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Correlates of violent disorders. Health Aff Millwood. Screening, treatment initiation, department. J Pediatr. Effects of marijuana use ;12 1 A single- ; Arch Intern Med. Criminal correlates of ; 13 J Emerg Med. Trends in US ;32 2 JAMA factors for violent injury and long-term mortality among adult victims of violent injury. A meta-analytic review Profiles of violent youth: of psychosocial interventions for substance use disorders. Am J substance use and other concurrent problems.
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Child Fam Psychol Rev. Western Journal of Emergency Medicine Volume 23, no. We also include an explanation of how the network was designed and launched as a response to the opioid epidemic. In the social assessment and situational analysis phase, we describe the opioid epidemic and available resources in the region at the outset of the program.
In the epidemiological assessment phase, we quantify the epidemic on the state and regional levels. In the educational and ecological assessment, we review local ED practices and resources. Finally, in the process evaluation phase, we depict the early lessons we learned. An implementation framework provides a structured means of evaluating this best practice model.
Few hospitals have dedicated inpatient units for treatment of OUD; so most patients presenting at EDs with acute opioid overdose or withdrawal symptoms are stabilized and treated with non-narcotic symptom-relieving medications before being discharged. Given the promise of ED-initiated buprenorphine as a public health approach to addressing the opioid epidemic20 and the need for a more scalable intervention model, the current study examines New York MATTERS Medication for Addiction Treatment and Electronic Referrals , a novel statewide network developed as a public health response to the opioid epidemic that operates through ED-initiated buprenorphine treatment and linkages to community-based care.
Population Health Research Capsule What do we already know about this issue? Buprenorphine has demonstrated efficacy for the treatment of OUD. What was the research question? What was the major finding of the study? We demonstrate that the establishment of a large-scale network to support ED-initiated buprenorphine and referrals for ongoing care is feasible. How does this improve population health? It is a racially and ethnically diverse county that includes Buffalo, the second largest city in the state.
The first four phases of the model represented by PRECEDE are as follows: 1 social assessment and situational analysis; 2 epidemiological assessment; 3 educational and ecological assessment; and 4 administrative and policy assessment and intervention alignment. Phase 1: Social Assessment and Situational Analysis In response to the rapidly evolving opioid epidemic, Erie County declared a public health crisis in and formed an Opioid Epidemic Task Force through executive order. Through observation of monthly workgroup meetings, the challenges and priorities of people with OUD living in Erie County were subjectively defined.
Phase 2: Epidemiological Assessment We accessed aggregated state population data28 to understand vital indicators of the opioid epidemic in Erie County, NY. Indicators included opioid-related mortality rates, opioid-related ED visits and hospitalizations, and opioidrelated treatment entries in community-based settings. These data were used to rank and prioritize problems related to the issues identified in Phase 1.
Phase 3: Educational and Ecological Assessment Following our epidemiological assessment of the opioid crisis in Erie County, we explored the educational and ecological needs of emergency physicians. We informally conducted key informant interviews with two emergency physicians at a single teaching hospital and identified predisposing, enabling, and reinforcing factors27 to implementing ED-initiated buprenorphine and establishing linkages to community-based clinicians.
One physician interviewed is the director of emergency medicine EM at a teaching hospital in Erie County and is board certified in EM. This physician also engages in prehospital care by serving as medical director for an emergency air medical transport service and several fire and police departments in the region.
The second physician interviewed is board certified in EM and practices at three hospitals in Erie County. This physician also serves as the medical director for several fire departments in the region. Phase 4: Administrative and Policy Assessment and Intervention Alignment We matched our strategies and intervention components with the desired outcomes identified in Phase 1 and Phase 2 and determined whether the capabilities and resources were available to develop and implement the program.
Figure 1. A trained program coordinator maintained a database of process outcomes that included the following: the number of participating hospitals and other referral sites; the number of participating community-based MOUD clinics; the number of participating pharmacies; the number of emergency physicians, nurse practitioners, and physician assistants collectively referred to as EM clinicians trained in buprenorphine prescribing; and the number of patients served.
