Wednesday, September 26, 2012

Pilgrim's Pride Opinion Allows Enhancements in Bankruptcy, Offers Comprehensive Overview of Bankruptcy Fees

The Fifth Circuit has affirmed a $1 million fee enhancement to a chief restructuring officer who achieved results described as “rare and exceptional.”  Matter of Pilgrim’s Pride Corp., No. 11-10774 (5th Cir. 8/10/12).   The opinion can be found here.   The Court rejected the argument that a recent Supreme Court opinion on fee shifting precluded enhancements and, in the process, set forth a comprehensive framework for allowance of professional fees in bankruptcy.   Curiously, the opinion did not mention the Court’s opinion in Matter of Pro-Snax Distributors, Inc., 157 F.3d 414 (5th Cir. 1998).

What Happened

When Pilgrim’s Pride Company filed for chapter 11 relief in December 2008, its prospects did not look good.   It had lost about $1 billion the previous fiscal year and was incurring negative cash flow of $300 million a year.   The Debtors anticipated that unsecured creditors would receive, at best, a debt for equity swap, and that equity would be cancelled. 
  
CRG Partners, LLC was engaged as chief restructuring officer.    Just over a year later, the company confirmed a plan which paid all secured and unsecured creditors in full and distributed equity interests valued at $450 million to the pre-petition shareholders.   

After the plan was confirmed, CRG requested that it be allowed compensation of $5.98 million plus an enhancement of $1 million.    The Debtor’s Board of Directors supported the enhancement.   The U.S. Trustee objected to the enhancement on the basis that CRG had already been adequately compensated through its lodestar-calculated fee.   The Bankruptcy Court denied the request for enhancement based on Perdue v. Kenny A. ex rel. Winn, 130 S.Ct. 1662 (2010).   The District Court reversed, finding that Perdue was not binding in the bankruptcy context.

On remand, the Bankruptcy Court approved the enhancement and the U.S. Trustee appealed.    The UST argued that Perdue precluded the enhancement.   The Fifth Circuit rejected the Trustee’s position and affirmed the Bankruptcy Court order approving the additional award.

An Overview of Professional Fees

In reaching its conclusion that enhancements remained viable, the Court of Appeals provided an extensive discussion of the history of awards of professional fees in the Fifth Circuit.   Under the Bankruptcy Act, courts in the Fifth Circuit applied the twelve Johnson factors, which included such requirements as the time and labor required, the novelty and difficulty of the questions, skill required, undesirability of the case and reputation of the attorneys.    In re First Colonial Corp. of America, 544 F.2d 1291, 1298-99 (5th Cir. 1977), quoting Johnson v. Georgia Highway Express, Inc., 488 F.2d 714 (5th Cir. 1974).   (Attorneys of a certain level of experience will remember preparing fee applications reciting the twelve Johnson/First Colonial factors even though many of them were usually irrelevant to the specific case).   While Johnson was a civil rights case, the First Colonial court found the factors to be “equally useful whenever the award of reasonable attorneys’ fees is authorized by statute.”     Id. at 1299.   While the same factors might be applicable, bankruptcy courts were advised to make awards at the lower end of the spectrum in light of the “strong policy of the Bankruptcy Act that estates be administered as efficiently as possible.”    Id.

The lodestar method was recommended by another Act case, In re Lawler, 807 F.2d 1207 (5th Cir. 1987).    Under the lodestar method, the Court determines a reasonable number of hours multiplied by a reasonable rate and then adjusts the resulting fee up or down based upon the other Johnsonfactors.

When section 330(a) was adopted as part of the Bankruptcy Code, it retained the overall framework of compensation under the Act, but rejected the “economy of the estate” limitation.   This meant that bankruptcy lawyers could be compensated at the same rate as other skilled professionals.   

Section 330(a) was amended in 1994 to include a list of six non-exclusive factors to be considered in awarding compensation and two instances in which the court should deny compensation.    Notwithstanding the statutory definition, the Fifth Circuit found that the prior case law and the statutory provisions provided a complimentary framework.

Following the Bankruptcy Code’s enactment, we made clear that the lodestar, Johnson factors, and §330 coalesced to form the framework that regulates the compensation of professionals employed by the bankruptcy estate.   (citation omitted).   Under this framework, bankruptcy courts must first calculate the amount of the lodestar.   (citation omitted).    After doing so, the courts “then may adjust the lodestar up or down based on the factors contained in §330 and [their] consideration of the factors listed in Johnson.”   (citation omitted).    We have also emphasized that bankruptcy courts have “considerable discretion” when determining whether an upward or downward adjustment of the lodestar is warranted.

