Fresh Look at a Fast Way to Kick a Heroin Habit
Mary Duenwald, New York Times- 12/4/2001

The patient strapped to the hospital gurney, breathing through a respirator, is James, a 40-year-old man addicted to heroin. The anesthesiologist loads a syringe with 20 milligrams of naloxone and slowly injects it into the IV in James's right arm. During the next 10 minutes, the drug will enter his system, pry off the billions of opiate molecules that have been clinging to his brain cells and wash them away.
    This is a rather abrupt way to come off heroin. Were it not for the anesthesia holding him in a state of unconsciousness, James would be writhing, shivering, vomiting and perhaps screaming in pain. Even in his deep sleep, his heart rate and breathing speed up, his pupils dilate, his nose runs, his temperature rises, his arms and legs twitch sporadically and his skin erupts into gooseflesh. Over the course of the next four hours, as the opiates are flushed out through his liver and kidneys, his heart rate, breathing and temperature fall back to normal, his pupils readjust and his goose bumps recede. When he is awakened, his body is fully detoxified from heroin--a process that can normally take days or even weeks.
    After a night in intensive care, James returns to his family in Queens and, a few days later, to his job as an executive chef at a Manhattan hotel restaurant. For a few weeks, he has trouble sleeping and he feels achy and weak, as if he had the flu. Every day, he attends meetings of Narcotics Anonymous. And every day, he swallows a tablet of naltrexone, a drug that prevents heroin and other opiates from affecting his brain.
    This is rapid detox, a practice invented in Austria at the University of Vienna in the late 1980's. In the world of addiction medicine, no technique for treating heroin users has ever been more controversial. Five years ago, when the procedure was introduced in this country, it was offered at a only a handful of hospitals. Two years ago, seven patients died soon after rapid detox performed by one New Jersey doctor, who had conducted some 3,200 procedures. The technique was widely condemned.
    But it has continued to be practiced. Dr. Clifford Gevirtz, an associate professor of anesthesiology at the Mount Sinai medical school in Manhattan and the Bronx Veterans Affairs Medical Center, estimates that about 1,000 procedures a year are done in this country. In Europe, 12,000 are performed each year, chiefly in Spain, England, Germany, Belgium and the Netherlands. But the numbers are likely to rise, if clinical trials show that the procedure is safe. "Patients want it," Dr. Gevirtz said, "because it gives them a compassionate and comfortable way to get clean." Until recently, Dr. Gevirtz performed rapid detox at Metropolitan Hospital Center in Manhattan. In addition to heroin addicts, people who became addicted to painkillers after injuries or operations have also sought the procedure.
    Many doctors say that until more research is done, rapid detox, which costs anywhere from $3,500 to $8,000 and is usually not covered by insurance, is too risky. And, they say, unless strong measures are taken to keep patients from returning to heroin use, rapid detox, even if it is safe, may not be worthwhile. "I view it as more of an experimental procedure," said Dr. Patrick G. O'Connor, a professor at Yale University School of Medicine, who has studied rapid detox. "We really need to understand it more before we start using it willy-nilly." Dr. Mary Geanne Kreek, an addiction researcher at Rockefeller University, said: "We don't need this approach. We have several good approaches, and this one is a waste of money." Jennifer Sandu, a spokeswoman for the New York State Office of Alcoholism and Substance Abuse Services, said, "It is an expensive procedure, with no proven benefit over less expensive existing methods."
    Occupying a middle ground are addiction experts who believe that rapid detox may turn out to be useful for certain patients. "It's not chicanery or malpractice," said Dr. Michael Miller, a psychiatrist at the University of Wisconsin Medical School, who is chairman of the public policy committee of the American Society of Addiction Medicine. "There is a good body of science that supports what is being done and why. The question is, Is it necessary? There are other methods of detox which are effective, safe and cheap."
    Dr. Bennett Oppenheim, a psychologist who runs UltraMed International, a company in Fort Lee, N.J., that offers rapid detox (and where, until recently, Dr. Gevirtz was chief medical officer), said his patients included a wide range of heroin users. At one end, he said, is "the guy who has nothing, but grandma's paying for his detox," and at the other end are "high-profile celebrities of sports and entertainment whose names you would definitely recognize." A majority, Dr. Oppenheim said, have tried other ways of getting off heroin, have relapsed and are afraid to face withdrawal again. Or, they are people who want to come off methadone maintenance. Some 980,000 Americans use heroin, the Office of National Drug Control Policy says. About 175,000 are now enrolled in government-regulated programs where they receive a daily dose of methadone. Dr. Miller said rapid detox might turn out to be useful for select people who needed to detoxify quickly. These may include addicts who have developed severe gastrointestinal side effects to opiates, or those who need to begin taking antidepressants for newly diagnosed depression.
    A growing group of patients, providers say, are people who have become dependent on pain medications--"your soccer mom who became dependent on morphine after a car accident," Dr. Oppenheim said. Perhaps as many as one in 100 people who take prescription drugs for chronic pain are opiate-dependent, Dr. Gevirtz said.
    One reason for the atmosphere of suspicion surrounding rapid detox is the perception that some hospitals offer it merely because it is a good cash-only business. Also, some practitioners have tried to patent the use of medications to rapid detox, drawing further disapproval from their peers.
    One standard way of detoxifying people from opiate addiction is by switching them to methadone, a synthetic narcotic that mimics heroin, and then tapering the methadone over a period of days or weeks. Another method is to give the patient clonidine, a drug used to treat high blood pressure, which can help quiet the jittery symptoms of withdrawal. A third strategy, which may soon come into wider use, is to prescribe a drug called buprenorphine, which like methadone, mimics heroin's effects, but even more mildly. Unlike methadone, which is distributed only in daily doses through government-regulated clinics, buprenorphine could be prescribed in weekly, or even monthly doses, by private physicians. The Food and Drug Administration is now deciding whether to approve it.
    Rapid detox, Dr. Gevirtz said, can be as safe as any other strategy. At a meeting of the American Society of Anesthesiologists in October, he presented an analysis of the seven New Jersey deaths, which occurred from one to three days after rapid detox performed in the Camden County office of Dr. Lance L. Gooberman. All but one of the deaths were caused by pulmonary edema, a buildup of fluid in the lungs. In the other case, the patient vomited and breathed some of the material into his lungs, which caused a fatal bacterial infection. Dr. Gervirtz concluded that both problems could have been avoided. He faulted Dr. Gooberman for not having a board certified anesthesiologist present. Anesthesia was administered by a nurse anesthetist (The New Jersey Board of Medical Examiners now prohibits Dr. Gooberman from performing rapid detox.)
    Dr. Herbert Kleber, a psychiatrist who is conducting a clinical trial of rapid detox at Columbia University, said that keeping patients in the hospital overnight could minimize the risks, but that even then, it was not yet clear that the technique was safe. "The fact is, we still don't know why some people die," Dr. Kleber said. "What causes the pulmonary edema?"
    In addition to the deaths in Dr. Gooberman's practice, there was another death two years ago in Massachusetts, and there have been at least two more in Europe. Researchers say there may be some inherent danger in giving prolonged anesthesia to someone whose heart function or body chemistry is already compromised by heroin use. "I think there may be a role" for rapid detox, Dr. Kleber said. "I think that we need as many arrows in our quiver as possible. But science must be driven by data. And I'm waiting for the data."
    The second major issue is whether the treatment can stick. Heroin addicts are notoriously resistant to permanent recovery. More than 80 percent of addicts who manage to withdraw from heroin eventually go back to it. Dr. David Cullen, an anesthesiologist at the Tufts University School of Medicine, said the high rate of relapse was what had led him to stop dong rapid detox. He had performed the procedure on 43 patients, but within two years, more than 89 percent were either back on heroin or dead from an overdose. "This is a safe and effective procedure," Dr. Cullen said. "That's not the issue. One hundred percent of our patients are detoxed when we finish with them. But until psychologists figure out a better way to deal with these patients, I don't see the point."
    Other practitioners argue that the return to addiction is a separate problem, not a reason to condemn rapid detox. "You have to think of addiction as a chronic relapsing disease," said Dr. Gevirtz. "It might take a couple of goes at detox." Dr. Kleber of Columbia recently released some preliminary data showing that three months after the treatment, about 50 percent of rapid detox patients were still heroin-free. "I stress that these data are preliminary," Dr. Kleber cautioned. The way to promote long-term abstinence, Dr. Oppenheim and others say, is to see that patients get counseling for many months after rapid detox and continue to take naltrexone so that they are not in danger of returning to opiates.
    As for James, it has been nearly three months since his detoxification. The side effects afterward, he says, were somewhat worse than Dr. Oppenheim led him to believe they would be. Nevertheless, he said, after spending $25,000 on heroin in 14 months, the $7,000 cost of the procedure was worth it. James said it would not have worked without the support he had received from his family and from daily attendance at Narcotics Anonymous. "It put me in the right direction," he said. "but it's not a magic cure."

