Noteworthy News Articles on Mental Health Topics, February 14-19, 2001

Maryland Mental Health Providers Plead for Money
Matthew Mosk, Washington Post- 2/14/2001

Maryland legislators heard a gloomy forecast for the state's mental health program yesterday, as a budget analyst detailed the system's mounting deficit and psychiatric caregivers warned of dire consequences if more hospitals and clinics go bankrupt. "This vehicle for delivery of mental health care is currently out of gas," said Rita Tate, a past president of the National Alliance for the Mentally Ill, whose 49-year-old brother is schizophrenic. "I don't want to see my brother and thousands like him without services."
    During hours of testimony, mental health advocates and providers pleaded with lawmakers to ask Gov. Parris N. Glendening (D) for more money to help offset a deficit in the Department of Mental Hygiene that is expected to top $40 million by the end of this fiscal year. The legislature's budget analyst, Simon Powell, recommended that the department take a series of cost-containment measures and suggested that lawmakers cut Glendening's $2 million proposal for school-based mental health care in favor of paying off the department's rising debt. "We feel you have to get your house in order before you launch new programs," Powell said.
    Glendening's communications director said complaints from those testifying yesterday were similar to those the governor hears from numerous interest groups that want more money from the state. "The governor has given them a good, solid allotment," said Michael Morrill. "There's a lot of good things that the governor supports and wants to spend money on." State health officials also tried to assure lawmakers that the mental health system is not on the verge of collapse, as some of the providers suggested. "This is a great program," said Georges C. Benjamin, secretary of health and mental hygiene. "At the end of the day, it will be adequately funded."
    Mental health care in Maryland has faced financial strain since 1997, when the state changed the way it pays providers for the care they offer to poor and uninsured mentally ill patients. Instead of paying for care in yearly grants, the state decided to reimburse clinics and hospitals in much the same way private insurers pay doctors -- offering a set fee for every service caregivers provide and reimbursing them only after they submit claims detailing what care was given. The system was widely viewed as an ambitious way to get more care to more of those who need it, including those who lack insurance. But the state underestimated just how many patients would suddenly demand, and qualify, for care. Powell blamed the deluge of patients for the department's current debt of $23 million and projected it would cause additional overruns of $19 million this fiscal year.
    Although state officials told lawmakers they expect the financial picture to improve, representatives from psychiatric clinics and private hospitals said they worry that the situation is worsening. "Outpatient mental health clinics face severe financial problems," said Richard H. Bayer, chief executive of a 1,200-patient clinic in Elkton. "Each year has seen an increase in the number of providers who have gone out of business." Bruce T. Taylor, chief executive of Taylor Manor, a private psychiatric hospital in Howard County, added: "A year ago I wrote the governor to tell him we were in a crisis. I can tell you that since then, we've gone from bad to worse." Mental health care providers' greatest concern is the possibility of more hospitals shutting down, because, they said, the state already faces of shortage of space for long-term psychiatric patients. In recent years, one mental hospital has closed and two more have declared bankruptcy.
    Members of the House Appropriations health and human resources subcommittee remained mostly silent during the first hours of the hearing. But Del. Martha S. Klima (R-Baltimore County) said afterward that she found the testimony "alarming, to say the least." "I don't know where we're going to get the money to deal with this," Klima said. Del. Samuel I. Rosenberg (D-Baltimore), who chairs the subcommittee, reminded those at the hearing that there is only one place to get it. "Only one person can put this money in the budget," Rosenberg said, referring to Glendening. "But we can certainly urge him to do it."

Maryland DWI Crackdown Gains Steam
Daniel LeDuc, Washington Post- 2/14/2001

Momentum is building in Annapolis for new crackdowns on drunk drivers as Maryland lawmakers this week begin to consider a range of proposals that includes lowering the blood alcohol limit for motorists, increasing sanctions for repeat offenders and closing a loophole that allows drivers to refuse a breathalyzer test. Advocates for tougher drunken driving penalties say this year's General Assembly session appears to be their best chance in years for passing some of their most long-sought legislation. Even legislators who have resisted the initiatives in the past say this year's efforts appear nearly inevitable.
    The momentum is driven by a federal law passed last summer that links federal highway aid to states lowering the legal limit to 0.08 blood alcohol content, passing penalties on repeat drunk drivers and prohibiting drivers and passengers from having open containers of alcohol. This year, for the first time, Gov. Parris N. Glendening (D) also has added drunken driving reform to his list of priorities. Lt. Gov. Kathleen Kennedy Townsend (D) will be the administration's main lobbyist on the proposals; she will hold a news conference with other advocates today. Advocates also cite increased media attention, including a Washington Post series last fall that described how repeat offenders routinely refuse breathalyzer tests and receive relatively light sentences. The financial pressure -- with $173 million in federal money over the next six years at stake -- has been felt by Maryland legislators, as has Glendening's influence. Lawmakers have responded with a record number of drunken driving proposals this year: At least 35 bills are pending, a dozen more than in any of the previous five years.
    "It's just been dismal what's happened in Maryland the past few years. It's very frustrating," said Wendy Hamilton, Maryland policy director for Mothers Against Drunk Driving. But there is reason for hope this year, she said. "We've been hearing a lot of good things -- and from people who have not always said outwardly that [these reforms are] a good thing."
    Lobbyists for liquor and beer companies have mixed views on whether to support lowering the legal limit to 0.08, but most have said they'll support other crackdowns. "Miller Brewing Company is willing to support lowering the DWI to 0.08, given the federal mandate," said Miller's Annapolis lobbyist, William Pitcher. "But it still feels that isn't going to solve the problem. We believe it should be coupled with increased penalties for 1.5 [blood alcohol content] and repeat offenders." House Judiciary Committee Chairman Joseph F. Vallario Jr. (D-Prince George's), a lawyer who represents drunk drivers, has resisted many of MADD's proposals in past years. Vallario's committee will hold hearings on the legislation next week; he has not indicated his position this year.
    House Speaker Casper R. Taylor Jr. (D-Allegany) has made lowering the blood alcohol content one of his priorities for the session, assigning it a low bill number, House Bill 3, as a sign of its importance. (Virginia and the District have already adopted 0.08.) "There's definitely going to be significant pressure to do something this year," said Del. Dana Lee Dembrow (D-Montgomery), who serves on the Judiciary Committee. In the past, he has resisted efforts to lower the blood alcohol content and prohibit passengers from drinking while in a car, calling such efforts "anti-alcohol political correctness."  Current Maryland law allows drivers with a blood alcohol content from 0.07 and 0.1 to be charged with driving under the influence, a lesser charge than driving while intoxicated but one that can carry significant penalties. Dembrow said that shows that Maryland's laws are adequate, but he appeared resigned to the momentum. "We'll give them 0.08. We'll be politically correct, and we'll get our highway money," he said.
    In the Senate, the influential Judicial Proceedings Committee chairman, Walter M. Baker (D-Cecil), has resisted many drunken driving proposals in the past. But this year, said he is amenable to many of them, including changing the current law, which says that drivers can refuse breathalyzers and that judges and juries can draw no inference of guilt from that refusal. "It's a good prosecutorial tool, and it's proven to be reliable. Why not use it?" he said of the breathalyzer standard. His committee will hold hearings tomorrow.
    Last year, the House passed legislation that would have ended the presumption of innocence for anyone refusing a breathalyzer test, but it died in Baker's Senate committee. Virginia breathalyzer laws are similar to Maryland's; its legislature is also considering legislation to end the presumption of innocence. In Annapolis, Del. John A. Giannetti Jr. (D-Howard) has reintroduced that legislation, HB 338, and has proposed making refusing a breathalyzer test a crime, HB 834, which nine states currently do. "We want to remove any advantage to refusing the test," Giannetti said. "We're getting more and more refusals, and we've got to do something about it."