Additionally, necessary modifications to the intervention were identified and made during the scale-up process of the phased implementation and are described. These committees each meet approximately once per month, and the full Opioid Epidemic Task Force meets quarterly where committees report on progress. The formation of the Hospital ER Committee brought together leaders from local hospitals with a focus on this goal and allowed them to leverage the expertise of other stakeholders from the larger task force.
PHASE 2: Epidemiological Assessment Aggregated population data28 documented a significant increase in opioid-related mortality in New York State; the age-adjusted rate of opioid overdose deaths increased nearly threefold from 5. Data shows that the crude rate of opioid overdose ED visits in was However, New York State had a crude rate of opioid-related hospital discharges of This suggested that the greatest hospital burden of opioid overdose was occurring in the ED setting in Erie County, whereas other counties may have had more dedicated inpatient units for the treatment of OUD.
This suggested that there was unrealized potential to address the opioid epidemic by facilitating linkages from the ED to outpatient treatment programs in Erie County. This data was discussed and supported the notion of expanding access to MOUD in ED settings and establishing a network to enable patients to link to outpatient programs for continued MOUD. The data was also useful in demonstrating the extent of these challenges to hospital leaders outside of the EDs as well as potential external funders.
Phase 3: Educational and Ecological Assessment The two emergency physicians interviewed as key informants identified several predisposing, enabling, and reinforcing factors27 to implementing ED-initiated buprenorphine and establishing linkages to communitybased MOUD clinics Table 1. These findings are important because they illuminate barriers and facilitators to implementing this type of intervention that may be common to other communities affected by the opioid crisis. Predisposing Factors Clinician self-efficacy to appropriately determine buprenorphine dosing.
The dose is then slowly titrated upward until withdrawal symptoms are satisfactorily abated. Clinicians expressed concern regarding their ability to properly determine the appropriate dose, and the time and resources needed in a busy ED to observe the patient during a gradual titration. Clinician self-efficacy to provide patients with followup instructions. Once patients are discharged from the hospital, they require clear follow-up instructions. Clinicians admitted that they did not feel sufficiently knowledgeable to instruct patients on how to take buprenorphine at home especially the first dose , how to obtain medication if they did not have health insurance, and how to navigate their first Volume 23, no.
Predisposing, enabling, and reinforcing factors for emergency clinicians to prescribe buprenorphine and refer patients to follow-up clinic. Both licit and illicit opioids can be bought and sold on the street. Clinicians expressed concern that the medication they prescribed in the ED would be sold by patients or otherwise diverted.
This is a common perception among buprenorphine prescribers in the United States. Clinicians indicated that a streamlined process would reduce the time and administrative burden of linking patients to community-based care for continuing MOUD. Patient ability to pay for buprenorphine. Many patients with OUD are uninsured or underinsured. Enabling Factors Clinician X-waiver to prescribe buprenorphine.
Nurse practitioners and physician assistants were required to complete 24 hours of training to obtain the waiver. Clinicians in the ED perceived this requirement as a barrier, in addition to the multiple other unfunded certification courses they must complete for licensure and hospital privileges. Process for timing and location of clinician referral to community-based clinic. Based on the experiences shared by patients with OUD, clinicians worried that they would not be able to secure immediate follow-up appointments for their patients with a community-based clinician following an ED visit.
In addition to the timing of a follow-up appointment, clinicians expressed concern about the multiple permutations necessary to determine the appropriate clinics to which they could refer patients. At the time, there were several communitybased MOUD clinics in the region and each had unique rules regarding patient acceptance, such as health insurance coverage, concomitant benzodiazepine use, or a previous discharge because of failure to follow the clinic policies.
Process for scheduling follow-up appointment at community-based clinic. Given the heterogeneity of community-based clinics and scheduling processes, clinicians expressed a desire for a streamlined process to schedule Volume 23, no. The program first recommended an initial 4-milligram mg dose of buprenorphine followed by 4 mg of buprenorphine twice a day for three days.