Judge Allows Yates Confession
Carol Christian, Houston Chronicle12/5/2001

Andrea Pia Yates' confession to police that she drowned her five children cannot be kept from the jury at her capital murder trial, the judge overseeing the case ruled Tuesday. State District Judge Belinda Hill's decision came after a pretrial hearing in which Russell Yates testified he thought his wife was "psychotic" when she killed the children. Testimony also revealed he believed his wife did not get sufficient treatment for depression. Hill also denied a request from Yates' lawyers to exclude the death penalty as a possible punishment.
    Most of the two-day hearing was testimony on the motion to suppress Yates' confession. Defense attorneys George Parnham and Wendell Odom were trying to prove she was mentally impaired and could not have knowingly waived her rights to remain silent and to have a lawyer present when she spoke with police the day of the drownings. The 37-year-old Clear Lake mother, whose trial is scheduled to begin Jan. 7, is charged with capital murder in the June 20 deaths of three of her children. She has pleaded not guilty by reason of insanity.
    During his testimony Tuesday, Russell Yates said his wife was "psychotic" that morning. But when he left for work about 9 a.m., she was not in such shape that he felt uncomfortable leaving the children in her care. According to a statement prosecutor Joe Owmby read in court, Russell Yates told police that day, "She was quiet, but she often was. I've seen her more depressed." When he returned home less than 90 minutes later in response to a call from his wife, police told him what had happened. She had called 911 after the children were drowned in the bathtub. He kept shouting at his wife, "How could you do this?" he testified.
    Later that day, Russell Yates told police he did not want to talk to his wife because he could not face her, even though he understood she was mentally ill. "Logically, a part of depression is psychotic behavior," he told police June 20, according to his statement read in court. "I don't feel like she got the treatment she needed ... ," he told police the day of the drownings. "Looking back, I think she should have been on anti-psychotic medicine, but she wasn't. Even knowing that, I can't face her."
    Russell Yates testified he first noticed that his wife had mental problems in 1999, after the birth of the couple's fourth child, Luke. She was hospitalized that year at Methodist Hospital and the former Spring Shadows Glen Hospital. This year, she had two stays at Devereux Texas Treatment Network in League City, he said. When he and Andrea Yates' brother first took her to Devereux on March 31, the attending physician, Dr. Mohammed Saeed, wanted to have her committed to a state mental hospital, Russell Yates said. She was not admitted, however.
    During cross-examination, Owmby said it appeared from Russell Yates' notes that his wife initially refused treatment at Devereux but was persuaded to sign a consent form by her husband. "You got your wife to sign rather than be committed (to a state hospital)," Owmby said. Yates agreed. During her first two-week stay at Devereux, Saeed prescribed the anti-psychotic medication Risperdal, Russell Yates said. She was readmitted May 4.
    At that time, Saeed prescribed another anti-psychotic, Haldol, which Andrea Yates had taken previously under another doctor's care and had improved with it, her husband said. A month later, in an outpatient visit at his office, Saeed took Yates off Haldol and prescribed Remeron. "Dr. Saeed said he didn't want to put her back (on Haldol) because it was a bad medicine," Yates said.  By the time Andrea Yates saw Saeed again June 18, she was "really sick," her husband said. She did not carry on conversations and was not eating well. Her husband said he did most of the talking during the June 18 office visit.  During that appointment, Saeed inquired about her suicidal thoughts but did not ask about the possibility of her harming anyone else, her husband said.
    On the morning of the drownings, Russell Yates said, his wife seemed nervous and carried her 6-month-old daughter everywhere on her hip. "She didn't say much; she hadn't been saying much for several months," said Russell Yates, who testified for about three hours. "She ate some Sugar Corn Pops out of a box, which was really uncharacteristic for her." But he thought it was safe to leave her alone with the children for an hour until his mother, Dora Yates, arrived to help care for them, he said. Russell Yates' mother had been coming to the home in the 900 block of Beachcomber to help with the children daily for two months prior to the drownings.
    Other motions that Hill denied Tuesday included requests to declare unconstitutional a Texas statute that prevents jurors from being told what happens to a defendant who is found not guilty by reason of insanity as well as a statute that sets the standard for determining criminal responsibility as knowing right from wrong.

Lemak Insane, Friends, Dad Say
Jeff Coen and Flynn McRoberts, Chicago Tribune- 12/5/2001

If Marilyn Lemak was descending into insanity in the weeks before the slayings of her three young children, as her attorneys have suggested, apparently not even her family and closest friends knew it. Those who testified for her defense Tuesday--including her father--said they had no inkling she might be struggling with dangerous depression in March 1999, let alone on the brink of committing murder. "She absolutely couldn't understand the criminality of her conduct on March 4. She would never, ever hurt her children," said her father, William Morrissey, his voice breaking. "Prior to March 4, I had no observation that she didn't know right from wrong."
    Like the prosecution witnesses who had come before them, those who took the stand Tuesday said they remember a kind, intelligent and meticulous woman who seemed stressed by her pending divorce from emergency room doctor David Lemak, but was keeping herself together. One close friend considered Lemak so trustworthy that she allowed her young daughter to play at the Lemaks' house the day before the murders. "I always admired the way she never lost her patience with the children," Ann Hahn-Baiyor said.
    The first day of the defense case made it clear her attorneys would not seek to demonize Lemak's ex-husband or blame him for the family's tragedy. Beginning Wednesday, defense attorneys plan to call a parade of forensic psychiatrists, psychologists and other mental health experts to support Lemak's plea of not guilty by reason of insanity. In Illinois, defendants are legally insane if, because of a mental defect, they are unable to understand that their actions are criminal.

Before the deaths
One of the few signs defense attorneys offered of Lemak's allegedly troubled mind was a witness account of a visit she made to a downtown Naperville gift shop the day before the killings. As Nicholas and Emily stood close to each other and whispered, shop owner Patricia Shetina noticed 3-year-old Thomas crammed into a baby stroller. Surprised to find such a "large child" in the stroller, Shetina testified she asked Lemak why she had tightly wrapped Thomas in a blanket on an unseasonably warm March day. "You wouldn't want him running around in your store," Shetina recalled Lemak saying of her youngest child, who friends and neighbors all knew to be well behaved.
    Also that day, Lemak revealed to a number of people at her children's grade school that her estranged husband's new relationship with another woman was deeply disturbing her. David Lemak had moved to a rental home up the street and next to the school Feb. 11, 1999, as their divorce neared completion. "She said she didn't know how much more she could take--seeing her husband's girlfriend's car in his driveway," said Cindy Wittman, a health technician at Ellsworth school, under cross-examination. Prosecutors contend Lemak killed her children to spite her husband.

Children recalled
Wittman fondly and tearfully recalled 7-year-old Nicholas as "a frequent flier" who often came to her to mend his schoolyard bumps and bruises. "He was one of my little buddies," she said. The boy's 2nd-grade teacher, Jan Reid, recalled Lemak approaching her at school March 3 and asking to get in touch with a school social worker because "Nicholas was having trouble sleeping." Lemak blamed the child's restlessness on the ongoing divorce. But Reid said the boy was behaving no differently than usual. "He was a serious student, very bright," his teacher said, as David Lemak smiled proudly in the courtroom gallery. "He had lots of friends"--a quiet child who didn't ramble on like many his age.
    Tuesday's first witness was Hahn-Baiyor, who said Lemak loved her children, had a supportive network of friends, a showpiece home and a husband who, though estranged, kept the children at the center of his life. Another neighborhood woman who knew Lemak agreed and noted how surprised she was to find out David Lemak was seeing another woman. "He was with [the children] so much, I didn't think he had time," said Christine Butler, whose daughter was close friends with Emily Lemak, 6. Like Morrissey, Hahn-Baiyor told the jury she believes her once-close friend was insane the day she drugged and suffocated her daughter and two sons inside the family's Victorian home in Naperville's historic district.
    Defense attorney Joseph Bugos asked whether she believes Lemak knew right from wrong. "Based on the person I knew, I can only answer that, `No,'" said Hahn-Baiyor, a nurse who said she had been a friend of Lemak's for four years before the slayings. Hahn-Baiyor said she felt Lemak was battling anxiety as her divorce was becoming final.
"She complained about being stressed," Hahn-Baiyor said. "She said her teeth hurt because she was clenching her jaw. She was hot all the time."

Cross-examination
But on cross-examination, prosecutors tried to challenge Hahn-Baiyor's opinion that Lemak was criminally insane, prodding Hahn-Baiyor to acknowledge she felt comfortable enough with Lemak to allow her daughter to play with Emily at the Lemaks' home the day before the killings. "Did she ever do anything that would indicate to you that she had impaired judgment?" DuPage County Assistant State's Atty. Joseph Ruggiero asked. "No," Hahn-Baiyor answered. Hahn-Baiyor, who wept softly and dabbed her eyes through much of her testimony, was asked to identify Lemak in her police mugshot. "It doesn't look like the person I know," she said. "There's nothing there."
    Outside the court, Butler put it bluntly. "Of course she's crazy," she said. "Who would kill their kids if they were in their right mind?" The day Lemak called 911 and reported the deaths, her father testified, her parents didn't hear about the slayings until they arrived at their Orland Park home to find local police officers. Told to call Naperville police, Lemak's parents were instructed to go to Edward Hospital, where their daughter had been taken. A heavy snowstorm delayed them, and by the time they arrived at the hospital they'd heard media reports of the crime, Morrissey testified. Stepping into their daughter's hospital room, they found a woman "drifting in and out of consciousness." "She was inanimate," Morrissey said. "She was almost in a catatonic state." `It wasn't the same Lynn'
    On cross-examination, State's Atty. Joseph Birkett aggressively challenged Morrissey's recollections of his daughter's mental state in the weeks before March 4. He repeatedly asked Morrissey if he has ever discussed the killings with his daughter. Morrissey said no. "You would do anything to protect your daughter?" Birkett then asked him. "Absolutely," Morrissey replied and acknowledged that he had told authorities that while his eldest daughter was distressed over her impending divorce, Morrissey didn't recall her acting irrationally. The daughter he saw in her hospital room spoke in a flat, "childlike" voice, Morrissey said. "It wasn't the same Lynn I always knew. "She was an intelligent, articulate and vibrant person. [That night] she was none of those."