Dialing Help for Abused Women
Katherine Zezima, Boston Globe- 2/15/2001

Offering the city's imprimatur to an innovative new way to protect victims of domestic violence, Mayor Thomas M. Menino yesterday challenged cellular phone owners in Boston and across the state to donate their old phones to victims so they can call for help any time, any place. Menino says he hopes socially conscious consumers who accumulate outmoded cellphones as they upgrade to newer models or switch to other service providers will consider his proposal - which might save lives and should provide comfort to thousands of low-income women who have been victims of domestic abuse. Encouraged by successful drives in Chicago and Rhode Island, Menino announced the new program along with Jane Doe Inc., the state's coalition against domestic violence, and Nextel Communications, which will preprogram all donated phones to direct-dial the police and a statewide domestic violence hot line at one touch.
    ''I think that having the cellphone will be much more effective than having the bat in my hand. That's not going to get the police to come,'' Danielle Hawkes, a 41-year-old mother of four, said yesterday. ''This is an immediate weapon. It's a weapon that lasts.'' For the last six years, a baseball bat has shared Hawkes's bed, laid across the space where her husband used to sleep. Yesterday, Hawkes gave up the 38-inch blue wooden Wilson.
    The bat-cell swap was made possible by Donate a Phone, an expansion of Call to Protect, a national organization that fights domestic violence. Founded in 1999 by the Wireless Foundation, the National Coalition Against Domestic Violence, and Motorola, the nonprofit agency provides new phone numbers and free emergency air time to women in danger. The phones are distributed to victims' aid programs and battered women's shelters.
    Though the plea to the public is new to Boston, the cellphone donation idea is not. In 1996, the Boston Police Department's domestic violence unit launched a panic-phone program with phones donated by Cellular One. The department received 50 phones, each programmed to dial Boston's 911. If a call was placed outside the 617 area code, State Police were contacted. In March 1998, Governor Paul Cellucci initiated a plan to distribute 600 cellular phones to the state's 32 battered-women's shelters. Similar programs were launched in Dedham, Marlborough, and Framingham.
    Sergeant Detective Margot Hill, commander of the Boston Police Department's Domestic Violence Unit, said the cellular phone is a resource that can be used as a key part of a safety plan, something she thinks all victims of domestic violence should draft. ''It's another level of support for victims, that shows that we're all about providing immediate support in a dangerous situation,'' Hill said. ''It not only reassures victims that they have access to a communication device that allows them to get a response from local police, but that that level of security is with them wherever they go.''

Vermont Senate Committee Plans Action on Drug Plan
Ross Sneyd, Associated Press, 2/14/2001

MONTPELIER, Vt.--Senators are poised to rescue the governor's money to fight heroin at the local level, but they're on a collision course with him over treating heroin addicts. The Senate Appropriations Committee supports Gov. Howard Dean's request to send $230,000 from the state budget surplus to local law enforcement agencies to combat the spread of illegal drugs. The House voted against that proposal last week.
    But the budget adjustment act now pending in the Senate could face a Dean veto over how to treat heroin addicts. The Senate committee wants to recraft some of the regulations governing clinics that dispense methadone for heroin treatment, allowing addicts to take doses of methadone home with them for perhaps a week at a time. That infuriates Dean. ''I will not allow, to the best of my ability, methadone to enter our communities,'' Dean said, his face reddening in anger at a news conference.
    Methadone is addictive, just as heroin is. But it is prescribed to replace the addiction to heroin, a drug that is debilitating and illegal. Clinics typically require addicts to visit every day early in their treatment regimen to be sure the doses of methadone are taken as prescribed and aren't sold on the street to pay for more heroin. But as the addict increasingly becomes weaned from the effects of heroin, and gets away from the culture of illegal drug use, clinics typically send them home with a dose lasting them a week or more.  Dean argues that those multi-day doses are just going to become another habit for addicts who will seek to sell them illegally, thereby creating a new problem.
    Sen. James Leddy, D-Chittenden, who has a background in substance abuse treatment, disputes that contention and has led the drive to treat addicts with methadone. ''How long are we just going to punish people?'' Leddy said. Under a compromise reached last year, methadone treatment clinics will be permitted only at hospitals. The budget adjustment bill calls for $168,000 to let two clinics open before the end of the budget year on June 30. The House went along with that and the Senate is ready to, as well, but it insists that Dean administration rules preventing take-home doses of methadone be overturned. ''We can't expect and shouldn't require people every single day to have to travel for medication,'' Leddy said. ''It's counterproductive therapeutically.''
    Dean believes allowing methadone into the community, despite controls, threatens to help spread drug abuse into areas of the state where it does not currently exist. ''My job is to balance the good and evil in every program,'' he said. People who take doses of methadone home with them have to undergo urine testing and other monitoring to ensure that they are taking the doses. If they're not, they no longer get to undergo at-home treatment. ''The testimony we received is people who are on take-home are closely monitored and clinics; doctors and technicians know when people are diverting (their doses),'' said Sen. John Bloomer, R-Rutland.
    While the Senate Appropriations Committee and Dean feuded over methadone treatment, the administration unveiled a blueprint for reducing substance abuse, particularly among youth. ''Kids who start drinking early are five times more likely to become alcohol dependent as someone who begins drinking at age 21,'' said Health Commissioner Jan Carney. ''They are also more likely to move into harder drugs, including heroin.'' The plan seeks in the next decade to end alcohol drinking among youngsters 13 years old or younger; reduce the percentage of older teen-agers who have binges of drinking and drive drunk; and eliminate marijuana use among teen-agers.

Domestic Violence Panel's Work Today to Take on New Urgency
Maryanne George, Detroit Free Press- 2/15/2001

Today, prosecutors, judges, police and survivors of domestic violence will ask Lt. Gov. Dick Posthumus to improve the state's efforts to end domestic violence. They'll meet at a public hearing at Wayne State University. Among other things, they'll ask for standardized enforcement of existing laws, including those governing stalking and personal protection orders, a more efficient way for law-enforcement computers to share data and a better system of collecting crime statistics to reflect the true number of domestic violence-related crimes. "If any one of these takes effect, it will be a step forward," said Lisa Ortlieb head of the Oakland County prosecutor's domestic violence unit. "I believe victims of domestic violence can never be protected too much."   The hearing will be the third forum this month conducted by the Domestic Violence Homicide Prevention Task Force, which Posthumus chairs. Domestic violence experts from Oakland County gave their recommendations during the first hearing on Feb. 6.
    Judy Hernandez, 30, of Waterford, was fatally shot early Sunday by her estranged husband, police said. Joy Rumsey's three children were fatally shot in a closet by their father in their home in Katy, Texas, Houston police said. The Rumseys had recently moved to Texas from Hudsonville, near Grand Rapids. Hernandez and Rumsey had made attempts, using police and the court system, to end their violent marriages. But domestic violence experts believe the legal system failed them. Posthumus' task force is looking for ways to close loopholes in the legal system that allow domestic violence cases to end in homicides. The task force will make recommendations to improve state laws later this year, Posthumus said. In 1999, more than 100 women were killed in domestic violence incidents, according to State Police statistics.
    Wayne County Circuit Judge Richard Halloran, a member of the state's Domestic Violence Prevention and Treatment Board, said the Rumsey and Hernandez cases are classic examples of domestic violence. Halloran investigated the cases earlier this week. Hernandez had obtained two personal-protection orders to keep her husband from harming her. But an apparent glitch in a computer system prevented police from arresting him on Saturday because there was no record that Gilbert Hernandez had been properly served with an order. Although Joy Rumsey had tried to divorce her husband, she kept returning to him in Michigan and Texas to protect her children, Halloran said. Despite repeated arrests for aggravated stalking and probation violations, Timothy Rumsey did not appear to spend any significant time in jail, Halloran said. "She didn't think the system would help her and she knew he was using the kids to threaten her, so she stayed with him to protect the kids," Halloran said.
    But experts know that many domestic-violence homicides are preventable if the legal system works and victims are offered adequate resources. In Detroit, domestic homicides have fallen from 78 in 1996 to 38 last year. Officials from the Wayne County Prosecutor's Office say they believe the drop is due to the efforts of the Detroit Police Department's domestic violence unit. Thirty officers, five social workers and a children's therapist work as a team to provide better investigation of domestic violence cases, more services for victims and more accountability for batterers, said Sgt. Dennis Myers, a supervisor of the unit. The unit, which now serves nine police precincts, will expand to include all 13 city precincts by April, he said. "We have investigators who go right to the scene and do an evidence-based investigation, just like a homicide, before it becomes a homicide," Myers said. "They interview the victim and the children. They take photos, collect physical evidence. If we do not have the victim present at the trial, we can present the case without the victim." The unit, which works with the prosecutor's office, also offers therapy for children to break the cycle of domestic violence and a 52-week batterer's counseling program. It also has a crisis intervention specialist to assess the danger of each situation.
    "We know what works," said Nancy Diehl, director of the child and family abuse bureau of the Wayne County Prosecutor's Office and chair of the Wayne County Council Against Family Violence. "Domestic-violence homicides are preventable. In how many other crimes do they leave a road map? They tell you what they're going to do." But she said too often, the legal system views domestic violence as a family problem. If the police and courts don't take it seriously, the victim can't trust them to help.
    To improve the system, the prosecutor's office has initiated a domestic violence fatality review team. Of the eight cases studied so far, all of the victims had called police. Either charges were never brought against assailants or were dismissed at trial, said Emily Wolfe, an assistant Wayne County prosecutor, who heads the team. Lisa Ortlieb, head of the Oakland County prosecutor's domestic violence unit, said Oakland County is considering a homicide review unit similar to the one in Wayne County. That would dovetail with Oakland's increasing emphasis on prosecuting abusers. A staff of five assistant prosecutors, a paralegal and a victim's advocate are dedicated solely to domestic violence cases, which number roughly 800 per year in Oakland. Prosecutors devoted to the cases have increased by 150 percent since the unit was created in 1992, Ortlieb said.  But it often takes high-profile tragedies like the Waterford and Texas slayings to focus attention on the need, she said. "They're so tragic, and so high profile people pay attention," she said.

