DOCSLIB.ORG

Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic Dorothy E. Vawter,* J. Eline Garrett,* Karen G. Gervais,* Angela Witt Prehn,* Debra A. DeBruin, Carol A. Tauer, Elizabeth Parilla, Joan Liaschenko and Mary Faith Marshall * Guarantors responsible for the integrity of the work as a whole, from inception to this report. Minnesota Pandemic Ethics Project Report www.health.state.mn.us/divs/idepc/ethics 2010 A project of the Minnesota Center for Health Care Ethics and the University of Minnesota Center for Bioethics Sponsored by the Minnesota Department of Health With funding from the US Centers for Disease Control and Prevention Minnesota Pandemic Ethics Project: Resource Allocation Panel Report Minnesota Pandemic Ethics Project Team Minnesota Center for Health Care Ethics (MCHCE): J. Eline Garrett, JD; Karen G. Gervais, PhD; Ruth Mickelsen, JD, MPH; Angela Witt Prehn, PhD;* Dorothy E. Vawter, PhD University of Minnesota Center for Bioethics (UMCB): Debra A. DeBruin, PhD; Jeffrey Kahn, PhD, MPH; J. P. Leider; Joan Liaschenko, RN, PhD, FAAN; Mary Faith Marshall, PhD; Steven Miles, MD; Elizabeth Parilla, MPH;** Carol A. Tauer, PhD; Susan M. Wolf, JD Corresponding author: J. Eline Garrett, JD Minnesota Center for Health Care Ethics, Carondelet Center, 1890 Randolph Ave., St. Paul, MN 55105 612-964-9425, [email protected], www.mnhealthethics.org _________________________ * Midway through the project Dr. Prehn also became affiliated with Walden University. ** Ms. Parilla worked for the University of Minnesota Center for Bioethics during much of the project. When Ms. Parilla accepted a position with the Minnesota Department of Health, she moved to a solely advisory role on the project. Inclusion here reflects her early contributions to the project team. © Minnesota Department of Health 2010 Minnesota Pandemic Ethics Project: Resource Allocation Panel Report Acknowledgments The authors gratefully acknowledge the many individuals and organizations that contributed to the Minnesota Pandemic Ethics Project. We especially thank the Minnesota Department of Health for supporting the project while providing the freedom necessary for the work to remain truly independent. We owe thanks as well to the US Centers for Disease Control and Prevention for its generous financial support. Above all, we thank the members of the Resource Allocation Panel and each of the work groups (Appendix A), all of whom generously contributed time, energy, intellect and even humor to this work. The panel with its diverse membership embodied and embraced the values of genuine public engagement; they listened respectfully, thought creatively and spoke candidly. It is with immense respect that we bring the panel‘s final recommendations forward in this report. Hundreds of people enriched the panel‘s work by engaging with others in their communities and sharing their perspectives and values or by sending us written comments. To each we extend our deepest appreciation. We worked with a remarkable and committed group of people. In particular we acknowledge the contributions of: Julia Anderson, RN; Roger H. Bernier, PhD, MPH; Patricia Bloomgren, MS; Rynn Burke, RN, MD; Susan L. Craddock, PhD; Richard Danila, PhD, MPH; Kathryn J. Draeger, PhD; Denise Dunn, RN, MPH; Charles G. Durbin Jr., MD; Jody Erikson; Buddy Ferguson; Kerry G. Hjelmgren; Jane Harper, RN, MS, CIC; John Hick, MD; Pamela Hoopes, JD; Lawrence R. Jacobs, PhD; Allan Kind, MD; Barbara A. Koenig, PhD, RN; Niki Koszalka; Nick Kuhnley, RCP, RRT; Peggy Kvam; J. P. Leider; Aggie Leitheiser, RN, MPH; Emily A. Litt, RN, MSN, DNP, PHN; Franci Livingston, JD, MPH; Ruth Lynfield, MD; Sanne Magnan, MD, PhD; LuAnne McNichols, RN, MN; Ruth Mickelsen, JD, MPH, MA; Sheila Mirembe-Larsen; Angela Morley, JD; Daniel T. O‘Laughlin, MD; Bruce Pederson; Jean Rainbow, RN, MPH; Johanna Raquet; Christopher Tate, MPH; Pat Tommet, RN, PhD, CNP and Caitlin Wills-Toker, PhD, MA. We also are indebted to the dozens of people who volunteered to be trained and to serve as small group facilitators or note takers for the community forums in Duluth and Owatonna (Appendices C – D). Finally, we extend our thanks to the numerous other state and local agencies and organizations whose employees lent their expertise and time to this project: The Minnesota Departments of Employee Relations, Human Services, Labor and Industry, and Public Safety; the Minnesota Boards of Aging, Nursing and Pharmacy; Clay County Public Health; Community Education Division of Independent School District 518; Community Health Information Collaborative; Courage Center; Dodge County Department of Health; Fond du Lac Reservation‘s Min No Aya Win Human Services Center; The Keystone Center; Leech Lake Band Health Division; Minneapolis Urban League; Phillips Neighborhood Clinic; Saint Louis County; Steele County Community Awareness & Response; Steele County Public Health; Virginia Rotary Club and the West Side Citizens Organization. Minnesota Pandemic Ethics Project: Resource Allocation Panel Report Table of Contents Executive Summary ..................................................................................................................... i 1. Introduction ....................................................................................................................... 1 2. The Minnesota Pandemic Ethics Project ........................................................................... 2 3. Scope of Recommendations ............................................................................................. 