Noteworthy News Articles on Mental Health Topics, February 7-14, 2001

Early Puberty: Why Are Young Girls Developing So Fast?
Robin Eisner, ABC News- 2/7/2001

N E W Y O R K — One day a few years ago, Marilyn Saunders noticed that her 8 ½-year-old daughter Susan was starting to develop small breasts and pubic hair. It seemed odd to Saunders (not her real name), a 43-year-old mother from New York's Long Island, since she herself didn’t mature until she was older. Her doctor told her not to worry: Early onset of puberty is now considered the norm by most pediatricians.

Early Puberty in Girls Is Norm
According to research first published in the medical journal Pediatrics in April of 1997, the age of the onset of puberty is getting earlier for girls, with the average age of either breasts or pubic hair showing up as 9.7 years for Caucasians and 8.1 years for African-Americans. Before this study of 17,000 girls — evaluated by their pediatricians during routine examinations — the norm for puberty onset was considered to be 11 years old, or one year later for white girls and two years later for African-Americans. In October 1999, a group of pediatricians redefined when puberty occurs in girls, so doctors could better identify when it was abnormal. What can be causing this premature pubescence? Researchers have many theories, including an increase in obesity among children, low birth weight, absent fathers, unrelated males in the household, a sedentary lifestyle, chemicals that act as endocrine disrupters and the sexualization of children by the media.

Causes May Include Obesity, Chemicals and Sex on TV
Some research indicates that overweight girls have a tendency to reach puberty earlier. Other work indicates girls may be exposed to pheromones, or sexual hormones, from unrelated men, such as stepfathers, prompting them to sexual development. Children who live in families without fathers may be experiencing stress, bringing about early puberty. Another theory is that the increase in images of sex on television fosters sexual maturity, in a way that food stimulates salivation.
    "The picture is more complicated than a single cause or a single effect," says Jeffrey Peterson Myers, director of the W. Alton Jones Foundation and co-author of Our Stolen Future, a book on endocrine-disrupting chemicals. Myers spoke today at news conference on this issue in Washington. "There are different factors playing a different role in different people." Researchers convened the news conference to bring attention to parents, educators, pediatricians and others, about this issue. They also called for more studies to understand how these different factors might be contributing to this problem. "No one can really think that little girls in second or third or fourth grade should be developing breasts," says Diana Zuckerman, a psychologist and executive director of the National Center for Policy Researcher for Women and Families. This is the age, she says, when youngsters are being taught how many quarters are in a dollar. "These are young kids," she says. "How can you begin to explain to them why some of them might becoming moody or looking different?" says Zuckerman. "Or why are older boys might be interested in them or why are teenagers being nice? Are they flirting or coming on? Even adult women sometimes have problems with these issues."
    If these children do not become aware of their blossoming sexuality, then they might become victims of sexual predators who see them as vulnerable, Zuckerman says. Saunders says she still has difficulties talking to her daughter about sex. Her daughter is still so sheltered or emotionally immature that she cannot understand how someone could have a baby outside of marriage.

More Research Needs to Be Done
Marcia E. Herman-Giddens, an adjunct professor in public health at the University of North Carolina School of Public Health who authored the landmark study, says the psychological effects of early onset puberty need to be studied and data should be collected every 10 years to understand if the age is stabilizing or dropping. "This is a serious public health issue," Herman-Giddens says. "We don’t know about the sexual urges of 7- and 8-year-old girls and how they might affect their mental health."
    Zuckerman highlighted studies indicating psychological problems in girls who experienced early menstruation as a way to get a handle on what might be happening. Herman-Giddens did not find that menstruation started earlier in her population of girls, except among the African-American population. The age of the first periods for Caucasian girls was 12.8 years; for African- Americans, it was about six months earlier. In a study of 6- to 11-year-old girls, those who matured earlier were more depressed, aggressive, socially withdrawn and had more sleep problems than those who hadn’t. Another study of 1,700 high school girls revealed that earlier menstruation was linked to drinking smoking, substance abuse, lower self-esteem and suicide attempts. Whether boys are experiencing this early puberty is unknown. Research is ongoing about this question.
    Myers says if research finds that some chemicals are contributing to early puberty, manufacturers might be apt to change the products they offer to consumers. Some studies in animals, he says, reveal that exposure to certain chemicals in the womb can lead to early sexual maturity later on. Other studies have indicated an association between exposure to certain chemicals called phthalates, found in plastics and cosmetics, and early breast development. The cosmetics and plastics industries call their products safe.

Some Question if Early Puberty Is Real
But some pediatricians question the new puberty norm. Dr. Robert Rosenfield, professor of medicine and pediatrics at the University of Chicago Pritzker School of Medicine, challenges the methodology of the 1997 study, calling it biased in having too many girls with early puberty problems. "The study was not done in a random fashion," Rosenfield says. "The children were kids brought into a pediatrician’s office. … Early cases of puberty might be over-represented in the sample. Parents might have brought children in with a cold or a rash, but might have really been more concerned about early development of breasts or pubic hair." A better study would have selected participants from the general population, he says. Rosenfield says while most of these children may be all right by developing early, others may have some other medical condition that needs further study. Tumors and over-secretion of hormones by the adrenal gland can also lead to early development. He agrees more research should be done to see if what Herman-Giddens found is real, but adds increasing childhood obesity may be a significant factor contributing to this issue.
    While Saunders’ daughter is coping well with her early sexuality, her mother says she fears other parents promote teenage behavior in younger girls by allowing them to date and wear skimpy outfits. "I think kids should be kids," Saunders says. "They should be riding their bikes, playing, enjoying school and sports. They are innocent and should not being subject to the pressures of a teenager."

Early Puberty Statistics
According to the 1997 Pediatrics study, these are some of the numbers for early puberty:
The average age of breast development in African-American girls is 8.9 years; for white girls, it’s around 10 years.
The average age of pubic hair in African-American girls is 8.8 years; in white girls, it’s around 10.5 years.
Breast and/or pubic hair development occurs, on average, in African-American girls at 8.1 years of age and in white girls at 9.7 years of age.
Approximately 27 percent of African-American girls who are 7 years old have either breast or pubic hair development; the comparable number for white girls is 7 percent. These girls are usually in second grade.
Approximately 50 percent of African-American girls between the ages of 8 and 9 have either breasts or pubic hair; the comparable number for white girls is 15 percent. These girls are usually in third grade.

Authorities Crack Down on New Drug in Kentucky
Roger Alford, Associated Press, 2/7/2001 12:53

LEXINGTON, Ky.--State and federal authorities arrested 201 alleged dealers in Kentucky in a two-day crackdown on a deadly new drug that produces a high similar to heroin. Warrants were issued for six more dealers on charges of distributing OxyContin, a prescription painkiller whose use is said to be epidemic in the region. The crackdown Tuesday and Wednesday was the biggest drug raid in Kentucky history, U.S. Attorney Joseph Famularo said. The drug, known on the streets as Oxy or OC, is prescribed for cancer victims and others suffering severe pain. At least 59 people have died from Oxy overdoses in eastern Kentucky in the past year, Famularo said.
    Eastern Kentucky is one of the first regions of the nation where abuse of the drug has caught on, said Gary Oetjen of the Drug Enforcement Agency. The drug, produced by Purdue Pharma of Norwalk, Conn., is also popular in parts of Ohio, Pennsylvania, West Virginia, Maryland and Maine, according to the Justice Department's National Drug Intelligence Center. Authorities alerted hospitals in eastern Kentucky to be ready for an onslaught of people suffering withdrawal symptoms. ''The abuse and availability of OxyContin has become such an epidemic in eastern Kentucky,'' Famularo said. ''Had this been diphtheria or smallpox, we'd have been quarantined from the rest of the state,'' Hazard Police Chief Rob Maggard said. ''It's become a terrible epidemic.''  
    Last week, a doctor was arrested on charges of illegally prescribing the medication to patients. OxyContin pills contain a synthetic morphine designed to be time-released. Abusers crush the pills into powder and snort it, or dilute it and inject it into their veins.