This recommended standardized dosing scheme was created by the physician leadership of the program in consultation with local addiction medicine specialists. Prescribers were still able to use a patient-specific dose and duration at their discretion, but most clinicians used the standardized scheme. Standardized patient instructions for clinicians. The packet included a decision-support flow chart, the phone number to the central referral line, and discharge instructions with blank spaces for patient-specific instructions, such as the date and location of their follow-up Western Journal of Emergency Medicine Novel Statewide Network Support in ED-initiated Buprenorphine Treatment appointment.
For patients who were not induced in the ED, these instructions also included guidance on when to take their first dose of medication using non-technical language. Diversion education for clinicians. To address concerns about buprenorphine prescription diversion by ED patients, ED clinicians were educated regarding the true buprenorphine diversion risk.
Evidence shows that the majority of people who use illicit buprenorphine do so to manage opioid withdrawal symptoms or achieve or maintain abstinence from other opioids. Leveraging a hybrid model, physicians first participated in four hours of online, asynchronous training and then attend a four-hour, faceto-face training. Mission, vision, and values document for clinic participation in network.
To facilitate a process for timing and location of clinician referral to community-based clinics, a mission, vision, and values document was created to detail the goals of the network and the obligations of both ED clinicians and clinics receiving referrals through the network. A key component of this document was the obligation for clinics to accept all patients referred through the network. Participating clinics included those that were single site, multisite, urban, suburban, and rural.
Leadership from these clinics were asked to identify days of the week in which they would have the ability to accept a patient from the referral network to ensure that patients were seen within hours after their ED visit. These were not dedicated appointments; rather they were periods in which the clinic felt their capacity was adequate to absorb an additional patient into the schedule on short notice. The referral process provided patients with the date and location of their first follow-up appointment.
The clinic contacted the patient on the next business day to select a mutually agreeable appointment time. Centralized referral system. This enabled ED staff to call the hotline and instantly find clinic availability within the necessary referral period. Once an appropriate clinic appointment was selected, Western Journal of Emergency Medicine Clemency et al.
The dispatcher would also note that the scheduled clinic appointment was no longer available in the master log to avoid double-booking clinics. Patient voucher for buprenorphine prescription. All uninsured patients and patients who reported that they were covered by Medicaid were automatically given a voucher for buprenorphine.
If the patient arrived at the pharmacy and had active insurance, then the voucher was not charged. This was established through a partnership with a local pharmacy association that had experience with operationalizing voucher programs and had relationships with a network of local pharmacists who were willing to honor their vouchers. Patients identified as uninsured or underinsured received a voucher in the ED with information on participating pharmacies. Clinician honorariums.
A summary of the intervention components is shown in Table 2. The pilot network consisted of one teaching community hospital including two emergency physicians and three communitybased MOUD clinics. During this pilot stage, the clinician and patient worked together to complete a short, paper referral form with questions on patient contact information, medical history, past drug use, and mental health history. On the final page, the patient then ranked which clinic they would like to go to.
The patient was also given buprenorphine discharge instructions. The clinician, unit secretary, or counselor called the centralized referral line with this information, and it was recorded on a master spreadsheet. New hospitals and community-based MOUD clinics joined the network after reviewing the mission, vision, and values document and agreeing to the obligations of both ED clinicians and clinics receiving referrals through the network.
After clinic leadership agreed to these obligations, they completed a short, data collection form, which included information on clinic location, contact information, MOUD types prescribed ie, buprenorphine, naltrexone, methadone , and appointment availability. However, the growing number of available clinics and the need to standardize the data collection process for referrals required a more robust information technology solution.
Through a partnership with the New York State Department of Health, an online referral portal was created. Instead of a paper referral form, patients reviewed a growing list of clinics via a Wi-Fi-enabled tablet prior to their departure from the ED. After entering their information, patients were able to view a list of available clinics and dates from which to choose follow-up care.
Patients could search for specific clinics, look for available sites near their homes, and select a site based on MOUD types available at that location. Additionally, despite follow-up appointments being scheduled within 72 hours of discharge, we identified several instances when an appointment needed to be postponed or authorized prescribers were not available for the first clinic appointment.