Opinion, at p. 8.   

The Court also conducted an historical analysis of fee enhancements in bankruptcy, finding that, although they were extraordinary, they had been allowed under both the Bankruptcy Act and the Code.    The Court noted that 

(I)f enhancements were possible when fees were awarded “at the lower end of the spectrum of reasonableness,” then they surely remained possible after that ceiling was removed and the statutory text was otherwise unchanged.

Opinion, at p. 13.    The Court’s point is that because the Bankruptcy Act allowed enhancements despite the focus on economy of administration that it would be reasonable for enhancements to be allowed under the more liberal provisions of the Bankruptcy Code.

In conclusion, the Court ruled that enhancements were a part of the process of upward or downward adjustment of the lodestar and remained available in extraordinary situations.

In sum, we have consistently held that bankruptcy courts have broad discretion to adjust the lodestar upwards or downwards when awarding reasonable compensation to professionals employed by the estate pursuant to § 330(a). However, this discretion is far from limitless. Upward adjustments, for instance, are still only permissible in rare and exceptional circumstances--such as in Rose Pass Mines and Lawler, where the applicants had provided superior services that produced outstanding results--that are supported by detailed findings from the bankruptcy court and specific evidence in the record.

Opinion, at 15.

Sub Silentio and the Rule of Orderliness 

Having concluded that enhancements remained viable, the Court turned its attention to whether the Supreme Court had “unequivocally, sub silentio overruled our circuit’s bankruptcy precedent.”   Opinion, p. 15.  
 
In Perdue, the Supreme Court rejected a request for an enhancement in a civil rights case.   In interpreting the term “reasonable fees” under 42 U.S.C. §1988, the Supreme Court noted that the courts had initially applied the twelve Johnsonfactors, but had transitioned to a lodestar approach in order to “cabin() the discretion of trial judges.”    The Supreme Court concluded that enhancements could be allowed under section 1988, but only where the hourly rate used in the lodestar calculation did not adequately measure the attorney’s true market value, where the litigation involved an “extraordinary” outlay of expenses and where there was an “exceptional delay” in payment, especially where that delay was due to the defense.    The Court also noted that in civil rights cases, the presumption should be against an enhancement because defendants would be less likely to settle if faced with an open-ended fee request and because civil rights judgments were often paid by the public rather than the defendant. 
  
The Fifth Circuit found that Perdue did not apply in the bankruptcy context.   Relying on the rule of orderliness, as recently articulated in Technical Automation Services Corp. v. Liberty Surplus Insurance Corp., 673 F.3d 399 (5th Cir. 2012)(which held that Stern v. Marshall did not implicate the authority of Magistrate Judges), the Fifth Circuit found that Perdue was not directly on point and therefore did not compel the Court to abandon its prior precedent.   Among other things, the Court found that bankruptcy fee requests did not entail the same settlement considerations as civil rights cases and that the bankruptcy estate rather than the taxpayer would be paying the fees. 
 
The Court also noted that while the term “reasonable fees” in section 1988 offered little guidance to courts, that section 330(a) of the Bankruptcy Code contained detailed criteria for awarding fees.   

As a result, the Court concluded that until rescinded by a higher authority, fee enhancements were still possible in bankruptcy.   As a result, the Court affirmed the bankruptcy court’s enhanced fee award to CRG Partners.

What It Means

In the particular case, Pilgrim’s Pride means that a particular professional was recognized for doing an extraordinary job.    In the larger context, Pilgrim’s Pride is significant for what its historical analysis said for what it left unsaid.    