An Unlikely Suspect: Neighbors Call Shooting Suspect a ‘Quiet’ Man
Julia Campbell, ABC News- 2/8/2001

Like many suspects in highly publicized shootings, the gunman in Wednesday's White House shooting, Robert "Bob" Pickett was described as a "quiet man." He was not, said his friends and neighbors, the type they ever suspected to brandish a gun in front of the White House. "They said on the news that it was a Mr. Pickett from Evansville," said Beverly Buck, a Pickett family friend and tax client of Pickett's. "I thought 'Surely, oh dear God, that is not Bob.' But it was and I was shocked, absolutely shocked."
    But while neighbors in the middle-class community where Pickett grew up could provide few clues as to why the 47-year-old single accountant from Evansville, Ind., would find himself in such a bizarre and violent predicament, Pickett did have a history of mental illness. According to legal papers Pickett filed himself when he sued the Internal Revenue Service for firing him in 1987, he had been hospitalized five times by psychiatrists in the mid-1980s, including twice after trying to commit suicide. In the lawsuit, Pickett claimed his mental illness was aggravated after he was allegedly harassed for reporting that an audit manager in the Cincinnati IRS district office had violated federal regulations and abused her authority.
    After a tense standoff with Secret Service agents near the South Gate of the White House, Pickett was shot and wounded by one of the uniformed officers at 11:36 Wednesday before he was taken into custody. He is in serious condition at George Washington University Hospital.

No Criminal Record
Police said Pickett had no criminal record but was once reported missing by his father in 1993, only to turn up a short time later. A couple of years after he was fired from the IRS in 1987, Pickett sued the federal agency, according to his then-lawyer Joseph Yocum, of Evansville. "They said he wasn't doing his job properly and having trouble with attendance," said Yocum. The first lawsuit was dismissed, but in 1999, Pickett sued again — this time without a lawyer's help. Papers filed by Pickett claim that his rights were violated after he was a "whistle blower" and told district officials about an audit manager he said was directing auditors to violate federal tax regulations. After he reported this to the auditor's supervisors, the woman was transferred to another office, according to Pickett's lawsuit. But Pickett said in his lawsuit that the officials then treated him like "an uncooperative employee who questioned the authority of his supervisors" and that he was "subjected to harassment, including false criticism of his work." The IRS denied the allegations.
    But his neighbors say there was nothing about his life in the middle-class subdivision in Evansville, where he lived in the home his parents once owned before their deaths, that would give others an indication of violent tendencies. "He was quiet, polite," said Sahar Wafa, a former neighbor who now lives in Racine, Wis. "He would sometimes say 'hi' to my husband when they cut the grass. There was nothing unusual about him." Family friend Buck said she did not even know that Pickett had a gun or any interest in guns. Pickett, she said, did her taxes last week and neither said nor did nothing to indicate he might be troubled. Another neighbor, Lewis Gates, said Pickett "would always wave or speak to you when he did see you out, and never caused no problems with anybody."

May Have Wanted Attention
Pickett, a 1971 graduate of William H. Harrison High School who briefly attended West Point Military Academy, took over his father's accounting business after his father died in 1995. Steve Yurks, a man who has been a client of Pickett's for 12 years, says Pickett told him he spent a semester at West Point, but "couldn't handle it" and left. Buck said that Pickett was not married and did not have any children and lived alone in his parents' two-story house on Tyler Avenue in Evansville. She said he was the youngest of four children, but that he stopped speaking to his two sisters and a brother in 1995 after their father died. She said the siblings may have had a dispute over the parents' inheritance. "There was some sort of separation," she said. Pickett's mother died in 1987. Buck said that while Pickett did not mention last week that he was headed to Washington, he did like to travel and sometimes went to Texas to visit a favorite aunt. "He said he enjoyed her company," Buck said. Yurks said he believes Pickett did not want to kill anyone when he was found at the White House fence Wednesday morning with a gun, but only wanted attention.

Heroin Lure Is Growing
Adrian Walker, Boston Globe- 2/8/2001

This might be the stereotype of a heroin addict: a middle-aged, longtime drug user with track marks and a vacant expression. This is the reality on the streets of Boston: a teenage user who has never shot any drug, lured to snort heroin that has steadily become cheaper, purer, and more potent over recent years - and no less addictive. It's not news that heroin has taken its place with marijuana and crack cocaine as a street drug of choice, meaning the fight against the deadly drug is more important than ever.
    Tomorrow, an ambitious program to address the growing popularity of the drug will be unveiled at the South Boston Neighborhood House on H Street, in one of the neighborhoods most harmed by heroin. ''The healthy stigma associated with heroin really isn't there anymore,'' said Michael Kineavy, director of the Office of Neighborhood Services. ''We have a lot of young people who don't have that fear of heroin addiction that was there a few years ago. I don't think they can comprehend the addictive powers of heroin.'' The three-part program is aimed at the growing community of younger users as well as their parents. An hour-long video, to begin airing on the city's public-access cable channel next week, will highlight the dangers of heroin addiction. In addition, a local communications firm, Holland Mark Edmund Ingalls, produced a campaign free of charge to warn parents of the danger signs of addiction and where to turn for help.
    Finally, $1 million in federal and state funds is to be allocated to provide more space in residential care for addicts trying to kick the habit. The program debuts at a precarious time for drug treatment in South Boston. The South Boston courthouse, which has been the command post for many of the neighborhood's treatment efforts, is scheduled to close for renovation next year, prompting fears already that some of the people it serves will disappear from treatment. Of course, the heroin problem is not limited to South Boston. The director of the city's public health commission, John Auerbach, rates the neighborhoods with the most pressing heroin problems in this order: Dorchester, South Boston, Roxbury, the South End, and East Boston. ''That's not to say it's not in other neighborhoods,'' Auerbach said. ''Those are the ones we're seeing the most in.''
    One of the big problems, Auerbach said, is the plunging price of the drug. ''A bag of heroin that will get a couple of people high is less expensive than a six-pack. It's not a lot of heroin, but it's enough. ''The second thing we know is that the purity level of heroin has risen over the past few years. The heroin being sold now is so pure that you don't need to shoot it in your arm.'' Being free of the need to inject the drug has made heroin more attractive to a lot of people, who can use the drug with less of the stigma historically associated with it. ''Teens like the idea of snorting for a couple reasons,'' Auerbach said. ''They might be worried about [transmission of HIV]. And they don't think of it as the same kind of addictive drug. It gets them hooked by what seems to be a less pernicious way of getting high.''
    Analysts say it's hard to tell whether the city's heroin problem is worsening. But no one seems to think it's getting better. Emergency workers and police say there has been an uptick in non-fatal calls, as well as overdoses in which no aid is called in. While the high-profile rash of fatal overdoses of a few years ago may have peaked, heroin's lure remains strong. ''It's like a tornado just ripping through families,'' Kineavy said. ''If someone is using heroin in the household, it's a problem that's there every day.''

Colorado Bill Bars Mental Illness Defense in Death-Row Cases
Julia C. Martinez, Denver Post- 2/8/2001

State lawmakers and prosecutors said Wednesday they want to make it harder for death row prisoners to claim mental illness in order to delay their execution. The Senate Judiciary Committee unanimously approved a bill that bans a defendant, his family or friends from raising the issue of "mental incompetence" before a scheduled execution. Senate Bill 104, sponsored by Sen. Joan FitzGerald, D-Golden, would allow only the convicted person's lawyer, a state prosecutor or executive director of the Colorado Department of Corrections to bring the issue before a court.
    The bill also toughens the standards for determining incompetence and sets procedures and time frames for having the person evaluated. "We want to be able to identify people who truly are incompetent," said District Attorney Jim Peters during testimony before the committee. "But we don't want to be taken advantage of by people who want to delay their execution." Peters, along with DA Bob Grant of Adams County and DA Dave Thomas of Jefferson County, said that under the current system, anyone can raise incompetency as an 11th-hour defense, causing delays before a scheduled execution. Attorney General Ken Salazar supports the bill because it would create a cleaner process for convicted killers as well as their victims, said Deputy AG Don Quick.
    But criminal defense lawyers vehemently opposed the bill. They said the issue of mental incompetency causing execution delays has never been an issue in Colorado. State public defender Dave Kaplan said the plan would make it harder for a truly mentally incompetent person to delay an execution. "You're creating additional hoops for someone who has competency issues," Kaplan said. Robert Peppin said that raising the burden of proof for people on the verge of execution was unfair and that the time frames for conducting psychiatric evaluations were too short. "This is very unsettling to us," he said.