2 3.1. Palliative care .......................................................................................................... 3 3.2. Statewide population health perspective ................................................................. 3 3.3. Containment ............................................................................................................ 3 3.4. Adapt and integrate into comprehensive plan .......................................................... 3 4. Process ............................................................................................................................. 4 4.1. Development of preliminary recommendations ........................................................ 4 4.2. Further public engagement ...................................................................................... 6 4.3 Development of final recommendations................................................................... 8 5. Assumptions ...................................................................................................................... 8 5.1. Pandemic assumptions ........................................................................................... 9 5.2. Demographic assumptions .....................................................................................11 5.3. Resource assumptions ...........................................................................................13 6. Definitions ........................................................................................................................15 7. Ethical Frameworks for Rationing .....................................................................................16 7.1. Ethical commitments ..............................................................................................18 7.2. Ethical objectives ...................................................................................................18 7.3. Strategies: Overview ..............................................................................................19 8. General Recommendations ..............................................................................................21 8.1. Extend and manage supply ....................................................................................21 8.2. Remove access barriers .........................................................................................21 8.3. Adjust and refine ethical frameworks ......................................................................21 8.4. Other recommendations .........................................................................................22 9. How to Read and Apply the Frameworks .........................................................................22 10. Ethical Frameworks for Rationing Antivirals ......................................................................24 10.1. Antiviral assumptions .............................................................................................24 10.2. General recommendations for rationing antivirals ...................................................26 10.3. Antiviral treatment strategies ..................................................................................27 10.4. Antiviral prophylaxis strategies ...............................................................................29 10.5. Discussion: Rationing antivirals ..............................................................................31 11. Ethical Frameworks for Rationing N95s and Masks .........................................................35 11.1. Assumptions about N95s and masks .....................................................................35 11.2. General recommendations for rationing N95s and masks ......................................37 11.3. Discussion: Rationing N95s ...................................................................................39 11.4. Discussion:
Load more

Recommended publications
  • Introduction Chaptar
    NOTES Introduction 1. David T. Bazelon, The Paper Economy (NY: Random House, 1963), p. 64. 2. Peter Newcomb, "The Richest People in America," Forbes (October 11, 1999): 169. 3. Michael J. Mandel, "How the Super-Rich Lucked Out Twice: New Data Show the Top Earners Are Already Enjoying Lower Rates," Business week (May 14, 2001): 52. 4. Erika Btown, Doug Donovan, Joanne Gordon, and Peter Newcomb, "Global Billionaires," ForbesOuly5,1999). 5. Bittlingmayer and Hazlett 2000 coined the expression DOS Capital. See George Bittlingmayer and Thomas W. Hazlett, "DOS Kapital: Has Antitrust Action Against Microsoft Created Value in the Computer Industry?," Journal ofFinancial Economics, Vol. 55, No.3 (March 2000): 329-59. 6. Newcomb, "The Richest People in America," p. 169. 7. United Nations Development Programme, Globalization with a Human Face: United Nations Human Development Report (NY: Oxford University Press, 1999), p. 68. 8. Karl Marx, Capital, Vol. 1 (NY: Vintage, 1977), p. 496. 9. Michael A. Perelman, Class Warfare in the Information Age (NY: St. Martin's Press, 1998). 10. Davoll v. Brown, 7 F. Case. 197 (Circuit Court, D. Massachusetts 1845). 11. Mitchell v. Tilghman, 86 U.S. 287. 12. Supreme Court decision 1949: CIR. v. Wodehouse, 337 U.S. 369. Chaptar Dna 1. Robert P. Merges, "The Economic Impact ofIntellectual Property Rights: An Overview and Guide," Journal ofCultural Economics, Vol. 19, No.2 (1995): 106. 2. Edith T. Pentose, The Economics of the International Patent System (Baltimore: Johns Hopkins University Press, 1951), p. 2. 3. Daniel Defoe, A Plan of English Commerce (London: C. Rivington; Kress Goldsmith Collection, Reel 407, No.