From an historical perspective, Pilgrim’s Prideevidences the development of bankruptcy law as its own discipline.    As of 1977, both bankruptcy law and civil rights law followed the twelve Johnsonfactors.   In the intervening 35 years, bankruptcy has developed its own body of fee jurisprudence.    While both bankruptcy law and civil rights law moved from the Johnson factors to a primarily lodestar based approach, Congress saw fit to define bankruptcy standards in more detail.     The Pilgrim’s Pride decision recognizes that bankruptcy fees fulfill a different role than fees in civil rights cases.    While the Court did not fully articulate it, I believe the difference is this.   Bankruptcy is inherently a collective process in which scarce resources are marshaled for the benefit of the creditor body and (in some cases) equity.    Allowing enhanced fees in rare cases provides incentives for professionals to take on difficult cases and be recognized when they deliver superior results.   Civil rights cases, on the other hand, are focused on compensating a harm and are a zero sum proposition.   Every dollar paid to the plaintiffs and their attorneys is a dollar taken away from the defendants and, by extension, the taxpayers.    While civil rights actions should incentivize government actors to obey the law in future cases, this function is secondary to compensating the wronged individual.    In a bankruptcy case, the professional may not only allocate scarce resources according to an ordered scheme of priorities, but may actually increase the pool of resources.   In a civil rights case, it seems that counsel is focused on obtaining an equitable transfer of resources from one party to another.    

Pilgrim’s Pride also curious because it does not mention the requirement that a professional demonstrate an “identifiable, tangible and material benefit to the bankruptcy estate” as required by In re Pro-Snax Distributors, Inc. in order to be compensated.   There is a tension between Pro-Snax and section 330(a)(4)(A)(i)(I) which mandates denial of fees for services not “reasonably likely to benefit the debtor’s estate.”   There is a significant difference in requiring that services be “reasonably likely” to benefit the estate as opposed to actually yielding an “identifiable, tangible and material benefit.”    In the one instance, compensation is based on whether the services appeared to be reasonable at the time, while the other makes compensation contingent on results.    Pilgrim’s Pride discusses the Johnson factors, the lodestar test and the statutory provisions of section 330(a), but does not discuss Pro-Snax.  Judge Carl Stewart, who authored Pro-Snax, was on the panel that decided Pilgrim’s Pride.

It is certainly possible that the panel did not see the need to discuss Pro-Snax for the reason that Pilgrim’s Pride was a case involving not just an “identifiable, tangible and material benefit,” but an extraordinary one at that.    However, given the Court’s comprehensive discussion of the framework for fees in bankruptcy and its contrast with fees in civil rights cases, the actual results requirement would seem to be a reasonable thing to mention.   

My personal opinion (which is partially motivated by self-interest) is that the Pro-Snax panel never intended to impose an actual results requirement.    The Pilgrim’s Pride opinion discusses how “the lodestar, Johnson factors, and §330 coalesced to form the framework that regulates the compensation of professionals employed by the bankruptcy estate.”    Under Johnson, results were one of twelve factors to be considered.   Under section 330(a), the court is instructed to examine whether the services were “beneficial at the time” and whether they were “reasonably likely to benefit the debtor’s estate.”   The lodestar may be adjusted upwards or downwards based upon the results.    Given that results are a factor to be considered under each of these approaches, it is much more reasonable to conclude that the Pro-Snax panel meant to emphasize the importance of results but not to make them an absolute requirement.   At the very least, it will make for an interesting argument when the Court is asked directly to reconcile Pilgrim’s Pride, Pro-Snax and the language of section 330(a).

Disclosure:   I have a case pending on appeal that raises the application of Pro-Snax.

Monday, September 24, 2012

I can fly.

By the seat of my pants.
Over the first big hump and giant fall on a rollercoaster.
Off a diving board.
Through my favorite online shops in .2 seconds flat and pinterest the heck out of them.
Through 2lbs of raw green beans in 30 minutes flat.

And out the side of a mother-loving plane 13,000 feet up.

GOPR6001+(2)


People...

So much has been up in the air.  My living situation, my job changing yet again, plus all the magic, random, greatness summer throws at you 794 times a week; all of these have made for a few months of so very much uncertainty, and a scrambling-frazzled-slightly-kookoo Sarah.  It's all I've talked about!  Because: it's true.  

In the midst of a run a while back, I got a call from one of my nearest & dearest who was having a rough evening due to some general douchebaggery that she had, unfortunately, experienced.  After calming down my inner rage-monster (don't mess with my loves, and don't keep me from working out - I go green and play with SUV's like they're Tonka Trucks), I met up with my friend, and a pretty grand opportunity arose.

Her:  "Wanna go skydiving?"

Me:  Instant elation, mental image of running and jumping out of a plane at full bore, intense desire to do it immediately.  And then I used my word(s)...

"YES!!!!!!!!!"

GOPR5867+%25282%2529I've never had an intense desire to skydive, but as soon as this opportunity presented itself, it was done.  I was smitten with the idea.  I could not wait until the moment I got to jump out of a plane, and this mental video clip, of sorts, just kept replaying in my mind of me sprinting unreservedly out of a plane with the biggest grin on my face ever.  It was done.