Schizophrenia Recovery Rare, Experts Say
Monte Morin, Los Angeles Times- 12/5/2001

Mass murderer Edward Charles Allaway says he has recovered completely from schizophrenia and is ready to live a normal life. If so, mental health experts said, he is a rare exception. The vast majority of schizophrenia patients endure the condition throughout their lives. It's a mental illness marked by a withdrawal from reality, illogical patterns of thinking and delusions. It has no known cause and no known cure, and in extreme cases has provoked sufferers to sudden, deadly violence. Of the more than 2 million Americans who have been diagnosed with schizophrenia, 10% to 20% eventually show some sign of recovery. The other 80% to 90%, according to experts, will see their condition worsen or stabilize.
    As an Orange County Superior Court judge considers arguments this week that Allaway has overcome the paranoid schizophrenia that led him to murder seven people at the Cal State Fullerton library 25 years ago, experts in mental illness say the type of natural recovery Allaway describes is rare. Even less common, they say, are cases where patients have overcome the disease without the use of drugs, as Allaway claims to have done. Even with the most promising recoveries, the odds of experiencing a relapse increase steadily with age unless patients receive regular treatment of antipsychotic drugs and psychotherapy. Past incidents of violent behavior are viewed by some experts as another warning flag. "The best predictor for violence is a past history of violent behavior," said Dr. Jeffrey A. Lieberman, a professor and chairman of psychiatry at the University of North Carolina at Chapel Hill.
    Schizophrenia is a broad term for disorders with symptoms ranging from deep depression to hallucinations. Sufferers also might believe they are being persecuted or conspired against. No one knows what causes it, but some scientists believe it's genetically inherited because it seems to run in families. They theorize that microscopic and chemical defects within the brain's emotion-regulating centers are to blame. These defects may stimulate the brain excessively and generate false and misleading signals. Although there is no cure, medical research has developed drugs to control some symptoms.   In Allaway's case, the janitor testified that prior to the shooting, he believed homosexual men were using the school's library for sexual liaisons and were plotting to kill him. Soon after the shooting, officials diagnosed him as being schizophrenic. In 1977, a judge found Allaway not guilty by reason of insanity.
    John Hinkley, who shot President Ronald Reagan, and Theodore Kaczynski, the Unabomber, are two well-known examples who have done much to forge the image of schizophrenics as being prone to violence. While some experts said there is some element of truth to this, others said that schizophrenics more commonly pose a risk to themselves. About half of all schizophrenics will attempt suicide at some point, according to Dr. Dilip Jeste, an expert on schizophrenia and the chief of the Division of Geriatric Psychiatry at UC San Diego. The suicide rate for people with schizophrenia is 10%, according to the Journal of Psychiatry. That compares to a suicide rate in the general population of 0.01%.
    Experts such as Jeste said little is known about schizophrenics who recovered without the aid of drugs, because it is standard procedure now to treat schizophrenia with antipsychotic medications. "Today, if somebody is diagnosed as having schizophrenia, it would be almost unethical not to treat him with antipsychotic drugs," Jeste said. Dr. Stephen Marder, director of the VA Mental Illness Research Center, Education and Clinical Center, Southern California, said patients helped by medications often relapse when they stop taking them. "For most people, it's a chronic condition that can be managed," Marder said. "Of those people who go into remission and then stop taking drugs, 80% or more will relapse."
    The medical expert who examined Allaway over a period of years and testified on his behalf at recent sanity hearings agrees that instances of schizophrenic remission are rare. But he insists Allaway stopped showing signs of the disease by around 1983, about seven years after the shooting. He hasn't show any symptoms since, suggesting he's recovered, the doctor said. But experts called by the district attorney's office, which opposes Allaway's release, said there is no guarantee he won't have a relapse.
    Speaking publicly for the first time about the seven people he killed, Allaway testified last week that delusions led him to believe he was one of the victims of the rampage, not the killer. The former Marine and Detroit auto worker has spent nearly a quarter of a century in state mental hospitals. He has twice previously lost bids to gain his freedom, but this time, doctors and staff at the hospital where he lives say they consider him safe for release.

Mental Health Expert Testifies for Caro
Steve Chawkins, Los Angeles Times- 12/5/2001

On the night Socorro Caro shot three of her young sons to death, she "was incapable of appreciating the nature and consequences of her actions," a mental health expert for the defense testified Tuesday. The testimony underscored attempts by Caro's lawyers to portray her as so drunk and depressed on Nov. 22, 1999, that she could not have known what she was doing.
    During punishment debate, jurors may view such impairment as a reason to spare her the death penalty and instead recommend life in prison without parole. The Santa Rosa Valley homemaker was convicted of first-degree murder on Nov. 5. The prosecution, however, on Tuesday attacked the conclusions of Ventura neuropsychologist Ines Monguio, arguing that Caro,44, had clearly made choices that would be logical for a mother who sought to kill her children. "Wouldn't her choice of a .38-caliber revolver demonstrate that the defendant was capable of understanding the nature of her act?" Deputy Dist. Atty. Jim Ellison asked. When Monguio asked if the handgun was the only weapon available, Ellison acidly countered, "Would it make a difference? The point is she didn't pick up a broomstick or a fly swatter to kill her children." Ellison also reminded jurors that Caro shot each boy once in the head, pumping a second bullet into the skull of 5-year-old Christopher. The shootings reflected Caro's deadly intent and her knowing ability to carry it out, he said.
    Monguio's testimony came on the sixth day of the trial's penalty phase. Closing arguments are set for Thursday, when jurors grapple with the question of whether Caro should be executed. On the witness stand all day, Monguio said Caro was suffering a major depression with psychotic features, describing those as "a deterioration of contact with reality."
    Ellison said Caro "manipulated the outcome" of certain tests by lying. He cited, for instance, her test response indicating she thought her marriage was problem-free. "She wasn't being truthful with you, was she?" Ellison said. "That's not the same as lying," Monguio contended, saying denial is one of Caro's chronic symptoms. Caro was a problem drinker, Monguio contended, citing a tequila binge the night she shot her sons. In response, the prosecution team--for the second day--brought up a scenario aimed at persuading jurors that Caro may not have been so impaired after all, despite a blood-alcohol reading nearly twice the legal limit for drunk driving. "Did you ever consider the possibility," Ellison asked, "that the defendant might have killed her children--and then drank the alcohol before she shot herself?"

D.C. Parents Charged With Murder in Baby's Death
Arthur Santana, Washington Post- 12/5/2001

The parents of a 2-month-old infant who died in October of starvation have been arrested and charged with felony murder, according to the U.S. attorney's office. Kimberly Price, 20, was arrested Saturday night in Southeast Washington and brought before a D.C. Superior Court hearing commissioner Monday, said Channing Phillips, a spokesman for the U.S. attorney's office. The infant's father, Tony Hodge, 20, was arrested yesterday on the same felony murder charge. If convicted, both face up to 60 years in prison, Phillips said.
    The infant, Shawn Hodge, died on or about Oct. 19, according to the arrest warrant. D.C. Medical Examiner Jonathan L. Arden said the boy, whose family was under the supervision of the District's child protection system, died of "starvation due to nutritional neglect." Shawn weighed just 4 pounds, 4 ounces when he died. A D.C. social worker assigned to monitor the family hadn't visited for seven months, government sources said. Officials at D.C. Child and Family Services Agency, which was assigned to monitor the family, have called the Hodge case a "tragedy." Price, who lives in the 4500 block of B Street SE, was released on her own recognizance by D.C. Superior Court Judge Shellie F. Bowers, who set Jan. 7 as a preliminary hearing date. Hodge is scheduled to appear before a hearing commissioner in court today, Phillips said.
    According to the arrest warrant, the autopsy by Deputy Medical Examiner Michael Pollanen noted that the baby was badly emaciated, with "no body fat present, skin paper-thin, the stomach was empty, and he appeared to have been suffering from protein-calorie malnutrition." On Nov. 28, nearly six weeks after the autopsy, Pollanen ruled the death a homicide, caused by starvation.
    According to a summary of events in the arrest warrant, Price called D.C. police on Oct. 19 from a home in the 4600 block of Bass Place SE. "My baby won't wake up," she told the officer who arrived. Paramedics were called, but by the time they arrived, Shawn was not breathing and no longer had a pulse. He was taken to Greater Southeast Community Hospital, where he was pronounced dead at 11 p.m. Evelyn Hodge, the infant's great-grandmother and Tony Hodge's grandmother, lives at the Bass Place address. According to the arrest warrant, Price said she had been feeding Shawn between five and eight ounces of baby formula every three hours.
    On Sept. 12, about three weeks after his birth, he had been taken to Children's Hospital as part of a follow-up medical examination. At that time, he weighed six pounds, the same as when he was born, according to the arrest warrant. A healthy 2-month-old baby boy typically weighs about 12 pounds, according to a Centers for Disease Control and Prevention growth chart.
    Shawn is one of nine children who have died since June while their families were under the supervision of child protection officials. The deaths of the children, some of whom had serious medical problems, are being examined by the child protection agency and the D.C. Child Fatality Review Committee to determine the circumstances.

