Noteworthy News Articles on Mental Health Topics, June 23-31, 2001

Postpartum Psychosis Defense in Texas Case Would Be Risky
Aaron Zitner, Los Angeles Times- 6/23/2001

The woman who told police she drowned her five children in her Houston home Wednesday would be employing a risky but occasionally successful defense if she told the court she had acted because of postpartum psychosis. "It's a very rare case where this type of defense is successful. It's not guaranteed to persuade a jury," said Laurie Levenson, a professor at Loyola Law School in Los Angeles.
    Andrea Yates, 36, has been charged with capital murder in the deaths of her children, but prosecutors in Harris County, Texas, have said that they are just beginning their investigation and that they may change the charges and the penalties sought. While Yates' defense strategy is unknown, her husband told reporters that she suffered from postpartum depression after the birth of their fourth child two years ago and after the birth of their fifth child six months ago. Russell Yates also said his wife had once attempted suicide, was taking medication and that a list of techniques had been posted in their home to help her deal with stress. Police say the children were drowned one by one in the Yates' bathtub. They say Andrea Yates called police to the home and then admitted to the killings when officers arrived. The children were Noah, 7; John, 5; Paul, 3; Luke 2; and Mary, 6 months.
    Levenson said several factors suggested that Yates' lawyers would likely pursue an insanity defense based on postpartum psychosis, the most extreme form of postpartum depression. Those factors included Yates' history of depression, the extreme and almost incomprehensible nature of the crimes and Yates reportedly relating the killings to authorities in a "zombie-like fashion," the Houston Chronicle reported Friday. Dr. Saul J. Faerstein, a forensic psychiatrist in Los Angeles, said that Yates would probably succeed with a postpartum psychosis defense if the case were tried before a California jury. "You have credible evidence of prior mental illness, so that's going to help her," Faerstein said. "Most jurors would look at this family as an intact, loving family. I'm speculating that there would be a lot of testimony that she was caring. So, they'll think there's no other reason for her to do this egregious thing other than she's crazy."
    However, Levenson said, the defense would be a risky one. "Some jurors' reactions will be, 'Oh, my God, it's such a horrible crime that she has to pay for it,' " Levenson said. "And some jurors will have the opposite reaction: 'It's such a horrible crime, she must have been out of her mind.' " At the same time, Levenson said, women who previously tried the defense have sometimes reduced the severity of the charges or the punishment they faced.
    In one unusual case, a California Superior Court judge in 1988 reversed a jury's murder verdict against an Orange County woman who had driven a car over her infant son. Instead, the judge found the woman, Sheryl Lynn Massip, not guilty by reason of insanity because of postpartum psychosis. In 1998, a Colorado judge found Bethe Feltman not guilty by reason of insanity and ordered her committed to a state mental hospital after the killing of her two small children. According to press reports at the time, the woman had told psychiatrists that she had been depressed since the birth of her daughter and that killing the 3-month-old girl and her 3-year-old son was the only way to get relief. A postpartum defense was used this year. Judy Kirby was accused of killing seven people by driving the wrong way on an Indiana highway. Kirby's attorney sought unsuccessfully to have her declared incompetent to stand trial. The attorney said Kirby was suffering from postpartum depression after a birth five months before the crash.
    Postpartum depression, or the "baby blues," affects an estimated 75% of mothers after childbirth, said Diana Lynn Barnes, a Woodland Hills psychotherapist who specializes in pregnancy and postpartum issues. The symptoms include irritability, tearfulness, anxiety and fear of not being able to cope. Women suffer its severe form, postpartum psychosis, in one or two out of 1,000 births, Barnes said, though not all cases involve violence. "One symptom in these cases is that women are feeling disconnected and disengaged from their infant," she said. "The attachment relationship has been disrupted. So, people say how could a woman do such a thing--she wasn't in her right mind. If you have a postpartum psychosis, the brain chemistry has gone awry."

Postpartum Disorder Eludes Easy Answers
Jeremy Manier, Chicago Tribune- 6/23/2001

More than 2,400 years after Hippocrates first described the symptoms of postpartum depression, scientists around the country are taking some of the first steps toward understanding what causes the mysterious ailment. The puzzle has persisted in part because until the last few decades, scientists did not consider the mental effects of postpartum depression to be much different from other kinds of depression. That debate continues, though most experts now believe the hormonal upheavals of childbirth can alter women's brain chemistry in ways that researchers and therapists need to understand. Progress has come slowly, as researchers studying blood samples and brain images piece together the effects on a woman's mind of carrying, then delivering and caring for a child.
    Some of the research's urgency comes from extremely rare yet wrenching cases such as the alleged drowning this week of five children by their mother in Houston. Though such incidents grab public attention, ordinary postpartum depression is a confusing and lonely ordeal for millions of women. "This is a major public health problem that we still don't pay much attention to," said Dr. Katherine Wisner, a professor of psychiatry at the University of Louisville and a leading researcher on the causes of postpartum depression.
    Among the basic questions that scientists have yet to answer is to what extent postpartum depression stems from the huge hormonal changes women go through after delivering a child. Some psychiatrists argue that such chemical effects are minor compared with the stress and sleep deprivation that most new mothers experience. Answering those questions could affect what therapies and medicines doctors use for their patients with postpartum depression. Indeed, some studies are aimed at seeing which drugs work best for women with different postpartum symptoms. In one groundbreaking experiment published last year on the causes of postpartum depression, researchers trying to artificially replicate the effects of pregnancy took a major stride toward understanding how the shifting hormonal tides of childbirth help shape the mental illness.
    The scientists at the National Institute of Mental Health in Bethesda, Md., had simulated pregnancy in 16 women by giving them huge doses of hormones such as progesterone and estrogen, which pregnant women produce naturally. After eight weeks, the researchers abruptly stopped the hormone treatments—producing a sudden hormonal withdrawal, much like what pregnant women experience when a child is born. Remarkably, 60 percent of the women who had a history of postpartum depression developed new symptoms of depression when the hormones were removed. None of the women without a history of depression reported such symptoms.
    Although the study showed that hormonal changes play a major role in postpartum disorders, experts said this still doesn't explain why the changes produce depression in some women but not in others. The enigma of postpartum depression is deeply linked, experts believe, to the basic hormonal differences between all men and women. Even under normal circumstances, women are twice as likely as men to get depressed—a difference that is exaggerated during the chemical flux of pregnancy and labor. "Men don't go through that much hormonal fluctuation after puberty until we die," said Dr. Zachary Stowe, director of the pregnancy and postpartum mood disorders program at Emory University in Atlanta. "Women go through it on a regular basis, then at menopause they go through it again. "So you're talking about biological systems that are always changing. The more moving parts there are, the more opportunity there is for something to go wrong."
    Further complicating the problem, Stowe said, each woman's body responds to hormones and brain chemicals in distinctive ways that are dictated by genes and personal experiences. "If all women were hormonally the same, we'd have one birth control pill—but we have a bunch," Stowe said. "Women have varying sensitivities to these compounds." Estrogen and progesterone levels clearly have some effect on brain function, experts say. Estrogen raises levels of the brain chemical serotonin—which also is affected by anti-depressant drugs such as Prozac. Some of the byproducts of progesterone bear some similarity to calming drugs such as Valium. A few years ago, British researchers found that women with postpartum disorders had unusual sensitivity to dopamine, one of the brain's chemical messengers, which has been linked with increased anxiety.
    One of the first studies to look at postpartum depression using sophisticated brain scans is being done by Dr. Neill Epperson at Yale University. In a dark room, women lie still for more than an hour so that Epperson can measure the levels of brain chemicals associated with depression. For example, Epperson wants to see what effect pregnancy hormones have on the neurotransmitter GABA, low levels of which have been linked to depression. A major question is whether postpartum depression has different effects in a woman's body than depression stemming from other causes. "We're trying to get a sense of whether the women with postpartum depression look like any other depressed women, or if they look different because of this huge hormonal change," said Epperson, a psychiatrist and obstetrician-gynecologist at Yale.
    Most researchers agree that there's a huge difference between common postpartum depression and the more rare postpartum psychosis, which happens in about 1 out of 1,000 women. Women who experience postpartum psychosis are likely to have some history of mental illness such as schizophrenia or bipolar disorder, also called manic depression. In one follow-up study of such women, Louisville's Wisner found that most still were suffering bipolar disorder five years later.
    Researchers have found many risk factors for postpartum depression, including a sudden move or isolation from family members, the death of a loved one, and problems dealing with an especially restless baby. But one of the biggest risks for problems after birth seems to be depression during pregnancy, said Dr. Stephen Pariser, a psychiatrist and director of the women's depression clinic at Ohio State University. Fifty percent of women with postpartum depression started having problems during pregnancy, Pariser said.
    That's especially troubling, Pariser said, because depression during pregnancy has been linked with low birth weight and prematurity. Such risks make it important for some women to start taking antidepressant medicine before birth—and before the big hormonal changes kick in. "More and more, I realize the cornerstone of good health is the absence of depression," Pariser said.