Depression Plagued White House Gunman
David Montgomery and Serge F. Kovaleski, Washington Post- 2/9/2001

Robert W. Pickett's history of mental illness dates to the early 1970s, includes at least two suicide attempts and apparently led to his armed confrontation with Secret Service officers just outside the White House grounds. This portrait of a man who has struggled through bouts of severe depression -- creating problems and complications in virtually every aspect of his life -- is contained in legal filings and other documents related to his efforts to challenge his firing from the Internal Revenue Service in 1989.
    New details emerged yesterday about Pickett and the chaotic scene that sent tourists scurrying from the south fence of the White House on Wednesday morning. A federal law enforcement official gave this account of the shooting: About 11:30, Pickett approached the south fence, brandishing a handgun. He pointed the gun at the White House and fired one shot. Uniformed Secret Service officers and D.C. police raced to the scene and repeatedly ordered Pickett to drop his gun. After squatting mutely for about 15 minutes and ignoring calls to drop his weapon, Pickett was wounded in the leg by a uniformed Secret Service officer who fired a single round from an MP-5 submachine gun, according to a law enforcement source. Officials have not said what prompted the officer to shoot. When he was taken into custody, Pickett was carrying a five-shot .38-caliber revolver that had three spent shells, two law enforcement sources said. The spent shells support the account of witnesses who reported hearing several shots, but police agencies yesterday could not immediately explain where or when he fired the other two bullets. Officers spent yesterday searching the grounds for ballistic evidence. Pickett was listed in good condition yesterday at George Washington University Hospital. Prosecutors had not yet decided what to charge him with, but one source said they were leaning toward filing federal criminal charges.
    Pickett, 47, purchased the gun Feb. 24, 2000, at Casey's Pawn Shop in his hometown of Evansville, Ind., after passing an instant criminal background check. Although he had a long history of mental illness, two suicide attempts and treatment in several mental health facilities, Pickett was able to answer truthfully on state and federal gun application forms that he had never been declared mentally unfit by a judge. Answering "yes" would have barred him from buying the gun, according to the Indiana State Police and the Bureau of Alcohol, Tobacco and Firearms. Pickett apparently believed he would not survive his trip to Washington. He left clues hinting that he thought death was near. When investigators searched his home in Evansville, they found his will on the kitchen table, and a copy was found at his office, according to the federal law enforcement source.
    Shortly after the shooting, federal investigators told Metro Transit Police that Pickett had probably taken Interstate 66 to the Washington area, Metro spokesman Ray Feldmann said. The transit police were asked to search Metro parking lots in Virginia for Pickett's 1997 red Ford Probe. The car was found late Wednesday afternoon in a garage at the Vienna Metro station, Feldmann said. During a search of Pickett's home and office Wednesday, authorities confiscated a computer and several papers pertaining to his firing from the IRS. They said his home was clean and neat and filled with books by William Shakespeare and Edgar Allan Poe.
    Pickett's desperation and frustration are evident in a court filing Pickett wrote last year, in connection with his dismissal, and in a letter mailed last week and addressed simply to the agency's "Commissioner." "The plaintiff is emotionally and financially bankrupt," Pickett writes in a court motion filed in federal court in Cincinnati. "I have been refused assistance by all parties supposedly concerned for the protection of civil rights and mental illness. . . . My mental health therapist is concerned whether I will survive another rejection of the truth." A copy of the letter, which was mailed to elected officials, was tucked in his pocket, according to the law enforcement source. "My death is on your hands," the two-page missive said in part. "I have been a victim of a corrupt government. . . . I would rather not continue with life. . . . " Pickett did not file his whistle-blower lawsuit against the IRS until June 1999, more than a decade after he was fired. According to that suit, he had been hospitalized five times by psychiatrists since December 1985, including two occasions stemming from attempts to kill himself by overdosing on unspecified drugs.
    Once in the mid-1980s, when Pickett was working for the IRS in its Cincinnati district office, he locked himself in his apartment for days before finally calling a co-worker for help, according to a lawyer who represented Pickett after the IRS fired him. People familiar with the various lawsuits Pickett filed seeking redress for his firing said there were other episodes, particularly around tax time each year, when Pickett would not show up for work, apparently because the stress was too great. Pickett had been working as a GS-9 level tax auditor in the Los Angeles office of the IRS before requesting a hardship transfer to the Cincinnati office, apparently to be closer to his aging and ailing parents. He was granted the transfer and began working in Ohio in March 1985.
    Suffering from a severe onset of depression and grappling with the stress of his job, he would soon request that his position be downgraded to a GS-5 and ask for a leave of absence, both of which were granted. He returned to work in January 1986 at his new level at the IRS service center in Covington, Ky., and the next month was assigned to a position in the examination support and processing unit of the Cincinnati office. On Aug. 5 of that year, Pickett resigned from the agency, but nine days later he asked that the IRS consider the resignation invalid, saying that he was in a condition of severe depression when he quit. Upon a physician's recommendation, the agency withdrew the resignation. Pickett also asked to be reinstated at the GS-9 level, but the IRS denied his request, prompting him to file a complaint with the Equal Employment Opportunity Commission.
    A 1999 letter by a psychologist, Cal Robinson, who evaluated Pickett, was made part of the court record in Cincinnati. Robinson wrote that Pickett had tried a number of psychotropic medications without much change in any of his symptoms, which included mood swings and feelings of helplessness and hopelessness. The letter states that Robinson had referred Pickett for "intense" psychotherapy at Shepherd-Pratt Psychiatric Institute in Baltimore, where he received "long-term intervention." Robinson wrote that Pickett, a solitary figure who has lived alone since his parents died and never married, had trouble "forming meaningful and nurturant relationships," difficulties that he contended are most likely associated with Borderline Narcissistic Personality Disorder. "He has found it very difficult to trust therapists, attorneys and other care givers, complicating any therapeutic gain," Robinson wrote. After he was fired by the IRS, Pickett started working at the accounting firm his father had established many years earlier, finding the job more suitable to his mental condition, Robinson wrote. "This work environment is protected in that it is non-competitive, and Robert is able to escape to his home if and when the demands are too overwhelming. . . . His professional work world is tolerable because of the security he experiences in an environment that does not evaluate his accuracy, consistency, or for that matter, skill. I believe that in any other type of competitive environment, he would not be able to tolerate the demands."
    Pickett's dismissal from the IRS 12 years ago caused a marked deterioration in his condition because he became "fixated on the issue," said Joseph Yocum, the Evansville lawyer who represented Pickett in his unsuccessful efforts to get reinstated. Yocum said that during the trial in Pickett's discrimination case, "The really crushing thing for him was that the friends whom he thought he had and whom he thought would testify on his behalf did not. That really bent him over and disillusioned him quite a bit." In the court filing he wrote, Pickett reached for what might pass as an explanation of who he had become: "The fact that I have rational intelligence and morals which do not allow me to accept the illegal actions by government officials which have destroyed my career, my family and my life does not diminish the severity of my handicap. I would be glad to explain to the court how many episodes of suicidal depression I have suffered since I was wrongfully dismissed from the IRS."