In a Stressed New York City, No Room at the Bar
Marian Burros, New York Times- 12/5/2001

They were three deep at Guastivino's bar last Thursday night, downing flirtinis, cucumber martinis and patriots, a red, white and blue martini suitable for the times. Bartenders kept up a steady beat--mix, mix, mix--while waiters rushed to deliver trays of frothy daiquiris and coffee martinis. It wasn't unusual. Almost three months after the terrorist attacks, New Yorkers are drinking more than ever. Even as restaurants struggle with empty seats and fewer diners willing to pay high tabs, liquor sales are climbing at bars, restaurants and some liquor stores throughout the city.
    At a few places--a diverse list including Pravada, the Regency Hotel and McSorley's--liquor sales were 25 percent higher last month than they were in November 2000. And as the holiday season gets into full swing, the numbers are bound to increase. "People who were drinking three drinks are now having four or five," said Richard Schertzer, a senior bartender at Pastis, the brasserie in the meatpacking district. "They are drinking more martinis and fancy cocktails than before, even late at night, at 1 or 2 in the morning." "The mood is different," he added. "once people get out and see a few smiling faces around, they take it as a nice escape and use it to have a bit more fun."
    Whether people are drinking to relieve anxiety and stress, as psychotherapists believe, or because they want to socialize more and drinking is part of that, all over town bars are fuller and livelier. There's more hard liquor and less high-end wine; more big groups and fewer singles. People are staying later, locked in late-night conversation rather than giddy revelry.
    The dramatic rise in consumption of alcoholic beverages immediately after Sept. 11 was a nationwide phenomenon, liquor distributors and others in the business say. But nowhere was it more evident than in New York. After the first couple of weeks, there was a significant drop--until last month, when business came back, with a vengeance. Not only was it up in Manhattan and in some of the boroughs but also in nearby Long Island and Connecticut suburbs.
    Discus, the Distilled Spirits Council of the United States, plans to release national consumption figures next year. But ACNeilsen, which also tracks national retail sales of wine and spirits, reports that the sales volume of alcoholic beverages has been up every week since Sept. 11 compared with last year. For the week ending Nov. 3, the most recent figure available, volume rose 4.2 percent.
    At first, people felt a little uneasy and didn't want to appear to be celebrating--now I think there is a certain nervous fatigue that propels people," said Kurt Eckert, the wine director for Jean-Georges Vongerichten's five New York restaurants, where liquor sales were up 4 percent. "People are a bit relieved, but the recent plane crash, anthrax in addition, have left people a bit shaken. There has been a drop in the number of people dining, but they are ordering more wine."
    Many, who at first laughed nervously when asked if they were drinking more, and wanted to make certain no one thought they were drinking too much, eventually acknowledged that their consumption had increased, if only because they were going out more. For a lot of people--even 20- and 30-somethings, who in the past thought they were immortal--Sept. 11 was an awakening. "I used to be health-conscious," said Mark Booker, a 36-year-old real estate investor, sitting at a table in the Pastis bar. "I used to work out; bow I don't give a damn. I used to go out twice a month; now I go out twice a week. It's friends coming together to embrace each other. And the reason I am drinking more is because I'm out more."
    Others say they are drinking to relieve stress. "Boy, are you at the right table," said Esther Gweft, 51, a lawyer who does public relations for Paul, Weiss, Rifkind, Wharton & Garrison. "I'm a two-glass-of-wine person at home, but now it's three, three and a half glasses. My staff is stressed. Everything makes them anxious because of 9/11. I have two kids, and my son got very anxious. You get stressed trying to keep everyone else cheerful."
    For certain people, like recovering alcoholics, the problem can be very serious. Joseph Califano, president of the National Center on Addiction and Substance Abuse at Columbia University, is worried about them. "With a more traumatic and intense tragedy than Oklahoma City, I am concerned that we will have a greater increase in alcohol abuse in New York than was experienced in Oklahoma City," he said. "And that was substantial."
    People do a variety of things to ease discomfort, said James Bernard, a psychiatrist and psychoanalyst in Yew York. "Drinking or self-medication is just one of the behaviors," he said, "one of the central ingredients of people I've seen in a feeling of helplessness, which is one of the most intolerable feelings for most people." Dr. Gail Saltz, a psychiatrist and psychoanalyst who is chairman of public information for the New York Psychoanalytic Institute, said she had seen a definite increase in alcohol use in her patients. "People aren't often aware when they self-medicate for anxiety," she said. "They are also using it because they can't sleep, and the reason they can't sleep is anxiety."
    At Pastis, Chris Horn, 43, a casting director, ordered a second bottle of wine while the first was still half full. He said he was definitely consuming more these days. "When you sit down to relax and start talking, you don't realize it," he said, "Usually we have one and a half bottles. A year ago, it was one bottle."

Illinois Jail Psychiatrist Testifies of Signs of Mental Illness
Ted Gregory and Art Barnum, Chicago Tribune- 12/6/2001

A psychiatrist who examined Marilyn Lemak in DuPage County Jail testified Wednesday that he does not believe she is faking symptoms of mental illness, but he and other experts shed little light on Lemak's state of mind the day she drugged and suffocated her three children. DuPage County Jail psychiatrist James P. Corcoran, who visited with Lemak 43 times, said she told him during one visit that she saw a shadow on the floor she thought was her daughter, Emily, 6. Moments later she told Corcoran she thought she saw a shadow of son Nicholas, 7, Corcoran testified. She did not report seeing her third child, Thomas, 3, Corcoran recalled. The psychiatrist's testimony was the first strong support for the defense claim that Lemak was insane when she killed the children. Prosecutors say the Naperville mother, who sedated then suffocated the children March 4, 1999, may have been depressed. But they maintain she was sane.
    Illinois law states that a person is criminally insane if he fails to understand, "as a result of mental disease or mental defect," that his conduct is criminal. Corcoran was unable to say whether Lemak, 44, met that definition. "I didn't evaluate her for that," he testified Wednesday. He insisted, however, that "it's not likely she is malingering," or fabricating her mental illness. He also told of a visit to her cell on March 29, 1999, when he arrived to find Lemak crying. When Corcoran asked why she was crying, Lemak said she had asked her mother during a phone call how the children were doing. Lemak's mother told her the children were dead.
    But neither Corcoran nor a second psychiatrist testifying for the defense Wednesday could give definitive insight into her mental condition on the day the children were killed. In fact, prosecutors may have scored some points in their cross-examination of Northwestern University psychiatrist William T. McKinney. McKinney's testimony cast doubt on the defense argument that Lemak, though functioning normally around the time of the killings, was suffering from major depression.
    "If someone is able to care for their children on a day-to-day basis," prosecutor Jane Radostits asked McKinney on cross-examination, "to attend school activities, they definitely would not be severely depressed. Isn't that right?" "That's correct," McKinney answered. "At most, they would be moderate or mild," Radostits said. McKinney agreed. McKinney also stated that a person suffering from severe depression does not have homicidal tendencies or act out in anger. He also testified that an inability to concentrate is a symptom of depression.
    In testimony last week the prosecution detailed the methodical way in which Lemak carried out the killings, crushing sedatives in peanut butter on bagels and feeding them to the children, then adding more sedatives after the first appeared not have worked. Lemak waited for the children to pass out before suffocating them, they said. Lemak also placed their dishes in the dishwasher.
    Defense attorneys have indicated that factors other than depression, including stress over caring for the children and anger after learning of her estranged husband's new girlfriend, prompted a spontaneous episode of insanity. McKinney offered several statements that may bolster the defense. He said, for example, that major depression recurs frequently if untreated. Those recurrences can arise spontaneously, he added, and may be brought on by stress. Physicians, friends and family have testified that Lemak appeared coherent and sane two days before and one day after the killings.
    McKinney also said women are twice as likely as men to suffer major depression and that 11 million people suffer from serious depression in the U.S. In addition, he noted that depression typically afflicts people in their 20s and 30s. Lemak had two bouts with depression, one in her 30s and another when she was barely 40. Lemak had been taking prescribed antidepressants at the time of the killings. And, after killing her children, she attempted suicide.
    To underscore their contention that Lemak snapped March 4, 1999, two of her friends testified Wednesday that they recalled Lemak a caring, magnetic person before that date. She stopped by the house of neighbor Tracy Senica once a month to help Senica care for newborn triplets, Senica testified. Upon seeing that Senica was taking Zoloft, an antidepressant, Lemak consoled the woman and told Senica she too was taking the medication, Senica testified.
    Emily Lemak's kindergarten teacher at Ellsworth Elementary School, Judith Brian, provided the most poignant testimony of the day. "Emily was an adorable child who loved school and was advanced for kindergarten," Brian testified. Marilyn Lemak routinely picked up the kids from school and volunteered at Ellsworth, Brian recalled. On March 3, Brian testified, she saw Lemak, dressed in a green pantsuit, crying in the school hallway. Lemak told Brian it was hard being at school volunteering after seeing her estranged husband's girlfriend's car in his driveway, Brain said. Brian saw Emily Lemak for the last time March 4, she said. That day, Emily gave her teacher three drawings and a hug.