Tourette Syndrome: A Private Struggle
Jane E. Allen, Los Angeles Times- 6/24/2001

Behind the wheel of his sporty silver car, with Steely Dan's "Reelin' in the Years" blaring from the speakers, Alex Greene taps his fingers like a typical fan. What's not typical are the piercing, almost otherworldly, yelps coming from deep in his throat. That's not all. As he drives, he pushes and pulls at the steering wheel with his left hand, jams both elbows into the leather armrests so forcefully they leave impressions and periodically squeezes his eyes shut. Only in such private moments can he give full reign to the quirky vocal and physical tics that define Tourette syndrome. Greene is a sociable man--a high-powered Manhattan investment banker and volunteer firefighter, an attentive husband and dad, an all-around good guy who thrives in the company of others. But his private struggles--with neurological symptoms that can be distinctly antisocial--create a tension that underlies nearly every moment of his waking life.
    The roughly one in 1,000 people who have Tourette syndrome lack an internal filter. They're full of compulsive energy; gestures, words and sounds that others might stifle, they let fly. The disorder has entered the modern vocabulary through the power of popular culture: Characters with Tourette syndrome have been woven into plots of "The Practice" and last season's "Ally McBeal." (Both were creations of David E. Kelley, whose former business partner has two sons with Tourette.) Yet Tourette remains highly misunderstood. The inadvertent cursing people commonly associate with it affects fewer than 15% of patients (who may also make socially inappropriate gestures). In Greene's case, such sounds disappeared in his teens, and, he says, "I never had it that bad." He never barked; he wasn't a social outcast. Tourette symptoms tend to wane with age. And adults often learn compensatory behavior. There are Tourettic athletes, musicians, writers, surgeons, financiers.
    Greene had a supportive family, but it's his inner strength, and endless determination to make his renegade body obey, that may account for his successes. He battles, for starters, the nearly unstoppable urge--as reflexive as scratching a mosquito bite--to press his fingers ever tighter against an object, be it a pencil or a wine goblet. At dinner parties, his compulsion can leave him with a handful of glass shards, feeling stupid and embarrassed. "I take great pains to hold it in a certain way--hold the stem or grab the base--or exchange it out of fear I'll shatter it." At times, the urge has extended to biting down on the rim, sometimes breaking it. Now, he says, "I'm very careful to sip gingerly." At high-stakes business meetings, he uses sheer force of will to suppress the involuntary urges that are only ratcheted up by the pressure to appear in control of his body. He holds on until he can step out for coffee or a bathroom break and release the pent-up impulses "in the privacy of my own person."
    Greene's Tourette is accompanied by two often-associated conditions: obsessive-compulsive disorder, which brings intrusive and sometimes negative thoughts; and attention deficit disorder, which mars his concentration. "I bought the option package," he jokes.
Together, the three make him a man in continuous motion, inside and out. In the course of conversation, he will stretch his neck to the side, tense muscles in his back and legs, and dig his heels into the floor. All the while, he's tapping his fingers constantly to the music playing in his head--a never-ending internal musical soundtrack he calls "the loop." "I'm a walking Wurlitzer," he says. "I hear it all day long. Depending on my mood, it's either invasive or sometimes an accompaniment. I've probably heard 'Sweet Home Chicago' by the Blues Brothers 250 times today."  Ask him about particular tics, such as craning the neck or exaggerated blinking, and the suggestion sends him into a flurry of movements--a Tourette phenomenon. When he's fully engaged in activities that demand concentration, the tics tend to disappear. But stress or self-consciousness worsens them, as can extreme fatigue. So can intense elation, says Greene. "I remember ticcing in my wedding video."
    It's taken most of his life for Greene, 42, to come to terms with the disorder that appeared during elementary school, when doctors tended to treat it as a psychiatric illness. He spent most of his adult years fighting to keep Tourette from dominating his existence. He took pride in suppressing the tics. He pushed the disorder as far from his consciousness as he could. He didn't tell employers or the guys at the suburban fire departments where he's volunteered. Until he met his wife, he made excuses to dates about his constant flexing by saying he had a bad back. "From 17 until when my son was born, I stuffed it away like you do with your crazy aunt in the basement," he says. "Much of this was parked in very deep storage." Only in recent years, has he come to understand what Tourette has really meant to him.
    Ellen Greene, 68, recalls the precise time she realized something was wrong with her son. It was during a vacation in the Catskill Mountains. Alex, then about 7, was playing with other children. "I remember being quite a distance away and hearing a sound," she says, trying to summon an imitation of the penetrating yelp that rang out in the mountain air, cutting through the normal childhood noise. "It was hundreds and hundreds of feet away. I thought to myself, 'Oh, God. That's Alex."' Several years later, while reading the New York Times, she saw a commercial notice that asked, "Do You Know Anyone Who Makes Noises?" She dialed the Tourette Syndrome Assn. number that accompanied the notice--and began a family medical journey that summons painful recollections to this day.
    Even though she and her husband knew they were doing the best for Alex, she still cringes at those years that medications turned their vivacious older child into a zombie. Once, the drugs induced a seizure that left his body completely rigid, until the doctor arrived with an injection to relax his muscles. "It was probably the most frightening experience of my life," Ellen recalls.
Hints of Tourette may have been around since Alex's earliest childhood, she says.
    "When he was 2, 3 years old, he would clench his fists and put his arms up like in surrender, elbows bent, then go 'Uuummmhhhhh' with his mouth open," says Ellen Greene, now a magazine editor in Manhattan. "We gave it a name. We called it a 'yobble,' between a yawn and a gobble. It was nothing we gave any significance to." In subsequent years, though, she and her husband, George, asked themselves, "Could this have been the very first sign?" For Ellen, whose uncle was Erik Erikson, the pioneering psychoanalyst who specialized in childhood development, the vision of little Alex struggling with tics still brings tears. "It kills me. Anytime. It hurts. Absolutely that will never stop," she says. There were his sniffs and snorts, the incessant tapping that made him a natural drummer, the knuckle-cracking--so hard at times that he taped his swollen fingers for relief--and always the flexing of muscles in his back.
Given those indelible images, she's all the prouder of what her son has made of his life; there was a time when she wasn't sure what his future would bring. Now she marvels at how far he's come. "Who expected he'd have all this strength?"
    Ellen and George, 76, who has been a singer, writer and stockbroker, acknowledge that Alex's Tourette may be rooted in some of their neurological anomalies. Ellen has mild eye tics, while George at age 5 developed a short-lived tic disorder called St. Vitus' Dance, causing him to move his head back and forth. He later developed a stutter. As he puts it: "We all have a little something." As parents, they took great pains not to make a big deal of the Tourette. When they wanted to know how Alex was feeling, they'd ask, "How's 'Gilles' today?" It was a wry bow to Georges Gilles de la Tourette, a French neuropsychiatrist and friend of Sigmund Freud, who in 1885 described several cases of patients with involuntary body movements and vocal sounds, who often mimicked or repeated others' words or gestures.
George recalls the early coprolalia--involuntary cursing--and how Alex consciously tried to temper it by leaving off the first letter from particular curse words to make them sound more acceptable. One Christmas vacation, while crossing a street in Palm Beach, Fla., Alex, who was then about 7, looked up and said, "uck." "'Papa,' he asked, 'can I say that word?"' and then went on to say "uck, uck, uck" for a short time. Alex has purged most of the unpleasant scenes from his memory. "I had a rich and fulfilling childhood," he says.
    Most of the time, his best friend recalls, Alex was just plain hyper. Outbursts didn't seem out of the ordinary in the fourth-grade class where the teacher ridiculed Alex, says his best friend Steve Potolsky, although Alex's tics sometimes stood out: "I remember these ... facial distortions: His shoulders would jump up, his face would tic a little bit, he'd wrinkle up his face." But, Potolsky says, "from my standpoint, it was Alex I was interested in, not these things. After a while, I didn't even notice them to a great extent."
    From what Alex remembers, doctors didn't do much for him. Early on, his parents took him to see the late Dr. Arthur K. Shapiro, a New York psychiatrist, who along with his wife, Elaine, helped change the entrenched medical view of Tourette syndrome as a psychiatric disorder, one treatable through psychoanalysis and impulse control--measures that typically failed. The Shapiros redefined it as a neurological problem involving brain-signaling chemicals called neurotransmitters, particularly one called dopamine. Alex remembers not getting along very well with Shapiro, but no longer recalls why. He has only bad memories of the medications and in his late teens abandoned both the doctors and the drugs. The cure had become worse than the illness.
    For the most part, Alex was a well-adjusted, industrious child who channeled his considerable energy into sports, music and business--enduring pursuits requiring the discipline that may account for much of his success. At George Washington University in Washington, D.C., he juggled classes, social life and several jobs, including one as a hotel bellman. He had his routine down so well that he would wear wingtip shoes to class, then proceed to work. "Wingtips" became an enduring inside joke among friends and family members, perpetuated for years in his license plates. After graduation, he surprised everyone by choosing the buttoned-down banking profession, even though he was wearing his hair long.
    When he began, he says, "I wasn't the sharpest tool in the shed. I wasn't very sophisticated in terms of finance, business understanding, in terms of being worldly." But time and some crises in his 30s helped build his self-confidence. In particular, several periods of self-examination and counseling helped him to understand that he "saw the world in a convoluted way," often doubting himself or fearing that he'd made irrevocable mistakes. With therapy targeting the anxiety and obsessive thoughts that often are part of Tourette, that prism of distortion fell away. "I realized I was a pretty smart guy and I had been hiding a lot of things and had been afraid of my weaknesses," he says. He decided then to play to his strengths. "I joke a lot. I use a lot of Yiddish. I'm a good listener." Today, he says, "I'm secure."
   Since Alex was diagnosed, the medical world has made great strides in identifying and treating Tourette. In the continuing search for genetic underpinnings, researchers are closing in on regions of two chromosomes, with other areas likely to be implicated as understanding of the human genome progresses. Some see potential roots in interactions between genes and the environment. Others suspect autoimmune involvement, possibly triggered by strep infections. Dr. James Leckman, a Tourette specialist and director of research at Yale University's Child Study Center in New Haven, Conn., is convinced the higher occurrence in boys than girls--Tourette affects three to four times as many boys as girls--stems from boys' exposure to high testosterone levels in the womb as their brains are developing.
    Today, doctors recognize that Tourette comprises a range of treatable conditions and many focus their treatment on the related conditions. Stimulants like Ritalin can blunt the hyperactivity without worsening tics, while newer antidepressants such as Prozac, Paxil and Zoloft can ease the obsessive-compulsive disorder. Drugs like Haldol, while lessening tics, can create depression, and cause weight gain, social phobia and body stiffness, although some newer medications are well-tolerated by many children. Medication may be the solution at particular times, says Dr. Leon Dure, a Tourette specialist at the University of Alabama in Birmingham. For example, 7-and 8-year-olds often aren't bothered by tics, but may want medications in adolescence, when tics bring stigma. Psychologists can help such youngsters feel less isolated and get along better with their families.
    That children today with Tourette are better off than their counterparts decades ago became clear to Dure at a support group meeting that drew men in their 50s and one young boy. "It was amazing," Dure said. "The men told this little boy: 'You are so lucky. You know what you have. None of us knew what we had. People thought we were crazy, weird and eccentric."' It takes a long time to overcome stigma and stereotypes, says Dr. Cathy Budman, a psychiatrist and researcher at North Shore University Hospital in Manhasset, N.Y., who says the best intervention is educating the child, family and school. Tourette patients treated long ago "grew up with this sense they were very defective," she says, but the majority of people with Tourette have mild symptoms. "In the scheme of things," she says, "this is something you can live a pretty good life with." For those Touretters with severe symptoms, the social challenges can be greater.
   The neurologist Dr. Oliver Sacks, who has written extensively about Tourette in several popular books, has looked at how Tourette can enhance lives. He says the internal phenomena "tend to be vivid, heightened impressions and impulses of many sorts," often involving "a sort of playing with limits, socially, morally, intellectually, physically, a sort of risky adventurousness." The lack of inhibition can confer "a rich, surprising and sometimes associational freedom" upon those with Tourette.. A drummer Sacks treated years ago harnessed "Tourettic gestures for Tourettic improvisations." Leckman speaks of a tae kwon do world champion convinced that Tourette provided his willingness to do things over and over, and a pro basketball player's desire to practice free throws "until he could get the same sound as the ball swished through the net."
    Similar discipline helped Greene, whose acceptance of Tourette has come with age and with the decision to become a father. "My wife and I were making a very real decision--we were accepting the possibility that in having children, we would be having children with Tourette. The notion of hiding from Tourette was incompatible with my view of the responsibilities of being a parent," Greene says. He felt that his own experiences prepared him to tackle head-on any diagnosis in a child. After seeing a genetic counselor, he and his wife, Lori, "decided to go for it."
    Besides having two children, Greene has gradually come to terms with what it means to be more open about the Tourette he had long tried to hide from the rest of the world. Another step was becoming more involved with the Tourette Syndrome Assn.; he's on the national board and finance committee. Another was revealing his Tourette to his children.
Although the kids knew their parents were active in the association, "we'd never talked about the fact the reason we're involved was because of me." During the course of a dinner a little over two years ago, he asked if they knew what Tourette was, and prompted by their response, "I told them that I had it and they were not startled. It was a real defining moment for me."
    Greene isn't very comfortable being singled out as someone who has triumphed over Tourette: "Plenty of people have endured more," he says. "I am not a success story; I'm successful. The success story is all the people who have Tourette [whose symptoms] are more pronounced, more socially unusual--how they get through their lives. "I spent years hiding as a result of Tourette. I was afraid of being denied the things I wanted to do because of Tourette: being on the Fire Department, being accepted at work, being insured," he says. "Life is about confronting things, not walking away. Tourette has taught me something about persistence."
And acceptance. "Tourette is as much a part of me as anything else. My 'Gilles' is just part of the package."