Accountant Had History of Mental Problems
Kimberly Hefling, Associated Press- 2/9/2001

EVANSVILLE, Ind. (AP) Clients say accountant Robert Pickett had a tendency to disappear for weeks at a time sometimes months especially during tax season. On Wednesday morning, with a new tax-filing season under way, Pickett was missing again. The 47-year-old man was shot and wounded outside the White House more than 700 miles from his Evansville home after brandishing and firing a handgun.
    He was ''an enigma in the respect that he was so extremely intelligent but always second fiddle'' in falling short of his goals, said Steve Yurks, Pickett's client for 12 years. Pickett, a West Point dropout and fired IRS auditor, spoke openly about his grudges against the government and had a history of mental illness and had attempted suicide. Last week, Pickett sent an angry letter to the IRS commissioner, contending the U.S. government had destroyed his life and suggesting he expected to die soon. ''My death is on your hands,'' the letter said. ''I have been a victim of corrupt government.'' President Bush was listed among those copied in on the letter, which was sent to The Cincinnati Enquirer and The Evansville (Ind.) Courier & Press. It was not known whether the president received it.
    Pickett is a recluse and ''neat freak'' who had severed ties with his brother. ''He never talked about a personal life, and I never saw him with anybody. I think he lived a very secluded and lonely life,'' said Mike Jewel, who lived next door to the simple two-story house where Pickett remained after his parents' death. Yet, his neighbors say nothing seemed out of the ordinary. He was often spotted jogging at night or washing his car. His lawn was kept neat. ''As far as I knew, he was an outstanding neighbor,'' said Lewis Gates, who last saw Pickett in December. Betty Perry, who works in the same building where Pickett worked recently, said Pickett would talk to her grandchildren when they visited the office and had said he wished he had a granddaughter. Pickett was single and had no children, said Stephen Pickett, his brother.
    In a lawsuit Pickett filed relating to his 1987 firing by the Internal Revenue Service, he disclosed he suffered from mental illness and had tried to commit suicide. He also alleged the government repeatedly betrayed him starting with his departure from the U.S. Military Academy at West Point and extending to the IRS dismissal. ''This continued persecution by the different government offices has acted as a catalyst to recreate Mr. Pickett's original trauma at West Point,'' alleged Pickett's suit, which was filed against one of his former attorneys in the IRS firing.
    Pickett, who in 1979 earned a history degree from Indiana University, wrote he felt betrayed by fellow West Point cadets who turned him in for unspecified misconduct, and he dropped out of the military academy in 1972. Feeling depressed and betrayed again amid problems at his IRS job in Cincinnati, Pickett traveled to West Point in 1987 and tried to kill himself with an overdose of his psychiatric medication, his suit said. Pickett wrote that he became extremely angry when he felt betrayed. ''He became afraid to confront this anger which had caused him to seek release from his pain by attempting suicide,'' the lawsuit said. The IRS fired him in part for being away from work during his hospitalization after that suicide attempt, Pickett alleged. The lawsuit was dismissed.
    Pickett also sued his brother in a dispute over their father's estate. Stephen Pickett wrote in 1996 that his brother's accusations were ''full of hatred and anger.'' Pickett lost that lawsuit, too. Outside his Illinois home Wednesday, Stephen Pickett said he was grateful that ''no innocent people were hurt.'' ''We've been estranged from Robert for several years now,'' Stephen Pickett said. ''We hope that he gets the help that he needs.''
    Police said Robert Pickett had no criminal record but was reported missing by his father in 1993 an investigation that was suspended when he resurfaced. In his lawsuit, Pickett said he suffered a ''severe depression episode'' that year and was treated by a Baltimore psychiatrist. Officials close to Fellowship House, a treatment facility in Baltimore, confirm he sought resident treatment there in the 1990s. Neighbors in his middle-class Evansville neighborhood said Pickett kept to himself in the home where he once lived with his parents. His mother died in 1987, his father in 1995. His father's will allows Pickett to live in the house for the rest of his life, as long as he pays real estate taxes and other expenses.
    Jewel, a neighbor who hired Pickett to do the payroll accounting at his floral shop, said he continued to be angry with the IRS. ''I could tell he was aggravated by the tax system and the IRS sometimes,'' Jewel said. Yurks said the accountant frequently talked about his departure from West Point. Pickett kept things orderly, Yurks said. If you moved his pencil, he would move it back in place, Yurks said. ''He was a neat freak. A perfectionist. He was different,'' Yurks said.

Therapist Forced to Resign
Alice Dembner, Boston Globe Staff- 2/10/2001

A Boston psychoanalyst who wrote the ethical standards for his profession has surrendered his medical license after acknowledging an inappropriate relationship with a female patient, according to members of the Boston Psychoanalytic Society and Institute. By surrendering his license at the end of January, Ralph P. Engle Jr. avoided the possibility of disciplinary action from the state medical board. He also resigned from the psychoanalytic society, a professional group which had begun investigating his conduct last fall when a patient complained.
    Officials of the society said Engle acknowledged a ''boundary violation'' with one patient, a term used to describe a range of behaviors in which a therapist oversteps the lines of professional behavior. Boundary violations can include anything from a sexual relationship with a patient to giving a patient gifts. The psychoanalysts declined to reveal the details of Engle's misconduct, citing the need to protect the confidentiality of the patient. Engle, a practicing psychoanalyst for 40 years, could not be reached for comment. ''He agreed with us that his conduct in this particular therapy had been unwise,'' said Dr. Jeffrey Nason, president-elect of the society. ''He had been dealing with illness in himself and his family and he felt that his functioning as an analyst had been impaired. Had he not resigned his license, the society would have made a report to the Board of Registration in Medicine,'' Nason said.
    Psychoanalysts usually see their clients several times a week for sessions that probe deeply into patients' present and past experiences and feelings. Maintaining professional distance is a particular challenge, but one that Engle had taught others how to meet. Engle, who is 68, had not only treated private patients, but also taught psychiatry at Harvard University and trained new psychoanalysts through the Boston institute. He chaired the board of professional standards for the American Psychoanalytic Association and recently helped develop a code of ethics for the organization. In recent years, he organized a conference for colleagues on avoiding sexual abuse of patients. And, according to his colleagues, he was known nationally for helping members of his profession deal with ethical problems. He had served as president of the Boston society from 1988 to 1990 and chaired its ethics committee from 1990 to 1992.
    ''It's a very tragic story. You have someone who got sick and got into a mess, but whose career has been devoted to caring for people and standing for an important ethical position,'' said Dr. Elliot Schildkrout, chairman of the society's board of trustees. Schildkrout led the inquiry into Engle's behavior. Schildkrout said a female patient came to him in November with concerns about Engle's actions, but was unwilling to file a formal complaint. Schildkrout said he convened an ad hoc committee on peer review and impairment to look into the issue by talking with the patient, Engle, and other colleagues. ''There was enough concern about the quality of his practice that he decided to resign,'' said Schildkrout. Schildkrout said the society was not aware of any other complaints about Engle. And the Board of Registration in Medicine said it had never taken any disciplinary action against him.
    Society members said Engle recently developed prostate cancer and that his wife has also been sick with cancer. While they said his illness did not excuse his professional misconduct, they said it might explain why someone they respected had stumbled so far. ''It was a mixture of illness, poor judgment, and boundary problems,'' said Dr. Malkah Notman, president of the society. The Boston society and the Psychoanalytic Institute of New England called meetings in the last two weeks to discuss Engle's resignation, as word spread through the psychiatric community.
    ''It's sad to see someone with such fine credentials and outstanding qualities fall to this professional hazard,'' said Dr. Robert Kenerson, who is a former student of Engle's. ''He was known to be a very competent clinician, which is why there is such deep concern in the community.'' According to Schildkrout, Engle will continue to see patients over the next several months as he winds down his practice. Under state law, he can practice as a therapist without a medical license. However, Schildkrout said Engle had agreed to retire.

