Noteworthy News Articles on Mental Health Topics, July 24-31, 2001

Clues to Impending Doom in Poets' Language
ABC News, 7/24/2001

The writings of poets of various nationalities who committed suicide contain words and language patterns that give clues about their eventual fate, researchers said today. Using a computer program that examines word usage in written texts, the researchers analyzed 156 poems written by nine poets who committed suicide and 135 poems written by nine poets who did not. They found that the suicidal poets gravitated toward words indicating their detachment from other people and preoccupation with themselves. "The key finding is that we were able to distinguish features of people's mental health by the language they use," said James Pennebaker, a University of Texas psychology professor who conducted the research along with University of Pennsylvania graduate student Shannon Wiltsey Stirman. "The words we use, especially what often appear to be the unimportant words, say a lot about who we are, what we're thinking and how we're approaching the world," he added. The study appears in the journal Psychosomatic Medicine.
    The researchers looked at the works of John Berryman (1914-1972), Hart Crane (1899-1932), Sergei Esenin (1895-1925), Adam L. Gordon (1833-1870), Randall Jarrell (1914-1965), Vladimir Mayakovsky (1893-1930), Sylvia Plath (1932-1963), Sarah Teasdale (1884-1933) and Anne Sexton (1928-1974), all of whom took their own lives.  It compared their works to poets matched as closely as possible by nationality, era, education and gender. All the poets were American, British or Russian. The comparison group included Matthew Arnold (1822-1888), Lawrence Ferlinghetti (1919-present), Joyce Kilmer (1886-1918), Denise Levertov (1923-1997), Robert Lowell (1917-1977), Osip Mandelstam (1891-1938), Boris Pasternak (1890-1960), Adrienne Rich (1929-present) and Edna St. Vincent Millay (1892-1950). The poets who committed suicide used many more first-person singular self-references such as "I," "me" and "my" and fewer first-person plural words than did the non-suicidal poets.
    "Issues of identity, isolation and connection to others is revealed in pronoun usage," Pennebaker said in an interview. "One of the most telling words of all is the word 'I.' People who are suicidal or depressed use 'I' at much, much higher rates, and there's also a corresponding drop in references to other people." The suicidal poets also generally reduced their use of communication words such as "talk," "share" and "listen" over time heading toward their self-inflicted deaths, while the non-suicidal poets tended to increase their use of such words. The suicidal ones also used more words associated with death, but surprisingly the amount of words with negative emotion (for example, "hate") or positive emotion ("love") did not vary significantly between the groups.
    Pennebaker said previous research has found that suicide rates are much higher among poets than among other literary writers and the general public, and that poets are more prone to depression and bipolar disorder, also called manic-depressive illness. "As a group, no one would call poets a particularly bubbly, chipper group," Pennebaker added. He said the patterns of language used by the poets who eventually took their lives could serve as "linguistic predictors of suicide" in current poets. "This is not some kind of causal relationship. We're not saying that if you use 'I' a lot, then you'll commit suicide. It's just simply a marker of of greater risk," Pennebaker said.

Lobbying Intensifies As House Nears HMO Vote
Adam Entous, Reuters News Service- 7/24/2001

WASHINGTON - - The White House is launching a last-ditch effort to convince wavering Republicans to stand by the president in his fight to prevent the passage of a far-reaching patients' bill of rights, a struggle viewed as a major test of President Bush's leadership. With the House of Representatives set to begin the patients' rights debate as early as this week, Republican leaders conceded on Tuesday that they have yet to round up the votes Bush needs to block the bill, which expands the right of patients to sue their health plan, and push through legislation setting strict limits on lawsuits. But Republicans insisted they were gaining ground and expected the president to take the lead in a final lobbying blitz when he returns from Europe on Tuesday night. The White House said Bush would meet with a group of pivotal Republicans on Wednesday. "We are building momentum," said Kentucky Republican Rep. Ernest Fletcher, who crafted the patients' bill of rights backed by Bush. But he added, "Are we going to be able to build that momentum by the time the vote is? I don't know."
    If Bush does not succeed in rounding up enough votes, House Majority Leader Dick Armey, a Texas Republican, suggested that the leadership could put the patients' rights debate on hold. "There is not much sense in allowing, if you can do otherwise, ... passage of legislation that is harmful ... especially if it is destined for a veto," Armey said.  Republican aides said the vote, tentatively planned for Thursday or Friday, could slip to next week and possibly until after the month-long August recess.  At issue is legislation approved by the Democrat-led Senate that would grant patients sweeping new rights to sue their health maintenance organizations (HMOs) and insurance companies over treatment decisions that result in injury or death. A similar measure was introduced in the House by Republican Reps. Charles Norwood of Georgia and Greg Ganske of Iowa, and Democratic Rep. John Dingell of Michigan.
    Bush has threatened to veto the bill, warning it would drive up health-care costs and increase the number of uninsured by permitting jury awards of up to $5 million in federal court and unlimited damages under state law.  In its place, the president has thrown his support behind Fletcher, whose bill would cap noneconomic damages in federal court at $500,000 and give patients a limited right to sue in state court if an HMO or insurer fails to abide by the decision of a medical review board. But the White House may be facing an uphill fight.
    Supporters of the Norwood-Dingell bill say they have the 218 votes needed for passage, including the support of at least 11 Republicans. They expect 207 Democrats to back the measure. House Republican leaders said the vote count was changing daily, and predicted that last-minute arm-twisting and deal-making by Bush would make the difference. "It could be crucial," said John Feehery, spokesman for House Speaker Dennis Hastert, an Illinois Republican. "There's no better salesman than the president."
    For weeks Hastert delayed the patients' rights debate as he struggled to build support for Fletcher's bill. But in recent days, at least three Republicans who supported Norwood and Dingell in the past have joined the White House camp, including New York Republican Rep. Peter King, who declared on Tuesday: "I want a bill the president can sign."  Stepping up pressure on undecided Republicans, the White House dispatched Health and Human Services Secretary Tommy Thompson to Capitol Hill, where he said supporters of the Norwood-Dingell bill were wasting their time since it was headed for a veto. "Why go through this effort?" Thompson asked.

Sex Offenders' Freedom Begins
Kirk Mitchell, Denver Post- 7/25/2001

Forty-three sex offenders, including child molesters and rapists, were given $100 and their own clothes Tuesday then led through prison doors to freedom. "We have no authority to keep them," Department of Corrections spokeswoman Heidi Hayes said Tuesday. "We're doing the best we can to get them all out today." On Monday the Colorado Supreme Court refused to rehear arguments in two key sex offender cases, Hayes said. The 4-3 vote triggered the release.  The Supreme Court earlier had ruled that sex offenders were mistakenly sentenced to lengthy parole terms by the wrong statute. The offenders should have been sentenced using a law passed in 1996 that made parole conditional. In many cases, sex offenders should not have been required to serve parole. The high court's decision affects more than 1,500 sex offenders who committed crimes between 1993 and 1998.
    The mass release angered rape victims, said Kathie Kramer, spokeswoman for the Rape Assistance and Awareness Program. After the trauma of rape and testifying in court, victims now must watch as sex offenders are released from prison, she said. "Some of them are just angry," she said. "We always are going to put the community at risk when we release convicted sex offenders."
    Convicted child molester Kenneth Hoover, who spoke by phone Tuesday from his uncle's home, said because of the appeals over the parole issue, he stayed in prison eight months longer than he should have. He hated prison and will never re-offend, he said. "I went to the sheriff's office today and registered," Hoover said. "I'm just going to try to hide out in my own little world." He doubts he will have the time to get sex-offender therapy, and said he will focus on getting home repair and construction jobs so he can pay child support.
    On Tuesday, DOC officials also began releasing 116 sex offenders who violated parole that the court said they should not have served. Thirteen prisons, from the Sterling Correctional Facility to the Colorado Territorial Correctional Facility in Can~on City, freed sex offenders, according to Hayes and DOC records. About half of 71 sex offenders scheduled for release Tuesday had been sentenced in the Denver area. The Colorado counties that had sentenced the most sex offenders affected by the Supreme Court ruling were El Paso County with 14, Denver County with 13 and Jefferson County with 10. Parole officers across Colorado on Tuesday also notified 155 sex offenders that they no longer are on parole. Once off parole, the sex offenders do not have to attend therapy sessions, take blood-alcohol tests or keep a required distance from children. Over the next several years, another 1,145 sex offenders still incarcerated will be subject to the 1996 law, meaning that many will serve little or no parole. They can only be forced to serve parole for the remainder of their prison terms.