Anna Webster, a Wayne County woman who escaped a violent marriage, will testify at today's hearing about her experiences. "I want to tell people not to give up," Webster said. "Personal protection orders are not infallible, but they can be one more tool. If we arm ourselves with enough tools, we can be free."

Suspect in Officers' Slayings Battled Schizophrenia
Manuel Roig-Franzia- Washington Post- 2/15/2001

CENTREVILLE, Md., Feb. 14 -- A wrenching cycle of psychiatric hospital stays and arrests for violent outbursts mark the troubled life of a schizophrenic man accused of killing two law enforcement officers in this quiet Eastern Shore town. Francis Mario Zito, 42, was charged with murder today and held without bond in the shooting deaths of Queen Anne's County Sheriff's Deputy Jason C. Schwenz, 28, and Centreville Officer Michael Nickerson, 26, whose fiancees were left to mourn on Valentine's Day. The two were called to Zito's home last night at 8:30 after a neighbor complained about loud music, Sheriff's Capt. Curtis Benton said.
    When they arrived, Zito refused to come out, rebuffing the pleas of both the officers and his mother, Betty Zito, who lived in the same trailer park, said next-door neighbor Doug Larrimore. Minutes later, Zito allegedly unleashed a volley of 12-gauge shotgun blasts through the screen door of his sagging trailer park home, police said. A third office who had arrived, State Trooper Richard Skidmore, ran into the park's central yard, hollering, "Officer down!" Larrimore said. "It was chaos." The trooper doused Zito with Mace or pepper spray, Larrimore said, then handcuffed him. Schwenz died at the scene, Benton said, and Nickerson was pronounced dead after being taken to Maryland Shock Trauma Center in Baltimore.
    Zito's home was familiar ground for police in Centreville. They had been called there numerous times, most recently on the night before the killing, when Larrimore said his neighbor agreed to lower the blaring Southern Rock music pouring out of his home. As recently as Jan. 21, Zito's mother asked court officials to order an emergency psychiatric evaluation of her son because he had screamed and sworn at her, threatening "to break my bones," according to a court filing. At age 8 or 9, Zito was treated with the antidepressant Thorazine, according to a psychiatric evaluation included in his court record. Schizophrenia and manic depression were diagnosed during at least a dozen hospitalizations over the last two decades, the report states. His condition has worsened because of his refusal to take prescribed medication, the report states. However, the June 1999 report states that Zito was competent to stand trial for weapons and assault charges, and he was found guilty of second-degree assault against his mother Feb. 18, 2000. He had also been accused of kicking his mother in 1997. Court documents also show that a protective order was filed against him in September because a Centreville woman said he was making harassing phone calls.
    Neighbors know Zito as a troubled but essentially innocuous man. He was often seen in the parking lot of Corsica's Lighthouse Pub, two blocks from his home, "talking to the Dumpster," bar patron Ed Falcey said. At other times, Zito would point his finger like a gun and pretend to fire at passing cars. Pub owner Chris Kelbaugh had long ago banned Zito from his property. Kelbaugh sat below the huge stuffed bear's head in his bar today, wondering aloud with the lunchtime regulars about why Zito was not permanently institutionalized. "It shouldn't have happened. He fell through the cracks," Kelbaugh said.

Washington, D.C. Family Mourns Slain Woman Who Kept Fighting Son's Schizophrenia
Maureen O'Hagan, Washington Post- 2/16/2001

Mary Jane Hawkes was at the stove making dinner Sunday afternoon, just like usual, when her son burst through the door, angry and delusional. It was a moment the close-knit Howard County family had feared. According to police, Ben Hawkes, 25, bludgeoned his beloved mother to death, then turned his rage on a family friend, Teena Wu, who had been living in their Dorsey Hall home and attending Howard Community College. Wu, 18, also died at the scene.
    For years, Mary Jane Hawkes, 59, had battled her son's schizophrenia. In the past, he had assaulted his father, terrorized her and a sister and at one point wound up on the streets because of the devastating disease, according to family members. "We lived in terror for several years in our home," Glenn Hawkes Sr. said yesterday at his wife's funeral. "It wasn't constant, but it was very, very real. We never conceived it would come to this." Mary Jane Hawkes least of all. According to those who loved her, Mary Jane was Ben's most staunch supporter. Although a constant worry, her fourth son's troubles were a challenge that she refused to back away from.
    As the Hawkes family yesterday endured the first of two funerals -- the second will be in Utah, where many relatives live -- they still spoke proudly of the love Mary Jane had for Ben.  "Tell him that I love him and I do completely," she wrote to her son Peter in 1996, when Ben was staying with him, long after Ben had withdrawn from his three other brothers and two sisters. "He is a good boy." When he refused to eat her food because his illness made him think it was poison, she loved him more. "And that's what my mom's all about . . . feeding people," Nathan Hawkes said in an interview. When Ben was jailed for marijuana possession, she wrote long and poetic letters about how she longed to see his face.  Mary Jane Hawkes, her grieving family told those assembled at the Ellicott City Mormon chapel yesterday, was a woman who never gave up.
    In an interview, Nathan Hawkes said the family noticed that his brother Ben began acting somewhat oddly when he was in high school. "We didn't know it was mental illness for a long time," he said. "We thought it was drug abuse." Ben used marijuana and alcohol and spent several months in jail on drug charges. But on New Year's Day 2000, Nathan said, "it became really clear he was psychotic." Ben was terrorizing his mother and sister, Nathan said, busting down doors, punching holes in walls and at one point running around naked and delusional. The family and police persuaded him to seek treatment.
    Ben did well on antipsychotic medications, according to Nathan, but didn't like the side effects, which included weight gain and lethargy. Off the medications, "he started cycling on back down to where he was before," Nathan said. After the New Year's Day incident, Nathan said his mother and father were reluctant to take Ben back into their home, where the younger daughter, Katie, still lived. "He was on the streets for a while, in the cold last year. I think they had a hard time with that," Nathan said. In the end, they decided they would do everything to help their son.
    Last Thursday, Mary Jane Hawkes called a neighbor who is also a mental health worker and asked her for help. On Friday, she asked her son Tim to find some mental health hot line numbers. That afternoon, Ben Hawkes visited the Woodside Clinic, a Howard County mental health provider, according to family members and Jane Walker, the neighbor. Nathan Hawkes said Ben was told to come back in two weeks for an evaluation. "My parents tried to get that date changed, but nobody would budge," he said. On Saturday, more desperate, Ben and his father went to the Howard County General Hospital emergency room. Doctors gave him a tranquilizer and a prescription for an antipsychotic drug and sent him on his way, Nathan said. The next day, his mother and Wu were dead.
    Now, the family has to contend with not only Mary Jane Hawkes's death, but also the loss of a brother, whom they remember as a talented artist, a gifted writer and a fiercely competitive basketball player. "In a way, we feel like he has been taken from us, too," Tim Hawkes said at yesterday's funeral. "All the hope that we had for Ben that he might find peace and joy in this life is gone." Ben Hawkes is being evaluated at Clifton T. Perkins Hospital, a state psychiatric hospital, held under a warrant for murder. "If he is stabilized, I don't think he's going to want to stay alive," Nathan Hawkes said. "If he isn't stabilized, I want him locked up. I don't feel very safe."