Abortion Clinics Decline in Michigan
Sarah Kellogg, Grand Rapids Press, 2/11/2001

The number of Michigan abortion providers has been cut nearly in half in the past decade, according to a new national report. The National Abortion Rights Action League's annual survey, to be released Monday, shows the number of abortion providers in Michigan has shrunk from 70 in 1992 to 59 in 1996 to 36 in 2001. "There are definitely fewer," said Rebekah Warren, executive director of the Michigan Abortion Rights Action League, which supports abortion rights. "We know that impacts access. For all practical purposes in some Michigan counties, there are no abortion services."
    But Kathy Humphrey-Vaughn, head of Planned Parenthood Centers of West Michigan, said the loss of services is news to her. "I have not personally witnessed a decline in West Michigan," she said, though she would not comment further. There are three abortion-service providers in Kent County. Providers can be found in 11 of Michigan's 83 counties. In addition to Kent, they include Genesee, Ingham, Kalamazoo, Muskegon, Oakland, Saginaw and Washtenaw. Wayne County has the most, 11.
    Abortion foes say they're not surprised by the shrinking number of abortion providers in Michigan. "Between 1987 and 1999, there was a 46 percent decrease in the number of abortions performed," said Pamela Sherstad of Right to Life of Michigan, based in Wyoming, which opposes abortion services. "People don't associate abortion as part of a business, but when you have less people utilizing a business, my guess is you're going to end up with fewer of those businesses."
    The number of reported abortions dropped significantly in Michigan between 1989 and 1999, according to the Department of Community Health. In 1989 there were 36,557 abortions, while there were 26,207 in 1999. The national abortion rate for women 15 to 44 is 20 abortions per 1,000 women, compared with Michigan's rate of 11.5 abortions per 1,000 women. Sherstad says the decline in abortions reflects the changing attitudes in the state's population about the procedure. "Michigan is a more conservative state than other states," Sherstad said. "Just because abortion is legal, that doesn't make it right for a lot of people, especially in small communities where people know what's going on."
    Warren of the National Abortion Rights Action League disagreed. She attributed part of the decline to retirements: Doctors who have been performing abortions for the last 20 or 25 years are leaving the business. "The physicians are aging, and there aren't as many doctors being trained to take their place," Warren said. She also said recent health-care system mergers have brought secular hospitals and faith-based hospitals together. When that happens, abortion policy often is set by the facility that is run by a religious order. For example, hospitals run by Catholic Church-affiliated groups do not perform abortions. Warren called the report's findings "disturbing," but she said abortion-rights advocates are hoping that President Bush, who opposes abortion, may help their cause. "We have people coming out of the woodwork to get involved," Warren said. "During the election, we kept telling people we were afraid of what (Bush) might do. We had a hard time convincing people a Bush presidency was going to be bad for abortion rights, but not anymore. He's proven it himself." On his third day in office, President Bush cut off U.S. funds to overseas family planning agencies that provide abortions.

Boston Ratchets up Battle Against Heroin
Brian MacQuarrie, Boston Globe- 2/11/2001

Until recently, rising heroin use among Boston's teenagers and young adults had been a little-recognized problem. Now, city officials intend to take the fight public in an unprecedented way. A one-hour cable television documentary about young Bostonians affected by heroin debuted Friday night; an aggressive public information campaign hit local newspapers last week; and new funding sources are being tapped to step up the battle across the city. Generals and foot soldiers in that fight gathered at the South Boston Neighborhood House on Friday to unveil what John M. Auerbach, executive director of the Boston Public Health Commission, called the city's most ambitious effort to combat the spread of heroin.  ''Heroin addicts are our sons, our sisters, our cousins. And the bottom line is, this drug and disease will destroy anyone's life,'' Mayor Thomas M. Menino said. ''The drug's stigma is gone. Heroin is so strong that kids can snort it now and don't have to use needles.''  In Boston, substance abuse is the leading cause of hospitalization for men between 25 and 34, and the third-leading cause for males between 15 and 24. During fiscal 1999, according to the state Department of Public Health, 41 percent of admissions to publicly funded treatment centers involved people who had used heroin within the previous year.
    The documentary, titled ''I'm Not a Junkie,'' made its debut on Channel 22 in Boston and will be shown at 8 p.m. daily through next Sunday. Produced by Catherine O'Neill of the city's cable office, this stark view of young Bostonians affected by heroin is designed to be a sobering warning for vulnerable youths and a wake-up call for parents. The film will be complemented by an advertising campaign whose message - ''Kids can get hooked on anything. Why not heroin?'' - was developed and paid for by Holland Mark, a Boston advertising firm.
    The city has received more than $3.2 million to bolster a range of substance-abuse treatment and services. The funding will include:  $1.5 million, over three years, for eight additional openings for pregnant Latino women, new mothers, and their children at Entre Familia, a residential substance-abuse treatment program based in Mattapan. $1.5 million, over three years, for job training and job placement for women in residential treatment who are recovering from drug abuse. A one-year $97,000 grant for a full-time social worker and part-time community organizer to focus on heroin use in South Boston. The drug has hit the neighborhood particularly hard. A one-year, $90,000 grant to provide education about hepatitis C and support services. Drug abuse puts users at increased risk of this liver disease. A one-year, $75,000 grant to create a smoking cessation program for people receiving substance-abuse treatment and who are participating in a Public Health Commission addiction program.

Financial Ills Mar Maryland Mental Health Program
Matthew Mosk, Washington Post- 2/12/2001

When Lynne Edwards's son was 4 years old, his emotional outbursts were so bad they disrupted his Head Start class. Little RaQuon was brimming with aggression, and worse, bedtime had become a battle most parents couldn't fathom. He was sleeping only six hours a week when Edwards finally took him to Corner Clinic. Doctors at the Glen Burnie mental health center diagnosed bipolar disorder and started RaQuon on a regimen of medication that, adjusted over time, began to show promise. "Everything was going so well, and then we got the phone call," Edwards recalled. The Oct. 1 call was from RaQuon's counselor. Corner Clinic was out of money. "All of a sudden, they were closing their doors, and we had no idea where he would be going."
    Corner Clinic's abrupt shutdown at least temporarily stranded RaQuon and more than 1,700 other psychiatric patients. At the time, the state's top mental health administrators expressed shock and blamed the clinic's young owner, James F. Crosson. But Crosson pointed the finger of blame right back at the state, saying his company's failure offers a glimpse at a financial crisis plaguing Maryland's mental health system. Crosson said that when the clinic closed in October, the state owed him more than $1 million for psychiatric care his clinic already had provided to low-income patients. And he is not the only one complaining.
    Since Maryland changed the way it funds mental health care four years ago, the state has amassed more than $26 million in debt and has been late paying nearly a third of its $400 million in bills. The first legislative review of the Mental Hygiene Administration budget for the next fiscal year will take place tomorrow before a House of Delegates Appropriations subcommittee.

A Changed Approach
Buried under a backlog of claims for payment, the state has left dozens of treatment centers struggling to stay solvent. Several hospitals and clinics now blame the delinquent payments for forcing them into dire financial straits over the past three years. "The system is failing," said Montgomery County Council President Blair G. Ewing (D-At Large), who watched with frustration last fall as his county's largest psychiatric caregiver, CPC Health Corp., declared bankruptcy. "What we thought was a great strategy to privatize mental health care three years ago is coming back to bite us."
    The crumbling of Maryland's mental health system traces back to an ambitious privatization plan launched in 1997 with one noble goal: to expand service to the uninsured mentally ill by changing the way the state paid for care. Instead of doling out annual grants to some 200 clinics and county agencies, the state decided to pay psychologists and therapists the same way insurance companies do -- with a set fee for every procedure they performed on each patient they saw. By the time state health officials decided to make the switch, other states were already struggling under similar plans. But virtually every advocacy group with a stake in mental health care agreed it was still worth the gamble. Worth it, said advocates for the poor, because it meant the state would start spending money on more than just Medicaid patients. It would also pay for those trapped in the so-called gray zone -- where people are disqualified for federal help because their income is too high but they still lack money for private insurance. "We all agreed it was an excellent idea," said Phyllis S. Goldberg, executive director of the Maryland Council of Community Mental Health Programs. "But we also recognized that changing mental health care was going to be a huge undertaking. This would be a tremendous overhaul."

Signs of Success
When Jim Crosson opened Corner Clinic in Annapolis in 1994, he was 26 and had little experience in the mental health field, beyond seeing his own father suffer from psychiatric problems and ultimately commit suicide. Crosson had studied some psychology in school and worked after college as a low-level aide at Crownsville State Hospital, a sprawling psychiatric institution just north of Annapolis. The onetime Thom McAn shoe store manager with a boyish face, ruffled hair and aw-shucks manner said he was never concerned about failure. "My father was pushed around by the system, and it never served him the way it could have," Crosson said. "I wanted to open a clinic that treated clients like human beings."
    Crosson's Annapolis clinic found its footing after just one year and quickly started to expand. Corner Clinic opened its second branch in Glen Burnie and bought rival clinics in Annapolis and St. Mary's County. Soon, Crosson added a child and adolescent center and purchased the first of eight private homes where he would rent rooms to mentally ill patients. "I remember driving into the [clinic's crowded] parking lot and thinking, 'Boy, this has really worked out,' " Crosson said. With his success, he bought a 1999 supercharged Jaguar, a new motorcycle, and a Lincoln Navigator for his wife. The fancy cars were a point of pride for this man of modest beginnings. But it would not be long before they engendered scorn from his employees, who worked weeks without pay to keep his business afloat.