Stressed Turn to the Hands of Massage Therapists for Relief
Kara G. Morrison, Detroit News- 7/25/2001

Michael Townsend was designing paint shops for the automotive industry when, needing stress relief, he turned to massage therapy. Not only did his stress level drop, he found he loved massage so much he quit his job and took up a massage therapy career. That was 14 years ago. Today, as co-owner of American Therapeutic Massage in Birmingham and Farmington Hills, Townsend says interest in massage continues to grow as Americans become more health conscious. He estimates his business sees 15,000 clients a year. Nationally, Americans visit massage therapists 114 million times annually and spend as much as $6 billion on the visits, according to the American Massage Therapy Association. "More and more younger people are getting massages," says Townsend, who hasn't regretted his career change. "They're becoming more aware of it."
    People seek massages for everything from reducing stress and anxiety to easing physical symptoms like stiffness and tight joints. If you're in the market for the service, and can afford about $45 to $80 for a typical one-hour treatment, there's just one hurdle left. Finding a qualified massage therapist can be tricky in Michigan, which doesn't regulate the profession. Checking the phone book under "massage" may locate escort services rather than a professional massage therapist, Townsend says.
    Julie Wineman, a massage therapist at Finn Chiropractic Center in Wixom, recommends checking the American Massage Therapy Association web site, www.amtamassage.org, which lists its members. She also suggests clients interview potential therapists before scheduling an appointment, asking about their education, experience, professional memberships and references. Once at the appointment, Wineman says the therapist should ask if the client has any medical conditions that could hamper massage treatment. "Knowing a client's medical history is important," she says. "I always have clients fill out a history form."
    Dawn Kahl, who runs Comforts of Home Massage Therapy, says a good therapist commutes well with clients.
"A massage therapist who knows to ask questions is a good one," says Kahl of Canton, who provides the added convenience of traveling to clients' homes. Although there are dozens of massage techniques, including Shiatsu, deep tissue, sports massage and Swedish massage, Townsend says the client only needs to know how much pressure they'd like applied and how they want to feel after the massage. "Most people get a very good sense of relaxation from it," Townsend says. "A whole lot of people come in for stress reduction and realize they have an ache or pain they didn't even know we could address."
    Here are the various types of massage therapy:
* Deep tissue: Technique that releases the chronic patterns of tension in the body through slow strokes and deep-finger pressure.
* Myofascial release: Form of body massage to rebalance the body by releasing tension in the fascia. Long, stretching strokes are utilized to release muscular tension.
* Reflexology: Massage based around a system of points in the hands and feet thought to correspond, or "reflex," to all areas of the body.
* Shiatsu and acupressure: Oriental-based systems of finger-pressure that treat special points along acupuncture meridians (the invisible channels of energy flow in the body).
* Sports massage: Therapy focusing on muscle systems relevant to a particular sport.
* Swedish massage: System of long strokes, kneading and friction techniques on the more superficial layers of the muscles, combined with active and passive movements of the joints.
Source: American Massage Therapy Association, www.amtamassage.org.

Patients' Rights Vote Postponed
Juliet Eilperin and Amy Goldstein, Washington Post- 7/26/2001

On the eve of House debate, GOP leaders yesterday postponed a vote on legislation to protect patients in health maintenance organizations because they lack enough support to pass their own patients' rights bill despite aggressive efforts by President Bush to corral Republicans. As prospects for a rapid vote eroded, the White House entered an intense new phase of negotiations with Rep. Charles Whitlow Norwood (R-Ga.), the longtime sponsor of a patients' rights proposal that the president has said he would veto. Bush has said the proposal would give patients too much latitude to sue their health plans, and the negotiations revolve mainly around that disagreement.
    Top Republicans and White House officials acknowledged that a compromise from the administration's talks with Norwood holds the most realistic possibility of a quick resolution that would avert a major GOP defeat. House leaders said the vote could be postponed until the fall, although aides held out the possibility that it might take place next week before Congress takes a month-long break, if they can find a strategy that would produce enough votes.
    The House is considering two rival bills designed to create the first federal safeguards for Americans who belong to managed-care plans. The narrower bill that Bush supports, sponsored by Rep. Ernie Fletcher (R-Ky.), would compel health plans to furnish much of the same care as the Norwood-backed measure, including emergency room treatment and access to pediatricians and women's health specialists. Both would guarantee that patients can appeal to outside review boards if they believe they have been denied care. But the bill sponsored by Norwood and Reps. Greg Ganske (R-Iowa) and John D. Dingell (D-Mich.) would make it easier for patients to sue and make it more difficult for states with their own patient protections to bypass federal rules. The fact that at least a dozen Republicans have resisted intense party pressure to endorse the bill the president prefers represents a daunting problem for the administration and the House leadership.
    A month after the Senate's Democratic leaders pushed through a patients' rights measure that closely mirrors the Norwood bill, the White House has hitched its fortunes to the Republican-led House to prevent an embarrassing loss on an issue that opinion polls suggest is of paramount concern to voters. The outcome also will determine whether the millions of Americans in managed care gain more clout against a form of health care that has tried to control medical costs but provoked widespread public resentment. Senior White House aides have expended enormous effort in recent weeks lobbying balky House members. Bush held the most recent of four meetings on the issue with groups of lawmakers yesterday afternoon. Several participants said the meeting ended apparently without commitments of more votes for the Fletcher proposal, though White House officials expressed optimism that Bush was changing minds. "We had a very good day," one White House aide said. "Frankly, we're turning votes."
    For House Speaker J. Dennis Hastert (R-Ill.), meanwhile, the disunity on patients' rights is fresh evidence of the leadership's lack of control over moderates in the Republican caucus. On managed care, Hastert and other leaders have been unable to repair a hemorrhage that occurred two years ago when 68 House Republicans voted for the Norwood proposal, which is backed by most Democrats. Although they were left yesterday with little choice but to postpone the debate -- originally planned for today or Friday -- House leaders face considerable pressure to bring managed-care regulations to a vote. Polls show that patient protections remain popular among voters, and the absence of a vote would give Democrats ammunition during next year's congressional elections.
    House GOP aides said last evening they were attempting a strategy that would bring the Norwood-backed bill to a vote next week but allow members to vote on the Fletcher measure as an amendment. Even so, in a chamber in which the GOP margin is just six votes, they acknowledge they remain a half-dozen votes short of victory. "Obviously, if we had the votes today, we'd move it today," said Rep. Thomas M. Davis III (R-Va.), who chairs the GOP's campaign arm.
    White House officials are pouring their energies into fresh negotiations with Norwood, who has been for years the dominant force behind the patients' rights issue in the House. The conservative Georgia dentist originally refrained from supporting his own bill this year, to try to reach an accommodation with a new Republican president. But he sponsored his legislation after concluding that compromise was unlikely. On Tuesday, Joshua B. Bolten, Bush's top domestic policy adviser, met for three hours in Norwood's office. The congressman then went to the White House for a meeting that lasted until nearly midnight with Bolten, White House Chief of Staff Andrew H. Card Jr. and Nicholas E. Calio, the president's main lobbyist. Sources said the talks included a variety of possible modifications to the Norwood bill, primarily involving the delicate issue of lawsuits, but neither side committed to any changes. "I never give up," Norwood said of the effort to bridge differences. "The idea here is to get it signed, but it's got to be a bipartisan bill."
    House members who attended yesterday's session with Bush said the president emphasized the talks with Norwood. He reiterated his desire to sign a patient-protection law this year and his vow to veto legislation he does not like. Afterward, Rep. Robert L. Barr Jr. (R-Ga.) said, "I'm still hopeful the two sides can reach a compromise." But he said he remains "a very strong supporter of Norwood's bill."