Detroit Patient Sues Psychiatrist's Estate
Amy Klein, Detroit Free Press- 12/6/2001

A woman who was caught in the crossfire when a schizophrenic patient fatally shot psychiatrist Reuven Bar-Levav and then himself filed suit Wednesday against Bar-Levav's estate, claiming the doctor endangered his patients. The suit, filed by Elizabeth Dawe in Oakland County Circuit Court, seeks at least $25,000 from Bar-Levav's estate, his practice and his daughter, Leora Bar-Levav, who is also a psychiatrist.
    Dawe, a Bar-Levav patient, was participating in a group therapy session in June 1999 when former patient Joseph Brooks Jr. walked into the Southfield office, shot Bar-Levav three times, killed another patient and wounded four others. Brooks then shot himself. Six bullets hit Dawe's left foot, right leg and both her hands, requiring multiple surgeries, according to her lawsuit. Dawe of Beverly Hills has a veterinarian license and works at Wayne State University School of Medicine.
    Reuven Bar-Levav and Associates now operates out of an office on Northwestern Highway in Southfield. No one at the office would comment on the lawsuit. The suit contends that Bar-Levav and his daughter, who worked in his office, had a professional responsibility to warn other patients as well as the police of Brooks' threats. Eight months before the June 1999 killing, Brooks pulled out a gun at Bar-Levav's office and talked to the staff about murder and suicide, according to police reports. That incident ended when Brooks turned the gun over to Leora Bar-Levav, who gave it to Brooks' father, Joseph Brooks Sr., commander of the 9th (Gratiot) Precinct of the Detroit Police Department.
    In essays and letters Brooks wrote in the days before his deadly visit to the Southfield office, he described how he felt his therapy group was trying to degrade him and ostracize him the previous year. "She was never made aware of any of that information," said Justin Haas, Dawe's lawyer. "She was still put under circumstances that obviously and eventually did pose a threat to her life." Dawe's lawsuit is the first filed against the psychiatrist's estate by one of the injured patients, her lawyer said. In May 2000, patient Ronald Rissman, who also was shot, sued Target Sports Inc. in Oakland County Circuit Court for selling Brooks a pistol. The suit is in the final stages of a confidential resolution, Rissman's lawyer said.

Los Angeles Planners Reject Proposal for Mental Health Clinic
Michael Krikorian, Los Angeles Times- 12/6/2001

Residents who opposed plans for a mental health clinic in San Fernando were delighted Wednesday when the city's Planning Commission denied a permit request. The panel refused to grant permission for construction of the proposed Anne Sippi Clinic--planned for up to 76 patients--at 14138 Hubbard St., which is zoned for residential use.
    "I'm thrilled," said Peggy Bennett, who lives three blocks from the site, where a drug-rehabilitation facility once operated. "I walk right near there, and if those people get out, it could have been bad like it was before. It's been a long and draining process, but we won." The co-president of the Anne Sippi Clinic Treatment Group, which has facilities in El Sereno and Bakersfield, said another location will be sought.
    "Our goal is to move on and get a suitable place for the many people who have a need for mental health care," said Dr. Chess Brodnick, whose clinics treat schizophrenia, depression, food disorders and other illnesses. "The surrounding neighbors objected because there was a previous facility there, which I hear was not properly run," Brodnick said. "We run a very secure operation." She said there would be no appeal.
    The Los Angeles County drug-rehabilitation center at the site closed more than a year ago, City Councilwoman Beverly DiTomaso said. "Oh, God, it was horrible," she said. "My sons used to see people walking down the street and fighting all the time."
    At the Planning Commission meeting Tuesday night, most of the 25 speakers opposed the new clinic. A few hoped it would be built. One was a San Fernando man whose two brothers suffer from schizophrenia. "I support the Anne Sippi Clinic, because we shouldn't be afraid of people just because they have a mental illness," said Gilbert Avielas, 21. "As long as people with schizophrenia take their medication, they do well."

Abuse Cases' Investigator Settles with Washington State
Chris McGann, Seattle Post-Intelligencer- 12/6/2001

OLYMPIA -- The investigator who exposed abuse cases that cost the state more than $28 million has dropped his own lawsuit alleging retaliation in exchange for a $450,000 settlement. In October 2000, Karl Parrick filed a $10 million lawsuit, charging that state Attorney General Christine Gregoire and two other supervisors retaliated against him for exposing the Department of Social and Health Services and the state to liability for negligence.
    Now 60, Parrick documented problems with DSHS in its care of vulnerable clients for nine years as a state investigator. He led the investigation into the case of Linda David, the battered and abused Everett woman who was beaten by her husband -- also her state-paid caretaker. She sued the state and settled for $8.8 million. Parrick also investigated the case of three developmentally disabled patients who say caretakers at a state-licensed home in Bremerton sexually and physically abused them. A jury found the state negligent and awarded the men a record $17.8 million. Gregoire's office later missed the deadline for filing an appeal.
    The cost of Parrick's settlement dwarfs any recent employee claims that stemmed from the Attorney General's Office, which has only paid one claim since 1997, according to state officials. Risk Management Administrator Betty Reed said Parrick filed the suit the same year the state paid out more than $85 million in claims -- $62 million from just 10 high-profile cases -- and the Attorney General's Office was under fire for mishandling at least one case Parrick exposed.
    Parrick's case underscores the attorney general's dual mission: Protecting patients in the state's care from abuse and defending state agencies charged with providing the care from liability. Parrick claimed he was a victim of that arrangement at a time when the Attorney General's Office faced strong criticism for record settlements. "Instead of taking these public liability exposures as a mandate to better serve and protect the disabled, (the Attorney General's Office) chose to deal with the problem by attacking the person who, because he did his job too well, was forcing them to face the consequences of failing to do their job," Parrick's claim said.
    Parrick declined to comment on the settlement yesterday, but his attorney David Moody was pleased. "This represents a major victory for Mr. Parrick and an equally large concession on the part of the attorney general," Moody said. "I've never seen an instance where the state paid almost a half million dollars when they did nothing wrong. Of course this is an admission that they treated Mr. Parrick wrongly." State officials disagreed. "The decision to settle was a simple business decision," spokesman Gary Larson said yesterday. "It's not an admission of any of Mr. Parrick's claims. We're not pleased with the outcome, but the realities of an employment case made it a wise decision" Larson said it's risky to take employment cases to trial, explaining that if the state lost in court -- even $1 -- "it would have been obligated to pay attorney fees that would have been well in excess of what we paid. "This will permit us to put an end to the disruption that this case has put in the office and enable us to focus more fully on protecting vulnerable adults," Larson said.

Gay Woman Sues Va. to Allow Adoption
Brooke A. Masters, Washington Post- 12/6/2001

An Episcopal priest asked an Arlington court yesterday to force Virginia to allow her to adopt a foster child from the District, contending that the state is stalling on her application because she is a lesbian. Linda Kaufman has already adopted one child, and the District has more than 1,000 children awaiting placement. District officials and an adoption agency licensed in Virginia have found she is well qualified to care for a second child.
    But Virginia officials must approve the arrangement as well because she lives in South Arlington, and she alleges in an eight-page lawsuit that the Virginia Department of Social Services has failed to act for two years because of her sexual orientation. "The stability that a child gets from being in a permanent home is something that can't be made up in a foster home or institution, and we have that to offer," Kaufman said. "We have a great neighborhood and great friends who would like to welcome someone else. It seems silly not to." The Virginia attorney general's office and the Virginia Department of Social Services declined to comment on the lawsuit.
    According to the suit, filed by the gay rights group Lambda Legal Defense Fund, Virginia doesn't officially ban adoptions by gay men and lesbians. Rather, applications are supposed to be considered on a case-by-case basis with the welfare of the child being the most important criterion. In 1992, Virginia approved Kaufman's adoption of a boy, then 5 years old, from District foster care. Kaufman's lawyers allege that state officials are acting in an ad hoc fashion to bar her because of their own views of homosexuality, and Kaufman wants an Arlington Circuit Court judge to force the Department of Social Services to follow its own policies.
    Outsiders, too, detect politics rather than formal policy in the handling of the case. "There isn't any legal bar that I'm aware of. They're simply making a decision by not making a decision," said University of Richmond law professor emeritus Robert Shepherd. "Maybe that will change with a new administration." Gov.-elect Mark R. Warner is a Democrat, as was L. Douglas Wilder, who was governor in 1992 when Kaufman adopted her first child.
    Lesbian custody has been a hot legal issue in Virginia over the years. The Virginia Supreme Court held in the 1981 case of Doe v. Doe that being a lesbian does not automatically make a woman unfit to be a parent. But in 1995, the state high court ruled 4 to 3 that lesbian Sharon Bottoms should lose custody of her son to the child's grandmother.
    Although the Bottoms case has been viewed widely as hostile to the rights of gay parents, Kaufman's lawyer, Michael Adams, argued it is not a barrier to his client's adoption plans. The majority opinion specified that the decision was based on Bottoms' behavior rather than just her sexuality. Bottoms, who had no stable job, was accused of leaving her child for days at a time and allowing her partner to hit the child, the opinion said.
    Kaufman, 50, is director of homeless services for the Downtown DC Business Improvement District and preaches part time at St. Stephen and the Incarnation in Columbia Heights. She decided to try to adopt a second child in 1999 and went through the District's training program for prospective parents. Then she and her partner of four years, Liane Rozzell, went through a home evaluation from Lutheran Family Services, as required by Virginia, and received a favorable report. But Virginia officials have not acted on Kaufman's application, despite repeated requests from Adams and Lutheran Family Services. In April, the state told the agency that Kaufman's application had been referred directly to Social Services Commissioner Sonia Rivero.
    Kristin Hansen, spokeswoman for the conservative Family Research Council, praised Virginia's refusal to approve the adoption. "Adoption law should not intentionally deprive a child of both a mother and a father," she said. District officials, who are short of adoptive parents, say they regularly welcome gay and lesbian applicants. "The requirements for adoption are the same for everybody. We do not discriminate based on sexual preference, race or religion," said senior supervisory social worker Gwendolyn Menefee, who works on adoption issues for the Child and Family Services Agency.
    Menefee said the agency warns would-be parents that Virginia often makes it difficult for openly gay people to adopt. "After counseling, the applicants often make decisions to move into the District, [and] there are persons who don't tell us [their sexual orientation], and we don't ask." Kaufman, who grew up in Loudoun County and attended a seminary in Virginia, said she doesn't see why she should have to move. "I know there's tremendous need. We're really committed to taking a child who might otherwise not have that opportunity," Kaufman said. "There is nobody else who wants the kids I want."