As soon as we got there, I saw this guy.  He was nutty.  He was loud, hilarious, rough around the edges, and looked like he'd be a whole lot of fun and/or trouble.  So, when I heard him say, "ALL RIGHT - which one of you's SARAH?!" I was pleased.

I kept waiting for the moment when I'd get nervous or have second thoughts, but it never happened.  They even had to make us wait to resolve an issue with the plane, and that made me even more excited.

GOPR5995+(2)Fast forward past some coffee, great tunes, and watching others make it back to planet earth a few times to me, dangling out in mid-air, strapped to the chest of Crazy Todd.  My eyes are closed, yes, but it was a moment of happiness, I assure you.  

The butterflies that accompanied the initial drop were unreal. That moment of dropping straight down, feet first, was one of the greatest feelings I have ever experienced.  Falling.  Just falling...

I've felt a bit like I've been falling all summer - having jumped off of something with no bottom in sight, no person strapped to my back ready to pull the cord for me, and a frenzied, flailing, rather ungraceful fall.  I've been so concerned with seeing what I'm about to come careening down into, that I've neglected taking in the view of all the great things that have happened along the way.

Before I jumped, I had a chat with another one of the divers who worked there.  He asked how I was feeling about it, and I let him know that at this point, my only emotion was thrilled anticipation.  He gave me some great advice: no matter what, do not look down.  It wasn't that it's scary to look down, but he said, "Why bother staring at the ground, when all of the good stuff is straight ahead?"

GOPR6010+%25282%2529So I took his advice.  I checked out the landscape a few times, but I spent what felt like an hour watching the skyline.  I watched as I grew closer to the clouds and then blew right through them.  I watched as the skyline faded into a slightly lighter blue.  And I smiled.  I smiled so much my face hurt when it was over.

Was it scary?!
What about the whole you-could-die thing?
Why?

No.
I didn't think of that...  I really didn't.  There was a pro stuck to my back, and all I wanted to do was run and jump and fly.
Why not?  

It was so quiet.
It was so peaceful.
It was magical.
It was absolute bliss.

The combination of being out of control yet completely at peace with the moment was just...  Correct.  I can't think of another word.  It was right.

Learning to be at peace with where you're at is something that I've been trying to learn for a long time.  During one of the key moments in my life, totally disconcerted and depressed with life as it was, my Dad told me, "Sarah.  You will not be able to progress until you are at peace with where you're at."

This is something that has come to mind more times than I can possibly recollect, and has been a bigger lesson than what I could have imagined.

So, what now?  Instead of feeling as though life is currently an ungraceful, frenzied, frightening fall with nothing but uncertainty and an impending rocky abyss awaiting to meet me, I'm going look ahead.  I'm going to remind myself that while I may be in mid free-fall, I need to take in the view and appreciate everything that's going on right in front of me.

I gave myself some time this summer to take a break and remember what it's like to live without being so overly control-freaked-out that I missed out on life.  I ate things I shouldn't have.  I drank things I shouldn't have.  I went places and did things at the drop of a hat.  While it was great, I've also been guilt-ridden the whole entire way. We'll talk more about this soon.  But, what do I have because of my giving in a bit?  Some amazing memories and life lessons, including learning to realize that the difference between falling and flying is as simple as putting my chin up.



Even if my face looks like this:
GOPR6038+(2)


PS - Don't even pretend you haven't used "Pinterest" as a verb, too.  

Cause-Specific Mortality in Relation to Chrysotile-Asbestos Exposure in Chinese Cohort

The dangers of chrysotile asbestos continues to remain a contentious topic,
especially among defendants who argue that chrysotile is a “safe” fiber.
Chrysotile represents 95% of all asbestos ever used and is currently the
only type of asbestos commercially being used in the world. Its uses include
textile products, friction and heat resistant materials, cement and rubber
products.  China happens to be one of the biggest consumers of asbestos and
have consequently experienced an alarming rate of asbestos-related disease
and asbestos-related death among exposed workers.

In this study, scientists evaluated a group of 577 workers from a
chrysotile-textile plant in China from between 1972 to 2008. Their analysis
indicated that exposure to chrysotile asbestos was closely associated with
excess mortality from cancer and respiratory diseases compared to an
occupational control group and the Chinese national level. Furthermore, the
study found that increased mortality was associated with the amount of
chrysotile exposure, number of exposure years, age at first exposure year
and other variables, such as smoking history and birth year.