California Lacks Resources for New Law on Drug Offenders
Fox Butterfield, New York Times- 2/16/2001

LONG BEACH, California--Sgt. Walt Turley has been on the Long Beach police force for 26 years, long enough to know that many of the drug addicts he arrests wind up back on the street, and long enough to know that prison sentences alone will never solve the nation's drug problem. But Sergeant Turley is worried that Proposition 36, a new law that sentences drug offenders to treatment rather than prison, is also in danger of failing when it goes into effect on July 1. There isn't enough money for good treatment, and there isn't enough coercion for judges to keep the hammer over addicts without the threat of jail," Sergeant Turley said.
    It is a concern shared by the police, judges, prosecutors, probation officers and officials of drug treatment agencies in Long Beach and around California as the state rushes to find ways to carry out the new law, the most sweeping change in its criminal justice system in decades and one that was approved overwhelmingly in November. It is not that these authorities disagree with the goal of Proposition 36, which is to provide drug treatment instead of prison for first-and second-time offenders who are not charged with other crimes. Overwhelmingly, they agree, treatment can work. But they worry that the law was hastily written, without sufficient money or authority for treatment programs, and they see a cascading number of unintended consequences. Will drug addicts refuse to plead guilty, for example, and take their chances on a trial, because the worst that can happen to them is to be sentenced to treatment? That could cause havoc in the state's courts, where more than 95 percent of drug offenders plead guilty, saving the courts significant time and money. Moreover, who will make sure the addicts will go from the courtrooms to the new treatment centers, and how will they be tested to make sure they are drug free, since there is on money in the new law to address either of these problems?
    "Frankly, I think this could work, if it were better funded," said Lael Rubin, special assistant tot the Los Angeles County District Attorney and a member of a task force appointed by the Los Angeles Board of Supervisors to find ways to carry out the new law. "We believe in drug treatment, we want it to work," Ms. Rubin said. "But this is our dilemma. We're afraid if this fails, people will want to go back to the lock them up days."
    Even a number of treatment centers, for whom the new law could prove a bonanza, are skeptical. "The language of Proposition 36 did not define the assessment criteria to determine what kind of treatment an addict needs, or where they will be placed, which are critical issues," said Elizabeth Stanley Salazar, regional director of Phoenix House, a national nonprofit drug treatment agency. "The most significant indicator of success, we know from years of experience is time in treatment, but the backers of Proposition 36 seem to believe that most people only need outpatient services, or literacy training, when we think they may be hard-core addicts who need long-term residential care, which is much more expensive." Already, Ms. Rubin and other Los Angeles officials have been to Sacramento to lobby the Legislature for more money to carry out the new law. Unfortunately, right now the Legislature is focused on only one thing--California's power crisis.
    California's prison population exploded to 161,000 at the end of 2000 from roughly 30,000 in 1980, with one-third of those inmates serving time for a drug-related crime, more per capita than in any other state. In the mid-1990's, as California began to spend more on its prisons than on its state college and university system, voters began to question appropriations for prison construction.
    Proposition 36 was financed by three businessmen: George Soros, the New York investment billionaire; Peter Lewis, chief executive officer of Progressive Insurance in Cleveland; and John Sperling, the founder and chief executive officer of the University of Phoenix, a network of private educational institutions. Their main argument was that the nation's drug war had failed. And the initiative in California came at a time when voters and politicians in other states, too, were expressing disenchantment with the war on drugs. Last month, Governor George E. Patiaki of New York proposed softening the harsh Rockerfeller-era drug laws, allowing shorter prison terms for nonviolent drug offenses and giving judges the discretion to offer treatment instead of incarceration.
    Voters in California may also have been influenced by the success of the state's specialized drug courts. Los Angeles County alone has 12 drug courts, in which drug addicts who waive their rights and agree to be sentenced by the courts receive treatment instead of prison time, unless they repeatedly fail or drop out. Michael Tynan, the supervising judge of drug courts for Los Angeles County, said the addicts he supervises had a success rate of 75 percent. But it is not an easy program. Most of the defendants who agree to enter the program, Judge Tynan said, are hard-core addicts and have already been in prison. At first he puts them in intensive treatment for 12 to 15 hours a day in the Los Angeles jail. After that, they are put on probation for up to five years, with drug tests four times a week, and are required to stay in treatment centers. He can send them back to jail if they fail a test.
    "Drug court judges who have experience dealing with addicts believe you need sanctions, the hammer to put these folks back in jail," Judge Tynan said. "Their major problem is not criminality, but drug addiction." That is why, Judge Tynan said, he is skeptical about how well Proposition 36 will work. After a defendant is sentenced to treatment, a judge will have no more authority over the person. "The lack of a hammer is a real problem," he said.
    The supporters of Proposition 36 provided $120 million a year for treatment statewide, estimating that there would be 36,000 addicts who would be eligible. Addicts arrested on other charges--for burglary, robbery, drug sales or possession of a gun--would not be eligible. But Maria Luna, a former drug court judge who is now chairperson of the Los Angeles County task force to carry out Proposition 36, estimates that Los Angeles alone will have 24,000 defendants eligible for treatment. A year of outpatient services for a drug addict comes to $4,000, Judge Luna said, or $96 million alone for the 24,000 new offenders in Los Angeles. Many offenders need more costly inpatient treatment. In addition, Proposition 36 prohibits using the new money for drug testing, which at $8 a test, four times a week, could cost Los Angeles another $10 million a year.
    The new law also does not provide money for additional probation officers, a serious flaw, since probation officers in Los Angeles often have case loads of 1,000 offenders. There are also questions about where the new treatment services will come from. It can take two years to overcome neighborhood opposition to a new drug treatment center, said Ms. Salazar of Phoenix House. Sergeant Turley in Long Beach worries about he practical effect of the new law on police officers and citizens. "From the point of view of a street cop," he said, "humping and grinding in his black and white, what happens when he makes a drug arrest, then has to do two hours of paper work, then has to go to court, only to see the knucklehead right back on the street because he skipped out on his treatment?"