Doctor Bolsters Lemak's Insanity Claim
Flynn McRoberts and Jeff Coen, Chicago Tribune- 12/7/2001

Marilyn Lemak's moral fog--her certainty that killing her children was the right and loving thing to do--did not lift until the day after the murders, when a police officer at Edward Hospital told Lemak she "hoped she would burn in hell," her psychiatrist testified Thursday. Before that moment, "she didn't think she had done anything wrong," Dr. Lyle Rossiter, a forensic psychiatrist hired by Lemak's attorneys, said in her murder trial.
    Killing the children and herself, she told Rossiter, would free the children from their sadness over their parents' pending divorce, free her husband to date his new girlfriend and free her from her anger and confusion. In jailhouse interviews shortly after the slayings, Lemak told him of a vision: that she'd reunite with her children in death. "She said there was a beach on which they would be walking," Rossiter said, the kids perhaps clutching the same beloved blankets and dolls she'd tucked them into bed with before smothering them on March 4, 1999. "She had hoped the kids would have their favorite things with them when they were buried." The painful, usually private exchanges between psychiatrist and subject were aired publicly as Rossiter read long passages from notes he had taken of the interviews.
    His testimony, the first from a mental health expert to bolster Lemak's insanity defense, disclosed the most riveting evidence yet to support her lawyers' contention that she shouldn't be held criminally responsible for drugging and suffocating her two young sons and daughter inside their Naperville home. For most of his numerous interviews with an apparently "dazed and haunted" Lemak, she spoke between long pauses, in a halting voice, Rossiter said. Five days after the murders, she even asked Rossiter if her children were dead. The Glen Ellyn psychiatrist told her that was his understanding. "Why would I do that?" Rossiter recalled her asking. "They were good kids."

`Emotional storm'
A week later, Rossiter asked her why her blood-splattered wedding dress was found close to where she and Emily's body lay. She never explained, but the psychiatrist said the question apparently triggered something. Speaking rapidly and breathlessly for the first time in their several days of interviews, Lemak blurted out: "What did I do to my kids? ... Oh God, why did I do that? I don't want to be me. I want to be dead. I want to be with my kids." After that "emotional storm passed," Rossiter said, Lemak reverted to her flat, lethargic manner.
    Lemak, 44, gently bounced in her chair at the defense table as she often has, and pursed her lips as she listened to Rossiter recall the conversations. The psychiatrist also said Lemak told him she initially gave her children medication on March 4 only to help them sleep because she said they were sick and unhappy. Asked by Rossiter when she first got the idea to kill her children, Lemak told him: "It must've been that morning after Emily got home from school. ... I thought, if we could all just die."

Failed suicide
Rossiter's testimony also provided the clearest explanation to date of how Lemak, an experienced surgical nurse, failed in her suicide attempt after smothering the kids. She told him she hoped that taking a large number of aspirin would keep her blood from clotting when she slashed her wrist with an X-acto knife. She took only three Ativan tablets, Lemak told him, to make her sleepy, not to overdose on the drug. After smothering all three children and slashing her right wrist, Lemak awoke the next morning to find them dead and herself alive. Unable to find the X-acto knife, she called 911. When Rossiter asked her why she called the emergency number, Lemak replied: "I don't know why I did that. Maybe I would've died if I didn't do that."
    Rossiter, who told the jury he has testified for both the state and defense in dozens of insanity cases, gave them his diagnosis of Lemak. She couldn't appreciate the criminality of her actions--the legal definition of insanity--because she was "immersed in depressive thoughts that her husband didn't love her and didn't love the children," he testified. Rossiter said Lemak believed that "the children were suffering from intense emotional pain because they had an unloving father." Rossiter said she told him she regretted that authorities kept her on a 24-hour suicide watch because she wanted to "kill herself in the jail if she could find a way to do so." Her reason: She believed "the children were waiting for her."

Coaching implied
On cross-examination, prosecutors suggested that Rossiter coached Lemak into saying that she intended to kill the children to take them to a better place. At one point, prosecutor Joseph Ruggiero asked Rossiter if he suggested to Lemak in a March 14 meeting that she might have "been in a trance" on the day of the murders. Grudgingly, Rossiter agreed. He also acknowledged that none of the psychiatrists or other medical experts, including her personal physician, had said she suffered from a mental illness with "psychotic features" before March 4. Rossiter also agreed with Ruggiero that Lemak initially made no mention of a fantasy beach walk and was very clear on the time of the murders and how she carried them out. Earlier in the day, Rossiter said Lemak recalled the order in which she murdered her children--saying she held them in the same way she used to hold child patients when she worked as a surgical nurse.
    Defense attorney John Donahue asked Rossiter how he determined that Lemak was legally insane. Rossiter said it was based on "what did she think she was doing, what kind of meaning did she attach to her actions?" In the weeks leading up to the slayings, Lemak was especially adamant that the children not find out from someone else that their father was dating another woman. "Hell hath no fury like me if they find out from someone else," she told Rossiter.
    The psychiatrist also revealed a previously undisclosed trigger for the murders--that David Lemak had rejected Marilyn's effort to reconcile. According to Rossiter, she told him: "My head heard you, but my heart can't believe it's really over. I was hoping that he'd change his mind. He'd said it many times--we can stop this at any time." Convinced his refusal meant the end of their relationship, Lemak reached the tipping point the following day, Rossiter testified. Having drugged her children, she tucked them in bed, each with their favorite things. For Thomas, that was his "ba-ba"--a makeshift rag doll she'd crafted from bits of her old sweatshirts. "They looked something like little ghosts," Rossiter recalled her saying. Weeks after the murders, Rossiter said, Lemak told him she thought she saw her children again--this time in the fabric of her jail bedclothes. She thought, he said, "that the kids were trying to communicate with her."

Third Suicide Bewilders Colorado School
John Ingold & Marilyn Robinson, Denver Post- 12/7/2001

Three Green Mountain High School students have become the latest victims in the state's ongoing struggle with suicide. The teens' deaths, clustered in the past month, have cast attention on what is often a quiet killer among teenagers. "It doesn't make sense to me; I don't understand why suicide is such an option," said Michael Auerbach, a senior at East High School in Denver and the leader of the school's Yellow Ribbon suicide prevention group. "Maybe this will just really show kids how important it is that if they're feeling badly, they'll get help." The third Green Mountain victim had transferred to the school from East in October. Many students who knew him at East felt the repercussions of the suicide, Auerbach said. Many who didn't know him did as well.
    Last year, 47 kids between the ages of 10 and 19 committed suicide, according to Colorado records. In 2000, nine people under the age of 18 did so in Jefferson County, where Green Mountain High School is located. Colorado's rate of suicide ranks 12th in the nation, which is 40 percent above the average. Suicide is the second-leading killer among teenagers, according to federal statistics.
    The tragedy at Green Mountain began on the afternoon of Nov. 7, when a woman found her 15-year-old son dead in the family's garage. Five days later, a teenager found his 14-year-old brother dead at home. And on Monday, a 16-year-old killed himself. The suicides left many at Green Mountain searching for answers and trying to cope. "There were some tears shed (Monday) and a lot of hugging when they heard the news," said Lakewood police Sgt. Patt Heffner, who oversees the department's school resource officers and who visited Green Mountain the day after the most recent suicide. "In talking with a couple of the kids today who were good friends with the third victim, some of them are angry they didn't try to reach out."
    Teen suicides annually scar metro-area schools and often get much less attention, officials said. Betty Fitzpatrick, director of health services for the Jefferson County School District, said the district typically sees between nine and 12 youth suicides a year. Denver averages several a year as well, said Pat Lopez, manager of psychological services at Denver Public Schools. Yet every suicide is its own tragedy, Lopez said.
    Auerbach knows. When he was a freshman at East, his best friend killed himself. Auerbach also has contemplated suicide, he said. According to national studies, as many as 40 percent of all teenagers have had suicidal thoughts in the past year. "It's horrifying to me because I know how kids feel when they're depressed," he said. "They feel like there's no way out, that the only way out is to kill yourself. You feel so alone."
    Kids experiencing problems should ask an adult for help, said Dale Emme, executive director of the Yellow Ribbon Suicide Prevention Program in Westminster. Parents worried about their teens should ask them what they are feeling, he said. Teachers should train themselves to spot warning signs.
    At Green Mountain, more than 100 kids have sought counseling in the wake of the suicides. Additional counselors at the school are focusing on suicide prevention. And the entire school is hoping there isn't another incident. "We don't want to lose any more kids," Fitzpatrick said. The year-old state Office of Suicide Prevention has implemented a series of public awareness campaigns and educational efforts. "At this time, parents are really, really scared, and kids are scared," said Shannon Anderson, the office's director. "How you protect yourself is you get knowledge. You don't sweep this issue under the rug."