Maker of OxyContin Faces at Least 13 Lawsuits
Chris Kahn, Associated Press- 7/27/2001

The maker of OxyContin has been hit with at least 13 lawsuits from people who say they have become addicted to the painkiller and others who want to hold the company responsible for an alarming wave of overdoses and deaths among abusers. ''This drug has been like a cancer attacking the very fabric of our little corner of the world,'' said Ira Branham, a lawyer and state legislator from Pikeville, Ky., who is suing on behalf of three people and the estate of a dead woman. He said the responsibility should ''fall on the shoulders of the company that was the genesis of this problem.''
    OxyContin, America's best-selling narcotic painkiller, is made by Purdue Pharma LP of Stamford, Conn. Many of the plaintiffs say they received OxyContin legitimately and became addicted by taking the prescribed dose. Other lawsuits seek to hold the company responsible for illegal use of the drug, which has become a deadly scourge in some parts of the country, especially Appalachia.  Among those suing is the state of West Virginia, which alleges Purdue Pharma violated state consumer law.   ''They were telling doctors that OxyContin was far less addictive than other painkillers in this class of drugs,'' said Doug Davis, an assistant attorney general in West Virginia. ''Now, we have a lot of people addicted to OxyContin in West Virginia. So was that a misleading statement? Yeah.''
    Purdue Pharma spokesman James Heins disputed the allegations, saying that the plaintiffs were using the drug illegally or improperly. Dr. J. David Haddox, senior medical director, said the chances of someone becoming addicted when taking OxyContin as directed are extremely small. ''A lot of these people say, `Well, I was taking the medicine like my doctor told me to,' and then they start taking more and more and more,'' Haddox said. ''I don't see where that's my problem.''  Already, the billions of dollars in claims represent more than what Purdue Pharma has made on OxyContin.
    OxyContin is a slow-release narcotic that is prescribed for victims of moderate to severe chronic pain from such ailments as arthritis, back trouble and cancer. One pill is designed to last 12 hours, but those who abuse OxyContin usually crush it and then snort or inject it, producing a quick, heroin-like high.
    OxyContin abuse first became widespread in mountainous areas of Kentucky, West Virginia, Virginia, Tennessee and Maine. It has since spread to urban centers, including Boston, Philadelphia and South Florida. OxyContin abuse has been blamed for more than 100 deaths nationwide. Purdue Pharma said that those estimates are unreliable and that in the vast majority of those cases, the victims were abusing other drugs at the same time.
    To try to curb illegal use, Purdue Pharma and the Food and Drug Administration announced an agreement this week to place the strongest warning possible on the painkiller, stressing to doctors that the pills are only for patients with serious pain and that improper use can cause addiction and death. Florida, Maine, West Virginia, Ohio and South Carolina have put restrictions on the drug's distribution to Medicaid recipients. Some pharmacies in Virginia are considering fingerprinting everyone who fills a prescription for painkillers. At Purdue Pharma, a family-owned company that has been media-shy throughout most of its 109-year history, Heins said he knows of at least 13 lawsuits since May.
    OxyContin, introduced in December 1995, has been a breakthrough drug for Purdue Pharma, accounting for 83 percent of its revenue this year. Doctors wrote 6.9 million prescriptions for OxyContin from May 2000 to May 2001, producing $1.27 billion in sales, according to IMS Health, a health information company. To get the word out about managing pain, which the company says is often undertreated, Purdue Pharma invited hundreds of doctors to meetings. Some doctors were recruited to instruct their peers at seminars, which stressed the importance of aggressively treating pain with OxyContin and other drugs.
    ''Aggressive marketing of pharmaceuticals has been on the rise for the past few years,'' said Steven Findlay, director of research at the National Institute for Health Care Management. ''What we're seeing is a marketing campaign that has gotten a little too assertive and had the unfortunate result of increasing the prescriptions of the drug that were clearly inappropriate.'' John Craig, a pharmacist in Scottburg, Ind., said OxyContin salesmen from Purdue Pharma were ''in your face.'' ''It was as if OxyContin was the best drug out there,'' Craig said. ''They said it had a low potential for abuse. That's what we were told at the beginning. I think everyone was surprised and they were probably, too when we started seeing all the overdoses.''
    Dr. Jerry A. Menikoff, an expert in public health law at the University of Kansas Medical School, said if plaintiffs can show that Purdue Pharma downplayed the risks, the OxyContin lawsuits could stick. ''The question is, did the manufacturer properly notify the consumer of all the risks?'' Menikoff said. ''If you're pushing inappropriate uses of medication, then you can be responsible for the consequences.''
    Dr. Claire V. Wolfe, an expert in chonic pain at Ohio State University, said if the lawsuits succeed in discouraging Purdue Pharma from selling OxyContin, her patients will suffer. ''You would take away a drug that is a really big help,'' Wolfe said. ''Frankly, I think (prescription drug abuse) is the doctors' responsibility. It's the physician who's writing the prescription.''
    On the Net:
www.pharma.com
www.recalloxycontinnow.org

Drug Users Turn to Embalming Fluid for a New High
Joann Loviglio, Associated Press- 7/27/2001

PHILADELPHIA -- Embalming fluid is becoming an increasingly popular drug for users looking for a new and different high one that often comes with violent and psychotic side effects. Users mainly teen-agers and people in their 20s are buying tobacco or marijuana cigarettes that have been soaked in the fluid, then dried. They cost about $20 apiece and are called by nearly a dozen names nationwide, including ''wet,'' ''fry'' and ''illy.''
    ''The idea of embalming fluid appeals to people's morbid curiosity about death,'' said Dr. Julie Holland of New York University School of Medicine. ''There's a certain gothic appeal to it.'' Formaldehyde can be bought in drug stores and beauty supply stores. (It is an ingredient in nail care products). It is also available in many school science labs. In addition, there have been reports of embalming fluid thefts from funeral homes in Louisiana and New York.
    Although there are no national statistics on usage, many drug experts say it appears to have spread from the inner cities to well-to-do suburban neighborhoods and college campuses. ''Whether they live in a million-dollar house or a $5,000 house, kids who are smoking pot or crack and are looking for a different type of high are turning to wet,'' said Julie Kirlin, a juvenile probation officer in Reading, about 50 miles from Philadelphia.  Embalming fluid is a compound of formaldehyde, methanol, ethanol and other solvents. The high depends on what the user is really getting: Often the drug PCP is mixed in. In fact, PCP has gone by the street name ''embalming fluid'' since the 1970s.
    Twenty Houston-area users interviewed for a 1998 study by the Texas Commission on Drug Abuse said the effects include visual and auditory hallucinations, euphoria, a feeling of invincibility, increased pain tolerance, anger, forgetfulness and paranoia. Stranger symptoms reported include an overwhelming desire to disrobe and a strong distaste for meat. Other symptoms may include coma, seizures, kidney failure and stroke. The high lasts from six hours to three days. ''Fry users are described like those who do a lot of inhalants they're just spaced-out, dissociative,'' said Jane Maxwell of the National Institute on Drug Abuse's Community Epidemiology Work Group. When they've taken PCP, ''they come into the emergency room and are just wild. They have to be strapped down in their beds or they destroy the room.''
    In the Philadelphia suburb of Morrisville, a 14-year-old boy fatally stabbed a 33-year-old neighbor more than 70 times last year after smoking wet. The boy, who said he took wet to quiet the voices in his head, is serving a seven-year sentence. ''This is a violent drug, and it will turn into a big fire if it's not watched very closely,'' Kirlin said.
    On the Net: Texas study: http://www.tcada.state.tx.us/research/fry.html

Bush Lobbies Hill On Patient Rights
Amy Goldstein and Juliet Eilperin, Washington Post- 7/27/2001

