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can be challenged in the courts and decisions held in abey-ance till the legislative hurdles are removed, and meanwhilethe patients remain in the same unsatisfactory conditions.But at least if matters get to the courts, that is something,defects will be exposed, and when the legal delays are overperhaps put right. But what if the inspectors are incompe-tent, if they can be bribed, or if their reports of malfeasanceare ignored ? What if exploiting nursing-home proprietorsare protected by elected legal or political figures ? In thesecircumstances the most scandalous conditions can exist

unchecked, and this is exactly what seems to have beenhappening, particularly in New York City.

It is alleged that a good deal of criminally derived moneyhas gone into the financial backing of many nursing-homeswhose operators are far less interested in the care and welfareof the patients than in squeezing the last cent out of them.They have plenty of money to fight any attempt to rectifymatters via the courts and for the subornation of thosecharged with seeing that regulations are enforced. In suchan atmosphere of suspicion and allegation as now exists, it isimpossible to decide the rights and wrongs; the innocent

proprietors are as concerned, perhaps more concerned, asthe alleged villains. There is a call for the new Governor ofNew York State to hold a full inquiry not only into nursing-homes but into the whole system of long-term health carein New York State. The Attorney General is trying toimpanel a special grand jury, and an official fact-finder hasbeen nominated. It is high time we knew the facts.

REFORM OF PRISONERS

Prisoners do reform, but they seem to do it throughthemselves, and not according to any system or experiencethat can be predicted. In recent years we have been througha plethora of approaches to the reform of convicted criminalsin an effort to reduce the crime rate, which continues to

go up. Indeed, it sometimes seems that life is made com-fortable for the convicted criminal at the expense, personaland financial, of the ordinary citizen; it is said the criminalsare free to indulge in criminal activities in the streets whilethe law-abiding citizen lives behind the bars he has erectedto secure his own house. We have tried pretty well every-thing-parole, psychiatry, probation, release to halfwayhouses, to rehabilitation centres-and all have failed.These are the conclusions reached by a sociologist, R.Martinson, who since 1967 has been analysing all systemsthat attempt to rehabilitate and reform convicted criminals.The former U.S. Attorney General, Mr Sabe, has describedthe rehabilitation of criminals as a " myth ", and practicallyeveryone involved seems, reluctantly or gladly, to be inessential agreement. We have thus come a long way inthe two years since it was recommended by a nationalcommission that no more adult prisons should be built andthat juvenile institutions should be closed down andoffenders sent back to their local community; this wasdone, and the communities have suffered badly.

So if nothing works in reform, just where do we go ?The public seems to be starting to think that protectingitself by putting convicted criminals in prison, and keepingthem there, and making no bones about it being openlyconsidered as punishment, is no bad thing. There is also afeeling that the punishment should fit the crime, and notthe criminal, and that the sentences should be less flexible.There is, finally, a growing demand for the violent criminalto be got off the streets as quickly as possible, and kept offthem, by speeding up the legal process, and by introducingtighter bail requirements, much longer sentences, and veryconditional release. If we are not to see vigilantism grow,something like this will have to be done. Those in the

poorer communities, and especially the Blacks, who aremore than others the victims of crime, are amongst theforemost in advocating sterner measures.

PAYING FOR MALPRAXIS INSURANCE

Last year a California-based company took over theState Medical Society’s group medical malpraxis coveragefrom the previous insurance company which, with adverseexperience, had decided to quit the field. It took a 90%increase to entice the Californians in, and now they wantanother 200% increase to stay in. Since the 90% increasehas begun to have serious repercussions, the 200% increasewas expected to be disastrous; the premiums for an averagegeneral practitioner would rise to$10,000 per annum, andfor some specialists the rise would be up to five or six timesthis amount. Clearly the effect would be either to force anenormous increase in fees, or to drive many doctors out ofpractice. In fact, those paying the very highest premiumswould have to earn the average income of a self-employedphysician in the U.S. just to pay the malpraxis premium.Obviously, something had to be done, and the 200%increase has been temporarily halted, pending publichearings in January. This is the decision of the New YorkState superintendent of insurance, who has to give approvalto such rate increases.But it is very doubtful if the public hearings will provide

any answers. The whole business has been hashed overagain and again, and all the arguments have been heardmany times before. The insurance company can hardlybe made to become bankrupt; no doubt its premiumdemands are actuarily based, and have been made withan eye to recent decisions and awards in this field. The

company is based in California, and though it is said thatthere have been only 16 suits in the history of that Statewhich have been settled for more than one million dollars,eleven of these have been settled in the last two years.Economically, another 200% rise is probably financiallyprudent for an insurance company that is not a medical

charity.Without changes in the law, and major changes, it seems

highly unlikely that the hearings will prove anything at allexcept that in existing circumstances a premium hike isjustified-though regrettable. But what will most surelybring some reality into these matters is the imminence, it isgenerally agreed, of some sort of national health insurancesystem. If this is to be saddled, directly or indirectly, withthe mounting costs of malpraxis insurance, then the systemwill be bankrupted. On the other hand, a national schemecan hardly leave the public or the doctor unprotected.Quite clearly we cannot go on as we are going.

In England Now

SAUTLESS VERSE

In protest at the Verses on Scarce Commodities*

There’s mony a scribblin’ versifierEttlin’ tae pluck the ploo’man’s lyre,Believes his lines hauld Muses’ fireTho’ dull and shabby,As lang’s they’re decked i’ the attire0’ " Standart Habbie ".

A’ isnae milk that’s oot a coo,Yon sautless verse wad staw a sooYe shairly should hae hid frae viewAnd wamies’ turns,Yon ferlie fit tae gar ye grue-

Third-degree Burns.Glossary: Mony=many; the ploo’man=Bums; ettlin’=

keen; Standart Habbie=the verse form used above; isnae=isnot; sautless=without inspiration; wad=would; staw a soo=choke a pig; wamie =that part of the intestinal tract lying betweenthe cardia and the first part of the duodenum; ferlie =a wondroussight, often horrific; gar ye grue =cause emptying of the wamie.* Lancet, Dec. 7, 1974, p. 1377.