Ruling Will Free Some Sex Offenders
Kirk Mitchell, Denver Post- 6/25/2001

A Colorado Supreme Court ruling today that clarifies parole laws for sex offenders will mean the early release of 375 people from prison and parole supervision in the coming weeks and will eventually affect 1,519 offenders. The court ruled that a 1996 law severely limiting the length of sex offenders' parole terms superseded a 1993 law requiring all offenders to serve parole at the end of their prison sentences. Initially, the state will release 375 sex offenders who have already completed their sentences under Monday's ruling, said Department of Corrections spokeswoman Alison Morgan. The department is awaiting instructions from Attorney General Ken Salazar's office on how to do that. The prison releases could begin this week, Salazar said. The other offenders will be released as they serve out their prison terms over the next several years, he said.
    "I am disappointed with the outcome of the decision," Salazar said. Sex offenders are dangerous because they often repeat their crimes, he said. But he added that the sex offenders affected by the ruling will be released gradually and will have to follow tougher reporting rules. The rulings in several related cases will affect all sex offenders convicted between 1993 and 1998. Sex offenders convicted since then are covered by the lifetime supervision law.
    The ruling Monday says "in no event shall the term of parole granted exceed the unserved remainder of the maximum sentence imposed by the court, or five years, whichever is less." The decision, that clarified which of several conflicting laws should take precedence, means the 1993 mandatory parole law does not apply to sex offenders. Before Monday's Supreme Court decision, most of the state's district judges believed this law applied to sex offenders and they routinely sentenced sex offenders to mandatory five-year parole terms.
    In one ruling, the Supreme Court said that sex offenders convicted between 1993 and 1996 could only serve parole for the amount of time they had left on their prison terms or five years, whichever was less. In a companion ruling, it said that sex offenders who committed crimes between 1996 and 1998 could only serve parole equaling the amount of time left on their sentences. Salazar said in 1996 that legislators were clearly trying to lengthen parole terms for sex offenders, not eliminate or reduce parole for any sex offenders, which the Supreme Court ruling says they did.
    But Kathy Brien, deputy state public defender, said the legislature used unmistakeable language that could only mean one thing: A judge decides whether to place someone on parole or keep him or her behind bars. "It is the legislature's job to pass laws that are clear," Brien said. "If the legislature does not do that, the court can not pick up the slack." Brien said if the Department of Corrections has already identified inmates who are affected by the Supreme Court decision, they should be released immediately. Prisoners should not languish in prison when it is clear they should be released, she said.
    Salazar said his staff will decide whether judges need to enter new sentences before the DOC releases prisoners whose mandatory parole terms were included in written sentencing orders. DOC staff will focus on releasing 128 sex offenders who were returned to prison after violating parole terms, because they shouldn't have been on parole at the time anyway, Morgan said. The department will notify victims before any releases.

Helping Boys Be Boys, Not Abusers
Elizabeth Mehren, Los Angeles Times- 6/26/2001

BOSTON--At school this year, 14-year-old David studied geometry, biology and the usual eighth-grade curriculum. At home, he took in lessons of a different dimension. "Like if I had a wife and I hit her, she would leave me, and then she would not be my wife anymore," David said. With his mother, two younger sisters and little brother, David fled a violent father just over a year ago. The comfortable old Victorian house that has sheltered them since has offered refuge and reeducation, a place where they could learn to be a family. As part of a novel domestic violence prevention effort geared to mothers and their adolescent sons, David took classes this year aimed at avoiding the abusive behavior he saw growing up. With other boys his age who also moved into the home with their mothers, David learned how healthy families express anger. He learned about respect. With counselors intent on keeping these vulnerable young males from becoming the next generation of abusers, David and the other teenage boys talked about girls and dating--"all the stuff that's usually secret," David said.
    In the Mothers and Adolescent Sons house--the acronym is MAS, Spanish for "more"--the steady, trusting atmosphere contrasts sharply with the volatile worlds these boys left behind. Gradually they have warmed to the attention of trained and caring staffers. At nightly meetings they addressed the hard truths behind domestic violence--a pattern of behavior experts say is hereditary and intergenerational. Before they moved into the home, David's mother said she worried nonstop that her sons would repeat their father's violence. "Todo el tiempo," she said through an interpreter: "All the time."
    The intensive, residential program launched here by New England's largest system of shelters for battered women and children is highly unusual. In domestic violence circles, teenage boys often are seen as potential predators: too disruptive, too defiant to be helped. Most shelters will not accept boys 12 or older. So mothers face the impossible choice of staying in a violent home, leaving a teenage son with an abusive father or further splitting the family by farming out the boy. "It was a recurring issue that came up often when people called our hotline for help," said Monica Roizner, director of clinical and community services for Casa Myrna Vasquez Inc., the parent organization for MAS. The nonprofit network of battered women's shelters and services is named for a Puerto Rican actress who fought against domestic violence.
    Roizner said she looked around the country but could find no model for a facility that houses as many as six sets of mothers, adolescent sons and younger children. Other than MAS, she could find nothing with the joint goal of treatment and prevention, "no specific program designed for boys," Roizner said. To Roizner, the decision to focus on adolescent males reflects a maturing within the quarter-century-old domestic violence movement. "In the past, people were thinking about the women and about little kids," she said. "Teenagers just don't present as friendly, or as warm and fuzzy."
    But psychologist William S. Pollack, director of the Center for Men at Harvard University's McLean Hospital, said the oversight was less benign. Worse than just being overlooked, adolescent boys were excluded from domestic violence rehabilitation efforts "based on the unwitting belief that boys are toxic and are going to become more toxic as they get older. The idea was you wanted to keep them away, because they were going to become men who are dangerous anyway," said Pollack, author of "Real Boys." Boys, Pollack said, "were given the message that they were unsafe objects. They were seen as potential perpetrators, and the very thing we didn't want them to do, which was to become perpetrators, we were virtually pushing them into." The prophecy about boys and domestic violence turns out to be self-fulfilling. Social psychologist Angela Browne of the Harvard School of Public Health cited a study that ranked boys raised in violent homes as five times more likely to become violent in future relationships than boys reared in non-abusive settings.
    Browne, author of "When Battered Women Kill," praised the MAS approach as "a significant national model." Allowing adolescent boys to remain part of a family if they are forced to move from a violent home is crucial, she said. "And terribly important, of course, to mothers who love their sons," she pointed out. "As a society, we should never have forced women to choose between living in a home where they and their children face violence and going to a shelter where they must leave behind one or more of their children."
    Because they fear retribution, David and his mother asked that their full names be withheld. While David listened and his younger siblings drew pictures on a recent afternoon, his mother told the story of how they came to seek safety at the MAS house. Fifteen days into her marriage in 1985, her husband began beating her, the 47-year-old nurse from Mexico said. "I thought this was normal, and that someday it would pass," she said. But the violence grew worse, to the point that her husband would not let her out of the house to go to work. Though her children were not targets, they began "acting tough"--especially David. When one child developed a persistent rash, the doctor said it was psychosomatic--a result of "going through all the violence."
    Through a speaker in her English class, the mother learned about Casa Myrna Vasquez. Fortunate timing, she said, made her the first mother to move with her children into the MAS house last year. But David said he made the move reluctantly. Leaving his friends, his neighborhood and his school was hard, and at first he found it lame to sit around with other boys and a social worker and talk about their experiences. Soon, David changed his opinion. One big lesson that came from these sessions was what to do with anger--something David said his father has yet to learn. "You try to calm yourself down," David said, "then talk, so you won't get into fights." By learning more about their mother and her efforts to keep the family together, David said he and his siblings came to feel "more united" as a family.
    They are the first family to graduate from the MAS house and are preparing to move to an apartment near Boston this month. Roizner said Casa Myrna Vasquez staff will stay in close touch with the family, with hopes of conducting long-term evaluations of each set of mothers and children. After a year in the old Victorian residence, David said, "I don't want to leave." He takes with him a deep abhorrence for domestic violence. "What's the point of it?" David asked. "If you love someone, why would you hit her?"