    [Show full text]
  • MI COVID Response Data and Modeling Update June 30, 2021
    MI COVID response Data and modeling update June 30, 2021 NOTE: all data as of June 29 unless otherwise noted Draft and pre-decisional Note: lower national rankings are more favorable Executive summary Percent Positivity is steady, and Case Rate is down 27% since last week. Positivity (1.3%, ↔) and case rates 13.1, ↓3.9) have declined or plateaued for eleven weeks Michigan has the 33rd lowest number of cases (↑3), and 8th lowest case rate (↑5) in the last 7 days (source: CDC COVID Data Tracker) Percent of inpatient beds occupied by individuals with COVID has decreased 14% since last week and is decreasing for nine weeks. There are 1.7% (↓0.3%) inpatient beds occupied by COVID-19 patients. Michigan has the 12th lowest inpatient bed utilization (↑13), and the 14th lowest adult ICU bed utilization (↑9) in the country (source: US HHS Protect) Deaths have decreased 40% since last week. There were 65 COVID deaths between Jun 16 and June 22, and the Death Rate is 0.9 deaths per million residents (↓0.4) Michigan has the 6th highest number of deaths (↔), and 10th highest death rate (↓2) in the last 7 days (source: CDC COVID Data Tracker) The 7-day average state testing rate has decreased to 1,255.3 tests/million/day. Daily diagnostic tests (PCR) is 12.4K per day, and the weekly average for PCR and antigen tests conducted in Michigan is 24.9K. 9.4 million COVID-19 vaccine doses reported to CDC, 4.693 million people have completed their vaccine series 2 Agenda Status of COVID-19 Epidemiological Risk State-by-state comparison of epidemic spread Michigan epidemic spread Public health response Science round-up 3 Global and National Comparisons What we see today (data through 6/29): • Globally, 181,533,728 cases and 3,932,077 deaths • Countries with the highest number of cases are U.S.
    [Show full text]
  • County Government in Mississippi Fifth Edition
    County Government in Mississippi FIFTH EDITION County Government in Mississippi Fifth Edition Sumner Davis and Janet P. Baird, Editors Contributors Michael T. Allen Roberto Gallardo Kenneth M. Murphree Janet Baird Heath Hillman James L. Roberts, Jr. Tim Barnard Tom Hood Jonathan M. Shook David Brinton Samuel W. Keyes, Jr. W. Edward Smith Michael Caples Michael Keys Derrick Surrette Brad Davis Michael Lanford H. Carey Webb Sumner Davis Frank McCain Randall B. Wall Gary E. Friedman Jerry L. Mills Joe B. Young Judy Mooney With forewords by Gary Jackson, PhD, and Derrick Surrette © 2015 Center for Government & Community Development Mississippi State University Extension Service Mississippi State, Mississippi 39762 © 2015. All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transcribed, in any form or by any means, without the prior written permission of the Center for Government & Community Development, Mississippi State University Extension Service. This publication is designed to provide accurate and authoritative information regarding the organization and operation of county government in Mississippi. It is distributed with the understanding that the editors, the individual authors, and the Center for Government & Community Development in the Mississippi State University Extension Service are not engaged in rendering legal, accounting, or other professional services. If legal advice or other expert assistance is required by the readers, the services of the Office of the Attorney General of Mississippi, the Office of the State Auditor of Mississippi, a county attorney, or some other competent professional should be sought. FOREWORD FROM THE MISSISSIPPI STATE UNIVERSITY EXTENSION SERVICE The Mississippi State University Extension Service is a vital, unbiased, research-based, client- driven organization.