Freud, Influential Yet Unloved
Jared Diamond, New York Times- 2/17/2001

Have any individuals really made a major, lasting difference to the course of science? More specifically, would their discoveries or conceptualizations have eluded other scientists until decades later if these individuals had not been born, and did their contributions have a unique impact that persisted long afterward? By those two criteria, I think that only two scientists within the last two centuries clearly qualify as irreplaceable: Charles Darwin and Sigmund Freud. (I feel unsure whether Albert Einstein's impact was as far-reaching.)
    To begin with, Darwin and Freud were both multifaceted geniuses with many talents in common. Both were great observers, attuned to perceiving in familiar phenomena a significance that had escaped almost everyone else. Searching with insatiable curiosity for underlying explanations, both did far more than discover new facts or solve circumscribed problems, such as the structure of DNA: they synthesized knowledge from a wide range of fields and created new conceptual frameworks, large parts of which are still accepted today. Both were prolific writers and forceful communicators who eventually converted many or most of their contemporaries to their positions.
    Darwin's contributions came at a time when almost everyone (including scientists) believed in the divine and independent creation of species, and when scientists were recognizing patterns in the burgeoning discoveries about fossils, taxonomy and biogeography but still lacked explanations for those patterns. Freud's contributions came at a time when interest in mental illness and its classification was growing but its etiology was virtually unknown and treatments were mostly ineffective--in part because clinicians and researchers were still focused on conscious, cognitive processes. Freud's status is unique because he recognized an entirely different mental realm, and many of his concepts--pioneering and radical in their time--are so familiar today that they have entered the daily vocabulary of the general public.
    Yet today we seem much more inclined to castigate Freud for his omissions and errors than Darwin for his. I suspect that there are two reasons for our differing attitudes toward these two pioneers. One is that Freud's failures, unlike Darwin's, have had a direct impact on the lives of individual human beings. Most of us don't suffer as a result of Darwin's having eventually attributed too much scope to the process termed sympatric speciation than it actually deserves. But a powerful man's mistaken ideas about women have certainly caused suffering, just as victims of child abuse have been made to suffer when the reality of their trauma has been denied.
    The other reason we are inclined to judge Freud more harshly than Darwin is that these two scientists were near opposites in their relations with peers. In this regard, we find much to admire in Darwin and much to deplore in Freud. Darwin was outstandingly generous in crediting others--including, most notably, Alfred Russell Wallace--for their work. Freud, on the other hand, was outstandingly ungenerous: he denied credit to others, was intolerant of rivals, hated many people, and surrounded himself with unquestioningly loyal admirers.
    Both Darwin and Freud have had their detractors, and the ideas of both men initially faced fierce opposition. Today very few scientists hold low opinions of Darwin, either as a person or as a scientist. The overwhelming majority of those who fundamentally disagree with Darwin's findings today are not scientists at all, but creationists, who do not engage seriously with the facts of biology. Virtually no contemporary scientists believe that Darwin was basically wrong. Since Darwin's time, we have of course discovered masses of new facts, formulated new concepts, and advanced beyond many of his specific interpretations, but modern biologists still consider themselves to be Darwin's intellectual descendants, working within his tradition. By contrast, Freud's detractors remain numerous, even though they take for granted many of his concepts and contributions.
    I acknowledge a legitimate moral base underlying such Freud-bashing: the human consequences of his scientific errors, and his often ugly interpersonal relations. But there are two other types of Freud-bashing that are not defensible. One consists of pointing out all the new things learned and all the new therapies devised since Freud, as if these represent his failures or demonstrate the uselessness of his work. The other type of Freud-bashing--much more damaging because it hurts patients--comes from a too-narrow focus on biological psychiatry. I fully accept the importance of biological psychiatry, having devoted some of my own research to problems in that area (neuro-transmitters and manic-depressive illness). . .But now the pendulum has swung to the opposite extreme: psychiatry departments have become bastions of molecular biology, at which much more time is devoted to studying and teaching psychopharmacology than to what are called talk therapies.
    To my mind, academe's swing away from talk therapies is tragic. Major advances are still being made in this field--for instance, in crisis counseling and child and family therapy. Even specialists in biological psychiatry need thorough training in talk therapies, because it can be difficult to figure out whether a patient's problems have a primarily biological or primarily non-biological basis. Even clients whose problems are probably fundamentally biological (such as in manic-depressive illness) tend to have associated psychological issues that need attention. Physicians who rely heavily on prescribing drugs often don't take time to establish a relationship with a patient, regularly forget that the patient and physician are locked in an emotionally charged relationship, and then are surprised at how often patients fail to take the drugs prescribed for them. Understanding that unique two-way relationship was one of the deep and far-reaching insights that put Freud right up there with Darwin.

Ritalin Use, Debate, Both Rising
Patti Brandt, Bay City Times- 2/18/2001

For Jody Drouin, it doesn't matter that Michigan ranks third in the nation in Ritalin consumption - she's just happy there's an effective treatment for attention deficit hyperactivity disorder. The Auburn woman's 10-year-old son was put on Ritalin, the most common brand name for methylphenidate, a central nervous system stimulant, when he was 7 years old. Ritalin is considered the drug of choice by many pediatricians and psychiatrists for treating children with hyperactivity or attention deficit disorder. It is frequently prescribed. Maybe too frequently, some say.
    According to the latest figures from the U.S. Department of Justice Drug Enforcement Administration, in 1989, 121 grams were consumed per 10,000 people. Ten years later, in 1999, Michigan consumed 485 grams of the drug per 10,000 people, an increase of more than 300 percent. A typical dose of the drug is five to 20 milligrams given two to three times per day. A milligram is a thousandth of a gram. About 90 percent of prescriptions written for Ritalin are going to children.
    Ritalin's detractors, those who want to reform the way drugs are used in school children, have accused schools of relying on the drug to control a student's "bad" behavior instead of dealing with underlying issues that may be causing problems, and of creating a nation of addicts. They have also accused the American Psychiatric Association and the Novartis Pharmaceutical Corp., the maker of Ritalin, of promoting the idea that many children have the disorder as a way to create a market for the drug. In fact, class-action lawsuits have been filed in Texas, California and New Jersey alleging that the medication has been grossly overprescribed. The Texas suit even goes so far as to say the American Psychiatric Association received money from Ritalin manufacturers for encouraging the diagnosis of the disorder.
    But experts say the drug, which stimulates neurotransmitter chemicals in the part of the brain that controls short-term memory, focusing, motor planning and organization, gives these children better control over their own behavior and the ability to concentrate.  Russell A. Barkley, professor of psychiatry and neurology at the University of Massachusetts Medical School and a nationally recognized expert on the disorder, says Ritalin and other stimulants, when combined with accurate diagnosis and counseling, are the safest kinds of drugs to give for the disorder. He also says that stimulants do not cause addiction when used as prescribed.
    Becky Scheerhorn, principal at Bangor's Lincoln Elementary School, said that Ritalin is suggested as a last resort by teachers at her school. Out of more than 300 pupils, six have Ritalin or other stimulants dispensed to them by the school, she said. Some may receive a timed-release form of the drug that would be given at home, but she has no way to track those students. "There's been a lot of hype in the media about Ritalin, both pro and con. We are finding more and more physicians becoming cautious about giving it," Scheerhorn said. Schools and teachers do not put children on Ritalin, she said. Parents and physicians do. "Certainly, teachers make families aware that a child is standing out in a way that's not productive, but the parents decide whether to put a child on medication," Scheerhorn said.
    Drouin's story is familiar to many who have had to deal with a child who can't sit still, can't concentrate, just can't learn. Drouin's son was put on Ritalin three years ago. Drouin held off on the medication for the first year her son was in school, not wanting her child to be "on drugs." Although he was very active, she said, his kindergarten teacher allowed his rambunctious behavior, and worked with Drouin on behavior modifications. But by the first grade, school is more structured, more disciplined. Children are expected to sit for longer periods of time and listen. "He couldn't do those kinds of things," she said, and his behavior became a problem - to the teacher, other students, and most of all to himself. "Nobody likes to have their kids on drugs, but sometimes it's necessary. He was the one being hurt by my decision not to do that. He was the one who had to suffer the consequences," Drouin said.
    Her son now has no discipline problems at school and his grades have improved, she said. "In the beginning, I felt guilty. But in the end, when I saw the results - his grades and the fact that he was able to do his work - it just got reinforced that he needed it." Drouin's physician switched her son's medication to Adderal about a year ago because of behavior problems he was having when the Ritalin began to wear off. Adderal is an amphetamine that acts in much the same way as Ritalin. "The yelling, the screaming, the throwing of things ... he doesn't have anger outbursts like he did when he was coming down off the Ritalin." Her son takes a dose of the drug in the morning, at 1 p.m., and again when he gets home from school if he has homework to do - which is most days.
    Ritalin, which lasts about four hours, often has to be dispensed by a child's school, which can make some children uncomfortable. But it also can be given in a sustained-release form that only needs to be taken once, in the morning. Lisa Gano is a school social worker with Bay City Public Schools. She is often the first person seen by a child with behavior problems. When a teacher sees that a child is having problems, the school will contact a parent and may suggest that the child be taken to a pediatrician to see if there is a medical reason for his or her behavior. Or they will ask a school social worker to evaluate a child for attention deficit hyperactivity disorder, Gano said, and that evaluation is only done with a parent's permission. "That suggestion is based on a teacher's experience with ADHD. Teachers are good at knowing what's typical behavior. The national norm for kids with ADHD is 3 to 5 percent, so they know what it looks like."
    Studies show that the disorder often goes hand in hand with other disorders, Gano said. Disorders like oppositional defiant disorder, conduct disorder, anxiety, depression, and bipolar disorder, have "acting out" symptoms, or angry, hostile behaviors. These symptoms may prompt a child to be misdiagnosed with attention deficit hyperactivity disorder when, in fact, they do not have it. "There are a lot of kids with behavior problems, but it is not due to ADHD," Gano said. The number of children in Bay City schools with the disorder is actually quite low, Gano said.
    Statistics from the U.S. Drug Enforcement Administration back this up. In the U.S. Postal Service zip code areas that begin with 487, which cover most of Bay County, in 1999 357 grams of methylphenidate were consumed per 10,000 people; the lowest in the state except for the city of Detroit, where that rate is 187 grams. Children who have an attention deficit disorder without hyperactivity are not as easily noticed, Gano said. "The child that is just sitting there quietly doesn't get noticed. A lot of times they look like they are working because they are doodling on their paper. A lot of times people say, "Oh, they just need to buckle down,' or, "they just need to work harder,' Gano said. "Kids who act out get noticed more, because it's real obvious. Attention deficit disorder is not so obvious."   And what works best for these children is medication, Gano said. Of the stimulants used, Ritalin is the No. 1 choice.
    While the high number of children in Michigan who are on Ritalin seems to point to more children with the disorder, Dr. Debbie Filek, a Bay City pediatrician, says that's not true. "There is nothing different about Michigan in itself," she said. "ADHD is not more prevalent here. But there may be better systems in place for evaluating those children and identifying them."  Filek admits there is probably some overuse of the drug. "Even in the states where it is prescribed the least, there are probably some kids who get it and don't need it," Filek said.  A Duke University study done on a group of school-age children in North Carolina between 1992 and 1996 seems to confirm Filek's observation. Researchers found that while one-quarter of the children with confirmed attention deficit hyperactivity disorder were not receiving stimulant therapy, more than half of the children who were receiving stimulants did not meet the criteria for the disorder.  While teachers today are trained to handle children with all sorts of problems, Filek said, there is that rare teacher who cannot tolerate any misbehaving and feels those children all need to be on Ritalin.
    "There are some teachers who just think that a child should just sit in their seat all the time. They think because a kid is a little bouncy he needs this medication. There are individual teachers here who are very intolerant of these types of behaviors." Education is the key, she said. And Drouin agrees. "If you are going to use Ritalin or Adderal, you still need the counseling to help them (children with the disorder) learn to channel that energy to the positive so that they can eventually be off it. It's not a quick fix," Drouin said.