President Bush applied direct pressure yesterday on a defiant House to adopt limited protections for Americans in managed-care plans, paying a rare lobbying visit to Capitol Hill and negotiating privately with the architect of a rival patients' rights bill in an attempt to broker a compromise. A day after House leaders postponed a vote on the issue to avert a GOP defeat, the White House and senior House Republicans said the president's personal intervention was attracting support. They predicted they soon would have enough votes to prevail. "It is my intent to take up the patients' rights bill next week," House Speaker J. Dennis Hastert (R-Ill.) said, although other ranking Republicans hedged on the vote's timing. Bush's Capitol trip came in response to the urging of GOP leaders, who have implored him to engage more directly with Congress to secure passage of his legislative priorities. It represented an escalation of his role in the patients' rights battle, reflecting White House concerns that a defeat on managed-care regulations would be a major political reverse.
    Despite the pains GOP leaders took to foster a sense of momentum, however, several Republicans, including ones who have met with Bush this week, said they remained largely unmoved by the president's appeals. Rep. Greg Ganske (R-Iowa), one of the main sponsors of the measure the president has vowed to veto, accused the White House and party leaders of "blowing smoke." Still, White House aides said they were particularly encouraged by yesterday's negotiating session between Bush and Rep. Charles Whitlow Norwood Jr. (R-Ga.), a Ganske ally who for years has led a large bloc of Republicans who espouse broader federal safeguards for patients in health maintenance organizations -- notably, greater freedom to sue -- than the White House wants to allow. Bush officials and congressional sources said Norwood left the 8:30 a.m. White House meeting with the president with a promise to confer with his allies about several modifications to his bill proposed by the administration. The sources said Norwood did not explicitly pledge to support those changes -- many of them involving the contentious issue of lawsuits -- but indicated he would do so if he concluded they had bipartisan support.
    The changes represent an attempt to reconcile what have been the most intractable areas of dispute as Congress has tried to define the first federal guidelines that would give patients greater clout against their health plans. Two years ago, the House passed a broad bill in defiance of GOP leaders. A month ago, the Senate, with its new Democratic majority, approved a similar measure that Bush repeatedly has said he would not sign.
    Unlike in previous years, the House now faces a choice between two versions of the protections, each of which has attracted substantial support. The bill authored by Rep. Ernie Fletcher (R-Ky.) and favored by Bush, and the bill sponsored by Norwood, Ganske and Rep. John D. Dingell (D-Mich.), have many similarities. Both would ensure that patients could get emergency room bills paid and would guarantee that patients could easily visit pediatricians and women's health specialists. They would promise access to clinical trials of new therapies, and they would enable people to file grievances to outside appeals boards. However, the Fletcher bill would give states with their own patient protections more ability to win exemption from the federal rules. Most significantly, that bill contains far tighter restrictions on lawsuits against health plans and would limit damages. For several weeks, Bush has spoken out in favor of the Fletcher measure, saying that it conformed with principles the president laid out last winter. Because the Senate approved a bill the administration believes goes too far, the White House has channeled its energy toward the House, inviting dozens of Republicans to meetings with the president.
    Yesterday, Bush alluded with humor to his understanding of the message he has been hearing from Republicans: that he must expend more energy in pursuit of his policy goals. "A dictatorship would be a heck of a lot easier -- there's no question about it," the president said. "But dealing with Congress is a matter of give and take." Bush's efforts yesterday were two-pronged. In the afternoon, he visited Hastert's office, where he met with several Republicans from the New Jersey delegation.
    According to sources familiar with the session, Bush made largely the same arguments he has made previously in urging more limited managed-care legislation. Echoing the position of the insurance industry and businesses, the president contends that too many lawsuits would make insurance more expensive and thus lead more people to lose coverage. In the other part of his effort, the morning negotiating session with Norwood, the president indicated slightly greater receptivity to letting patients sue health plans in state courts, rather than the federal litigation he previously has preferred, sources said. Neither Bush nor Norwood would publicly discuss the substance of their discussions, but the sources said the two worked to span the two bills' large divergence on damages. Congressional sources said the president remained eager to shield from lawsuits employers who pay for health insurance and to allow patients to sue health plans only after they won an appeal to an outside review panel.
    Yesterday evening, Norwood met to discuss the White House's proposal with Ganske, Dingell and Rep. Marion Berry (D-Ark.), as well as Sens. Edward M. Kennedy (D-Mass.) and John McCain (R-Ariz.), sponsors of the Senate-passed legislation. Participants said afterward that the White House suggestions were unacceptable in their current form, although they did not rule out a compromise. Berry said Bush's proposal had "serious flaws" but added: "This is the first time we've actually had an opportunity to negotiate with the White House. That's the big movement here."

Man Charged in Capitol Killings Can Be Medicated to Stand Trial
Derrill Holly, Associated Press- 7/27/2001

WASHINGTON -- A man accused of killing two U.S. Capitol Police officers in 1998 can be forcibly medicated to make him mentally competent to stand trial, a federal appeals court ruled Friday. Russell E. Weston Jr., who has a 20-year history of paranoid schizophrenia, is charged with murder in the deaths of Jacob J. Chestnut and John M. Gibson, who were shot and killed as they manned their posts inside the Capitol July 24, 1998. He is also charged with the attempted murder of Officer Douglas B. McMillan and faces three lesser weapons charges in connection with events preceding his arrest.  For nearly three years, Weston has refused to take medication to treat his mental illness. His lawyers contend that forcible medication would violate his Fifth Amendment right to due process and violate his right to a fair trial.
    ''The government's interest in administering anti-psychotic drugs to make Weston competent for trial overrides his liberty interest,'' Judge A. Raymond Randolph wrote on behalf of the three-judge panel of the U.S. Circuit Court of Appeals for the District of Columbia. The panel upheld a ruling issued in March by U.S. District Judge Emmet G. Sullivan.
    Weston, 44, is from Valmeyer, Ill., and lived part-time near Helena, Mont., before his arrest. Russell Weston Sr. said he and his wife, Arbah Jo, are opposed to their son's being medicated to stand trial ''as long as they have the death penalty.'' On advice of attorneys, he declined to comment further. Since his arrest, Weston's mental condition has continued to erode, according to mental health experts at a U.S. Bureau of Prisons hospital in Butner, N.C. He uses a cane or crutches to walk because of injuries he received when he was shot by police before his arrest.
    More than a year ago, Dr. Sally Johnson, a psychiatrist and associate warden at the Federal Correctional Institute, testified that without treatment Weston's condition would likely worsen. Although he remains at Butner, he has not been medicated pending the decision by the appeals panel. ''The only thing we have left to do is petition the Supreme Court, and we will,'' said A.J. Kramer, an attorney with the federal public defender's service. Kramer, who has represented Weston since his arrest, said he continues to have the support of his family. ''His parents come down to visit him from Illinois, and so does his sister,'' Kramer said.