British Study Finds Autistic Disorders More Common
Reuters News Service- 6/26/2001

CHICAGO - - Autism and similar developmental disorders may be more prevalent than thought among preschool children, a finding that could help focus efforts on early intervention, researchers reported on Tuesday. The report from the Central Clinic, Stafford, England, and King's College, London, involved a look at 15,000 children aged two to six in the Staffordshire area in central England in 1998 and 1999. The researchers estimated that the prevalence of autism in the group was nearly 17 cases per 10,000 children. By contrast earlier studies have placed the disorder at about four to six cases per 10,000.
    Autistic disorder or autism is a severe developmental disorder involving abnormal and often delayed development of language or communication skills, social interactions and reciprocity, and imagination, play and interests, said the study published in this week's Journal of the American Medical Association. The study also found that "pervasive developmental disorders" which fall short of the strict diagnostic criteria for autism were running at a rate of nearly 46 per 10,000. Among these were Asperger syndrome, a condition in which children display autistic behavior, but have well-developed language skills; Rett syndrome, a disorder in which skills that have been acquired, such as walking and talking, gradually disappear; and childhood disintegrative disorder, a rare condition involving severe deterioration of mental and social functioning. The report said methodological limitations in the study prevent a conclusion that the disorders looked at are actually on the increase but it said that possibility requires "further rigorous testing."
    In an editorial in the same issue commenting on the study, Susan Hyman, a physician with the University of Rochester School of Medicine and Dentistry in Rochester, New York, said along with colleagues that the findings point out the need for improving the early detection of affected children. "There is increasing evidence that behavioral and educational intervention with young children may significantly improve developmental and behavioral outcomes and that basic deficits in play and communication may be therapeutically modified," the editorial said. "Given the limitations of current knowledge, valuable data sets such as these (in the British study) should be used to increase understanding of the characteristics of young children with pervasive developmental disorders as well as to determine the current prevalence," it said. "Those figures will assist in planning for services that affected children and their families will need," the editorial said. It added that it is "incumbent on those who care for young children to identify the children with atypical social and language development, refer them for assessment, and advocate for effective treatments."

Florida to Curb Distribution of Painkiller OxyContin
Associated Press, 6/26/2001

TALLAHASSEE, Fla. -- Hoping to curb abuse of the painkiller Oxycontin, the state will no longer pay for prescriptions of more than 120 pills a month without prior approval from Medicaid. With the move, Florida joins four other states Maine, West Virginia, Ohio and South Carolina that have put restrictions on the drug's distribution to Medicaid recipients. Medicaid will also not pay for different dosages of the drug in a 30-day period without prior approval. The drug is intended for use by terminal cancer patients and chronic pain sufferers but has been linked to scores of deaths around the country among people using the drug to get high.
    About 10 percent of all OxyContin prescriptions covered by Medicaid would require approval, said George Kitchens, chief of Medicaid's pharmacy services. Jim Heins, a spokesman for Connecticut-based Purdue Pharma L.P., OxyContin's maker, said requiring prior approval to change the drug's strength within a 30-day period could disrupt patient care. Florida's Medicaid spending on OxyContin rose from $4.4 million in 1998 to nearly $21 million last year, while the number of pills dispensed rose from 1.5 million to 6.1 million, according to Medicaid reports. Overdoses of OxyContin and other morphine-like drugs killed 152 people statewide during the final six months of last year, more than any other drug, according to state medical examiners.

Mental Health a Priority for Connecticut Lawmakers This Year
Kathryn Masterson, Associated Press- 6/26/2001

HARTFORD, Conn.--For mental health advocates, the $98 million allocated for the mentally ill in the state budget passed Tuesday represents a first step to repairing a system in crisis. Last year, a panel appointed by Governor John G. Rowland said the mental health system was crippled by inadequate public funding for an increasing number of people requiring mental health services and cost-cutting by managed care companies. Officials estimate there are 600,000 adults and 85,000 children with some form of mental illness. Many do not receive adequate care for illnesses that could be treated early, advocates say.
    Both Republicans and Democrats declared mental health care a priority during the legislative session. Rowland and Senate President Pro Tem Kevin Sullivan both pushed for increased funding in the two-year $26.47 billion spending plan. ''Connecticut is finally recognizing that treatment works and must be accessible to all in need of help,'' Sullivan said. The budget includes $45 million to be used for community-based services, $15 million for supportive housing for the mentally ill, and $40 million in additional aid.
    The $15 million for supportive housing will be used to create 250 apartments across the state for mentally ill people facing homelessness, said Janice Elliot, director of the Corporation for Supportive Housing. The budget also designates $3 million for support services for those living in the housing. ''This budgetary provision holds remarkable foresight and a real understanding of the need,'' Elliot said.
    Advocates said the money will help ease the strain on the state's system, but much work still needs to be done to ensure all Connecticut residents with mental illness receive care. Sheila Amdur, co-chair of Keep the Promise Coalition, said the $98 million only partially fulfills the promise the state made to care for its mentally ill when large state institutions were closed. ''We haven't solved our problem, but we're starting to and that's very encouraging,'' Amdur said.

When Mothers Kill, Justice System Faces Difficult Dilemmas
Geraldine Sealey, ABC News- 6/28/2001

Andrea Yates were accused of killing five strangers on a Houston street, public sentiment about her fate would likely be more unanimous. But the 36-year-old mother, said to have suffered from postpartum disorder when she allegedly drowned her kids last week, instead faces a society not quite sure what to do with mothers who kill their own. More than two dozen other countries have laws standardizing the treatment of mothers who kill children in the months after giving birth.
    In the United States, what happens to mothers who kill varies. But generally, despite the nation's comfort with capital punishment, juries and judges often can't bring themselves to condemn mothers to death. Only one woman has been executed for killing her children in the modern death penalty era. Christina Riggs, who admitted killing her two children in 1998 during a failed suicide attempt, was put to death in Arkansas last year. Currently, eight other women sit on death row across the nation for murdering their children. But that figure is disproportionately low considering that about 180 children are killed by their mothers every year.
    Some experts cite the general apprehension in America toward executing women. "There are entire parts of the country that have never done this," said Victor L. Streib, a law professor at Ohio Northern University. "I suppose there is a general attitude that women's lives are more valuable than men." Many times, though, tragic circumstances surrounding the woman's story, such as past abuse or crushing depression, just weigh too heavy in jurors' minds, and murderous mothers wind up with jail time or in mental institutions.
    Susan Smith's story is a case in point. Widely reviled for first covering up her role in her sons' deaths and then admitting she drove them into a lake to their deaths, Smith's life was ultimately spared by a jury. The jailed Smith, whose lawyer introduced evidence she had been sexually abused and emotionally neglected in her past, will be eligible for parole in 2024. Even in Texas, where more executions have taken place in recent years than in any other state, a Houston jury acquitted a mother just three years ago of killing her 4-month-old boy because she said she believed he was possessed by the devil.
    In Illinois, former Gov. Jim Edgar granted clemency in 1996 to convicted baby killer Guinevere Garcia after evidence showed she had been sexually, physically and emotionally abused for years. After killing her 11-month old daughter, Garcia claimed she killed her baby because she was afraid the state would place the child in a house with her uncle, who had routinely raped Garcia as a child.
    "Although we have the inclination to demonize these women, when you look closely at these horrible cases you find you can understand them, that's the shock," said Michelle Oberman, a DePaul University assistant professor who studies infanticide. "These killings become comprehensible, even as acts of love and attention."
    Although Yates' attorney has not yet announced how she will plead, a postpartum disorder defense is highly possible. Yates' husband has already told the national news media how his wife suffered from postpartum depression and had once attempted suicide. Since the late 1980s, judges have recognized postpartum psychosis as a legitimate defense for killing, and women have had their sentences reduced to manslaughter by reason of insanity or acquitted altogether and sent to mental health facilities.
    Even if Yates decides to plead insanity, though, legal experts say she'll have a hard time persuading a jury that she should not be held responsible. When defendants plead not guilty by reason of insanity, their lawyers are faced with the burden of proving their case to a jury, where normally they don't have to prove anything. "Anytime you have to rely on the insanity defense it is a very tough road, especially in the case of infanticide," said criminal defense attorney Jennifer Auger. "You are walking into court and saying, 'I killed my children, but I did it because of this reason,' and it is hard sometimes to get past the 'I killed my children' part of that phrase."
    The swarm of public attention being owed to her tragic case also may ultimately hurt Yates' legal defense, some experts say. According to legal analyst June Grasso, despite Yates' past struggles with mental illness, jurors would likely demand some form of punishment for the deaths of five children. "Juries these days are very interested in people being responsible for their actions," said Grasso, who has covered many high-profile cases for Court TV. "They have to go home to their community and people would say to them, 'How could you possibly let someone like that go?'

