10.1097/EDE.0b013e3181c30fb2

Young, G. J., White, B., Burgess, J. F., Berlowitz, D., Meterko, M., Guldin, M. R., & Bokhour, B. G. (2005). Conceptual issues in the design and implementation of pay-for-quality programs. American Journal of Medical Quality, 20(3), 144-50. doi:10.1177/1062860605275222

WMD Coordinator

According to the Federal Bureau of Investigation (FBI; 2007) and the U.S. Department of Justice (2009), the WMD Coordinator, a designated Special Agent within each field office, is responsible for initiating the federal response to any possible WMD event. “The Attorney General has lead authority to investigate federal crimes, which includes the use or attempted use of a WMD. 28 U.S.C. § 533 (2008) and 18 U.S.C. § 2332(a) (2008). The Attorney General has delegated much of this investigative authority to the FBI” (U.S. Department of Justice, 2009, p. 1). The WMD Coordinator helps to fulfill this mandate by being the point of contact for local and state officials when an event involving an WMD is suspected to have occurred.

In the Mattapan scenario, the initial response by the Boston Police Department and the Massachusetts Bay Transit Authority Police Department unveil a possible attempt to utilize an explosive to disseminate a chemical or biologic material in a public place. As soon as this plot is uncovered, an emergency response plan should be initiated, which involves notifying the Boston FBI field office of the suspected WMD event. The WMD Coordinator of the Boston field office would be the person receiving this notification. The Massachusetts State Police would also be notified to respond as they are able to provide their own subject matter experts and resources.

As a WMD subject matter expert, once notified of the circumstances, according to the FBI (2007), the WMD Coordinator responds to the scene and assists local and state law enforcement in determining the threat. Once it is established that an WMD is involved, whether by direct investigation at the scene or based on reports from law enforcement, the WMD Coordinator would immediately notify the WMD Directorate at FBI Headquarters. This notification would activate a team of WMD experts who would participate in a conference call with the WMD Coordinator to further identify the threat and, also, identify the additional federal resources needed to respond to the event. The additional resources could be individual experts, federal response teams from other departments or bureaus (e.g. the Joint Terrorism Task Force, the Bureau of Alcohol, Tobacco, Firearms, and Explosives), or the special teams of the FBI, including the Chemical and Biological Sciences unit (to identify the particular payload material), photo operations personnel, an explosives team (based on the dispersal mechanism being explosives), the disaster squad (to identify any potential victims), and the national level Hazardous Material Response Unit and the local Hazardous Material Response Team to collect evidence from the scene. The WMD Coordinator would, then, be responsible for leading the investigation.

The WMD Coordinator would most likely fulfill his role within the unified incident command structure as Law Enforcement Command. This position would allow him or her to delegate the responsibilities of the response, including the need to provide information to the public. Public Information Officers provide a critical role in major response efforts. They provide enough information to the public to allay any unfounded fears, provide direction and instructions when needed, and filter sensitive information so that it does not become public knowledge. It is important for the public to be apprised of the situation in a calm and authoritative manner to assure them that everything necessary is being done. It is also important for the public to understand the risks of the situation in a realistic manner to prevent a mass overreaction.

The WMD Coordinator position is a valuable tool of the FBI and the federal government. Though the value of this position has been criticized for the lack of readiness and training, preparations are being undertaken to ensure a quality approach to responding to WMD events in the future (McDonald, 2009; U.S. Department of Justice, 2009).


Federal Bureau of Investigation. (2007, March 5). WMD threats: How we respond. Retrieved from

McDonald, J. (2009, October 8). FBI WMD Coordinator program needs improvement [Web log]. The OC Sheriff Blog. Retrieved from

U.S. Department of Justice. (2009, September). The Federal Bureau of Investigation’s Weapons Of Mass Destruction Coordinator program (Audit Report #09-36). Retrieved from