Bush Offers HMO Bill Compromise
Anjetta McQueen, Associated Press- 7/27/2001

WASHINGTON -- President Bush on Friday offered his rivals on patients' rights legislation a way to move some lawsuits against HMOs into state courts. Negotiators planned to spend the weekend pondering how the plan could work. Bush, who had intensified his Capitol Hill lobbying after losing party moderates' support on a more-limited bill, presented the state plan to Rep. Charlie Norwood, R-Ga., the chief bargainer for the Bush rivals. The Bush compromise would essentially steer HMO cases to federal courts, but allow some suits to be heard in state courts - particularly if they apply to the local medical malpractice laws, sources said. Bush spokesman Ari Fleischer said he was not going to give a "play-by-play on any of the negotiations." "The discussions that are under way right now are what you would expect at the end of a legislative issue that is very serious and is approaching, it's possible, a vote sometime soon," Fleischer said.
    Some Democrats were still unhappy with the offer. Among the complaints is that the White House wants to create a "super-shield" for the millions of employers who provide employee health plans. Under the reported Bush proposal, according to sources familiar with it, employers would be liable only for federal laws governing contract disputes - even if they instructed or pressured a health plan into making a medical decision to deny a patient a needed test, medicine or operation.
    Mike Briggs, a spokesman for Sen. John Edwards, D-N.C., said Edwards found the talks "positive." A bipartisan group, among them Sen. John McCain, R-Ariz., and Rep. John Dingell, D-Mich., wants the president to sign a sweeping patients' bill of rights that has been more than seven years in the making. "We're, obviously, more than willing to look at more suggestions," said Senate Majority Leader Tom Daschle, who last month pushed a version of the bill through the Democratic-led Senate. "We've given and we've continued to try to find ways to seek common ground here. I don't know how much more there is to give and still keep the principles of the bill. ..." That version of the bill, favored mostly by Democrats, would expand the medical treatments health plans must offer their patients - and more controversially, give wronged patients access to federal or state courts and potential jury awards.
    GOP leaders have resisted attempts to push cases into state court. A 1974 federal pensions and benefits law confines most cases against HMOs and other employer-sponsored health plans to federal court. "There's room for flexibility on both ends of Pennsylvania Avenue," said Fleischer, referring to the street that connects the Capitol to the White House.
    Earlier in the day, Bush talked by telephone with Norwood, who is pushing a version the president has opposed. Despite Bush's efforts, Republican moderates may force GOP leaders to compromise on patient lawsuits when the House takes up the legislation next week. The president even went to Capitol Hill Thursday to push publicly for a bill that would curb most lawsuits. But in private talks, White House negotiators are considering concessions. Bush told a small group of lawmakers that he would consider higher limits on damages, but did not name a specific figure, sources familiar with the meeting said.
    On the Net: The bills, H.R. 2563 and H.R. 2315, can be found at: http://www.thomas.loc.gov

More Young People Treated in ER for 'Club Drugs'
Donna Leinwand, USA Today- 7/28/2001

Club drugs, including Ecstasy and GHB, are sending increasing numbers of young people to the hospital with toxic reactions and overdoses, emergency-room data released Tuesday shows. Emergency rooms in 21 metropolitan areas tracked by the Drug Abuse Warning Network reported 4,511 emergency visits involving Ecstasy in 2000, a 58-percent increase over the 2,850 cases in 1999. They also reported 4,969 visits involving the "date-rape drug" GHB, a 56-percent increase over the previous year's 3,178 cases. Visits to emergency rooms for all drug-related cases, including heroin, stayed the same in Metro Detroit, the network reported.
    Club drugs still account for only a fraction of emergency room visits. However, the numbers indicate the drugs are becoming more widespread. Club-drug users began arriving at emergency rooms in 1994. The drugs, including Ecstasy, GHB, an anesthetic called Ketamine and another so-called date-rape drug, Rohypnol, had grown popular at all-night rave parties and in dance clubs. That year, emergency rooms reported 56 visits for GHB and 253 visits for Ecstasy.
    People 25 and under account for almost a third of drug emergencies, the data show. Their share is much higher for club-drug emergencies: People 25 and under make up 80 percent of Ecstasy emergencies and 60 percent of those involving GHB. "We are concerned about the continued increase of club drugs among young people, which seems to be contributing to the overall increase of young people ending up in emergency rooms," says Mark Weber, spokesman for the Substance Abuse and Mental Health Services Administration in Rockville, Md., which collects the data from 466 hospitals. The patients may mention using more than one drug, so drug mentions exceed drug visits. In 2000, the hospitals recorded 601,776 emergency-room visits in 2000.
    Emergency-room visits for other drugs also increased. Heroin and morphine visits increased 15 percent to 97,287 in 2000. Emergency-room mentions of prescription drugs containing oxycodone, such as OxyContin, Percocet and Percodan, increased 68 percent to 10,825. Although drug-related visits to emergency rooms stayed the same or decreased in 14 of 21 cities, seven metro areas reported overall increases: Seattle (32 percent), Boston (28 percent), Los Angeles (22 percent), Miami (20 percent), Chicago (16 percent), Minneapolis (12 percent) and Phoenix (9 percent). Emergency room visits decreased 12 percent in San Francisco and 19 percent in Baltimore. Besides Detroit, other metro areas reporting no overall change included Atlanta, Buffalo, Dallas, Denver, New Orleans, New York, Newark, N.J., Philadelphia, St. Louis, San Diego and Washington.

Pitter-Patter of Paws Is Time-Tested Remedy
Anita Gates, New York Times- 7/29/2001

Don't worry so much about the cardiovascular workouts, the oat bran, the diet or the aspirin a day. They may have benefits, but apparently they're minor compared with one simple thing to do to live longer, heal faster, lower blood pressure and cholesterol and have a better chance of surviving a heart attack. Get a pet.
    "Dogs should be making rounds on the ward--and house calls," said Dr. Rand Stoneburner, an American epidemiologist working in South Africa. He was only half-facetious. He added, "A family member is beginning to lose his memory, but when he sees Bizou"--the Stoneburners' year-old brown standard poodle--"his face lights up and he calls her 'my little friend.' "
    Studies of people and their dogs and cats and other pets have been reported innumerous medical and psychiatric journals, with impressively academic titles like "The Effects of Pet Therapy on the Social Behavior of Institutionalized Alzheimer's Clients," "Pet-Human Bonding: Results of a Survey on Health and Well-Being" and "Presence of Human Friends and Pet Dogs as Moderators of Autonomic Responses to Stress in Women." There's a study that says dog owners are more likely than people without pets to survive heart attacks. A large Australian study, with 5,700 participants, showed that men with pets had lower blood pressure, triglyceride and cholesterol levels than men who didn't own pets. Another experiment showed that just putting a dog in the room where a child was having a physical exam lowered the child's heart rate, blood pressure and distress. A similar study, providing dogs and cats to stockbrokers in the examining room, had the same results. (The authors did not say what effect this experience had on the animals.)
    "It's well established in the way that we now understand the mind-body connection," said Dr. Stuart Brodsky, director of the Westside Veterinary Center in Manhattan, "And in studies where they can truly measure things, measure hormones in the body, all of these have come up with objective benefits." He cited positive results for emotionally withdrawn children, for single people who live alone and for formerly uncommunicative nursing home residents, among others. When his own father was in his 80's and ill, Dr. Brodsky said, "I got him a dog. It aggravated him into good health." Dr. Brodsky likes to quote Samuel Butler, the 19th-century British essayist: "The great pleasure of a dog is that you may make a fool of yourself with him. And not only will he not scold, but he will make a fool of himself too."
    Kik Fairlie, editor of Computer Shopper magazine, and David Santos, a human resources executive, contended that their dog and cat were therapeutic in many ways. Mr. Santos said he and the irascible cat, Cartman, had learned to read each other's moods. Mr. Fairlie said Patti, a Dachshund, "has made me meet people in my building and on my block because she's a small, funny-looking little dog." "She's got that funny little jaunty way of walking," he said. "She just looks happy." Maybe, he added, interactions with others might be different if Patti were a Rottweiler instead of a Dachshund. "She makes me smile; she makes me laugh," Mr. Fairlie added. "Given the pace of our lives, I think that anything that makes you smile is a good thing."
    That seems to be true at every age and stage of life. A study in a psychology journal found that children with pets had higher self-esteem and empathy than other children. Dr. Brodsky, whose household includes three cats, said, "No child should grow up without pets." For boys, caring for a pet can be a valuable lesson in nurturing--and one of the few that is gender-neutral, said Dr. Gail F. Melson, a professor of developmental studies at Purdue and author of "Why the Wild Things Are."
    The animal, incidentally, doesn't have to be a dog or a cat. Studies on interaction with turtles and horses have shown positive benefits. As for the elderly, a study published last year demonstrated that older people who had pets experienced better overall physical and mental health than those who didn't own animals. When the time comes to choose a retirement home, experts say, listen for the patter of little paws. A recent study showed lower mortality rates at a nursing home that kept lots of animals around.