Drug-Rehab Experiment Begins Sunday in California
Don Thompson, Associated Press- 6/28/2001

SACRAMENTO, Calif. -- The nation's biggest experiment in drug rehabilitation begins Sunday in California amid warnings from officials in Los Angeles County that they do not have enough money to carry out their part. Proposition 36, passed last fall by the state's voters, will require treatment instead of prison or jail for the estimated 36,000 California nonviolent drug users convicted each year of use or possession for the first or second time. Treatment will range from counseling sessions to a stint at a rehab center.
    Arizona, the only other state with a similar program, diverts only about 6,000 drug offenders a year to treatment. California led the way in jailing drug users two decades ago and now locks up more drug offenders per capita than any other state, at 115 people per 100,000 population. That is more than twice the national average.
    Proponents of Proposition 36 said drug treatment addresses the root of the problem and saves money in the long run by reducing the need for prisons. Each of California's 58 counties has its own plan to carry out Proposition 36, which allocates $120 million a year for implementation statewide. In Los Angeles County, California's biggest county with 9.5 million people, officials say their program could be overwhelmed and underfunded when it tries to handle a projected 17,000 cases about one-third of the state's expected eligible offenders with $30 million in state money. ''The county's going to go into debt. We just don't know how much,'' said Superior Court Judge Michael Tynan, who supervises the county's drug courts.
    Elizabeth Stanley-Salazar, California director for Phoenix Houses, one of the nation's largest treatment providers, said she expects a fight between counties and the state over which is responsible for providing any additional funding. ''At this moment we clearly have many more clients than we have funding for,'' said Stanley-Salazar, who sits on the state and Los Angeles County's Proposition 36 implementation task forces. ''We're building the transcontinental railroad here, six inches at a time.''
    Supporters of the initiative say officials are being alarmist. ''There's a lot of `Chicken Little' going on in L.A.,'' said Whitney Taylor of the Lindesmith Center, a policy research institute. She said it is too soon to say whether the county will be overwhelmed. Drug offenders who want to stay out of jail and get help from one of the 300 or so private treatment services in Los Angeles County will have to enter a conditional guilty plea. They will then be supervised during treatment by one of 26 special judges. Offenders' records are cleared if they complete treatment.
    Under the county's current drug treatment program, offenders are tested up to six times a week during the early stages of treatment. But no money has been set aside for testing under Proposition 36, which has led to one of the most serious debates about the measure.  Treatment proponents say counties like Los Angeles test far more often than necessary, driving up costs. Law enforcement officials say they need periodic tests to ensure that offenders stay drug-free during treatment. Both sides are supporting a bill in the Legislature that would provide an additional $18 million statewide for drug testing.
    Some counties have lowered their projections on the number of offenders who will be treated, after eliminating people with multiple offenses and estimating how many would show up for treatment. Al Medina, San Diego County's alcohol and drug services administrator, dropped his county's original projected caseload by one-third, but worries there are not enough residential programs for those needing long-term treatment to kick their habits.
    Bob Mimura, executive director of Los Angeles County's Criminal Justice Coordination Committee, said he hopes many small-time offenders accept a drug conviction instead and leave more funding for those who need more in-depth treatment. Those offenders, can ''just take their conviction and maybe 30 days in jail and they're gone,'' Mimura said.
    On the Net: California Department of Alcohol and Drug Programs: http://www.adp.ca.gov

Judge Orders N.Y. C. to Arrange Treatment for Released Mentally Ill Inmates
Samuel Maull, Associated Press- 6/27/2001

NEW YORK -- A Manhattan judge Wednesday ordered the release of medical records of mentally ill inmates at Rikers Island jail so their lawyers can proceed with contempt of court motions against the city. State Supreme Court Justice Richard F. Braun said the plaintiffs had shown that the city is probably in contempt of his July 2000 order to provide every mentally ill inmate with a discharge plan before his release. Lawyers for the plaintiffs charged that the city was dumping mentally ill inmates at subway stops in the middle of the night with a $3 MetroCard, $1.50 in cash and no plans for medication or counseling.
    Last July, Braun issued an injunction against that alleged practice. He also gave class-action status to a suit that had been filed against the city in August 1999 by seven mentally ill inmates of Rikers Island. The city appealed, and on March 7 the State Supreme Court's Appellate Division upheld Braun, making his ruling effective as of that date. The plaintiffs said they need the medical records so they can determine who the members of the class are, find and communicate with them, and learn to what extent the city has failed to provide discharge planning for them. The judge gave the city until July 9 to deliver the records to him.
    Heather Barr, a lawyer for the inmates, said the class includes about 30,000 inmates a year. She said her group waited about two months for the city to comply with Braun's order before filing the contempt motion. The city had argued against the motion for disclosure of the inmates' medical records, saying that state law makes them confidential. The judge disagreed. He said that section of the law on which the city relies ''is applicable only to facilities licensed or operated by the office of mental health or the office of mental retardation and developmental disabilities, which the city jails are not.'' Braun said that even if the section that the city cites were applicable, he would still grant the plaintiffs' motion ''in the interests of justice.'' The disclosure would ''enable them to try to demonstrate plaintiffs' need for discharge planning and defendants' apparent continuing failure to provide it other than to a small percentage of the class,'' he said.
    Tom Crane of the city's Law Department said most of the inmates whose records are being sought don't know they're part of a class action, and the city could be liable if it released their medical records. Crane also said the city has begun a discharge planning program for inmates receiving mental health treatment. Some parts of the program are in effect, and some are still being developed, he said. One aspect of the program includes borough offices, run by a nonprofit agency, where the former inmates will be able to get help. Those offices should be operating within a couple of months, Crane said.

127 Colorado Sex Offenders To Be Freed
Kirk Mitchell, Denver Post- 6/28/2001

Convicted child molester Gary Breazier violated parole guidelines intended to keep him from repeating his crime. So he was re-arrested. Now he and 126 other people who violated parole will be the first of hundreds of sex offenders to be released from prison or parole under a state Supreme Court decision announced Monday. Officials said the 127 offenders will be released upon further instruction from Attorney General Ken Salazar's office. Salazar's spokesman, Ken Lane, said attorneys are analyzing the ruling and have not decided their next step. Gov. Bill Owens has asked Salazar to appeal to the U.S. Supreme Court, the governor said in an interview in Washington, D.C. Owens said he believes the early release of the offenders will result in more sex crimes.   According to the ruling, the sex offenders shouldn't have been on parole when they violated rules and were sent back to prison. District judges had consistently sentenced sex offenders based on a 1993 mandatory parole law but should have used a conflicting 1996 law that limited parole, the ruling said.
    In response to a Denver Post request, the Department of Corrections on Wednesday disclosed the names of 127 inmates to be released and their crimes. Of the offenders, 103 were convicted of crimes against children. All crimes occurred between 1993 and 1998. The department also provided the names of 249 sex offenders who are serving parole in violation of the state Supreme Court ruling. Of those, 160 committed crimes against children. An additional 1,142 sex offenders will be released from prison as they complete sentences over the next several years.
    Releasing sex offenders without parole supervision troubles prison officials. "This is a public safety concern," corrections spokeswoman Alison Morgan said. "Sex offender supervision in the community is important." Sex offenders must register their names, addresses and other information with their local police or sheriff's departments the next business day after their release. The legislature increased the penalty this year to a felony for those who fail to register.
    Breazier has been in and out of prison since 1983 for theft, robbery, sexual assault, harassment and trespassing. In 1988, he was using LSD when he robbed and sexually assaulted a woman at knifepoint. In 1995, shortly after his release from prison, he molested his 7-year-old nephew in Weld County. The victim's mother said Breazier told her that he molested the boy because he was scared and wanted to return to prison. Breazier was one of nine sex offenders released Sept. 28 and 29 in the wake of a ruling that paved the way for Monday's decision.