In summary, chrysotile asbestos continues to be highly carcinogenic to
humans as illustrated by the study's cohort's increased mortality from lung
cancers and nonmalignant respiratory diseases which resulted exclusively
from chrysotile asbestos exposure. Click here to view this study.

Friday, September 21, 2012

Sarcomatoid Predominant Malignant Pleural Mesothelioma: An Institutional Approach and Experience

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig)  
Boston, MA – September 11-14, 2012

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Sarcomatoid-predominant malignant pleural mesothelioma is an especially difficult tumor to control. Thoracic surgeons at UCLA seeking to improve the poor prognosis that comes with this incredibly aggressive cancer looked at the treatment of non-mesothelioma pleural sarcomas, which is typically treated with chemotherapy followed by surgery and radiation.

Doctors identified four patients with sarcomatoid-predominant malignant pleural mesothelioma who had received pre-operative therapy before undergoing the lung-sparing pleurectomy/decortication procedure. Three of these patients utilized Ifosfamide/Adriamycin and one patient Cisplatin/Pemetrexed/ Veglin. Three-fourths of these patients were found to have pathological responses with 80-99% necrosis, or tumor death, which is not often seen with standard Cisplatin and Pemetrexed.

Multimodality approaches that utilize Ifosfamide/Adriamycin seem to be the optimal treatment strategy for sarcomatoid-predominant malignant pleural mesothelioma patients. In addition, patients who originally are not eligible for surgery may become so if they see 80% or higher necrosis and remain free of metastatic growth following chemotherapy. Click here to view this abstract.

Thursday, September 20, 2012

Thermal Therapy in the Treatment of Malignant Pleural Mesothelioma

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig)  
Boston, MA – September 11-14, 2012

IMIG+2012+Logo
Thermal therapy has been used in cancer therapy for decades and hyperthermic chemotherapy perfusion, specifically, has been used in the treatment of mesothelioma but without data as to the optimal conditions.

In a study performed at UCLA, doctors sought to define in vitro the most effective strategy for the use of thermal therapy in pleural mesothelioma. They exposed three human mesothelioma cell lines to varying hyper and hyperthermic conditions using either a standard metabolic MTS absorbance assay or a standard clonogenic (which is a microbiology technique for studying the effectiveness of specific agents on the survival and proliferation of cells). Each cell line was then expanded and exposed to varying combination of hyperthermia, hypothermia and/or chemotherapy – using chemotherapy agents cisplatin, gemicitabine, and/or pemetrexed.

Their findings show that thermal therapy appears to be most effective when using hypothermia rather than hyperthermia, and chemotherapy appears to be most effective when using two drug combinations over one individually. Click here to view this abstract. 

Wednesday, September 19, 2012

The Timing of Chemotherapy in the Multimodality Treatment of Malignant Pleural Mesothelioma

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig)  
Boston, MA – September 11-14, 2012

IMIG+2012+Logo
Chemotherapy used in multimodality treatment of malignant pleural mesothelioma is typically performed within 4-6 weeks prior to or after surgery, and various strategies have been used with regard to the timing of chemotherapy within a multimodality treatment.

Doctors at UCLA identified 121 patients who had undergone the pleurectomy/decorticationsurgery followed by adjuvant radiation therapy and received chemotherapy only after the first recurrence of the disease. The results of receiving delayed chemotherapy were comparable or better to those reported for “trimodality” therapy including the recent MARS trial. These findings suggest that a more rational and conservative approach to multimodality treatment of patients with malignant pleural mesothelioma may be warranted.

Multimodality Therapy is the combination of surgery, radiation, and chemotherapy; and for malignant pleural mesothelioma patients eligible for surgery, is almost always associated with the longest survival rates. Survival of patients who receive this type of treatment varies from 16 to 22 months, depending on the staging, type of surgery, cell type, as well as other factors. Click here to view this abstract.