Doctor Charged with Murder for Prescribing Oxycontin to Man Who Overdosed
Associated Press, 7/29/2001

WEST PALM BEACH, Fla. -- A doctor was charged with murder for allegedly improperly prescribing the painkiller OxyContin to a man who died of a drug overdose. Denis Deonarine, 56, also was charged with racketeering and drug trafficking in an 80-count indictment issued Friday. The indictment was sealed because other defendants remained at large, prosecutor Barry Krischer said. Deonarine was jailed pending a bail hearing. He was charged in May with related Medicaid fraud charges. His office manager also has been charged with fraud, trafficking and racketeering. The first-degree murder charge involved the death of Michael Labzda, 21, who died Feb. 8.
    Richard Lubin, Deonarine's lawyer, said the murder charges were inappropriate because alcohol and other drugs were found in Labzda's body. ''I'm very surprised the state chose to charge Dr. Deonarine with a drug overdose,'' he said. ''I don't know what their thinking is.'' A handful of other doctors around the nation have been charged with manslaughter in similar cases. But Deonarine could face either the death penalty or life in prison without parole if convicted on the first-degree murder charge. ''It is a new concept,'' prosecutor Barbara Burns said.
    OxyContin is a slow-release narcotic painkiller intended to relieve moderate to severe chronic pain from such problems as arthritis and cancer. One pill is designed to last 12 hours, but those who abuse OxyContin usually crush pills and then snort or inject them to unlock a quick, heroin-like high. OxyContin has been linked to overdose deaths across the county. Florida has recorded 152 deaths attributed to overdoses of OxyContin and other morphine-like prescription drugs in the last six months of 2000, a report by the state's medical examiners shows.

Group: Michigan Ranks Low on Funding for Smoking Control Programs
Associated Press, 7/29/2001

LANSING, Mich. -- Michigan ranks low in its spending on smoking control programs, despite having a high number of smokers, according to a national group. Most of the 44 other states in the national tobacco settlement created new smoking-cessation programs, but neither Michigan nor North Dakota is using any of the money that way, according to the National Center for Tobacco-Free Kids in Washington, D.C. And Michigan has a high smoking rate, with about 2 million smokers. The organization, whose supporters include the American Heart Association and American Cancer Society, ranked the states by how much of the tobacco money they spend, per state resident, on anti-smoking programs.
    Gov. John Engler and state lawmakers have decided to pour three-fourths of Michigan's share of the settlement into a college scholarship program and the Michigan Education Assessment Program, which administers statewide standardized school tests. State health department officials say that independently of the tobacco settlement, Michigan is spending about $8 million a year on an anti-smoking program it has had for years.   "A lot of other states started programs with the money, but we've been putting general-fund dollars into tobacco programs since the 1980s," said Geralyn Lasher, spokeswoman for the Michigan Department of Community Health. "More money doesn't necessarily equal better results. We want programs that are outcome-based and are working."
    The Center for Tobacco-Free Kids says the $8 million-a-year program falls far short of the minimum of $54 million advised by the U.S. Centers for Disease Control. Based on Michigan's population, the CDC estimates that is what a comprehensive anti-smoking effort would cost. "If Michigan doesn't spend that in the next few years, you're going to see its smoking rates significantly higher than in surrounding states," said Peter Fisher, a spokesman for the anti-tobacco group.  Under the settlement, the states are free to spend the money as they wish. Michigan expects to collect $8.5 billion over 25 years from the $250-billion, 46-state, 1998 settlement. Funds began flowing in 1999. Michigan's share will average $350 million a year.
    State leaders designated $1 billion toward development of a corridor of life-sciences research centers stretching from Detroit west to Grand Rapids. And they plan to use about $72.5 million to balance the state budget. Most of the rest will go to health care research, nursing homes and other health-related programs.
    Other states have used their settlement share for nontobacco use, including: $2 million toward law enforcement in Ohio, $315 million for property tax relief and an income tax rebate in Illinois, and $269 million directed to Wisconsin's general fund for various purposes, according to the National Conference of State Legislatures.
    Republican Sen. John J. Schwarz of Battle Creek, one of three physicians in the state Legislature, defends the Republicans' tobacco settlement priorities. Schwarz is one of 11 directors of the American Legacy Foundation, a national organization using a separate $1.6 billion pool of tobacco settlement money exclusively for smoking prevention among teen-agers over the next five years nationwide. "I would argue that there's only so much money you could put into tobacco control," he told The Detroit News for a Sunday story. "We do spend the (settlement) money on things that are both preventive and aimed at the treatment of medical conditions."
    Michigan's $8 million outlay for anti-smoking programs amounts to less than $1 per resident and ranks in the bottom 10 among the 50 states. Neighboring Ohio last year spent $5.43 per capita ($61.5 million total), Wisconsin $4.63 per resident ($24.6 million) and Illinois $2.63 per person ($31.7 million) on smoking cessation efforts.

Eating Disorder Experts Say Minnesota Settlement Could Make More Insurers Pay for Treatment
Coralie Carlson, Associated Press- 7/30/2001

ST. PAUL, Minn. (AP) With her weight dwindling to 95 pounds on her 5-foot-10 frame, Kathryn Bromfield decided she needed more than another trip to a hospital psychiatric ward to survive anorexia. Her insurance company, however, wouldn't pay for residential treatment at a center specializing in eating disorders. She turned to her parents, who mortgaged their house and used credit cards to pay more than $53,000 for 11 weeks of treatment. ''I felt guilty for asking my parents to pay for a place,'' said Bromfield, a 22-year-old college student in Ann Arbor, Mich. ''I was at a really fragile state.''
    Advocates for victims of eating disorders hope a lawsuit settled recently in Minnesota will compel insurers across the country to pay for treatment for anorexia sufferers like Bromfield. The lawsuit, filed by the state, involved a woman who was denied treatment for her eating disorder by Blue Cross Blue Shield of Minnesota. The woman, 21-year-old Anna Westin, committed suicide after suffering from anorexia for five years. Her family had covered her treatment costs, but sued Blue Cross for refusing to pay.
    In June, Blue Cross agreed to a $1 million settlement with the family and agreed to begin accepting doctors' recommendations for the treatment of eating disorders. ''We've failed these families,'' Richard Neuner, a Blue Cross vice president, said in announcing the settlement.  The settlement does not apply to insurance companies in other states, but observers said it could lead to similar lawsuits and changes across the country. ''In every instance where inappropriate insurance coverage is brought to public attention, it evokes a better response on the part of insurance carriers to give adequate treatment to their patients,'' said Christopher Athas, vice president of the National Association of Anorexia Nervosa and Associated Disorders. Harry Sutton, an independent health care consultant in Edina, Minn., said he expects the settlement to affect other insurance companies and eventually other states. Minnesota's other three major HMOs are already reviewing procedures for granting mental health treatment. ''The same pressure will come out everywhere else, but maybe not as violently as it did here,'' Sutton said. Bromfield's insurer is Blue Cross Blue Shield of Michigan. Spokeswoman Helen Stojic would not comment on Bromfield's case.
    Besides pressing for lawsuits, activists are pushing for federal legislation requiring insurers to pay to treat eating disorders and other mental illnesses. One supporter, Sen. Paul Wellstone, D-Minn., said insurers currently cover only some mental illnesses and require higher co-payments and restrictions on the treatment of others. ''When you make those kinds of distinctions, all too often eating disorders get left out,'' Wellstone said. Patients' rights plans offered by both parties would expand treatments health plans must offer. Patients also would have more ways to appeal decisions denying them coverage.
    The insurance industry said such moves would raise the cost of premiums and could leave hundreds of thousands of people uninsured. ''Our problem with mandates is that this stuff is not free,'' said Joe Luchok, spokesman for the Health Insurance Association of America. ''Nothing happens in a vacuum.''
    In Minnesota, Westin's family said they will donate the settlement money to the state's first residential treatment center for eating disorders. ''People need to be able to speak out and they need to be willing to come forward and tell their stories,'' said Kitty Westin, Anna's mother. ''When we talk about it openly, it's not something to be ashamed of.''
On the Net:
Anna Westin Foundation: http://www.annawestinfoundation.org
Eating Disorders Coalition: http://www.eatingdisorderscoalition.org
National Association of Anorexia Nervosa and Related Disorders: http://www.anad.org