Michigan Mental Health Care Criticized
Wendy Wendland-Bowyer, Detroit Free Press- 6/29/2001

Michigan's mental health system gets a failing grade in a report card released today by five organizations that advocate for children and adults with severe mental illnesses. The report says the state does not have enough long-term psychiatric hospital beds and the beds it has are not spread evenly across the state. It also says that the state fails to adequately coordinate care for people who have both a mental illness and a substance addiction. And it says there's "a virtual epidemic" of mentally ill people ending up in the criminal justice system.
    Geralyn Lasher, spokeswoman for the Michigan Department of Community Health, criticized the report and said the system has improved under Gov. John Engler. "I think it is another example of people who have been critical of the Engler administration from day one," she said. "They can be shown all the facts, all the figures ...all the changes of the past 10 years, and it is not going to change their opinion."
    The report measures 33 categories and was prepared by the Mental Health Association in Michigan, the Alliance for the Mentally Ill of Michigan, the Association for Children's Mental Health, Michigan Association for Children with Emotional Disorders and the Michigan Psychiatric Society. The groups got most of the data from state documents and say they are in a good position to evaluate the system because it is their members who are in it or dealing with it daily. "I hope this report card will raise some new measures of quality," said Kathleen Gross, executive director of the Michigan Psychiatric Society.
    In the last decade, 10 state-run mental health hospitals closed. The state also switched to a managed care system where a set amount of money for services is administered by 49 local community mental health boards. Michigan's mental health budget was about $2 billion in fiscal 2000 and served more than 200,000 people. Of that, about $1.6 billion went toward mental health services. One problem the report highlights is that about 85 percent of the adults and children who receive services have a mental illness, yet the system spends less than 45 percent of its treatment money on programs for them. The rest is generally spent on people with developmental disabilities, such as mental retardation.
    Lasher said that comparison is not valid because people with developmental disabilities often have severe physical needs that mentally ill people don't have. But Mark Reinstein of the Mental Health Association said many mentally ill people need more than medicine to stay well, including supportive housing, counseling and other services. Of the present funding situation, Reinstein said, "Basically, what you've got to do is ration the services and always look for the least expensive, minimalist approach. And it even gets down, on some levels, of having to turn people away."

Siblings of Yates Suffer From Depression As Well
Audrey Warren, Houston Chronicle- 6/29/2001

Andrea Pia Yates' brother and sister said Thursday that depression is common in their family, troubling at least four of the five siblings, including Andrea. Andrew Kennedy and Michele Freeman spoke about their sister from a house in Friendswood with CBS co-host Jane Clayson for Thursday's The Early Show. "My sister was a very good mother," Kennedy said. "I knew something was wrong but, you know ... I tried to talk to her and ask her `Is everything going OK?' and she'd say, `Fine.' But ... I could tell by looking at her that it wasn't OK."
    The two siblings described visiting their sister in jail Wednesday, the day Andrea Yates' husband, Russell, 36, closed the lids of five small white caskets holding the bodies of Noah, 7; John, 5; Paul, 3; Luke, 2; and Mary, 6 months, at their funeral. "She doesn't (say much)," Freeman said. "She stares in your eyes, and when you look at her, it's like she's a million miles away." Kennedy said his sister, 36, still does not quite comprehend the magnitude of what happened -- the drowning of her five children in a bathtub in the family home June 20 and her being charged with capital murder. "She really -- she doesn't realize what's happening," Kennedy continued. "She asked us if ... the funeral had occurred, and we told her that it had. And we were trying to be positive to her and we said everything was ... fine. But she just didn't -- didn't have much to say." Freeman added that her sister just nodded.
    Russell Yates has said his wife suffered from postpartum depression, for which she was taking medication. After the birth of Yates' fourth child, Kennedy said, he began to see a change in his sister, describing her state as often zombielike. "She just ... stopped laughing for at least the last two years, and she used to have a real hearty laugh so, you know, I knew something was wrong," he said.
    The youngest of five children, Andrea is not the only sibling to suffer from depression, Freeman said. "I myself am on medicine for (depression) and I have two other brothers that are on medication for that," she said. "I just want everybody to know that it's time for us to start observing people with signs of depression. My co-workers at work, where I am employed, they notice(d) the change in me and they supported me."
    A miscarriage between Yates' third and fourth child was very difficult for her, as was their father's death in March, Kennedy and Freeman said. They said that they "pray a lot" to deal with the possibility that their sister may face the death penalty. "This whole family has (come) together," Freeman said. "And we're sorry that a tragedy like this has brought us together, but every single one of us are positive that goodness will come out of this." Freeman said she hopes it will make people aware and intervene when they see someone depressed. "If you see signs of depression ... ask and promote ... any kind of support that you can," she said.

Bill to Rein in HMOs Nears a Final Vote
David Espo, New York Times, 6/29/2001

WASHINGTON -- Blending compromise and clout, supporters of a patients' bill of rights accepted fresh restrictions on lawsuits but swatted down other changes yesterday as they struggled to bring their legislation to a final vote. "The end is in sight," said Nevada Sen. Harry Reid, the Democratic whip, after 10 days in which the bill's backers have displayed unquestioned command over the events on the Senate floor.
    President Bush has threatened to veto the measure, citing provisions he says will lead to unnecessary lawsuits, and the White House showed no sign of backing down. "Why would the Congress want to engage in a political activity to pass something they know will not be signed into law?" presidential spokesman Ari Fleischer asked.
    After days of closed-door negotiations, the Senate voted 96-4 to shelter nearly all employers from the threat of lawsuits under the bill. A second proposal, agreed to by voice vote, makes it clear that HMOs can't be forced to provide treatment excluded under their insurance contract. A third revision, which sponsors said they were prepared to accept, would prohibit most lawsuits while an independent review panel considers any dispute between a patient and an HMO. An exception would be made if the review lasted longer than a month. Based on those changes, some Democrats urged Bush to reconsider his veto threat. The bill is "very close to the president's principles and I would hope he'll take another look," said Sen. Edward Kennedy, D-Mass.
    Critics of the bill said they were pleased with the changes, but quickly added they weren't enough to satisfy their concerns that the bill would be detrimental. "There are serious concerns for those of us who look on this as an extremely expensive piece of legislation in the sense it will drove up the cost of health insurance" and lead employers to cancel or reduce coverage, said Sen. Judd Gregg, R-N.H. By day's end, some Republicans were speculating that the measure could pass as early as today, although not by a veto-proof majority.
    The legislation, which Democrats made their top priority after gaining a Senate majority last month, is designed to rein in HMOs by guaranteeing patients treatment such as emergency-room care, access to specialists and the right to select a pediatrician as a child's primary care provider. After years of gridlock on the issue, there is relatively little dispute over the protections to be provided. Instead, the Senate has spent much of the past 10 days debating when and where lawsuits may be filed for denial of care, and what type of damages may be sought. The Democrats, aligned politically with the nation's trial lawyers, have drafted their bill to permit more lawsuits than Republicans want. And Republicans, who benefit from insurance industry backing, have devoted hours in debate to warning that suits will drive up the cost of insurance and prompt some employers to cancel their workers' coverage.
    According to the Center for Responsive Politics, the American Trial Lawyers Association gave $3.6 million to Democrats in the 1999-2000 election cycle, and nearly $425,000 to Republicans. The American Association of Health Plans donated nearly $120,000 to Republicans and almost $7,000 to Democrats. The Health Insurance Association of America gave slightly more than $230,000 to Republicans, slightly more than $30,000 to Democrats. The insurance industry is also spending heavily to shape public opinion. Officials showed a television commercial -- set in an upper-crust British lawyers club -- that slammed the legislation as a windfall for attorneys.

Movies As Therapy Gets Serious Treatment
Linda Shrieves, Orlando Sentinel, 6/29/2001

In an odd twist of pop culture meeting psychology, authors are cranking out self-help books that prescribe movies for what ails you. "Sometimes, people think it's strange or almost a joke," says psychologist Gary Solomon, author of "Reel Therapy: How Movies Inspire You to Overcome Life's Problems" (Lebhar-Friedman Books, $12.95). "But movies are a terrific tool. Movies help people see themselves, their family or their friends, through the movies they're watching." Solomon is serious about the subject, as is Texas psychologist John Hesley, author of "Rent Two Movies and Let's Talk in the Morning" (John Wiley & Sons, $44.95). And in a contrast to the somber approach, Nancy Peske and Beverly West have taken a campy view of movie therapy in "Cinematherapy: The Girl's Guide to Movies for Every Mood" (Dell Trade Paperback, $12.95).

A dose of reality
At one time, psychologists prescribed books for patients to read. Now some are prescribing movies. "If a picture's worth a thousand words, a movie's worth 10,000 words," says Solomon, who teaches and practices in Henderson, Nev. Besides, in a time-crunched society, movies are an easier sell if you're assigning homework. "It might take some clients weeks" to read a book. "But in the movie, it's right there. They can watch it with the family, and they're done in two hours," says Alan Entin, a Richmond, Va., psychologist and past president of the American Psychological Association's division of media psychology.
    Movies really do help patients, particularly those who don't see -- or understand -- their destructive behavior, psychologists say: a man who's abusive to his family but thinks of himself as merely strict; a woman who repeatedly finds herself attracted to domineering men. "That's the single greatest problem in therapy," Solomon says. "People come in, and they're in denial. They don't see things the way they really are. Movies help people see things as they are. Patients relate to the characters, sometimes they relate to multiple characters, sometimes they relate to the story line."
    After watching a movie, patients may be jolted by a revelation -- even after months of therapy. Solomon counseled an alcoholic for months, but the patient refused to admit that his drinking was a problem. "I struggled with him for a very long time," Solomon says. "When I finally got him to watch 'Drunks,' he was able to see what he was doing to himself -- and he came out of denial."