Feedback from patients and clinicians, as well as observed best practices in other areas, suggested that the initial dose of 4 mg of buprenorphine was insufficient for induction. Accordingly, the standardized dosing scheme was changed to 8 mg for induction and 4 mg twice a day for seven days for the initial prescription.
The referral phone line was invaluable to the initial launch of the program. As the program continued to grow, the volume and scope of the referral network necessitated a more robust referral solution. This OLRS allowed patients and clinicians to enter patient information, browse the available referral sites, confirm their referral date and location, and generate electronic discharge instructions. Referral information was sent directly to the receiving clinic, eliminating the need for a phone call in the ED.
A total of ED clinicians have been trained by the network in buprenorphine prescribing and obtaining an X-waiver, and patients with OUD have received ED-initiated buprenorphine and were referred to community-based care with a community-based network MOUD clinic. Further, leadership from an additional 12 hospitals and 14 community-based clinics have expressed an intent to join the network over the next year, expanding the size of New York MATTERS to an expected 49 hospitals and 61 community-based clinics by The process evaluation also identified several modifications that needed to be made to the intervention.
The centralized referral system was critical to the initial launch Table 2. Additionally, the pilot study system is known for progressive healthcare and public health programming; so the buy-in may have been greater, simply because of past experiences with novel program adoption or because the system had funding for DEA X-waivers, hybrid training, and incentives.
Finally, the educational and ecological assessment included the views of two emergency physicians; including additional relevant stakeholders may have yielded more robust information. Figure 2. Feedback from clinicians and patients reflected that the OLRS was faster and more userfriendly than the original referral phone line model. The OLRS also allowed for more reliable data collection because the patients or hospital staff entered data directly into the system using a combination of defined and free-text fields.
The pilot study and subsequent spread of the program took place in an area with already existing resources and infrastructure, such as clinics, pharmacies willing to participate in voucher programs, and call centers available to facilitate scheduling. These resources may not be available in Table 3. Western Journal of Emergency Medicine Clemency et al.
This review provides evidence that the financial burden of providing medications for opioid use disorder can and should be addressed through these types of interventions. As the network expands into new regions, future study is needed to examine the scalability and the generalizability of this intervention.
Address for Correspondence: Brian M. Email: bc34 buffalo. Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. Clemency [K12HL]. Hoopsick PI: Linda S. Large-scale analysis of opioid poisoning related hospital visits in New York State. Take-home naloxone 2.
National trends in hospitalizations for opioid poisonings among children and for the emergency interim management of opioid overdose: the adolescents, to JAMA Pediatr. Trends in U. Pain Medications for Opioid Use Disorder. Treatment Improvement Med. Publication No. Responsible, safe, PEP Pain Physician. Approach to buprenorphine dependence and associated serious infections increased sharply, use for opioid withdrawal treatment in the emergency setting.
Emerg Med. Opioid-related emergency Retrospective review department visits and hospitalizations among commercially insured of a novel approach to buprenorphine induction in the emergency individuals, Clin J Pain. Trends in opioid analgesic Treating opioid abuse and mortality in the United States.
CBHSQ data review: ;75 1 Buprenorphine for Opioid use in the United States. West J Emerg Med. Bahji A. Incidence and correlates of opioid-related psychiatric Buprenorphine in the emergency care: a retrospective, multiyear cohort study. J Opioid emergency department: randomized clinical controlled trial Manag. Drug overdose deaths in the withdrawal. Can Fam Physician. United States, Prescription opioid use, Differences in opioid misuse, and use disorders in U. Public Health Rep.
One-year mortality after He just wants to hang out with him There's a lot of surprising stuff in it. I wanted this film to feel intimate and real and truthfully acted, and I wanted very much to break away from the kind of bloated feeling I've gotten from a lot of comic-book movies. Stephen is a huge man. One of the things that is so wonderful filming with him for a character like this is that he's a good six inches taller than Logan, and huge over Patrick.
The little kid in the movie would come up to basically his knee. So there's a wonderful sense of scale—but he has heart too. So that was a wonderful energy to enter the movie, and someone who instead of turning things into their own energy kind of joined ours.