The Study and Treatment of Women's Sexual Dysfunction Comes to Los Angeles
Shari Roan, Los Angeles Times- 2/18/2001

Jennifer and Laura Berman didn't go looking to become torchbearers for the female sexuality movement so much as it came looking for them. When the two sisters--one a urologist, the other a psychotherapist--set up practice together at a low-profile Boston urology clinic in 1998, their goal was to improve the treatments available for women suffering from sexual disorders. Their timing, as it turned out, was perfect. The male impotency drug Viagra was grabbing worldwide headlines, prompting public debate for the first time about why similar effective treatments were not available for women. Within the year, more headlines: A major research study found that 43% of U.S. women experience sexual dysfunction. Interest in women's sexual health issues was peaking after years of inattention. In the meantime, the Bermans were gaining a reputation in Boston for their innovative work. Patients were waiting four months to get an appointment with the young and enthusiastic sisters known for their willingness to try novel therapies.
    By last year, the Bermans had emerged as the female sexuality experts in the media, appearing in Newsweek and Vogue and on "Good Morning America" and "Larry King Live." It didn't hurt that Jennifer, 36, and Laura, 32, are attractive and photogenic. "They have been in the right place at the right time," says Janell Carroll, a Hartford, Conn., sex therapist who is familiar with the Bermans' work. "There is a lot of attention being paid to female sexuality right now." And that attention didn't go unnoticed at UCLA, which recruited the sisters to head up a new clinic, the Female Sexual Medicine Center, which opens later this month. "They're a dynamic duo," says Dr. Shlomo Raz, a professor of urology at UCLA. "One complements the other. Their impact will not only be felt in L.A. I think they'll have an effect on how physicians look at sexuality."
    It was Raz, a leading authority on female urology, who invited the Bermans to join UCLA in hopes of establishing a leading female sexual dysfunction clinic in sexually liberated, media-friendly Los Angeles. Jennifer, the urologist, had been working with Raz since last summer, when she left Boston to begin a one-year fellowship with the UCLA doctor. The sisters were "impressed with how open UCLA was to our vision," says psychotherapist Laura. It was a vision that included an environment in which the university would enthusiastically support, rather than shy away from, a research program on female sexual dysfunction. The sisters made "great strides" in their research in Boston, but, she says, that city's more conservative climate was a detriment to securing research funds in their field.

Treating the Mind as Well as the Body
While the Boston clinic was among the first female sexuality centers in the country, UCLA hopes to take the concept much further. For example, the clinic--which is yet to be built--will be devoted to both research and treatment of a wide range of psychological, hormonal and urological conditions that interfere with sex--from relationship problems to menopause to pelvic pain. For now, the sisters are working from Raz's office near the campus. "As a team, they are the right combination," says Raz. "The psychological part will be covered by Laura; Jennifer will do the medical testing. That will provide the best service."
    Launching a clinic for female sexual dysfunction in an image-conscious city like Los Angeles calls for a certain amount of brashness. Indeed, the Bermans already are wondering how to strike a balance between serious science and celebrity medicine. Though accommodating and friendly to the media--they posed for a glamorous photo shoot in a Vogue magazine article titled "Doctors of Desire"--the sisters also fret about each television appearance and story in the press. "There aren't many role models," says Laura, "for being a scientist and being on 'Oprah.' " The challenge for the Bermans will be to make good use of their fame without falling victim to it, says Dr. Irwin Goldstein, a renowned Boston sex researcher who has been a professional mentor for the sisters. "There are blessings and curses in having significant media attention so early in their careers," says Goldstein. "They could get so carried away with this that they lose their focus. . . . My hope is that they use the media to get patients in the office--but once those patients are in the office, they use good science to move the field along."
    The motivation behind the media appearances, and a new book, "For Women Only" (Henry Holt, 2001), is to educate women about their sexuality, the Bermans say. "What we talk about is based on science," says Laura. "As long as we hold to that, we should be able to keep walking the line. And I think if there is any place to walk that fine line, it's L.A." That fine line between style and substance is complicated by the fact that the science of female sexual dysfunction is in its infancy. Though some new treatments are under investigation, most have not yet undergone rigorous scientific testing. "They have opened everyone's eyes, but this is such a new field," says Carroll. "We don't know what the treatment options really are. We know women's bodies are so much more complicated than men's."
    Carroll and some other sex therapists worry that the Bermans' approach will favor medical solutions, such as drugs, without giving other aspects of sexual dysfunction, such as psychology, lifestyles and relationships, the attention they deserve. The UCLA clinic will be an investigational site for several new drugs for women. "It's kind of scary to think that we have so much research going on to look for a Viagra for women," Carroll says. "Sexual desire is wrapped up in so many others issues. The fact that Jennifer is so involved in those studies makes me worry that they might see only out of that lens." But the sisters point out that Jennifer was the one who urged Laura to join her in practice to address such issues as relationships, loss of interest in sex, previous sexual abuse and other emotional and cognitive issues common to female sexual dysfunction. "I knew I needed someone with a psychological background," says Jennifer.
    The Bermans employ an array of techniques to diagnose female sexual dysfunction, including such tools as vaginal probes, ultrasound and Doppler imaging--to measure sexual response. In a typical exam, Laura does a psychological examination and takes a sexual history. Jennifer then provides a physical examination. Most patients are then asked to sexually self-stimulate in a private exam room while instruments record physiological changes related to arousal. Such a detailed diagnostic approach is not offered in most clinics, says Carroll.

They Give Treatment a Friendly Face
The Bermans possess a kindly manner and confidence that should bode well as they explore a field of medicine that is still largely experimental and untouched by earlier sex researchers such as Alfred Kinsey, William Masters and Virginia Johnson. Their solid credentials make them perfect pitchwomen for female sexual function as a serious and legitimate health issue. "The Bermans have brought this topic out of the closet," Carroll says. "They try to be positive and encourage women to get the help they need."
    Sex was viewed in a positive light in the Berman family--perhaps laying the necessary groundwork for two sisters to end up in the same male-dominated field. Their father was a colon and rectal surgeon and an art lover who collected paintings and sculptures of nudes. "Sex was normalized in our house," says Laura. "It was an open atmosphere. Our parents were interested in our questions about sex." "They just weren't interested in our partaking in it," quips Jennifer. Eventually, the sisters realized they were both interested in careers about sex. Laura had already earned her doctorate, specializing in sexual therapy, when Jennifer, pursuing her urology residency, became aghast at how little was known about female sexual response and decided to specialize in sex, too. They often talked on the phone, says Laura, comparing notes about what they were learning.
    After the residency, Jennifer joined Goldstein at Boston University Medical Center. She urged Laura to join her in the clinic in 1998 when her younger sister, who was living in Spain, decided to end her marriage. Now Jennifer, her husband and toddler live within a few miles of Laura and her young son in Santa Monica. In an interview, they show the typical signs of sibling give-and-take, sharing a late afternoon junk-food snack while occasionally challenging each other's answers to questions. Growing up and throughout their medical training, however, they say they instinctively knew what everyone else around them is just discovering. Says Laura, "We're a good team."