Deficiencies Found in D.C. Child Services
Sari Horwitz and Scott Higham, Washington Post- 12/7/2001

Nearly 80 percent of the District's child abuse complaints were not investigated within 30 days and close to two-thirds of foster homes housing city children were unlicensed this year, a study shows. Those are among the findings of a report released this week by the court-appointed monitor of the D.C. Child and Family Services Agency. The study is a snapshot of agency conditions taken in May, shortly before Child and Family Services returned to city control after six years of federal court supervision. Although the study notes that the agency has made progress since then, its findings documenting widespread failures took some officials by surprise. Another snapshot will be taken next year to determine whether the agency has made progress in a series of categories outlined in a court order. "We know there is a lot of work to be done," said Olivia A. Golden, director of Child and Family Services. "The report presents problem areas we knew about, although their depth, as illustrated in the report, is sobering."
    Using a detailed statistical analysis, the 35-page study by the Center for the Study of Social Policy confirms what many child protection experts have suspected for years: that the federal court takeover of Child and Family Services in 1995 failed to improve lives for the District's abused and neglected children.  Among the report's findings:
• Thirty percent of the children under District care were not visited by social workers during their first eight weeks in foster care.
• Thirty-seven percent of child neglect complaints were not investigated within 30 days after they came in to the city's hot line. Abuse and neglect cases are required to be investigated within a 30-day period.
• The agency had a backlog of 807 incomplete abuse and neglect investigations.
• Because of incomplete agency records, the number of children living in foster homes that exceeded their legal capacity could not be determined.
• Seventy percent of children in foster care had no case plans. Social workers are required to develop case plans for children within 30 days to chart a course of action to help the children.
    Court monitor Judith Meltzer noted in the study that agency officials are reforming Child and Family Services. She said the District has ended its practice of splitting abuse and neglect investigations between different city agencies. For the first time, the city has developed foster- and group-home licensing standards. Golden also has hired managers and more lawyers to help social workers. "Despite the severity and complexities of the system's problems and the formidable challenges that lie ahead, there is reason for optimism for future progress," Meltzer wrote. But Meltzer said the shortage of nearly 90 social workers at the agency is undermining efforts to protect children. Golden has launched a national recruiting campaign to bring more social workers to the agency.
    Under the court agreement ending federal control of the agency, Meltzer was required to take a snapshot of the agency May 31 and another by the end of the year. But because agency record-keeping has been so poor, Meltzer said, she could not finish the first report on time and does not expect to produce the next report until the summer of 2002. If the agency fails to meet 70 percent of the performance standards outlined in the court order, the city eventually could face contempt-of-court charges and possibly lose control of Child and Family Services again, Meltzer said. Meltzer and D.C. officials said they believe the agency can meet the performance standards by the court-imposed deadline, but they cautioned that it could take many months to repair the child protection system. "There are no quick fixes," Golden said.
    An investigation by The Washington Post published in September found that large caseloads, inadequate investigations into abuse and neglect complaints and the failure by social workers to visit children and inspect their living conditions factored into the deaths of D.C. children. The Post obtained records documenting the deaths of 180 of the 229 children who died from 1993 through 2000 after they or their families came to the attention of the city's child protection system. An analysis of the records found that one in five children -- 40 boys and girls, most of them infants and toddlers -- died after government workers failed to take preventive actions or placed the children in unsafe homes or institutions. The investigation also found that government panels reviewing the deaths in secrecy issued 670 warnings, criticisms and recommendations to prevent future fatalities. But the great majority of the proposed solutions went unheeded by District politicians and child protection officials.

Yates Gave Few Hints in 911 Call
Carol Christian, Houston Chronicle- 12/7/2001

In a telephone call to police June 20, Andrea Pia Yates gave no indication her five children were dead. Despite insistent questioning by the Houston Police Department dispatcher who answered the 911 call at 9:52 a.m., Yates would not say why she wanted police to come to her southeast Houston home. "Uh, I just need them to come," Yates answered in a flat voice when the dispatcher asked her about the problem. The officer who responded to the corner ranch house in the 900 block of Beachcomber had no idea he would find the bodies of five children who had been drowned.
    A recording of Yates' call has been placed into her case file at the Harris County district clerk's office. The Clear Lake mother is charged with capital murder in the deaths of three of the five youngsters. Jury selection in Yates' trial is scheduled to begin Jan. 7. Now held in the psychiatric unit of the Harris County Jail, she has pleaded not guilty by reason of insanity. If convicted, she could be sentenced to death. In her brief conversation with the 911 operator on June 20, Yates was calm but uncommunicative. After Yates identified herself, the operator asked, "What's the problem?"
"Uh, I just need them to come."
"Is your husband there?"
"No."
"What's the problem?" the dispatcher asked.
"I need them to come."
"I need to know why they're coming, ma'am."
Yates did not answer but gave a heavy sigh.
"Are you having a disturbance? Are you ill?"
"Yes, I'm ill."
"Do you need an ambulance?"
"No, I need a police officer. Yeah, I need an ambulance."
"What's the problem?"
"Uh ... "
"Is someone burglarizing your house? I mean, what is it?"
Again, Yates does not respond but is heard breathing heavily.
"What kind of medical problem do you have, ma'am?"
"I just need a police officer."
"Are you there alone?"
"Yes."
"You're Andrea Yates? Is your husband there with you?"
"No."
"Why do you need the police, ma'am?"
"I just need them to be here."
"For what?"
"I just need them to come."
"Are you sure you're alone?"
"No, my sister's here."
    Yates has a sister, Michelle Freeman, but she lives in Georgia and was not at the Yates home that day. When officer David Knapp responded, he knew only that he was checking on Yates' welfare, he testified this week during a pretrial hearing. Yates met him at the door and said, "I killed my kids," Knapp said. She then led him to the master bedroom where he found the four youngest children's bodies in bed, as though they had been tucked in for the night.  Frank Stumpo, another officer who arrived a few minutes later, said he found the body of the oldest child face down in the bathtub half-full of water.
    In the two-day hearing this week, state District Judge Belinda Hill ruled that the jury will hear the confession Yates made to police that day. Yates' lawyers, George Parnham and Wendell Odom, had asked the court to suppress her statements. Hill also denied defense requests to eliminate the death penalty as a possible punishment and to allow lawyers to tell potential jurors that a defendant found not guilty by reason of insanity remains under the court's jurisdiction, possibly for life. The judge also denied a request from Yates' husband, Russell Yates, to be released from a 5-month-old gag order in which Hill ordered lawyers and witnesses not to discuss the case with the media.
    In spite of that, Yates is scheduled to appear Sunday evening on the CBS News program 60 Minutes. On its Web site, CBS says that Yates told interviewer Ed Bradley that his wife drowned the children because of mental illness that was not treated properly. Based on Hill's earlier ruling, Yates could face possible jail time for contempt of court by granting the televised interview.

Mother Saw Death As Way to End Pain, Key Expert Asserts
Jeff Coen and Ted Gregory, Chicago Tribune- 12/8/2001

In Marilyn Lemak's mind, the murders of her children and her attempt to kill herself were a single event, the act of "a loving mother tenderly taking her children into another existence," the top expert for her defense said Friday. Dr. Phillip J. Resnick, a nationally known forensic psychiatrist, agreed with the defense argument that the Naperville mother did not understand she was committing a crime when she drugged and suffocated her children on March 4, 1999. Resnick, who has examined the cases of some of the most infamous defendants in recent American history, including Timothy McVeigh, Ted Kaczynski, Jeffrey Dahmer and Susan Smith, said Lemak suffered severe depression, which deeply distorted her thinking and rendered her legally insane.
    Under direct examination by defense attorney Joseph Bugos, Resnick dismissed prosecutors' argument that the murders were an act of vengeance against her estranged husband, who had begun dating again. "She wouldn't sacrifice the children just to get back at her husband," Resnick said. After reviewing the evidence in the case, interviewing Lemak's friends and family, and sitting with Lemak in an 8-hour session, Resnick said he believes her identity was built on being a good mother. On the evening before the slayings, when her husband, David, rejected what she believed was her final chance at reconciling their marriage, Lemak felt the part of herself she treasured most was fading, Resnick testified.  Left in her depression, feeling profoundly alone and overwhelmed, she decided to kill herself, he said. The children were swept up in what Resnick described as an "extended suicide." "She saw the four of them as inseparable," he said. "She perceived the deaths of the four of them as a single event, ultimately."
    The defense sought to portray Resnick as a global expert taking a hard, unbiased look at the Lemak case. His aid certainly did not come cheaply. He charged Lemak's defense nearly $19,000 for interviewing the defendant and $460 an hour to work on the case and appear on the stand, according to his testimony. But Resnick, director of the Division of Forensic Psychiatry at the Case Western Reserve School of Medicine in Cleveland, often has been retained for criminal cases and not testified because he disagreed with the view of those who hired him, Lemak's attorneys pointed out. Resnick did not testify in defense of Susan Smith, for example, because he concluded she was sane when she killed her sons by sending their car into a South Carolina lake in 1994.