Grant as Dr. However, the DNA from several mutants, including Logan, in that film was used to create the clones that are seen in this film. Not merely to change for change's sake, but also to make something that's speaking to the culture now, that's not just the same style—how many times can they save the world in one way or another?
How can we construct a story that's built more on character and character issues, in a way as if it almost wasn't a superhero movie, yet it features their powers and struggles and themes? I'm really proud of The Wolverine I would say I'm not there yet. But I have taken finger to key. Let's say that. There's been typing. And ideas.
And talking amongst all the principles. Jim Mangold and I were literally on the phone last night talking about ideas but there is no script and no writer yet so it's a way off. For Hugh and I, the first goal was to construct something more intimate. Hugh often brought up The Wrestler and Unforgiven as examples. I used those references as well as others. I pitched to both Hugh and the studio that I had an idea for an extremely bloody, existential Little Miss Sunshine.
I'm genuinely at that point where unless it's better than the last one I'm not going to do it. I think it has to be better. I can still see where we can improve on the last one. I love the intimacy of that story, I liked the small stuff, I liked that it was a little unexpected. That would be a very different sort of X-Men from the four movies that I've already done. After the film's release, it was revealed by Jackman that originally the script had the character play a role in the film, but that Sabretooth was excluded from the final screenplay.
Grant was cast as a villainous mad scientist , [] [] and Stephen Merchant had also been cast. It's violent, it's kind of like a western in its tone. It's just a very cool, different film. The director clarified that Marvel Comics allowed this on the condition that they could use actual characters and designs, but not use any real comic book issues. As a result, the comic book covers and pages seen in the film were made specifically for it, by writer Joe Quesada and artist Dan Panosian.
He pointed that the arts had to resemble the style used in the Bronze Age of Comic Books , and pointed out that they also served to contrast their campy style with the darker tone of the live-action film itself. He said that "The colors and art itself juxtaposed against the raw and savage world in the film capture just how much innocence has been lost over time".
On March 5, , James Mangold anticipated that filming would begin "early next year. Route between Ferriday and Clayton would be closed for a five-day period in connection with Fox's production. Route just outside of Ferriday. I don't want to be searching for stuff for him, I want to be working towards getting the cut right. There was a very clear decision to apply a film genre to the material, if that makes any sense. For Logan, his aim was to set frames that are descriptive, and evocative of comic-book panels and classical filmmaking.
In it, Deadpool notices a man getting robbed, and springs into action—but first has to change into his costume in a phone booth. As he is finishing up, the man is shot; the short film ends with Deadpool commenting on the strangeness of the phone booth's presence, and eating the man's ice cream.
The teaser met with positive reviews. Ryan Reynolds posted an extended version of the teaser via his YouTube channel the day after the film's release. Jackman stated that he was inspired by Michael Keaton 's performance in Birdman , and wished to portray the character of Wolverine until his death. The image, coupled with the hashtag " OneLastTime", signified that the film would be his last appearance as Logan, and officially announced his decision to stop playing the character he had been portraying for the past 17 years.
Oz Show in May , Jackman clarified the confusion over the conflicting sentiments, by stating bluntly that the film would be his final portrayal as the character; he said, "This will be my last one, it is my last time. It just felt like it was the right time to do it, and let's be honest, 17 years. I never thought in a million years it would last, so I'm so grateful to the fans for the opportunity of playing it. I kind of have in my head what we're going to do in this last one.
It just feels like this is the perfect way to go out. It's not about finishing on top, necessarily, but making sure you're, creatively, still got something left, which propels you into the whatever's next. Urging fans to campaign online, he stated, "I want Deadpool and Wolverine in a movie together. What we're gonna have to do is convince Hugh. If anything, I'm going to need to do what I can to get my internet friends back on board to help rally another cause down the line.