    [Show full text]
  • CARL ZIMMER Author & Journalist
    CARL ZIMMER Author & journalist carlzimmer.com @carlzimmer BIOGRAPHY The New York Times Book Review calls Carl Zimmer "as fine a science essayist as we have." He is the author of thirteen acclaimed books and a columnist for the New York Times. Zimmer first be- gan writing about science at Discover, where he served for five years as a senior editor, and has gone on to write hundreds of features for magazines including The Atlantic, The New York Times Magazine, Time, National Geographic, and Scientific American. He has also served as a scientific editor for television documentaries, consulted on museum exhibits, and contributed his writing to major science web sites. Zimmer has earned numerous honors for his work. In 2007 he won the National Academies Communication Award, and he has won the American Association for the Advancement of Sci- ences Science Journalism Award three times. In 2015, Zimmer won the Distinguished Service Award from the National Association of Biology Teachers, and in 2016, he won the Stephen Jay Gould Prize, awarded by the Society for the Study of Evolution. In 2018, Zimmer’s book She Has Her Mother’s Laugh was named by Publisher’s Weekly one of the ten best books of the year. The Guardian named it the best science book of 2018 and The New York Times Book Review chose it as a Notable Book of the Year. It was short-listed for the Baillie-Gifford Prize for Nonfiction and a fi- nalist for the PEN/E.O. Wilson Literary Science Writing Prize. His articles have been antholo- gized in both The Best American Science and Nature Writing series and The Best American Science Writing series.
    [Show full text]
  • Data Driven Decision-Making in South Dakota
    DATA DRIVEN DECISION-MAKING IN SOUTH DAKOTA EFFECTIVE USE OF STATE DATA SYSTEMS JOHN ARMSTRONG SD This paper is based on research funded in part by the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the author(s) and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. © 2016 by the State Higher Education Executive Officers Association (SHEEO) 2 TABLE OF CONTENTS INTRODUCTION ...................................................................................................................................... 3 THE IMPORTANCE OF DATA FOR THE EXECUTIVE .............................................................................. 4 THE IMPETUS FOR SDBOR DASHBOARDS ........................................................................................... 6 REACTIONS TO SDBOR DASHBOARDS ................................................................................................11 DISPELLING MYTHS WITH DATA ......................................................................................................... 12 CONCLUSION......................................................................................................................................... 13 © 2016 by the State Higher Education Executive Officers Association (SHEEO) 3 INTRODUCTION Analysis of student-level data to inform policy and promote student success is a core function of executive higher education agencies. Postsecondary data systems have expanded their collection of data elements
    [Show full text]
  • South Dakota
    Child & Family Research Partnership The University of Texas at Austin LBJ School of Public Affairs STATE-SPECIFIC SOURCES – SOUTH DAKOTA To provide states with guidance for building a strong prenatal-to-3 (PN-3) system of care, we sought to understand the progress states have made toward implementing each of the effective policies and strategies identified in the Prenatal-to-3 State Policy Roadmap. Policy adoption and implementation do not typically happen quickly. States may introduce legislation several times before adopting a policy and take even more time to fully implement it. States in which there has been considerable legislative initiative have made greater progress toward and are likely closer to adopting and implementing a policy compared to states in which there has been little to no legislative initiative. Once a policy is adopted, some states make the benefits more generous over time, whereas other states may rescind benefits in bills during subsequent legislative sessions. In the Roadmap, policies are defined as having been studied at the state level, and the evidence points to clear legislative or regulatory action that states can take to implement the policy and achieve better outcomes. Comprehensive reviews of rigorous evidence informed the definition for each of the five effective policies, including the level of generosity necessary to achieve outcomes for children and families. In contrast to policies, we define state-level strategies as effective programs or approaches that states have implemented, but research has not evaluated the strategy as a statewide policy, and research does not provide clear guidance on how states should implement the strategy statewide to replicate the impacts that were found in rigorous studies.