Several assertions doubted
At Bugos' invitation, the psychiatrist told the jury about several elements of Lemak's defense that he believes are false. Resnick said he has identified three untruths in the account of the murders that Lemak gave to those who interviewed her, including himself and Glen Ellyn psychiatrist Dr. Lyle Rossiter, who testified for Lemak's defense Thursday and Friday. First, Lemak has told psychiatrists she did not decide to kill herself or her children until March 4, Resnick said. He told the jury he believes her mind was made up after David Lemak rejected her attempt at reconciliation the evening of March 3.
    Second, Resnick said, Marilyn Lemak has told her interviewers she gave her children an overdose of a prescription tranquilizer in an attempt to put them to sleep because they were ill. The decision to kill them came later, she has said. "That I just didn't buy," Resnick said. "It didn't make sense to me." Resnick said he believes Lemak doped Nicholas, 7, Emily, 6, and Thomas, 3, as a "tender way to minimize the distress of the children."
    Finally, Resnick said he does not believe Lemak's repeated statements that part of her intention was to do her husband "a favor so he could race cars and go out with his girlfriend." "I did not find that to be a believable statement," he said. What was true in his opinion, he said, was that Lemak was angry with her husband over his girlfriend, but the anger was separate from her act to kill herself and her children. "In deciding to die, she couldn't imagine leaving her children in the world as she saw it then," Resnick said. "She wanted what was best for them."

Prosecutors get their chance
In the afternoon, prosecutors tried to discount Resnick's earlier testimony, in part by noting that he saw Lemak only once, nearly a year after the murders. By that time, her overall condition had deteriorated, prosecutors alleged. During the cross-examination, Assistant State's Atty. Jane Radostits led Resnick through the days leading up to the slayings. Resnick acknowledged that Marilyn Lemak gave a birthday gift to a friend, told her doctor during a visit that she was feeling better emotionally and even volunteered at her children's elementary school. But Resnick rejected Radostits' suggestion that Lemak was functioning normally just before the slayings. Resnick said Lemak was having a "hard time" keeping up her façade. "A hard time means it takes more effort to accomplish [daily tasks]," Resnick said, "not that she's not accomplishing them."
    Radostits also emphasized in repeated questioning of Resnick that Lemak was furious about her estranged husband's girlfriend. Resnick acknowledged that Lemak was "controlling and demanding," and Radostits noted another physician's earlier evaluation of Lemak as "an expert at manipulating David." But Resnick was adamant that Lemak killed her children out of her distorted belief that their deaths would bring them some relief from lives filled with severe emotional pain. "She loved them so much that she would not be willing to use them as pawns," Resnick said. Attorneys in the case said Lemak's defense is expected to rest as soon as Tuesday. After what is expected to be several days of prosecution rebuttal evidence on the insanity question, the jury could begin deliberating as soon as Dec. 18.

Former Astros' Player 'Doing Everything' to Fight His Addiction
Dale Leson, Houston Chronicle- 12/8/2001

Brushing her hair away from her face, 19-year-old LaToya Bowman spoke softly about her brief relationship with Ken Caminiti. During a recent interview at the Harris County Jail, she looked down while she spoke and quietly described what she said was a troubled man. Though she'd known him only a few days before they both were arrested on drug charges last month, Bowman said Caminiti had confided in her and asked for advice about dealing with his estranged wife. "He was a nice person, but he seemed to have issues at home," Bowman said.
    How Caminiti, once considered one of baseball's best players, wound up with Bowman in a southwest Houston motel room littered with crack cocaine, is a question that saddens as well as baffles many of those closest to him. Piecing together the details of the months before his arrest is difficult, but a series of interviews sheds some light on how hard it can be for even a tough-as-nails competitor to fight substance abuse. Bowman, Caminiti, 38, and Cedric Palmer, 23, are charged with possession of less than a gram of a controlled substance. They are scheduled to be arraigned Dec. 19. Caminiti, the former Houston Astros and San Diego Padres third baseman, is free on $2,000 bail. Bowman and Palmer remain jailed in lieu of bails of $2,000 and $15,000, respectively. Palmer has a higher bail because he is a convicted felon. Admitting that she has used drugs, Bowman said she had recently moved to Houston from Louisiana and had heard Caminiti's name when her friends spoke about Houston's drug scene. She said she watched him smoke crack cocaine when they were together.
    Caminiti did not return phone messages left at his home. His attorney, Kent Schaffer, said Caminiti was out of town "doing everything that's necessary to restore his health." He refused to say whether that means he has returned to a rehab program. Soon after his arrest, Caminiti spoke about getting "himself straight," said Rick Licht, his agent and close friend. "In the time I spent with him the last week or two weeks ago," said Licht, "he said he was focused and determined to get everything together."
    It's not the first time. In 1994, while with the Astros, Caminiti announced to the public that he had abused alcohol for years but said he had beaten his "disease." A subsequent article in the Los Angeles Times recounted a dramatic epiphany. It was late one night in October 1993, according to the article, and Caminiti was speeding through Houston streets with tears streaming down his face. He made it home safely, but vowed to kick his alcohol habit. He checked into a rehab clinic the next morning. According to reports, Caminiti remained sober for about three years. During that time, he was traded to San Diego and in 1996 was named the National League's Most Valuable Player.  But he started drinking again, explaining in another Times article that he drank, in part, because he had "voids" in his life and feelings of "self-hate."
    His father, Lee Caminiti, said his son appeared to have a "handle" on his alcohol abuse after another rehab stint in September 2000. But he said injuries last season with the Texas Rangers and Atlanta Braves and wayward friends in Houston may have led his son astray. Licht said he thought Caminiti had been sober for about 13 months before his arrest. "I would like to try to get him away from Houston," said Lee Caminiti. "He just knows too many people there." Caminiti has said he wants to remain in the area to be near his three young daughters.
    Sometime late in the afternoon or early evening of Nov. 13, Caminiti and two other men checked into room 2025 at the Ramada Limited, said Omar Arizpe, the motel's front desk clerk. One of Caminiti's companions used a California driver's license to book the room, though another motel manager said that man's name could not be released. The motel's night security guard said he saw a woman with the men. He said he had often seen her at the motel but did not know her name. Bowman said another woman, a friend whom she refused to name, had also been in the room but left before police arrived.
    The next morning, one of Caminiti's companions booked the room for another night, Arizpe said. About 3:30 that afternoon, five deputies arrived at the door. Earlier, federal officers with a drug-enforcement team had stopped a man driving Caminiti's Mercedes-Benz in Fort Bend County because they suspected the car had been stolen. The driver, who was not identified by police, told them Caminiti had given him permission to drive the car and that he was at the motel room, according to court records. Fearful Caminiti may have been hurt in a robbery, the deputies went to the room. Bowman opened the door when they knocked. Inside, they smelled burning crack cocaine. A Harris County prosecutor claimed deputies saw what appeared to be cocaine "all over the room" and crack-cocaine pipes made from a Coca-Cola can and a water bottle. Palmer was lying on the bed. Deputies said they found Caminiti in the bathroom with two more crack pipes. A white, powdery substance was on his wallet, they said.
    Palmer, who was convicted of a state felony for possession of less than 1 gram of a controlled substance in 1996 and pleaded guilty to unauthorized use of a motor vehicle in 1995, refused to speak about his relationship with Caminiti or why he was in the room. But in an interview from jail, he said that he was asleep when police officers arrived and that he did not know anyone in the room had drugs or used them. A woman who identified herself as Palmer's aunt, said the man driving Caminiti's car that day was one of her nephews. The woman, who asked not to be identified, said her nephew told her that he had known Caminiti for more than a year and that he frequently drove Caminiti's cars. She said he told her that he had driven Caminiti's Mercedes-Benz the day of the arrest to pick up his fiancee and child.
    Ultimately, how Caminiti ended up in the motel room with Palmer and Bowman is not the main issue. Some of his friends wonder whether his play-with-pain ethos was born of the same machismo that led to his hard living off the field. He put too much pressure on himself to play despite injuries, they said. He doesn't want to let his teammates down.
    A famous story from his days with the Padres relates how, just before a game, he was curled up on the floor in pain for hours after eating bad food the night before. He was receiving intravenous fluids to combat severe dehydration.  When the game started, he ripped the needle from his arm, demanded a Snickers bar and hit two home runs to lead his team to a 8-0 win over the New York Mets. Later in the game, he was helped to the trainer's table and the IV was replaced. Licht recalled another game when Caminiti was close to being scratched from the lineup because of a cracked toenail, but he pulled it out with a pair of pliers, taped the wound and played. "He takes being part of a team very seriously," Licht said. In his 1994 announcement, Caminiti said, "I felt I wasn't playing to my potential, and it was hurting me on the field and hurting my teammates with what I was doing off the field."
    Lee Caminiti said his son's most recent slip occurred because his son failed to keep up with the recovery program he started in 2000. He wanted to stay sober, but he thought he could do so on his own. "If it was up to willpower," said Lee Caminiti, "he wouldn't be doing this right now."