Hugh Jackman is one of the best human beings. But the timing may be wrong. The first call I made was to [director James Mangold]. I said, 'Jim, I got one more shot at this,' and as soon as Jim came up with the idea and we worked on it, I was never more excited. But, it feels like the right time. Deadpool, go for it man, do your thing. You don't need me. Jackman elaborated, "If that was on the table when I made my decision, it certainly would have made me pause.
That's for sure. Because I always love the idea of him within that dynamic, with the Hulk obviously, with Iron Man but there's a lot of smarter people with MBAs who can't figure that out. You never know. At the moment, honestly, if I really did have them there, I probably wouldn't have said this is the last. It just feels like this is the right time [to leave the character]. Jackman stated that while he noted the irony and felt some initial disappointment upon learning the news, he planned on standing by his decision to retire from the role.
And every time I saw an Avengers movie I could just see Wolverine in the middle of all of them like punching them all on the head. But it was like, "Oh well, that's not gonna happen," and it was interesting just when I first saw that headline—it was just the possibility of it and who knows what's gonna happen, obviously—I was like, "Hang on!
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Put your trust into Bettinger West Interiors, Inc. Corliss, Wis. In Lien, the South Dakota Supreme Court gave this explanation of the rule: "Each party is entitled to their respective property as of [the judgment] date. There were no special circumstances shown in this case to warrant not awarding interest on the deferred payments. Interest should be awarded on remand.
This type of plan consists of making periodic contributions to a fund by the employee, the employer, or both. This money is invested and each employee's account is credited with the contribution made plus the earnings made on the contributions. Retirement benefits are paid based on the accumulated contributions and earnings in the employee's account.
This arrangement is analogous to a savings account except there is no automatic right of withdrawal before retirement. Johnson, Ariz. His pension account was vested, i. Most courts hold that the valuation for equitable distribution purposes of a vested defined contribution plan is the present actual value of the contributions made and the accumulated earnings thereon.
Johnson, supra; Berry v. Duncan, S. Laffitte, So. Bloomer, 84 Wis. His expert had discounted both pension amounts by 29 percent. This discount was apparently based on his view that since the funds could not be paid until Mr. Bettinger's retirement in the year , a discount to present day value was appropriate.
The fallacy in this position is that the expert used the present day values as if they would be the value of the funds on the retirement date. The expert's position ignored the fact that the present values would continue to increase through contributions and earnings to the year when Mr.
Bettinger would be sixty-five. If he had taken these latter figures, then a discount to present day value would have been appropriate. We find that the trial court erred in discounting the present value of the pension and profit sharing plans. Upon remand, Mrs. Child Support Mrs. Guidelines for Child Support Awards, 6 W.
These rules were promulgated by the director of the Child Advocate Office pursuant to authority delegated by the legislature in W. Code, 48A a Code, 48A a , as amended. We concluded that the trial court erred in not following the formula and in failing to comply with the statutory requirement that if the guidelines were not followed to set forth "in writing, specific reasons for not following the guidelines in the particular case involved.
In the present case, the claim is made that with Mr. Bettinger argues that the formula is not to be used in this case and points to 6 W. Under such circumstances, the court shall equitably determine the SOLA support obligation so as to avoid a windfall to either support obligor or a hardship on either support obligor, and shall be cognizant of the fact that an excessive amount of SOLA support may not be in the best interests of the child or children.
Under the child support formula, there are two calculations for child support. The first calculation is to determine the primary child support, which essentially covers the basic needs of the children. The SOLA calculation is then made based on defined percentages for the number of children.
We do not read this section to mandate an absolute bar to use of the formula. We note initially that the language is "the court or master may not apply the percentages set forth in this section. Whyte, W. Second, the reference is to the SOLA part of the formula since this is the area where percentages are used.
Under 6 W. Nothing in 6 W. Indeed, the use of the term "discretionary income" in this section clearly indicates that the primary support obligation has been calculated. The term "discretionary income" under 6 W. It seems clear that 6 W. A decision not to follow the SOLA percentages must be undertaken in light of the legislative preference in W. Code, 48A b , which is that child support should be keyed to "the level of living which such children would enjoy if they were living in a household with both parents present.