An Overwhelming Demand
State officials acknowledge they bungled the launch of privatization in 1997. They had predicted they would need $1 million in the first year, assuming 40,000 patients would turn up for treatment. They were wrong. The number of patients that year was close to 80,000. The accompanying bills topped $5 million. "Initially, we were overwhelmed," said Oscar Morgan, director of the Mental Hygiene Administration. The state spent $8.3 million to hire Columbia-based Maryland Health Partners -- later swallowed up by Magellan Health Services Inc. -- to evaluate each claim and pay the providers. But the company "couldn't handle that volume," said its president, Damian Briggs. From 1997 to 1999, an auditor found, Maryland Health Partners sent out $138 million in payments past the 30-day deadline. Half were more than 60 days late. An additional $148 million in claim denials was also late, giving providers little time to appeal.
    Making matters worse, clinic and hospital directors said, Maryland Health Partners demanded detailed information on each patient they treated. How much did they earn? Where did they live? Did they qualify for Medicaid? In theory, these were important details needed to protect the state from paying for patients who didn't qualify for aid and to ensure the state got all the federal money to which it was entitled. In practice, "it was a disaster," said Richard H. Bayer, chief executive of Upper Bay Counseling and Support Services, an outpatient mental health clinic in Elkton, near the Delaware border. Many clinics had never kept that kind of paperwork before; some were not equipped to file claims at all. "We were dealing with people who are often very impaired. They wanted us to verify that these people were below the poverty line, but you couldn't just put your hands on their tax returns or pay stubs, if those even existed at all," Bayer said.
    The result: Volumes of claims were denied. By the end of 1997, the system was so clearly impaired that the Mental Hygiene Administration made a concession to the clinics: The state would start paying upfront until the kinks in the claims process could be ironed out. These payments totaled roughly $18 million. Corner Clinic received its first advance, $350,000, on Dec. 30, 1997. By 1999, the advances meant to offset Corner Clinic's poorly documented claims totaled $1 million.

Problems at the Corner
None of this, state officials note, hurt patient care. But at places like Corner Clinic, the reimbursement problem took its toll. A succession of financial managers was hired and dismissed. Supplies of photocopier paper and pencils ran out. In early 2000, Corner Clinic supervisor Moira Meagher recalled, a patient approached her and asked if everything was all right. "He told me he had been in court because he was being evicted, and the eviction case right after his was for Corner Clinic," she said. As Crosson fended off demands for past-due rent and canceled employee insurance policies, the state hired an outside consultant to figure out why Corner Clinic consistently failed to file "clean" claims -- ones with all the patient information filled out correctly.
    While Crosson blamed the vagaries of a homeless, mentally ill clientele, the consultant saw dismal management. Documentation was so poor, consultant William T. Atkins found, that some information was "written on scraps of paper . . . unsigned and undated." The state grew increasingly frustrated with Crosson. "Looking at his claims, we started to believe he had double-billed us. That we didn't owe him any money, and that he owed us money," said Morgan, the Mental Hygiene Administration director. "At a certain point, I felt very uncomfortable giving him any more money at all." But at almost the same time, independent state auditors were getting set to release findings about the problems plaguing Morgan's department. It was the auditors' second look at the Mental Hygiene Administration, after a 1999 report found its bookkeeping "unsatisfactory." The auditors criticized the state for a range of problems, including money management failures that cost the state millions of dollars in interest.
    A more substantial problem, said Simon Powell, a legislative budget analyst, was that the state lacked the money to pay for all the care being provided. From 1997 to 1998, he said, caregivers provided $10 million more in treatment than the state had in its budget. In 1999, that number grew to $15 million. In 2000, $16.5 million. "What they're facing now is having to cut elsewhere in order just to pay for what they owe," Powell said. By law, the state must pay for care to Medicaid patients. That means the cuts will likely affect other mental health programs. Powell speculated that the hardest hit would be the 17,000 uninsured gray zone patients, who could lose state coverage altogether.
    Morgan is more optimistic. He will protect many of the gray zone patients, he said, by converting them to Medicaid. And he said he thinks the problems with quickly reimbursing clinics will be solved with a get-tough program he has launched to quickly deny claims that aren't filled out right. He will defend that position before lawmakers tomorrow. "We're going to balance out our budget, and it will have nothing to do with denying services," he said. "We want people to get services. That's our whole purpose for being here."

Lives and Care Disrupted
Many of the 1,700 Corner Clinic clients learned of the shutdown much the way Lynne Edwards did. She received a call from RaQuon's counselor, Lori Clayton, who tried to calm her nerves. Clayton had made scores of similar calls on that disorienting October day -- when she learned from a newspaper article that her boss was locking the doors. "The day the story appeared in the paper, my pager went off at 3:30 p.m. and kept going off," Clayton said. "Patients were panicking."
    For clients like RaQuon, now 5, Clayton's help finding a new doctor did not completely resolve matters. While Clayton placed RaQuon with another counselor, she could do nothing to get hold of the boy's medical records. Locked in a darkened Corner Clinic office was the file that contained the recipe for treating his disorder -- a mixture of drugs unique to him that was developed over months of tinkering. "I'm entitled to those records. I'm his mother," Edwards said. "It's hard to remember what medication he was on in January, and which one he took in February. Just dealing with the illness alone is enough. But then to have to piece together the exact course of treatment, that's impossible."
    Crosson said he has tried to comply with requests for old patient files, despite Edwards's contention otherwise. But he doesn't deny that the transition period was difficult. "The state stopped paying, which in essence meant they decided to put me out of business," Crosson said. "In the process, my employees got screwed, and the patients got screwed." State and county mental health workers tried to ease that process. They contacted four other clinics and persuaded them to take the added cases. They hired temporary case managers to help patients select new doctors.
    But while 924 patients found a new place for care, more than 700 did not. "We put out calls, we put out letters, but they have not come in for care," Morgan said. "I don't know where those patients are." Many of the clinic employees have yet to receive a final paycheck. Seven who agreed to be interviewed for this article said they are each owed more than $1,000, and some are due as much as $13,000. Crosson has sued the Anne Arundel County Mental Health Agency, a nonprofit partner of the state's mental health department, which promised it would pay Corner Clinic employee salaries.
    But the employees blame Crosson. "He is still hiding behind his Jaguar," said Charles Chappelle, a former Corner Clinic counselor. "You look at how he came out of this, with his lifestyle unchanged, and it makes you wonder." Sorting Out the Money Apportioning blame for what went on at Corner Clinic appears to be a lost cause. Crosson insists the problems were with the state system, and a lawsuit making that claim is still in the courts. This month, his attorneys went before an administrative judge to review some of the thousands of claims for payment that remain in dispute. "I knew this new system would have problems, but I thought they'd be worked out," Crosson said. "I never thought we wouldn't be paid."  Morgan said he thinks Corner Clinic owes the state $500,000. He said that the company's problems were unique -- that many clinics have adapted to the new billing system. "There are 5,000 vendors in this system, and every Friday, I look at the providers who are having problems, and there may be a couple dozen of them, at the most," Morgan said. "I think things are generally healthy."
    But many who work in the field said Morgan is painting an overly rosy picture of mental health in Maryland.  Clinics from Montgomery County to Baltimore have faced closure in the past six months, including those run by CPC Health and by the Sheppard Pratt Institute. And more problems with billing have beset psychiatric hospitals, including Taylor Manor in Columbia and Chestnut Lodge in Rockville. "The real problem in the end is the money. There's not enough," said Bayer, who runs the mental health center in Elkton. "We have a number of clinics at risk of closing their doors, or at a minimum cutting back on services. When that happens, we will really see how patients will suffer."