Margot Kidder Becomes Mental Health Advocate
Bettijane Levine, Los Angeles Times- 2/18/2001

HOLLYWOOD -- A few miles east of where Margot Kidder received an award last month for her work in the cause of mental health, a woman marched south on the Hollywood Freeway. Head high and shoulders back, she looked determined and unafraid--a barefoot soldier led into traffic by invisible generals. For a reporter who had just spent the morning with Kidder, the urge was to stop and offer help, to ask the woman: Whose voices are you hearing? Where are they telling you to go? What medications do you have that you are not taking?
    It has been almost five years since Kidder took her own trip into downtown traffic, since what she now refers to as the "Big Flip-Out," "The Incident" or "The Event." It was an episode so publicized that it even reached Beijing via CNN, she says. The actress who'd played Clark Kent's sidekick in four Superman films had been found bruised and babbling in a Glendale backyard, wearing dirty rags and with the caps of her teeth missing. She was whisked to Canada by members of her family for treatment. And that, most people presumed, marked the end of any possible, meaningful public life.
    Kidder, 52, says it marked the beginning. Here she was in Hollywood again--still a working actress, and now an advocate for people who've been dealt some of the same nasty labels she has been subject to for 30 years: schizophrenic, manic depressive, narcissist, sexual hysteric. She is a doting grandma who skis, hikes with her dogs and who says she is in better shape physically and mentally than ever. "After a lifetime of waking up each morning and wondering who is going to come out today," she says, for the last four years she has awakened each day, "and generally I am the same person I was yesterday, and the same the one I will be tomorrow--a fact that is just beginning to cease being a surprise." Since the Big Flip-Out, she has worked in her native Canada and has made one feature film here--"The Annihilation of Fish" (1999), with James Earl Jones and Lynn Redgrave, in which she played an 80-year-old woman. She played a recurring role in the 1996 sitcom "Boston Common."
    Listening to Kidder explain her lifelong struggle, you begin to understand the horror of an illness in which the one thing that allows you to control your actions is the one thing over which you have no control: your mind. Eventually, Kidder accepted a diagnosis of manic depression. The label means little to her. "A diagnosis is just a description of symptoms to guide doctors on how to treat you. A diagnosis does not even hint at the root cause or the possible cure for those symptoms."
    Kidder was in Los Angeles to accept the Courage in Mental Health Award from the California Women's Mental Health Policy Council for her courage in speaking out about mental illness--something few people are willing to do. She holds forth in good humor about the huge problems she believes she has conquered, and that others also might conquer--with a little love and medical luck. Her narrative wanders back and forth, from what she calls pre- to post-cuckoo, about what turns out to have been a lifelong fear that she was going crazy, and a lifelong attempt to hide it. The public never knew, she says, of the many breakdowns she had, even in her 20s and 30s, at her peak of fame in Hollywood.
    She recalls when she wandered the streets, eventually reaching downtown Los Angeles. "One of the extraordinary gifts I got from that flip-out was the experience of the homeless people who took care of me," she says. It began when two men pushing shopping carts said, "`You look a bit confused. Why don't you come with us?' I somehow knew they were safe ... more than safe ... and as we walked to their shanty-town underneath a freeway, I said in my cocky little voice: `I don't know how to act in this part of town. I'm not from around here.' They looked at me and said, `None of us are.'"
    "After it was over, I totally understood the need to abolish the stigma attached to people with thought disorders. Those people tend to be treated, even by psychiatrists, as separate from the population, rather than as part of it, but with a problem," she says. These days, her most cherished job is that of baby-sitter for granddaughter Maisie. Her daughter, Maggie, married a Montana writer and soon will have a second child. They all live in a small town in the Rockies. "And guess what?" Kidder asks in that dusky, velvety, ironic voice: "I live in the foothills of a mountain range called `The Crazies.'"

Inspectors Find Inadequate Care at Psychiatric Hospital
Judith VandeWater, St. Louis Post-Dispatch- 2/18/2001

SouthPointe Hospital in St. Louis is under investigation by state and federal authorities because of numerous incidents that threatened the safety, health and privacy of its psychiatric patients. A scathing report prepared by state and federal regulators and obtained by the Post-Dispatch last week found that although no patients were seriously harmed in the incidents last year and this year, some were placed in "immediate jeopardy." The regulators have put the hospital on notice that it is at immediate risk of being shut down unless managers rectify the situation. State and federal officials suggested that poor training of temporary employees and inadequate staffing contributed to a lack of supervision and care of psychiatric patients at SouthPointe. Tenet Healthcare, which owns SouthPointe and three other hospitals in the area, said in a statement that the hospital was seeking to correct the problems and to comply with federal and state requirements.

Among the report's findings:
* During 10 days in April, a male patient with a history of setting fires got cigarette lighters and used them to set fire to the beds of three patients while the patients were in their beds. No patients were injured, state inspectors said.
* Two claims of male-on-male sexual assault between patients were inadequately handled by the hospital.
* Several instances of consensual sex or sexually suggestive contact took place between psychiatric patients.
* Adolescent and adult patients on suicide watch had access to materials in unlocked laundry rooms or unwatched housekeeping carts that could have been used to inflict serious or fatal self-injury.
* Patients placed in restraints or seclusion were not always seen by a physician within one hour--a requirement under hospital policy.
* On multiple occasions, hospital employees did not make the required 15-minute checks on patients or did not make such checks thoroughly.
In one instance, a medical record review showed a patient-care assistant on Dec. 16 found a woman, 69, dead in her room at 7:45 a.m., her body stiff. Hospital records indicated that the woman had been last checked at 7:15 a.m. The emergency room doctor who examined the body at 8:15 a.m. noted the stiffness as rigor mortis. That could suggest that the patient may have been dead for a longer time without anyone noticing. Pathology texts say that, depending on climatic and biological factors, rigor mortis sets in three to eight hours after death.

Lack of supervision
The report also notes multiple cases of inadequate supervision of patients, including a lack of monitoring patients in smoking lounges, where the hospital's own policy requires it. In cases in April and June of last year patients got punched by other patients in unsupervised lounges. In January, an inspector looking through the window of an empty smoking room saw something on the floor. The vice president of psychiatric services was called to the door and identified the matter as two piles of stool. A patient had just been in the room. During one inspection this month, an elderly man wearing nothing but slippers walked into a dayroom where nine other patients were gathered. The man suffered from a psychotic disorder. A social worker took the man back to his room but did not help him get dressed. Twelve minutes later, he returned - still naked.

Fixing the problems
SouthPointe has until Tuesday to develop a satisfactory corrective action plan, including a process for educating permanent and temporary staff in hospital policy. Carey Smith, chief of the state health department's facility regulatory staff, said a team of state investigators will reinspect the hospital Tuesday to measure what progress has been made and to satisfy themselves that the hospital administration is working diligently to correct the problems. In the meantime, a state Health Department inspector has been conducting a daily inspection of the hospital.
    The Health Department could suspend or revoke the hospital's license at any time. Under current law, Smith said, the state cannot just shut down the psychiatric floors and keep the rest of the hospital open. It would have to pull the entire hospital's license to operate. But Smith said such drastic action was unlikely and would be unprecedented. "Nobody in the state or federal government wants to see that hospital closed," Smith said. "There are some areas of the hospital that are functioning very well." Meanwhile, the Kansas City regional office of the Health Care Financing Administration, the federal agency that oversees Medicare has set a deadline of March 3 for compliance. Unless the hospital corrects its deficiencies by then, it will lose its Medicare certification and the ability to be reimbursed for treating Medicare patients.
    SouthPointe and Tenet limited comments on the regulatory action to a short statement issued last week in response to an inquiry from the Post-Dispatch. "Patient care and safety are the top priorities at SouthPointe Hospital, and we are making this matter our top priority as well," the statement said.
    The latest disclosures aren't the first dangerous incidents to come to light at SouthPointe. Another incident - one that proved fatal - occurred in an operating room at the hospital last April. As previously reported, an 84-year-old woman in for minor eyelid surgery was accidentally set on fire after a spark from a piece of surgical equipment ignited a flash fire in the oxygen-rich environment. She died two weeks later.
    A predecessor of Tenet, National Medical Enterprises, has a dark history in its psychiatric division. In 1994, after the company pleaded guilty to federal fraud charges, it was ordered to sell its psychiatric hospitals in Texas. In 1996, the company paid a $100 million settlement of nearly 700 suits filed by former patients in Texas who claimed that National Medical Enterprises held them against their will until it drained their insurance.
    Tenet, one of the country's largest for-profit hospital companies, was formed in a 1995 merger of American Medical Holdings and National Medical Enterprises. National Medical Enterprises had entered the St. Louis market in 1984 when it acquired Lutheran Medical Center. In the 1990s, Tenet also acquired the Deaconess-Incarnate Word Health System and St. Louis University Hospital. SouthPointe has 408 licensed beds. Its psychiatric service has 104 beds in seven units on six floors. Smith said that the hospital regularly fills almost all its psychiatric beds, proving there is a community need for the service.