Tuesday, September 18, 2012

Percutaneous Outpatient Cryoablation for Localized Recurrent Pleural Mesothelioma Following Lung-sparing Pleurectomy and Decortication Surgery

As presented by Dr. Robert Cameron at the 11th International Conference of the International Mesothelioma Interest Group (iMig) 
Boston, MA – September 11-14, 2012

IMIG+2012+Logo
Recurrence for patients with malignant pleural mesothelioma is extremely high following surgery, most patients are ineligible for repeat surgery and management of mesothelioma is among the most challenging of cancer therapies. Many of our clients have experienced good results with post-surgery cryoblation therapy. (including Martha MunozPatricia Crawford and Sylvia Ramirez

Cryoablationfor localized recurrent malignant pleural mesothelioma following surgery can be performed safely as an outpatient procedure. It is a minimally invasive procedure, which uses a needle to target argon gas directly to the tumor killing the cells it touches in a relatively safe and quick manner. It can be performed on multiple lesions at a time and is also a safe and relatively quick method to control pain and improve the patient’s quality of life.

Doctors at UCLA have published a promising study with the International Mesothelioma Interest Group which identifies 24 UCLA patients who have received one or more cryoablation treatments for localized recurrence of malignant pleural mesothelioma following surgery with or without adjuvant therapy. The patients in the study were found to have a minimal morbidity rate of 5.6%, a very high efficacy rate of 95.3%, and an impressive overall survival rate of 36.1 months.

Currently only a handful of centers specialize in the use of cryoablation in the management of mesothelioma, most notably diagnostic radiologists, Dr. Fereidoun Abtin and Dr. Robert Suh at UCLA.

Meso Empowerment Exclusive: Dr. Cameron shares his brilliant insights on breakthrough moments at IMIG Conference in Boston or, Galileo is Smiling

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Dr. Robert Cameron
iMig 2012
Dr. Robert Cameron, thoracic surgeon and mesothelioma specialist, was kind enough to provide us with his tweets as he attended the recent IMIG conference in Boston. His “boots on the ground” tweets were simply too compelling to leave alone so we followed up and asked him to elaborate

If you’re reading this, you’re no doubt aware of Dr. Cameron’s pioneering efforts to re-introduce “rationality” to the macho “bigger is better” mentality that unfortunately has tended to dominate meso surgery in the US. Although his pleurectomy/decortication (P/D) model is now becoming not only accepted but strongly endorsed, it wasn’t always this way.

I remember vividly at a meeting among surgeons 12 years ago where his fellow surgeons literally shussed Dr. Cameron when he tried to speak up against powerful, East Coast-driven forces who decreed that their big gnarly “extra-pleural pneumonectomy” (EPP) was as unassailable as a papal decree. For years, Dr. Cameron toiled away, mainly in the dark, while the spotlight remained brightly fixed on the “curative” EPP. But he never lost faith.  Like so many myth busters of lore (Galileo comes to mind), Dr. Cameron’s belief that removing the tumor and sparing the lung was the only rational way.

I can’t speak for Dr. Cameron, but for this cancer warrior, it feels good that his brethren have finally embraced the P/D on which Dr. Cameron based his career and his passion.

Here’s a few of the good doctor’s tweets and the follow up.

Enjoy the read and keep questioning, searching, learning and leaning towards the light.

*   *   *   *   *  

IMIG 2012: for the future of treatment of mesothelioma: the future is clearly immunotherapy!

Why is Dr. Cameron so optimistic? Let’s ask.

Dr. Cameron: Although we are only just now learning how to harness the power of immunotherapy, there is already evidence from decades ago that something as simple as stimulation with IL-2 into the pleural space can result in survivals that have rivaled "trimodality therapy" with median survivals as long as 28 months.

Furthermore, the immune system when it does work has been shown in other cancers, such as melanoma and renal cell carcinoma, to eradicate even bulky disease. We are now on a new learning curve with better understanding not only of what it takes to stimulate an immune response but what it takes to reverse the tumor-mediated escape mechanisms present at the actual tumor site. With the accelerated development in this field that has happened over the last few years, we should make good progress in the near future.

*   *   *   *   *  

IMIG 2012: Steven Albelda confirms that immunotherapy is a very promising treatment for mesothelioma.

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Dr. Steven Albelda
iMig 2012
No need for explantion here. Dr. Cameron’s succinct appraisal speaks for itself. Good news! I remember years ago when I was a director on MARF feeling proud to help sponsor Dr. Abelda’s futuristic benchwork research. Smart guy. Good guy. Glad Dr. A is on the team.

David Sugarbaker: "Can't we all just get along and operate on mesothelioma?"