Clubhouse Offers Help, 'Fresh Start'
Pamela Gossiaux, Ann Arbor News- 2/12/2001

Before his mental illness hit, Raymond Pierce was a faculty member at the University of Michigan where he taught anatomy and pathology and was involved in research. Today, while working on overcoming major depression, he still has a venue for teaching--at the Fresh Start Clubhouse. The clubhouse, which opened in September, is a member-run place where folks with mental illness can not only hang out but have a hand in running the business.
    "People with mental illness do better when they have a place to go, an opportunity to participate in meaningful work and meaningful opportunity for social interactions on a normalized basis," says Jim Salisbury, program manager. "The key is members and staff work side by side to run the clubhouse. The members are involved in every aspect of operations." That's where Raymond comes in. Originally a member of Trailblazers clubhouse on Division Street, he followed the new administration to Pittsfield Township where Fresh Start clubhouse has opened in its temporary location on Varsity Drive. Contracted through Washtenaw County Community Mental Health, Fresh Start Clubhouse is also affiliated with Livingston County Community Mental Health.
    "I myself teach living skills," says Raymond. "I'm in food care. I really teach diet and nutrition. I teach consumers that live in independent living situations how to shop, how to make up meal plans and how to budget. We generally do a monthly meal plan here and I prepare all the meals."
    The clubhouse opens at 9 a.m. each day. About 21 of the 80 members show up each day. "People will frequently just show up and start working," says Salisbury. "They know their role. People volunteer or quietly chip in later." The key, he says, is the clubhouse is run strictly on volunteerism. Members are just that--members and not clients. Folks can show up daily, or once a month, but when they've been away for a while the others send them a card or give them a call to let them know they're missed.
    "The work is self-paced," says Kirk, a 39-year-old man with bi-polar illness. "There's little or no condescension from staff. It's totally unlike any working experience I've ever had." Because of his mental illness, he was unable to complete his bachelor's degree, but has experience in restaurant work. At the clubhouse he has found an outlet for his musical talents and plays the drums for the group. "I don't have to hide who I am. I don't have to come in here and sell myself to people. I can just be," says Kirk. "There's some brilliant people here. I have an opportunity here to be a success story."

Virtual Reality Could Help Conquer Phobias
Nancy Deutsch, Detroit Free Press- 2/13/2001

Dr. Milton Huang of the University of Michigan is investigating the use of virtual reality in treating phobias. Most people have some sort of phobia, although for most of us, the fear does not hamper our lives. There are others, however, who are too afraid to board a plane or ride in an elevator. For them, phobias are life-altering. For years, psychiatrists have helped people overcome their phobias by gradually exposing them to their fears. For example, a person with a fear of flying might initially get comfortable looking at a plane, then sitting in a plane, then sitting in a plane with the engine running, then flying a short distance, and so on. But exposure treatment is not always practical, Huang says. "It's hard to rent a 747 for them to sit in. It's a lot cheaper to put someone in virtual reality."
    Several research centers are looking into virtual reality to help people with phobias. At U-M, a virtual reality room known as the Cave has been designed for people afraid of heights. The virtual environment is a 10-by-10-by-10-foot room made of projection screens. The patient wears special glasses to create a three-dimensional image, and a computer calculates what should be on each wall, based on the virtual model and the viewpoint of the subject. Huang and his research group are studying how effective virtual reality therapy is. "There is a very good sense that this stuff works," he says. "I'm really trying to understand what makes a person engage in virtual reality."
    Huang's study works this way: Fear of heights is measured in the elevator area of the main hospital. All subjects go up one floor at a time, looking out through the window and giving subjective fear scores while the researchers take physiological measurements of heart rate and galvanic skin response. Patients stop at the floor where they feel unable to continue. The patients are then randomly assigned to one of three treatments: relaxation, in vivo (genuine) exposure in the East Elevator area of the main hospital, or virtual exposure in the Cave, which simulates the elevator area. After 90 minutes of treatment, the original test is repeated to see if there has been any change. A person has to feel afraid in the virtual environment for it to be effective therapy. If people keep convincing themselves they are only in a room and not going anywhere, it won't work. "You have to get patients to stay with the panic and make them master it," Huang says.
    Huang is nearing completion of an experiment involving 50 patients treated with virtual reality and others receiving standard treatment. Once the data are compiled, Huang will publish a comparison study. "Virtual reality treatment will become more available and easier to use," Huang says. "Many people actually prefer virtual reality treatment because it can be more private and because they find it more palatable than facing the real thing."
    For more information, go to www.psych.med.umich.edu/web/UMpsych/staff/mhuang/research.htm.

Doctors Sue Six HMOs Over Payment, Treatment Disputes
Diane Scarponi, Associated Press- 2/14/2001

NEW HAVEN, Conn. (AP) Dr. Sue McIntosh, for one, is fed up. Fed up with insurance companies giving her the run-around when it comes to paying claims. Fed up with not getting paid at all. Fed up with going into debt to keep her small Guilford practice afloat.  McIntosh and thousands of other Connecticut doctors said Wednesday they are not going to take it anymore. The doctors and the Connecticut State Medical Society are suing six health maintenance organizations in state court, seeking monetary damages and a court order to stop some HMO business practices.
    The lawsuits allege the for-profit HMOs are breaching contracts with the doctors and violating state law by making decisions about patients' care and failing to pay claims on time. ''These lawsuits are intended to allow physicians to practice good medicine in an environment unfettered with concerns about insurance company profits,'' said Dr. Donald Timmerman, president of the medical society. The six insurance companies being sued in Superior Court are Aetna U.S. Healthcare, Anthem Blue Cross and Blue Shield, CIGNA HealthCare, ConnectiCare, Oxford Health Plans and Physicians Health Services.   Some of the companies said the lawsuits were baseless, and noted that they have been working with doctors to address complaints.
    The medical society, which represents about 7,000 doctors, has fought insurance companies for several years in the Legislature, resulting in a laundry list of regulations that are among the most comprehensive in the country. On Wednesday, however, its lawyers said insurance companies have been able to wriggle around these laws. So the doctors are now turning to the courts. ''They need to be jolted into action. They're not going to be able to run away from this,'' said Melvin Weiss, a New York lawyer representing the medical society.
    The health insurance industry's Capitol lobbyist, Keith Stover, said the lawsuit has more to do with the financial interests of doctors and trial lawyers than with the needs of patients. ''The medical society has become extraordinarily good at wrapping their economic interests in the sheep's clothing of patient protection,'' Stover said. The state Insurance Commissioner, Susan Cogswell, also said she was disappointed in the lawsuits. Her office had facilitated meetings with the medical society and insurers to resolve prompt payment issues, and the office was ready to help the two sides work out other differences. ''Lawsuits are costly, and they're going to be costly ultimately to the consumer. If they can sit down and work through the problem and get resolution, that's a preferable route,'' Cogswell said.
    Aetna, Anthem and CIGNA said they had made progress working with doctors and other HMOs to address complaints, so they could not understand why the doctors decided to go to court. ''We are surprised and disappointed that the parties have chosen to use litigation, which is costly, cumbersome and adversarial, instead of raising these issues directly with us,'' Aetna said. Oxford responded that it consults with doctors in running its business, and uses doctors' groups to develop its guidelines for care. ConnectiCare said it had not seen the lawsuit and could not comment on it. Physicians Health Services did not respond to requests for comment. Messages were left at the company's Shelton offices.
    In the past several years, the state has enacted laws to require insurance companies to pay claims within 45 days, and has set up an external appeals process for people who are denied medical care from an HMO. The Insurance Department also investigates late or denied payments. Last year, the agency levied over $1 million in fines against all insurance companies including HMOs and got insurers to pay $6 million in denied claims, Cogswell said. Twenty people won appeals over denial of care from HMOs. But doctors such as McIntosh and her partner, who aid children who have blood disorders and cancer, said despite the law, payments still come months or years late if at all. ''We get lies, we get 'errors,''' McIntosh said of the insurance companies' responses. ''This is jeopardizing the viability of our practice.''
    The American Medical Association, a national group, also supported the lawsuit but has no plans to pursue a similar one on its own. The group agreed with Connecticut doctors that insurers have made a lot of empty promises. ''We have long been concerned about some of the troubling business practices many of the insurers have engaged in. We have had assurances from many that things are going to change, but it appears many of the changes are more cosmetic than real,'' said Dr. Richard Corlin, a California gastroenterologist who is slated to become president of the AMA in June. In May the Connecticut Medical Association filed a lawsuit against three insurers in federal court, alleging fraud under anti-racketeering laws. In September, Connecticut Attorney General Richard Blumenthal sued Anthem, CIGNA, Oxford and Physicians Health Services in federal court in an effort to force reforms.