As we have earlier pointed out, the primary child support obligation amount must be calculated first. In view of the absence of an appropriate factual record on the child support calculation, we remand for an appropriate calculation under the principles set out herein. Alimony Award Mrs. First, she believes it is inadequate in view of her husband's income.
Second, she also asserts that an award for only five years is akin to an award of rehabilitative alimony and that there was no showing that she met the criteria of Molnar v. Again, we are faced with a record that fails to set out the reasons that alimony was granted in this amount and in this form. Code, b , the legislature set forth a number of factors that should be considered in making an award of alimony.
Molnar, supra, that a broad inquiry must be made: "There are three broad inquiries that need to be considered in regard to rehabilitative alimony: 1 whether in view of the length of the marriage and the age, health, and skills of the dependent spouse, it should be granted; 2 if it is feasible, then the amount and duration of rehabilitative alimony must be determined; and 3 consideration should be given to continuing jurisdiction to reconsider the amount and duration of rehabilitative alimony.
We find no detailed inquiry in the record with regard to Mrs. Bettinger's ability to engage in remunerative work. She was forty-five years of age at the time of the divorce proceedings and had not worked for ten years at her former profession as an occupational therapist.
Moreover, as we pointed out in Molnar, some courts are reluctant to give rehabilitative alimony where "there are minor children. Citations omitted. While rehabilitative alimony may be ideally suited to a young spouse, it is less suited to an older person who may find his or her age a limitation in a skilled job market.
In summary, we find the record inadequate to justify the alimony award and remand this matter for reconsideration under the foregoing guidelines. We are not advised as to the amount of additional attorney's fees sought. However, it is clear that a considerable amount of legal work was done after November 4, The circuit judge had, on August 5, , reversed the original recommended decision of the family law master.
This required additional discovery and hearings, culminating in a new recommended decision on June 16, This decision was subsequently appealed to the circuit court and confirmed on August 12, Code, a 4 , enables a court, which would include a family law master,[26] to "compel either party to pay attorney's fees and court costs reasonably necessary It would appear from Mrs.
Bettinger's exceptions to the family law master's decision of December 14, , that there had been no formal order for the payment of temporary alimony pendente lite. Despite assertions in Mr. Bettinger's brief that his wife had prolonged the litigation and made onerous discovery motions, we do not find the record to bear this out. It is true that Mrs. Bettinger's attorney felt that the original recommended decision of the family law master was erroneous and was successful in having it reversed.
Equally true is the fact that he complained about the final recommended decision which was approved by the trial court. We have, by this opinion, found his appeal to be substantially justified. The purpose of W. Code, a 4 , is to enable a spouse who does not have financial resources to obtain reimbursement for costs and attorney's fees during the course of the litigation.
It is unreasonable to expect an attorney to shoulder not only the cost of the litigation, but to conduct the litigation on a no-fee basis unless the client can pay or until it is ended and some fee is awarded. Here, Mrs. Bettinger was not working, and Mr. Bettinger was earning a sizeable income. The request by Mrs. Bettinger's attorney for additional fees should have been granted.
Moreover, since Mrs. Bettinger has prevailed on this appeal, her attorney is entitled to fees and costs for his appellate work. Moreover, as we pointed out in Nagy v. We also observe that in this case the basis for the divorce was one of no fault, i. There is included within W.
Code, a 4 , the right to modify attorney's fees already ordered, which modification may "require full or partial repayment of fees and costs" previously ordered. Ordinarily, before such a modification is appropriate, the court should look to the income of the spouses at the time of the final decree.
Other courts have arrived at much the same conclusion. See Weiman v. Weiman, Conn. Tydings, A. Peak, So. Lavene, N. Bettinger's claim for reimbursement of a reasonable fee for her expert witness was rejected. This was error. There is little doubt that in valuing interest in pension and profit sharing plans or the value of a business or property which have been found to be marital assets, expert witnesses are needed.
We have noted their presence in the following cases. Tankersley, supra; Shank v. Where one spouse has an adequate income and the other spouse has no adequate income to retain an expert witness to assist in valuing property subject to equitable distribution, it is apparent that the impecunious spouse is at a substantial disadvantage.