From E.T., Stuart and Toto, too
This may sound like a new low in psychobabble, but it's not entirely new to the world of psychology. In the 1930s, William Menninger gave his psychiatric patients homework assignments -- reading fiction -- to help with therapy. Since then, therapists have used books, short stories and poetry in therapy. Now, they're merely adding movies to their arsenal. Few have discussed it, much less named it. But Solomon has -- and he trademarked the term "cinematherapy."' "We've become a very visual society," he says. And people relate more to movies than books.
    Russel Hiett, an Orlando, Fla., psychologist, says he, too, suggests movies to patients -- especially men or women who keep making the same mistakes. "I like to use movies for tracking certain themes in people's lives," Hiett says. "For example, women who always find men who are aggressive and controlling. Or when I'm looking for particular role models. The one I often think of is Sigourney Weaver in 'Aliens.' While it was a horror flick, the women were the ones who were the survivors and the strong ones, resolving problems. I use that for a role model for women with poor self-esteem."
    Entin says he sometimes uses movies in his therapy sessions because patients -- particularly couples -- feel freer to talk about movie characters than themselves. "If you and I are having a problem, we may not be able to talk about it," Entin says. "But if we see it in a movie, we can objectively talk about it. It's not about you and it's not about me; it's about Woody Allen and Diane Keaton." One of his favorite movies, he said, is "The Wizard of Oz." "I suggest it because people are always searching for something. And yet, what they're really searching for is inside of themselves, and they don't recognize it."
    Despite the popular conception, watching movies -- and making recommendations for other therapists -- isn't leisure. "It's a lot of work," Solomon says. "What I'm doing is categorizing and cross-categorizing film for therapy." Old movies or new movies, TV movies or box-office bombs, Solomon doesn't care. "I have very little interest in whether a film does well or not -- or whether a reviewer likes it. I'm interested in therapeutic value," he says.
    He even recommends "Stuart Saves His Family" -- a 1995 dud that featured Al Franken as Stuart Smalley, the "Saturday Night Live" character who believes that 12-step recovery programs can save the world. "It's probably the best film that deals with a variety of issues. Comically, yes, but it deals with issues," Solomon says. You might not think of "E.T.: The Extra-Terrestrial" as therapeutic, but Solomon does. "It deals with abandonment, and the idea that we are so critical and quick to make decisions about other things that we can be betrayed by the people we trust. Not to oversimplify: We all want to get home."
    But there are limitations. For one, says clinical psychologist Entin, people should be wary of reading a self-help book about movie-therapy and then decide they can fix their problems through movies alone. People could easily latch on to the wrong message in a movie. Take "The Prince of Tides," he notes. Construe the message somewhat, Entin says, "and you might think that you can have sex with your sister's therapist -- and you'll feel great. That's one of the messages in that movie." "You have to do this within the context of therapy," Entin says.

Let mood be your guide
Unlike Solomon, West and Peske -- two cousins who are writers, not psychologists -- organized their book by moods. "We reduced the entire female experience to 13 moods," West says. Moods include PMS, bad hair days, dumped and out for blood and straining to hear your inner voice. Let the psychologists analyze everything, say Peske and West. They know what works. "We take two approaches. One is to rise above what you're feeling -- laugh off your troubles," West says. "The other thing cinematherapy does is let you wallow in it. Weepers are cathartic." Need a good cry? Peske, who specializes in weepers, suggests "Beaches," "Born Free," "The Way We Were" and the all-time great, "Love Story."
For girlfriend movies, group viewing is preferred -- unlike in Solomon's method, which requires people to view movies alone, without snacks and without interruption. "Sometimes movie watching is a way to shut people out, and sometimes it's a way of bonding," Nancy Peske says. " 'Romy and Michele's High School Reunion,' for instance, is mandatory group viewing. It's a great girlfriend movie." Other recommended girlfriend-bonding movies include "Waiting to Exhale" and what the authors call the ultimate girlfriend movie, "Steel Magnolias."
    Peske and West resent any suggestion that theirs is not serious work. "We do take it seriously. In the sense that we think it's OK to tell women to take a few hours away from the job, the kids, PTA and do something that feels good," West says. "Something that is nurturing and cathartic -- hopefully accompanied by a few thousand empty calories. We're trying to give women permission to do that."

New Women's Shelter Under Way In Livingston County
Steve Pardo, Detroit News- 6/29/2001

HOWELL, MI -- With a shovel in the ground and the release of white doves, construction began Thursday on a new 19,000-square-foot shelter for women of domestic violence. The Livingston Area Council Against Spousal Abuse, the organization that began with one phone line in a volunteer's house in the 1970s, will soon have a new 20-bed facility.
    "This is really a grass-roots organization," said Debbie Felder-Smith, executive director of the organization. "Its beginnings here were over 20 years ago, but today we've come so far. We belong to the community." The group logs nearly 2,000 crisis calls a year and representatives talk to about 1,500 victims. The new shelter will have a children's area, more beds for the abused women who turn to the shelter for sanctuary, counseling rooms and administrative offices. The construction of the new shelter brings in all of the organization to one location at 2895 W. Grand River in Howell.
    The dream of upgrading the existing shelter, a 150-year-old house, began sometime in 1995. The community was growing, caseloads were increasing and LACASA workers knew the current building couldn't suit the needs of the population much longer. Fund-raising efforts began and in March of last year, the organization had collected about $1 million. That's when the Kresge Foundation came forward with a fund-raising challenge grant. If LACASA could raise $2.1 million by June 1, the foundation would kick in an additional $400,000.
    Soon, makeshift donation cans started appearing in party stores, shops and gasoline stations. The Boy Scouts and Girl Scouts collected donations. Rotary clubs held challenges. Businesses sold off food and trinkets with the proceeds going to the shelter. The Howell Soft Cloth Car Wash sponsored deluxe washes, donating the $20 cost to the shelter. Ideal Steel in Hamburg Township joined in and other donations also arrived in the final hours and LACASA made its goal -- and surpassed it. The tally a few days after the deadline was nearly $2.4 million.

Substance Abuse Center Surrenders License, Plans to Reorganize
Associated Press, 6/30/2001

DUBLIN, N.H. -- A troubled substance abuse center is planning a facility overhaul after having turned in its license to operate in exchange for the state dropping efforts to revoke it. A lawyer for Beech Hill Hospital, Arpiar Saunders, said the facility's last patient was sent home more than a week ago. He said he is confident the facility will provide services to patients in the future, but under whose management is unclear. ''A good number of institutions and groups have expressed interest in using Beech Hill to provide services,'' Saunders said. He did not rule out the possible sale of Beech Hill.
    Frank Potvin of Claremont, a substance abuse counselor, said he was let go two weeks ago from the facility with little notice.  ''This is heartbreaking and sad,'' he said. ''We did good work in there. The work that I did was for the betterment of the kids. They were never abused or battered while in our care.'' Potvin said teen-agers in the area who need drug treatment now won't be getting it.  ''That's the other half of this story,'' he said. ''There's a great demand for these services. There are human consequences to these political and financial decisions.''
    Earlier this month, state health officials said they were revoking Beech Hill's substance-abuse treatment license, calling the facility a ''sick building.'' The treatment center had 30 days to appeal the decision, but has decided to hand in the license instead. Poor maintenance is one of 45 deficiencies cited by state health inspectors who visited Beech Hill in late May. Other deficiencies included a barrier constructed between the nursing station and a detoxification room; nurses and doctors who lack the proper licenses; refusal of treatment to patients; failure to have staff members get state-required physicals and tuberculosis shots; failure to pay staff; and planning to start a methadone program without permission.
    Beech Hill failed its yearly inspection last fall, failed again during a surprise inspection in January, and later failed a second surprise inspection. The state threatened to shut down Beech Hill after it failed a health and safety inspection in 1997. Regulators allowed the hospital to stay open if it passed inspections over the next two years. It did. But last fall, inspectors found 38 deficiencies, including problems with nurses dispensing medication, medical records, fire-suppression systems, and unsanitary kitchen conditions.

Pot's Rise Reported in Young Arrestees
Greg Krikorian, Los Angeles Times- 6/30/2001

While marijuana use during the 1990s held steady in the nation's general population, its popularity among 18- to 20-year-olds arrested for crimes soared and is now epidemic, according to a report released Friday by the U.S. Department of Justice. Moreover, the study of 23 cities, including Los Angeles, found that as marijuana use grew, crack and heroin use declined significantly, raising questions about the long-debated inevitability that marijuana use leads to harder drugs.
    "I think the findings are powerfully significant," said the study's co-author, Andrew Golub, a senior researcher at the National Development and Research Institute, a New York-based private, nonprofit foundation. "Fifteen years ago, we documented that the use of cocaine, particularly crack cocaine, was rampant among arrestees. Five years ago, we documented that crack was declining," Golub said. "What we see today is that the drug of choice among arrestees is marijuana and that it is not serving as a gateway to something else," Golub said.
    Nationally, the study found, the rate of 18- to 20-year-olds who tested positive for marijuana when arrested for any crime rose from 25% in 1991 to 57% in 1996. From 1996 to 1999, the study found, marijuana use among that age group rose to about 60% and remained at that percentage through 1999, the most recent year for which statistics were available. The high percentage accounted for most of the increase reported among all adults, 18 years and older, who tested positive for marijuana after arrests in the 1990s, the study found. In that group, the study says, marijuana use went from about 20% of the arrested population in 1990 to about 37% from 1996 on. By comparison, the rate of marijuana use in the nation's general population has remained static at about 5% for more than a decade, according to the study. "Marijuana appears to have become the drug of choice among youths coming of age in the 1990s who tend to get in trouble with the law, in the same way that crack had been the drug of choice previously," the report says.
    The research, Golub said, suggests that the spike in marijuana use is attributable to several factors, including its acceptance as a far less damaging alternative to harder narcotics. "Many of these individuals have seen the devastation resulting from crack and heroin use, and they blame their parents' experiences on their use of these drugs," he said. "And this explains why for many of these youths, use of marijuana is perceived as an act of resilience" that is celebrated in everything from clothing to music. "This is a social phenomenon," Golub said. "These youths define marijuana as not a drug."
    "I would say that, generally, that's true," said Lawrence Gentile, who runs the nonprofit Behavioral Services Inc., one of the largest drug treatment programs in Los Angeles County. "My perception is that these kids just see this as a recreational activity," said Gentile, whose clinics and residential programs handle more than 5,000 clients a year, about a fourth of them ages 18 to 20. "They don't see . . . a major issue with using marijuana."
    While the study found that marijuana use among arrested youths in Los Angeles may not have yet peaked as in other cities, the relative percentage (54%) was well below that of other cities such as Miami (66%), Atlanta (72%) and Chicago (75%).
But Los Angeles' lower number may only reflect a separate drug trend: the West Coast prevalence of methamphetamines, according to researcher Golub. A 1999 Department of Justice report, he said, found that 10% of Los Angeles arrestees of all ages tested positive for methamphetamines. The rate in New York City and other East Coast locations was less than 1%. The study was funded by the National Institute of Justice and is part of a larger project funded by the Robert Wood Johnson Foundation.