Ecstasy Use Rising, Senators Told
Melissa B. Robinson, Associated Press- 7/31/2001

WASHINGTON -- Philip McCarthy just wanted to have as much fun as the other kids when he took ecstasy for the first time at a house party in a New York City suburb. But soon the 17-year-old was hooked and stealing televisions and VCRs to support a $300-a-week drug habit. When he was on ecstasy, ''I felt like the world was glowing with love and my body felt unreal,'' McCarthy, of Central Islip, N.Y., told the Senate Government Affairs Committee, chaired by Sen. Joseph Lieberman, D-Conn., Monday at a hearing on ecstasy's explosive growth. ''It was a high I definitely wanted again,'' said McCarthy, who is currently in drug treatment.
    Ecstasy, known scientifically as methylenedioxymethamphetamine, or MDMA, is a synthetic, psychoactive pill that typically induces feelings of euphoria and dramatically raises blood pressure, heart rate and body temperature. It gained popularity in the 1990s at all-night dance parties known as raves. ''While users of club drugs often take them simply for energy to keep on dancing or partying, research shows these drugs can have long-lasting negative effects on the brain that can alter memory and other behaviors,'' said Alan I. Leshner, director of the National Institute on Drug Abuse. He said more public education about the drug's dangers, including heart, kidney and brain damage, is essential to combatting its use.
    McCarthy and fellow Phoenix House drug treatment program participant Dayna Moore, 16, said they knew nothing of the anger and depression that would hit after ecstasy's high wore off. That quickly led them into cycles of addiction as they took more and more ecstasy, which sells for $20 to $40 per pill. ''It was a depression that I couldn't stand,'' said Moore, of Ridge, N.Y.
    Seizures of ecstasy by the Customs Service grew from about 400,000 tablets in 1997, to 3.5 million tablets in 1999, to over 9 million tablets in 2000. The drug is manufactured mostly in Belgium and The Netherlands. ''No matter how successful our enforcement efforts, our best defense is less demand,'' said John Varrone, assistant commissioner in Customs' office of investigations.
    The White House's drug policy office began a $5 million radio and Internet campaign in August aimed at educating youths and adults about ecstasy's dangers, said Donald R. Vereen, the office's deputy director. MDMA ''is a public health problem that is behaving like an epidemic,'' Vereen said, citing hospital data showing the number of ecstasy references in emergency room episodes grew from 250 in 1994 to 4,511 in 2000.
    In Connecticut, ecstasy has become more popular among suburban drug users than heroin or cocaine, said John M. Bailey, the chief state's attorney. Through a special Nuisance Abatement Program that utilizes criminal and civil actions to clean up nuisance properties, three rave clubs where ecstasy trafficking took place were closed in Hartford. ''The drug traffickers know what they are doing,'' said Bailey. ''Just as they work to develop new markets ... we must develop new strategies.''
    Sen. Bob Graham, D-Fla., and Sen. Charles Grassley, R-Iowa, have sponsored legislation that would require more public education about ecstasy and provide funding to state and local law enforcement and to the National Institutes of Health for research on the drug's health effects. In the House, a similar bill by Rep. John Mica, R-Fla., has bipartisan support. The bills are S. 1208 and H.R. 2582.
    On the Net:
http://lieberman.senate.gov/
www.phoenixhouse.org

A Mother's Addiction, a Family's Recovery
Marcia Slacum Greene, Washington Post- 7/31/2001

Iyarn Brice has nine children, but until a warm day last September, she had never thrown a birthday party for a single one. Crack cocaine, once dearer to her than a child, had snuffed her maternal urges and the rituals of normalcy. Year after year, she gave birth in a crack fog and turned the babies over to someone else to raise. Eventually, child welfare stepped in. On the day of the party, Brice was 18 months sober; the crack had been purged from her body, much as it had been from the city's headlines. The warring in the streets had tapered, and the body counts had crested. Yet the devastation remains. And children are part of the crack legacy.
    Crack, often stronger than the parental bond, turned child welfare systems upside down. Children flowed into foster homes. Now, policymakers face two options: stitching together new families or mending the old ones. Brice, with financial help from the government and the House of Ruth's Reunified Families Program, wanted to mend her family. She wanted to raise eight of her children. She vowed to stay clean, get a high school diploma, find a job, take care of those she brought into the world. Why she thought she could succeed -- why she should be allowed to try -- was difficult for her to explain.
    This is what she said: "I took my kids through a lot, and they don't deserve that. I've always run away from all my problems. I've got to be responsible now. I think I owe it to them. I owe myself a chance at a new life, a chance to start this thing over and get on the right track." This is what she faces: She reads only as well as a third-grader, and her résumé amounts to two lines. None of the eight men who fathered her children -- some born when she traded sex for drugs during her decade-long addiction to crack -- provides regular child support. Most of her children suffer from psychological and behavioral problems. Sometimes, she posed a simple -- and monumental -- question to herself: "Can I do this?"

Working on Custody
By last September, she had custody of four of her children, halfway to her goal. The baby, born in late 1999, has been with her always, delivered while Brice was in drug treatment. Shortly after entering the House of Ruth program, she got back the next youngest, a 2-year-old boy, after his caregiver was jailed. Then, in August 2000, her two oldest children, girls, were conditionally released from foster care because Brice was making progress.  Four were left -- three boys in foster care, another boy with a relative. She wanted each of them. One child, a daughter, lives with her father and will stay with him. As an addict, Brice said, "I didn't want the responsibility. I just had them and dropped them off with my mother." Brice insists she has changed: "I want to be a normal mother. A mother is supposed to raise her children."
    Across the country, crack produced a generation of children neglected by parents pursuing one more high. A 1999 report by the National Center on Addiction and Substance Abuse said the drug "fundamentally altered the challenge of protecting the nation's children." In the five years before crack arrived in Washington in 1985, the city recorded 2,418 allegations of child neglect or abuse. In the five years from 1995 through 1999, there were 7,912 such allegations, and officials of the city's Child and Family Services Agency estimate that 85 percent of the parents whose children are in government care abused drugs. Some child advocates believe that the indulgent acts of addicts nullify their right to raise children. Even when addicts manage to get clean, only one-third are able to do so without a relapse, according to treatment experts. Shouldn't the children of addicts have some stability? Wouldn't adoption be better than awaiting miracles?
    A recently enacted federal law, in fact, requires officials to find permanent homes for any child who has been in foster care for 15 of the previous 22 months -- a response to dysfunctional child welfare systems and long waits for addicted parents to reform. As a result, there were 330 adoptions in the District in fiscal 2000, a record. Of the 2,796 city children now in foster care, 1,072 are on track for adoption. Three of them are Brice's.
    Other child welfare advocates say the best solution is having children raised by their parents -- despite years of drug addiction -- if they are drug-free and caring. That reinforces children's sense of being loved and diminishes their fears of abandonment. It is an expensive and difficult proposition. Becoming drug-free, especially for women, does not necessarily end their poverty, psychiatric troubles or the effects of domestic and sexual abuse. "If the parent doesn't have adequate and real support in working with those children, it is a setup for relapse," said Johanna Ferman, director of the city's nonprofit Center for Mental Health.
    A bill before Congress, the Child Protection, Alcohol and Drug Partnership Act, calls for spending $1.9 billion nationally over five years to treat and rehabilitate substance-abusing parents who have children in the welfare system. On its own, the District's Health Department plans to spend an additional $2.3 million. The money will help mothers -- fathers seldom join reunification efforts -- with detoxification, supervised living and other rehabilitation.
    Iyarn Bricegot a great deal of help: food stamps and public assistance; $38,000 worth of housing and services provided by the House of Ruth; therapy and drug tests; two Ruth counselors assigned to her; and a Ruth staffer just a short walk away any time of day if she needed help, which she often did. Since the reunification program opened in 1999, it has helped 18 women and 41 children, reuniting 21 of the youths with their mothers.
    Brice's goal of regaining her children, though, left her counselors dubious. Wanda Smith-Gerber, the program coordinator, feared success could breed failure: The more children Brice got back, the less time she would have for any one child, herself and household demands. Pressure would rise. So would the risk of relapse. But there was this, Smith-Gerber said: "She is a woman who has an enormous heart and a strong desire to parent and finish raising all of her children." Said Brande Maury, one of Brice's social workers: "I didn't think under any circumstances we would be here. She's made such progress, and she's still on a steady growth path."