A widening inspection
A small team of state inspectors visited the hospital Jan. 22 through Jan. 24 to investigate a complaint about psychiatric services and found conditions warranting a full investigation. The Health Department normally acts in a dual role as an agent of the state and Medicare regulators, but in this case two Medicare inspectors joined a larger state investigation team that returned to the hospital Feb. 3 through Feb. 9. That team conducted a review of the entire facility, but the report obtained last week was limited to the potentially dangerous problems in psychiatric services. Smith said the problems found in general medical services were more routine concerns including deficiencies in keeping medical records. That report has yet to be completed.
    Inspectors interviewed staff and patients, reviewed patient records and made observations all hours of the day and night. They concluded that the facility failed to provide care in a safe setting, and it failed to protect patient rights to personal privacy - a deficiency demonstrated by the lack of effective security measures in place to prevent sex acts from taking place, according to the report. "You need to protect the patients," Smith said. "It's not so much a rule against sex as it is a rule to protect patients' privacy" and health. "There is concern that even consensual sex could result in the transmission of venereal disease or hepatitis." With psychiatric patients there is an added concern that medications or a psychiatric condition may cloud judgment and the ability to consent to sex.
    Consider the case of one woman, 49, whose bipolar disease caused a psychotic detachment from reality. Two days after her admission to SouthPointe in early March last year, an entry in the hospital's critical-incident log noted the patient had "consensual" sex. That evening, the patient's condition was noted as being so distressed that she was placed in seclusion for slapping staff members. She was given repeated doses of anti-psychotic, anti-anxiety and anti-mania medications. That night she stripped nude, rambled incoherently and smeared her room with feces.

Shortage of staff
SouthPointe's staff was spread too thin and did not meet federal standards, according to the report. Although there is no federal or state regulation that mandates minimum nurse-to-patient ratios in acute-care hospitals such as SouthPointe, federal law requires the immediate availability, when needed, of a registered nurse for bedside care. A description of a safety drill conducted at 5:26 a.m. on Feb. 5 shows that six of the psychiatric units--wards containing between 11 and 18 patients--were each staffed by only one registered nurse and one patient-care assistant. The seventh unit had a nurse and two aides. The drill, which requires all available hospital personnel to respond to a potentially threatening situation, left some of the units with only one person to care for all the patients. Even so, Smith said SouthPointe's problems had more to do with poor orientation on hospital policy than with low staff-to-patient ratios. Smith said the national nursing shortage has forced many hospital administrators to increasingly rely on technicians to deliver patient care rather than registered nurses. "There are just not enough RNs," he said.

SouthPointe's problems
A government audit cited numerous deficiencies in the hospital's psychiatric wards. Among them:
* Failure to provide care in a safe setting.
* Failure to conduct 15-minute safety checks on all patients.
* Failure to have sufficient trained staff to respond to a potentially threatening situation.
* Failure to ensure the privacy rights of patients.
* Failure to assure that residents were free from abuse or harassment.
* Failure to ensure that patients are free from unnecessary physical restraints.
* Failure to provide training for temporary agency staff on the proper and safe use of restraints.
* Failure to provide supervision in smoking lounges.

Internet Population Reaches 56 Percent of U.S. Adults
Anick Jesdanun, Associated Press, 2/19/2001

NEW YORK --The Internet was used by more than half of the U.S. adult population last year as some 16 million new users ventured online in the last six months, according to a study released Sunday. In addition, nearly three-quarters of children ages 12 to 17 had Internet access, said the Pew Internet & American Life Project, which has been tracking Internet usage and habits since March.  It said the online adult population has hit 56 percent, totaling 104 million adults. The study also found continued gains among women, minorities and adults in households earning $30,000 to $50,000. Another strong group consisted of parents with children still living at home.
    ''As more people go online, the value of being online increases,'' said Pew center director Lee Rainie. That, he said, encourages even more Americans to log on. But the study found that two key gaps remain: Only 38 percent of the poorest Americans, those earning less than $30,000, had Internet access. That compares with 82 percent for Americans in households earning $75,000 or more. Only 15 percent of the 65-and-up group were online, compared with 75 percent of the 18-29 age bracket. For the survey, Internet access includes usage at home or work, as well as libraries, cybercafes and other public settings.
    The findings were based on a random telephone survey of 3,493 adults, including 2,038 Internet users, conducted from Nov. 22 to Dec. 21. The survey had a margin of sampling error of plus or minus 3 percentage points. The Pew survey found people logging on more often. On a given day, 56 percent of Internet users were online, compared with 52 percent during a midyear sampling. There were notable increases in daily use among women and blacks.
    E-mail was the most popular feature, used by 93 percent. Top uses on the Web were looking for hobby information, browsing for fun and getting news. Pew found that 52 percent had bought something online, a jump of 6 percentage points. That translates to 14 million more online shoppers in the last six months of 2000. ''This was all taking place in a season where the major story was the (financial) troubles in the dot-com world,'' Rainie noted.

Online Service Supports Smokers Who Are Trying to Quit
Lisa Lipman, Associated Press, 2/18/2001

BOSTON--Beau Raines had been smoking a pack and a half of cigarettes each day for more than 25 years. But when his 8-year-old daughter, Taylor, asked him to stop, he knew he couldn't do it alone. Then Raines, 49, heard about the QuitWizard, an online program created by the state that tries to help smokers kick the habit. He discovered the free program, available on trytostop.org, when advertisers for the Web site came to the radio station where he works to buy advertising. Raines decided to try it. He hasn't smoked a cigarette since Jan. 6. ''The two moments I thought about (smoking again) were when I visited my mom, and a couple of high-stress days in my job programming the radio station,'' Raines said. ''Those were the moments when I jumped on the Web site or called a friend. I think it really helped a lot.''
    QuitWizard has been around since November, but the first large-scale wave of radio and print ads for the service are beginning this week. The Massachusetts Department of Public Health developed the program in an effort to make the state smoke-free. ''I think it's a fun, interactive tool that will make counseling widely available to people in a very tailored way. And that's something we haven't had in the past,'' said Dr. Gregory Connolly, the director of the state Department of Health's Tobacco Control Program. About 2,000 people have logged on to the site so far. The Health Department estimates that 10,000 Massachusetts residents die each year from smoking-related illnesses.
    The QuitWizard compels a smoker to confront the health risks that he or she faces by continuing to smoke. It also provides a profile on a smoker's level of nicotine addiction and comes up with specific ways to avoid smoking in tempting situations like coffee breaks during work (cut an apple in pieces and eat it, do a crossword puzzle). The QuitWizard also asks users to complete a survey about the positive and negative aspects of smoking, as well as a questionnaire about the good and bad things that could happen if the person stops smoking. Connolly envisions bulletin boards and possibly chat rooms on the service that would provide an online support community for smokers who want to quit.
    With all that it offers, however, the Web site won't help everyone, said Dr. Trudy Manchester, an associate professor of clinical medicine at UMass Memorial Health Care who writes articles about smoking-related issues for the Web site. ''Some people like having something that they can do by themselves. On the other hand, I've got other smokers who work well in a group setting and who need interpersonal work to work through their issues, '' Manchester said. ''For them, a Web site just doesn't work.''
    On the Net: Department of Public Health smoker's site: http://www.trytostop.org