We believe that the analogy to awarding attorney's fees is appropriate. Consequently, we find that reimbursement for reasonable expert witness fees is permissible under similar financial considerations as those used in awarding attorney's fees. See In re Marriage of Munguia, Cal. Bagan, N. For the foregoing reasons, the judgment of the Circuit Court of Monongalia County is reversed, and this case is remanded for further proceedings consistent with the principles outlined herein.
Reversed and remanded. Bettinger's accountant, in arriving at the net tangible assets, deducted the corporate liabilities and deferred income tax on the accounts receivable, thus, comporting with the net value concept in W. Code, , et seq. See Tankersley v.
Code, [], requires a full disclosure of one spouse's financial assets to the other spouse at the time of divorce, and contemplates a meaningful hearing on the subject of equitable distribution of property at which the spouse submitting financial data may be cross-examined concerning the nature, origin and amount of assets.
Code, 48A c : "The circuit court shall examine the recommended decision of the master, along with the findings and conclusions of the master, and may enter an order in conformance with the recommended decision, may recommit the case, with instructions, for further hearing before the master or may, in its discretion, enter an order upon different terms, as the ends of justice may require.
The circuit court shall not follow the recommendation, findings, and conclusions of a master found to be: " 1 Arbitrary, capricious, an abuse of discretion, or otherwise not in conformance with the law; " 2 Contrary to constitutional right, power, privilege, or immunity; " 3 In excess of statutory jurisdiction, authority, or limitations, or short of statutory right; " 4 Without observance of procedure required by law; " 5 Unsupported by substantial evidence; or " 6 Unwarranted by the facts.
Appellee, if he is of the opinion that there is error in the record to his prejudice, may assign such error in a separate portion of his brief and set out authority and argument in support thereof. Such cross assignment may be made notwithstanding the fact that appellee did not file a separate petition for an appeal within the statutory period for taking an appeal.
Appellant may answer the cross assignment of error in his reply brief. Bettinger also argues that the goodwill factor in valuing the corporate stock was not proper, but again no cross-assignment of error is made. As a consequence, we decline to discuss this issue except to point out that courts have recognized that there may be a goodwill factor in a professional corporation if based on competent expert testimony. See Annot. No gain or loss shall be recognized on a transfer of property from an individual to or in trust for the benefit of " h a spouse, or " 2 a former spouse, but only if the transfer is incident to the divorce.
If property was not sold, but was simply transferred from one spouse to another pursuant to divorce, the spouse who made the transfer was deemed in United States v. Davis [ U. Code, d 7 A through E provide, in part: " To make such equitable distribution, the court may: " A Direct either party to transfer their interest in specific property to the other party; " B Permit either party to purchase from the other party their interest in specific property; " C Direct either party to pay a sum of money to the other party in lieu of transferring specific property or an interest therein, if necessary to adjust the equities and rights of the parties, which sum may be paid in installments or otherwise, as the court may direct; " D Direct a party to transfer his or her property to the other party in substitution for property of the other party of equal value which the transferor is permitted to retain and assume ownership of; " E Order a sale of specific property and an appropriate division of the net proceeds of such sale: Provided, That such sale may be by private sale, or through an agent, or by judicial sale, whichever would facilitate a sale within a reasonable time at a fair price.
Code, e , is: "In order to achieve the equitable distribution of marital property, the court shall, unless the parties otherwise agree, order, when necessary, the transfer of legal title to any property of the parties, giving preference to effecting equitable distribution through periodic or lump sum payments: Provided, That the court may order the transfer of legal title to motor vehicles, household goods and the former marital domicile without regard to such preference where the court determines it to be necessary or convenient.
If this is done, however, the trial court is required to give its reasons. See Johnson v. Bettinger's pension fund was not matured. A pension fund is deemed matured when the employee has an immediate right to receive pension benefits. These benefits are calculated on a percentage of salary plus years of service and represent the annual pension which will be received on retirement.
This is a future figure that must be projected over the retirement life and then reduced to present day value.
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