Funny question, coming from the Pope of the EPP himself who for years dominate the conversation, owned the paradigm, and didn't give much heed to his few naysayers. Let’s face it, we love a title fight between heavyweights, so I couldn’t resist asking Dr. C for his reaction to the EPP’s loudest and most cocksure advocate sudden plea for tolerance. Is Dr. S presuming that surgery, no matter what form it takes, must be bedrock of every treatment regimen for meso?

Dr. Cameron: Despite the continued lack of randomized prospective trials showing exactly what, if any, benefit that surgery offers, Sugarbaker must be feeling the heat of all the mounting data that EPP is not necessary.  In my view, he’s now trying to deflect that argument and avoid controversy by calling on all surgeons regardless of which operation you perform to tell medical oncologists and pulmonologists that surgery forms the cornerstone of treatment.

*   *   *   *   *  

IMIG 2012: David Sugarbaker admits that "EPP has no superiority" as an operation over pleurectomy and decortication

Dawgies! Is this one of those “Yes, the earth revolves around the sun” belated acknowledgements? So, Dr. C, why is this such a big deal (picture me feeding the tiger a little red meat).

Dr. Cameron:  “You're kidding right? Most of the posters at this meeting were people trying to do EPPs because they are all under the impression that the "data" shows that it is better.  [Which unfortunately means that for too many ‘get her done’ surgeons with yank-the-lung-it is the earth continues to be the center of the universe….].

*   *   *   *   *  

IMIG today: Sugarbaker admitted that he is now doing 2/3 pleurectomies for mesothelioma....a huge change from a few years ago

This is a radical reversal. We asked Dr. C if he knew whether the Titan of Tri-modal had ever publically debunked or disparaged PD for meso?

Dr. Cameron: “I’m not sure he’s ever disparaged the P/D for meso directly but he has said that the only curative operation for the disease was the EPP. “

*   *   *   *   *  

Pac Meso Center’s Presentation: "The timing of chemotherapy in the multimodality treatment of malignant pleural mesothelioma" received praise from IMIG.

Congratulations!  To read the abstract of this presentation (by Dr. Cameron), please click here.

Note, it was great to learn that the other surgeon who helped form MARF back in the day (1999), Dr. Harvey Pass, one of the most talented, gifted and intelligent doctors on the planet, complemented the presentation and agreed that chemotherapy may not be such a crucial part of "trimodality" therapy (patient ALWAYS want to avoid chemo; losing their hair, nausea, vomiting, etc.) Thank you Dr. Harvey Pass, one of my heroes in the topsy-turvy turbulent Mesoworld.

Our Presentation: Percutaneous outpatient cryoablation for localized recurrent pleural mesothelioma was likely the highlight of IMIG meeting

This is great news. My law firm is particularly proud of this since cryoablation has been used successfully on several of my meso clients (including Martha MunozPatricia Crawford and Sylvia Ramirez) who were relieved and impressed with it’s ease, efficiency and results.

The Pacific Meso Center is currently writing two papers that will be published soon. Consequently, since journals won’t publish anything that’s already been publically circulated, the PMC cannot a this time post it’s powerpoint slides on the internet. Dr. Cameron did however reveal, happily, if not surprisingly, that Dr. Sugarbaker mentioned cryoablation specifically as one of the highlights of info being presented. High praise from the High Priest of Meso! And well should the Big Guy be impressed – preliminary data show that the practice for recurrent patients was effective in 95% of the cases.

*   *   *   *   *  

David Sugarbaker TOTALLY BACKS OFF his beloved EPP to "MCR" Macroscopic Complete Resection, which is code for pleurectomy and decortication

We asked Dr. C to flesh out what this means for the typical meso patient. The backstory of course is that Dr. C has always pointed out that total eradication of all tumor is a pipe dream and they only reasonable goal was the removal of all “visible” tumor? (Note to patients – make sure your surgeon is wearing telescopic lens gear).

Dr. Cameron:  Yes, that’s been my common sense approach, but the EPP crowd never embraced this until now. This basically recognizes that what I have said for decades is actually now widely accepted and people like even Dr. Jablons who abandoned P/D for EPP were bowing to peer pressure not acting on data.”

Well, dear readers, hope you enjoyed the ride. It’s been fun. Please drop us a line if you want to learn more. In the meantime, praise hope!


RGW
Sept. 18, 2012
rgw_headshot
Roger G. Worthington

Wednesday, September 5, 2012

Can bankruptcy help with my student loans?

college
Student loans have become a larger and larger portion of the average consumer's debt. As a country, our student loan debt is now higher than consumer spending debt. While consumer spending debt can typically be discharged in a bankruptcy, though, most student loan debt cannot.