Washington Governor's Plan for Mentally Ill Stirs Alarm
Heath Foster, Seattle Post-Intelligencer- 2/14/2001

STEILACOOM -- In a dramatic shift in Washington state's 's approach to caring for the mentally ill, Gov. Gary Locke has proposed moving hundreds of elderly, drug-addicted and brain-damaged people out of the state's two psychiatric hospitals. To save about $15 million, Locke wants to transfer more than 400 patients from Western State and Eastern State hospitals into cheaper, community-based facilities.
    But there's a catch. The secure, highly staffed facilities needed by these patients, who were initially committed to the state hospitals because they posed a danger to themselves or others, do not exist in Washington state. And the Department of Social and Health Services' proposal to develop and license new facilities in as little as a year's time is striking fear in the hearts of the psychiatrists, psychologists, nurses, and family members who care for these patients. On one hand, they agree with the Locke administration that many patients would be better served closer to home in less restrictive settings. The patients at issue are now in a transitional program for those considered ready to leave the hospital, or in wards serving the elderly, the brain-damaged, or mentally ill people who also suffer addictions.
    But the critics say Locke is not providing nearly enough money to operate well-staffed, top-notch facilities. And because the hospitals would lose 45 percent of their beds for civilly committed mentally ill people, critics say some of the state's most vulnerable patients could end up warehoused in substandard homes or, worse, on the streets. "If these Draconian cuts are adopted, Washington's mental health system is headed for disaster," Dr. Dean Brooks, a retired psychiatrist and former hospital superintendent who now chairs the Western State Hospital Board, said at a hearing before the state Senate's Ways and Means Committee yesterday. "Chances are (these patients) will either become homeless or wind up in jail."
    Illustrating the concerns, a petite, mid-50s woman came to Western State five years ago after suffering multiple cerebral aneurysms. She would angrily hit or kick at anyone who tried to come near her. With gentle care and the right medications, she is now one of the sweetest women on the ward, clinical psychologist Nancy Larsen said recently as she made her rounds there. But nursing homes have refused to take the woman because she still spits on the ground, loudly demands her food, and resists having her clothes changed. "These are people that cannot just be warehoused," Larsen said. "What they need is not out there, and I don't want to see them pushed out of here to places where they don't get any care."
    In what has become one of the most desperate budget-making years in recent memory, it's not hard to see why Locke aimed his budget ax at the state's two mental hospitals. Together, Western and Eastern State hospitals spend about $164 million a year serving just 1,300 patients. In comparison, the community mental health services spread across Washington's 39 counties serve about 46,000 people each month for about twice as much annually, $326 million.
    Tim Brown, DSHS assistant secretary for rehabilitative services, said the patients proposed to be discharged no longer need the intensive psychiatric services they receive at Western State at the cost of $365 a day. But because there are no other facilities for them, many have made Western State their permanent home, he said. In the geriatric wards, for instance, 18 percent of the patients have been in residence for five years or more. And among the younger patients with serious mental illnesses living on extended care wards, more than half have been at the hospital for more than two years, he said. Pointing out that Western State is the largest state psychiatric hospital west of the Mississippi, Brown argued that Washington is behind in developing more economical residential facilities for elderly people suffering from dementia or younger mentally ill people with substance abuse problems.
    Mental health professionals generally agree that the closer a patient can be kept to home, the more likely he is to heal and eventually function in the community. They also agree on the crucial need for high-quality residential care facilities offering more than nursing homes but less than the intensive services in state hospitals. But both the professionals and state lawmakers are dismayed by the fast-tracked, bare-boned approach DSHS seems to be taking in developing an entirely new breed of facility.
    On Western State's geriatric wards, where more than 100 beds would disappear, about 68 percent of the patients have organic disorders such as Alzheimer's, dementia, or Huntington's Chorea. About three-quarters of the patients also have serious medical conditions, and about a third have severe mental illnesses such as schizophrenia. Larsen, the clinical psychologist at Western State, said many of her patients cannot remember what happened an hour or the day before. They need to be reminded to eat and drink, be coaxed gently into taking baths, and have their medications regularly reviewed by medical professionals.
    At yesterday's Ways and Means Committee hearing, many advocates and lawmakers expressed doubt that DSHS can develop new facilities for the mentally ill within the next two years -- the period covered by Locke's budget proposal -- and still save the $15 million Locke has aimed for. "It's pretty clear that the governor's proposal doesn't add up," said committee Chairwoman Lisa Brown, D-Spokane. "It's clearly going to take longer and cost more." DSHS's Brown said the department's initial surveys of the hospital's population have already shown that fewer patients are ready for community-based settings than initially estimated. And he acknowledged that the department is only at the initial stages of designing a new licensing category of secure, community-based facilities for the mentally ill. He promised to have more information for legislators in March. Tom Richardson, head of the Washington chapter of the National Alliance for the Mentally Ill, was not convinced: "This is a recipe for more of the same -- vulnerable people lost to the failures of an underfunded treatment system."

Pickett's Mental Health at Issue
Bill Miller, Washington Post- 2/14/2001

The former mental patient accused of firing two gunshots last week outside the White House made his first court appearance today, listening intently as a prosecutor raised questions about his competency to stand trial on a federal assault charge. Robert W. Pickett, 47, a former Internal Revenue Service auditor from Evansville, Ind., has been in custody since his arrest last Wednesday after a confrontation with uniformed Secret Service officers. Pickett allegedly pointed his .38-caliber revolver at the officers, who had rushed toward him after hearing the gunshots. One officer shot Pickett in the right leg after Pickett refused to drop the gun, authorities said. No one else was injured in the 11:25 a.m. episode near the White House's south fence.
    Pickett was discharged today from George Washington University Hospital and brought by federal marshals to U.S. District Court. Dressed in a dark blue jacket and blue jeans, Pickett used crutches to make his way into the courtroom. His right leg remains in a heavy brace after surgery. During the court proceedings, Pickett occasionally conferred with his federal public defenders, Gregory Poe and Michelle Peterson. Assistant U.S. Attorney Ronald L. Walutes Jr. asked that Pickett be taken to a federal psychiatric facility in Butner, N.C., for 30 days of evaluation to assess his competence to stand trial. The examination would determine if Pickett is able to understand the charges against him and assist in his defense. According to Walutes, Pickett's recent statements raised questions about his mental state. Poe, however, indicated that the defense will challenge the necessity of such an evaluation.
    After his arrest last week, Walutes said, Pickett told law enforcement authorities he had been suffering from psychiatric troubles for at least 15 years and had "stopped counting" after trying 24 types of medication. Walutes quoted Pickett as saying he was among the first people to use the drug Prozac, that he had been in and out of hospitals over the years, and that he had made a number of suicide attempts. Walutes also made reference to a lawsuit Pickett filed in federal court in Ohio over his dismissal from the IRS in 1989. A federal judge dismissed the civil suit last month, Walutes said, writing that he believed Pickett was "in need of some form of psychiatric assistance." Pickett responded to the judge's action with another court filing in which he acknowledged his mental problems and added, "May you all go to hell."
    Magistrate Judge Alan Kay scheduled a hearing for next Tuesday to consider the prosecutor's request for the psychiatric evaluation. At that time, the judge also will hear arguments about whether Pickett should remain held without bond pending trial. Prosecutors are likely to present additional evidence that day about the shooting. In the meantime, Kay said, Pickett will be jailed and put on a medical alert. Walutes asked for the extra attention because of concerns that Pickett might attempt suicide.