    [Show full text]
  • Illegal Immigrants Who Have Broken Federal and State Laws to Be in Our State
    THE IMPACT OF ILLEGAL IMMIGRATION ON MISSISSIPPI: COSTS AND POPULATION TRENDS PHIL BRYANT STATE AUDITOR A report from the Performance Audit Division #102 February 21, 2006 www.osa.st ate.ms.us PREFACE The focus of this report is costs and population trends associated with illegal immigration in the State of Mississippi. This report attempts to differentiate between lawful immigrants who are here within the legal framework and process established by the United States federal government and illegal immigrants who have broken federal and State laws to be in our State. This report provides limited regional and national background material and draws on national data sources where data collected by Mississippi State government is unavailable. Further, it contemplates recommendations for government data collection and changes to Mississippi law. These recommendations will help recover costs associated with illegal immigration in the State and help strengthen protections for law-abiding citizens and non-citizens (here legally) of Mississippi. Due to time constraints and limitations of scope, this report should not be considered a comprehensive study of the issue of illegal immigrants and their cost to government, but rather it should be viewed as a snapshot of the estimated impact of illegal immigrants residing in Mississippi. TABLE OF CONTENTS Executive Summary ......................................................................................................................... i Introduction:.....................................................................................................................................1
    [Show full text]
  • Minnesota State Substance Abuse Strategy
    DHS-6543-ENG 9-12 The Minnesota Substance Abuse Strategy was Minnesota developed in 2012 under the leadership of the Minnesota Department of Human Services State in partnership with the Department of Education, Department of Health, Substance Department of Public Safety, State Judicial Branch, Department of Corrections, Abuse Strategy Department of Military Affairs/ Minnesota National Guard and Minnesota Board of Pharmacy. E Table of Contents Executive Summary .................................................................................1 I Background and Purpose .................................................2 IV Guiding Principles ..........................................................46 A. Overview .....................................................................................2 A. Collaboration..............................................................................46 B. Magnitude of the Problem: Economic Costs .....................................3 B. Prevention and Early Intervention Work Best ..................................46 C. Purpose of This Report ...................................................................5 C. Reduce Health Disparities and Promote Cultural Competence ..........46 II Understanding Substance Abuse and Addiction ..............7 D. Sustain a Continuum of Services ...................................................47 A. The Nature and Extent of Substance Abuse .....................................7 E. An Integrated Approach to Service Delivery in Health Care ............47 B. Emerging
    [Show full text]
  • The Death Penalty in New York State - Past, Present and Future
    Pace Law Review Volume 28 Issue 3 Spring 2008 Article 5 April 2008 Death Becomes the State: The Death Penalty in New York State - Past, Present and Future Deborah L. Heller Follow this and additional works at: https://digitalcommons.pace.edu/plr Part of the Criminal Law Commons Recommended Citation Deborah L. Heller, Death Becomes the State: The Death Penalty in New York State - Past, Present and Future, 28 Pace L. Rev. 589 (2008) Available at: https://digitalcommons.pace.edu/plr/vol28/iss3/5 This Article is brought to you for free and open access by the School of Law at DigitalCommons@Pace. It has been accepted for inclusion in Pace Law Review by an authorized administrator of DigitalCommons@Pace. For more information, please contact [email protected]. Death Becomes the State: The Death Penalty in New York State- Past, Present and Future Deborah L. Heller* Introduction The death penalty is one of the oldest penalties available for the punishment of crimes. It has been utilized throughout this country since its inception. The death penalty in New York State has been through many incarnations throughout time, ranging from active use to moratoriums.' After years without a death penalty statute, New York enacted one in 1995.2 In 2004, the New York State Court of Appeals ruled that the New York death penalty statute could not be applied as written because the deadlock instruction 3 was unconstitutional. 4 Since that time, New York has been without a valid death penalty statute, and the death sentences of all but one man have been com- muted to life in prison.5 This Comment focuses on the history, present and possible future of the death penalty in New York State and the fate of the sole person left on death row.