As described in this infographic, student loan debt is exempt from many of the protections that consumers have available when it comes to other debts. If that seems unfair to you, then you're not alone. A few of our fellow legal bloggers have written some compelling posts on the necessity of changing the law on bankruptcy when it comes to student loans, and even the president has weighed in in favor of making a change.

However, until the law is changed, the current status is bleak for most. While a Chapter 13 plan can help you structure the payments and potentially stop wage garnishments, it will not reduce the overall debt, and at the end of the plan you may be back in the same position. In a Chapter 7, student loans are considered a non-dischargeable debt unless you can show "undue hardship." In the Brunner case, the U.S. Court of Appeals 2nd Circuit admits that that their is little help in the statute for defining what constitutes an "undue hardship."

The Court in that case required a three-part test to show undue hardship:

"(1) that the debtor cannot maintain, based on current income and expenses, a "minimal" standard of living for herself and her dependents if forced to repay the loans;

(2) that additional circumstances exist indicating that this state of affairs is likely to persist for a significant portion of the repayment period of the student loans; and

(3) that the debtor has made good faith efforts to repay the loans."

Essentially this means that to discharge the debt you have to show that you can't pay the loan now, you tried to pay the loan, and it is not likely you will be able to pay the loan before you die. Many believe this test limits the benefits of the "undue hardship" clause to the elderly or terminally ill.

For most, the best option may not be bankruptcy at all, at least not to deal with student loan debt. Until and unless the law changes, the Income Based Repayment Plan available through the Department of Education is the only option for reducing the burden of student loans when a partial financial hardship exists.

If you still think this is unfair, tell congress that you want it changed.

The Student Loan Problem (Infographic)

The following infographic provides an overview of the student loan problem in America, how we got here, and why it is getting worse:

student-loans
Infographic by College Scholarships.org

Reprinted from: College Scholarships.org

Kelsey & Trask, P.C. provides this graphic for informational purposes only. We do not endorse nor claim endorsement from the source site or organization. Kelsey & Trask, P.C. is not responsible for any information contained therein, unless indicated specifically on that site.

Monday, September 3, 2012

California Measure Imposing Reasonable Limits on Length of Plaintiff Depositions Moves Closer to Becoming Law!


The Worthington Law Firm has long advocated for reasonable limitations on the length of time that asbestos companies can question asbestos cancer patients. At this time, there is no state-wide rule that limits the amount of time that asbestos company lawyers can question asbestos cancer patients in the context of a pre-trial discovery depositions.

This “anything goes” policy has led to wide-spread abuse. Asbestos company lawyers have typically prolonged depositions well over 20 to 30 hours, over the course of 10 to 15 days – even when the patient’s doctor has warned of the deleterious impact of such interrogation.

Finally, on August 29, 2012, at the urging of plaintiffs attorneys, California lawmakers passed a bill that would impose state-wide limits on the length of plaintiff depositions.  The general rule would limit defense questioning of a plaintiff to seven hours of total testimony. In asbestos illness cases where a physician attests that the plaintiff’s illness raises substantial medical doubt of survival beyond six months, defense questioning would be limited to two days of no more than seven hours of testimony each day, or 14 hours of total testimony.

The Worthington Firm, along with other plaintiffs attorneys, had pushed for a limit of seven hours across the board, or at least for all asbestos cancer cases, similar to the rule that applies in Federal Court and many states such as Texas. While this was rejected by the legislature, we would nevertheless consider this new law just, fair and humane measure to curb abusive and deleterious deposition practices.

Under existing law, asbestos company lawyers are entitled to assume that depositions are limitless. If the new law is passed, 14 hours will be the presumed limit in most cases, with the ability to seek even shorter limits on a case-by-case basis with a doctor’s declaration.

The bill now moves on to Governor Jerry Brown who has not taken a position on the matter. It is hoped that Governor Brown will realize how the absence of California law on this subject has permitted defense attorneys to needlessly and cruelly capitalize on the physical frailties of injured plaintiffs.

We strongly urge Governor Brown to sign the bill into law. 

Governor Brown can be reached online at http://govnews.ca.gov/gov39mail/mail.php, and his mailing address is c/o State Capitol, Suite 1173, Sacramento, CA 95814. We encourage you to drop a note to Gov. Brown urging him to support a bill that will curb deposition abuse.