Senate Passes Patients' Rights Bill
Helen Dewar and Amy Goldstein, Washington Post, 6/30/2001

The Senate yesterday approved far-reaching legislation extending new rights to all Americans in managed-care health plans, defying a veto threat from President Bush and giving the Senate's new Democratic majority a big victory in its first test of wills with the White House. The 59 to 36 vote followed two weeks of debate during which Democrats fended off virtually all GOP assaults on the bill, compromising on some issues but preserving core provisions, including broad authority to sue health plans for large awards in state as well as federal courts.
    The legislation, which Democrats made their top priority after taking control of the Senate early this month, makes it easier for patients to secure a wide variety of services, including coverage for visits to the nearest emergency room, direct access to medical specialists, medically necessary prescription drugs and clinical trials for experimental treatments. To safeguard these new rights, the bill provides extensive new opportunities to challenge decisions by health maintenance organizations and insurers -- including a two-tiered review process -- and, if a patient remains unsatisfied, a right to sue insurers and HMOs over decisions that lead to injury or death.
    But its sponsors also agreed to numerous compromises on issues such as limiting lawsuits against employers and curbing class action suits in a bid to pick up support and address some of Bush's objections. "We've made a lot of changes I think would be to his liking. . . . I think he should reconsider" his veto threat, said Majority Leader Thomas A. Daschle (D-S.D.). Nine Republican moderates joined all Democrats in voting for the legislation; Vermont Sen. James M. Jeffords, an independent, voted against it. "Today's vote brings us a giant step closer to guaranteeing that millions of Americans will no longer be powerless when their HMOs overrule their doctor and deny needed care," said Sen. Edward M. Kennedy (D-Mass.), the bill's longtime champion.
    Bush praised the Senate for "narrowing some loopholes and giving greater deference to state patient protections" but warned the bill could still lead to "excessive, unlimited litigation in state courts [that] would drive up premium costs and cause many American families to lose their health insurance." He "could not in good conscience sign this bill because it puts the interests of trial lawyers before the interests of patients," he said, adding that he will continue to press for changes in the House.
    With the bill's Senate passage, the fight over patients' rights shifts to the House, which plans later this summer to consider both a bill similar to the Senate's and a less stringent alternative drafted by House Republican leaders with strong support from Bush. Two years ago, the House approved a bill that was stronger than this year's Senate bill.
    The bill's success in the Senate is a setback for Bush after his back-to-back victories during the spring, with the congressional passage of a $1.35 trillion, 10-year tax cut and the approval by both houses of a modified version of Bush's education reform package. It is also the second legislative triumph this year for Sen. John McCain (R-Ariz.), Bush's rival in the GOP primaries two years ago, who teamed up with Democratic senators Kennedy and John Edwards (N.C.) to sponsor the latest patients' rights legislation. McCain was a principal sponsor of a campaign finance bill that passed the Senate earlier this year despite objections from Bush.
    On the patients' rights issue, Bush had pinned his hopes in the Senate on a bipartisan alternative drafted by Sens. John Breaux (D-La.) and Bill Frist (R-Tenn.), but he never weighed in forcefully on its behalf. The Breaux-Frist measure got caught between Democrats who thought it did not go far enough and Republicans who thought it went too far. It was defeated 59 to 36.
    The Senate effort, although aimed at breaking five years of gridlock on the issue, does not guarantee enactment of the legislation, even though polls show strong public support for giving patients more clout in dealing with their HMOs. If the House approves a bill that is markedly different from the Senate's version, the legislation could die in negotiations between the two chambers, which was what happened two years ago. And if the House approves a similarly stringent bill, Bush will be forced to choose between swallowing the result -- as he did as governor of Texas -- or vetoing legislation that is popular even among Republicans.
    In its final action on the measure, the Senate agreed unanimously to include federal employees, Medicare recipients and other beneficiaries under the new protections, adding to safeguards that President Bill Clinton had imposed by executive order. Among them are access to clinical trials and a right to sue. The Senate also agreed to restrict class action lawsuits against health plans and to keep patients from going to court unless an appeal before an independent board drags on for more than a month. And it agreed to a proposal from Sen. John W. Warner (R-Va.) to cap lawyers' fees at one-third of a damage award, after expenses. An earlier proposal to cap the fees at 15 percent failed. Warner later voted for the bill. In addition, the Senate voted -- without dissent from abortion rights supporters -- to define fetuses born alive as persons under federal law and make them eligible for protection under the patients' rights bill. The bill itself applies to Americans who have private health insurance through their employer or buy coverage on their own. It would not improve access to insurance or medical care for 44 million uninsured Americans.
    After extensive debate over whether states that have adopted their own managed-care laws should be freed from the federal requirements, a compromise approved by the Senate would enable states to win exemptions if they can demonstrate that their laws are in "substantial compliance" with the federal rules. Specifically, the measure compels health plans to allow patients to see obstetrician-gynecologists and pediatricians without first getting permission from their primary doctor. HMOs would be required to provide access to medical specialists when needed. If the type of specialist a patient needs is not available in a plan's network, the patient could visit an outside doctor at no extra cost.
    In a related provision, health plans would have to offer patients a "point of service" alternative, in which they could visit doctors outside their network, for an extra charge. The measure requires managed-care plans to pay for emergency room visits whenever patients believe they have a true medical emergency. Patients who are most in need of medical care would gain protection against an abrupt change in doctors. If an HMO stops contracting with certain physicians, its patients could continue to be treated by those doctors for three more months if they have a serious or complex medical problem -- or are in the last third of a pregnancy.
    Health plans would have to enable patients to take part in federally funded clinical trials to test new therapies. They could not impose "gag rules" that prohibit doctors from discussing treatment options with patients. They could not offer doctors certain financial incentives to stint on patients' care. And they would have to defer to doctors' judgment as to how long patients need to be hospitalized for breast cancer surgery.
    Under the bill, patients would be guaranteed recourse if their HMO fails to abide by these rules. They would be able to file grievances to appeals bodies inside their health plan and, if they remain unsatisfied, with new, independent review boards. If still unsatisfied, they could go to court. Under the provisions that are most objectionable to many Republicans, including Bush, patients could file suits in state courts over health plan decisions that lead to injury or death, and they could collect as much money in damages as state law allows. Consumers could also file suits in federal courts over contract disputes, such as denial of benefits to which they believe their contract entitles them. Under current law, health insurers may be sued only in federal courts, and patients may collect only the monetary value of the treatment they were denied.

Justices to Hear HMO Review Issue in Fall
David G. Savage, Los Angeles Times- 6/30/2001

WASHINGTON--Before quitting for the summer, the Supreme Court said Friday it will decide next term whether states can set up independent panels of doctors with the legal power to review the medical decisions of HMOs. The question is at the heart of the current debate over the patients' bill of rights in Congress. If lawmakers do not resolve the issue by passing a new law this summer, the justices will take it up when they return to the bench in the fall.
    Advocates for patients say the administrators of health care plans should not have the exclusive power to decide what medical treatments will be provided. HMOs appear to have that authority now. Thanks to past rulings by the high court, patients who are unhappy with their HMOs' decisions cannot sue the plans for damages. The justices have interpreted a 1974 pension law as shielding "employee benefit plans" from being sued.
    Undeterred, many states adopted a fallback approach that gives disgruntled patients the right to appeal when their HMOs deny them treatment. Typically, a panel of three doctors is entrusted to review cases. If they agree the treatment was medically necessary, they can order the HMO to pay for it. Last year, then-Texas Gov. George W. Bush cited his state's independent review board as an example of the right way to balance the rights of patients and the responsibilities of HMOs. California and 36 other states have adopted these independent review panels. But the legality of the independent review boards has been put in doubt.
    Lawyers for the health insurance companies in Texas went to court there to challenge the state's power to establish these boards. They argued that the 1974 federal pension law shielded their plans from state interference. In June 2000, the U.S. 5th Circuit Court of Appeals in New Orleans agreed, saying the state did not have the authority to oversee HMOs. The appellate judges cited the Supreme Court's ruling that shielded HMOs from all state laws. In October, however, the U.S. Court of Appeals in Chicago came to the opposite conclusion.
    The Illinois ruling came in the case of Debra Moran, who had consulted her HMO doctors for severe pain in her shoulders and numbness in her limbs. They recommended physical therapy; she went to a specialist who recommended surgery instead. When the HMO refused to pay, she had the surgery anyway and later appealed to the Illinois review board seeking compensation for the $95,000 cost of the procedure. But lawyers for her HMO went to court to challenge the review board's authority. They lost when the judge ruled that Moran was simply trying to obtain what her medical plan had promised her. The Texas and Illinois cases were appealed to the Supreme Court, and the justices announced Friday they will hear the one from Illinois, Rush Prudential HMO vs. Moran, 00-1021.