    [Show full text]
  • Women in the Low-Wage Workforce by State
    WOMEN IN THE LOW-WAGE WORKFORCE BY STATE WOMEN ARE OVERREPRESENTED IN THE LOW-WAGE WORKFORCE IN EVERY STATE • In all but one state (Nevada), women make up at least 60 percent of the low-wage workforce, even though they are less than half of the overall workforce in every state. (In the District of Columbia, women are 51.2 percent of the overall workforce and 60.8 percent of the low-wage workforce.) • Women make up more than two-thirds of the low-wage workforce in 29 states. • In Iowa, Louisiana, and Mississippi, more than 7 in 10 workers in the low-wage workforce are women. FIGURE A: WOMEN’S SHARE OF LOW-WAGE WORKFORCE, STATE BY STATE LOW-WAGE WORKFORCE OVERALL WORKFORCE State Total Number Number of Women Women’s Share Total Number Number of Women Women’s Share United States 23,547,404 15,508,962 65.9% 148,938,864 70,380,895 47.3% Alabama 306,126 213,285 69.7% 2,053,141 972,273 47.4% Alaska 53,080 33,499 63.1% 369,580 165,466 44.8% Arizona 466,973 296,233 63.4% 2,892,377 1,343,304 46.4% Arkansas 197,912 136,608 69.0% 1,271,312 600,269 47.2% California 2,960,045 1,866,989 63.1% 17,715,678 8,078,268 45.6% Colorado 401,346 254,116 63.3% 2,724,940 1,255,541 46.1% Connecticut 268,369 179,576 66.9% 1,801,490 872,253 48.4% Delaware 67,686 43,805 64.7% 439,679 216,821 49.3% District of Columbia 40,481 24,631 60.8% 352,130 180,162 51.2% Florida 1,550,272 990,036 63.9% 8,811,877 4,206,066 47.7% Georgia 665,425 446,292 67.1% 4,531,464 2,158,715 47.6% Hawaii 127,198 79,713 62.7% 704,727 324,769 46.1% Idaho 115,931 77,046 66.5% 735,048 333,747 45.4%
    [Show full text]
  • The Johns Hopkins University
    THE JOHNS HOPKINS UNIVERSITY COMMENCEMENT 2019 Conferring of degrees at the close of the 143rd academic year MAY 23, 2019 CONTENTS Order of Candidate Procession ......................................................... 11 Order of Procession .......................................................................... 12 Order of Events ................................................................................. 13 Conferring of Degrees ....................................................................... 14 Honorary Degrees ............................................................................. 17 Academic Garb .................................................................................. 14 Awards ............................................................................................... 16 Honor Societies ................................................................................. 28 Student Honors ................................................................................. 34 Candidates for Degrees ..................................................................... 43 Divisional Ceremonies Information ............................................... 121 Please note that while all degrees are conferred, only doctoral and bachelor’s graduates process across the stage. Taking photos from your seats during the ceremony is allowed, but we request that guests respect one another’s comfort and enjoyment by not standing and blocking other people’s views. Photos of graduates can be purchased from GradImages®: gradimages.com
    [Show full text]
  • Is Our Use of Groundwater Sustainable?
    Educating and inspiring people to value, conserve and protect water resources Minnesota’s Groundwater: Is our use sustainable? A Freshwater Society special report / April 2013 White Bear Lake water levels 2003 – 2013 INSIDE: Our conclusions and recommendations. Page 2 Over-pumping threatens groundwater sustainability. Page 3 Areas of concern across the state. Page 5 Groundwater pumping grows faster than population. Page17 Enforcement shortcomings undermine sustainability effort. Page 19 2 MINNESOTA’S GROUNDWATER: IS OUR USE SUSTAINABLE? A FRESHWATER SOCIETY SPECIAL REPORT OUR CONCLUSIONS AND RECOMMENDATIONS The big decline White Bear Lake experienced in recent years  The DNR’s ability to enforce the law requiring well graphically illustrates the impact the pumping of groundwater owners to obtain permits for groundwater appropriations for all the activities of modern life can have on cherished surface is hampered by a time-consuming enforcement process waters. that requires misdemeanor prosecution of violators by sometimes-unwilling county attorneys. We urge lawmakers It is a powerful reminder that – even in Minnesota, the Land to give the DNR the authority it has sought to impose civil of 10,000 Lakes – our groundwater and our lakes, streams and fines against violators. wetlands are limited resources.  At present, a Minnesotan who wants to install a high- This report on groundwater by the Freshwater Society is a capacity well is required to notify the Minnesota Health significant effort to inform Minnesotans about the demands on Department of plans to drill the well, then drill the well our groundwater resources and the limitations those resources and install a pump, and then – later – seek a permit from face.
    [Show full text]