A Temporary Home
No sign proclaims the three-story, brick apartment building on a tree-lined street in Southeast Washington as the House of Ruth's Reunified Families Program. It is home, although temporary, to reformed drug addicts seeking to connect with their children. Unit 1 -- with two bedrooms, a smattering of mostly pine furniture and emerald green rugs -- had been Brice's home since April 2000, and it was the first household she headed in her 31 years. Brice assumed that she had crossed the biggest hurdle, getting sober. But in September, shortly after reuniting with her daughters at the House of Ruth, that view vanished. When she chastised her 14-year-old for skipping her chores, the teenager challenged her: "How do you think you can tell me what to do when you haven't been there?" The little girl Brice had given birth to at 16 was now a flirtatious ninth-grader interested in boys and bent on proving she was her mother's equal. "It's not like I thought it would be," Brice said. "They came in, and it's like they want to run over me."
    House of Ruth coordinator Smith-Gerber recognizes the sharp tensions that often emerge in reunited families: The children resist structure and authority; the mothers want control, respect and forgiveness. Unwittingly, the mothers Smith-Gerber works with often distance themselves. They see no need to eat with their children. At night, they need reminders to send the children to bed. Having regained a measure of control over their lives by becoming drug-free, they are suddenly boxed in by demands. Some days, all the Brice children stomping around in Unit 1 seemed bent on reclaiming every minute of attention crack stole from them. "It's ma, ma ma ma, ma ma ma," Brice said. "It's like they're singing my name. I want to say, 'Stop calling my name.' The only time I really get peace is when I'm asleep."

Little Relief
But even her dreams arrive with demands. "I was dreaming about when I first dropped him off with his father's family," Brice said of her 6-year-old son. "I told them that when I got my life together, I'd come get him back. I don't want him to feel I had abandoned him." Last September, before her dreams begin, Brice hears that the boy is panhandling. With the child's father in jail, the dreams urge her to act. One Friday a few weeks later, Brice picks up the grimy, urine-stained child from school and takes him home for the weekend.
    The 6-year-old is disruptive, aggressive, demanding and disobedient. One evening, a frustrated Brice makes a fruitless effort to stop him from tumbling in the living room, standing on his head during dinner and punching his 2-year-old brother. Three times, Brice sends him to his bedroom for a timeout. Each time, he howls like a wounded cat. Nevertheless, he becomes the fifth child to move into Unit 1. Brice, once guilty of neglect, this time becomes the rescuer. Later, during a school conference, she learns that the boy is emotionally disturbed and needs intensive therapy. The assessment -- intense anger, inappropriate aggression, depression -- sounds overwhelming to a mother trying to get to know her son.
    Such challenges defy quick solutions, making Brice typical of many mothers working their way back from crack hell, said Linda Spears, an official with the Child Welfare League of America. First, many parents can care for their children but might always need help. Second, many women with large families ultimately must accept a variety of placements -- with relatives, in adoptive homes and in therapeutic group homes for children with behavioral problems.
    At every step, drugs have remained the biggest influence in the lives of the Brice children. Brice's mother, concealing her own heroin addiction from authorities, had primary responsibility for most of the children until 1999. Brice, physically present but emotionally absent, also shared the household. She stayed out half the night, slept late, traded Barbie dolls and bikes for crack. "I stole, I begged, panhandled," she said. "I did tricks. I was getting high every day around the clock, 24-7. I was spending $100 a day." Then came the rescue. Adults called it that. The children recall a tearful ride in the back of a police car, strangers everywhere, the middle-of-the-night separation -- girls off to a group home, boys sent to a foster home. If Brice continued to use drugs, she could lose the children forever, a judge warned. So she entered drug treatment, gave birth to her ninth child and snapped crack's hold.
    A year and a half later -- six months into her stay at the House of Ruth -- her list of accomplishments includes many firsts: arranging day care for the two toddlers; hosting the birthday party; being awake, sober and involved on the children's first day of school; keeping track of medical appointments; and participating, every two weeks, in family visits with her three sons in foster care. She wants the House of Ruth to give her credit for all of it. She has done it mostly alone. One of the fathers of her children cares for his daughter. But as for the others, one is dead, three are in jail and the rest are simply absent. Some days, especially when all the children are home, Brice feels a creeping sense of chaos. During those times, she escapes by pulling out a Eureka vacuum. Switched on in moments of stress and trolled across the emerald rugs, the vacuum drowns out the noisy children and the worries in her head. No dirt survives, and one thing in her life is orderly.

Troubled Children
"I thought the kids would come out okay." Brice heard the anti-drug warnings, smoked crack heavily during seven of her pregnancies anyway and remembers the sense of relief when she saw one normal-looking baby after another. But by late October, she cannot ignore her doubts. "As the kids get older, I think their behavior has something to do with the drugs," she says. Month by month, Brice has been sinking into a world of educational and psychological assessments, which reveals that seven of the children she wants to raise have behavioral problems or learning disabilities. Counselors and court records describe three foster boys with enormous needs. Two are in therapy. One of them has received numerous school reports accusing him of destructive behavior, stealing and acting out sexually. The child has also been diagnosed with attention deficit hyperactivity disorder.
    Nationally, studies have concluded that prenatal exposure to crack seems to have no major lasting effect on children's development. But many child professionals in the District and elsewhere describe serious physical, intellectual, social and emotional problems in some children. They attribute some of those problems to the indirect effects of parental drug use, from neglect to family instability.
    By early November, Brice often seems unable to cope. On drugs, she never worried about time. Now, she cannot find enough of it. Some days, she's up at 4:30 a.m., sitting on the sofa, trying to calm herself before the rush to get the children ready for school. Her days are crammed with doctor and school appointments, cooking, relapse prevention meetings and laundry. But some afternoons she spends in front of the TV, drained. She's making friends among her neighbors, but she conducts most of her social life on the telephone. The House of Ruth mothers must obey a curfew, and men are banned from their apartments. She rarely has time to attend her adult education classes, and when she does, often sees them as irrelevant. "I don't even know the things they're talking about. They're talking about the president and what makes a good president. I'm not on their level." Like her mother, who is a recovering addict, Brice continues to test clean during random drug tests. But she often skips Narcotics Anonymous meetings. Her confidence seems to be slipping. Sometimes, she vacuums the emerald rugs four times a day.
    During one conference with her social worker Nadine Earlington, Bricerealizes that she is not masking her lack of control. "It is chaotic," Earlington says to Brice. "You're not to a point where dinner is at 5, the children are in bed at 8 p.m. every evening. I think the structure of the house needs work. . . . With structure and discipline, there is no room for lax." Lately, Earlington knows when Brice is home. Once every 30 minutes, Brice knocks or calls, seeking reassurance. "It seems that her foundation keeps cracking each time we get a structure in place for her," Earlington says.

A Fragile Intimacy
In the living room of Unit 1, children blanket the floor, squeeze into corners of the sofa. With the lights out and all eyes focused on a movie, the family portrait is one of normalcy. One son is away on a field trip, but seven of the Brice children are there, including two from foster care on their regular visit. Social worker Maury, who is there, too, has decided that the boys can stay for four hours, double the norm. The telephone rings. After Brice hangs up, she announces that a friend has arrived to take one child for a weekend visit. She takes him downstairs. When she returns, the moment of family intimacy has evaporated. Children are playing in a back bedroom or visiting friends and staff in the building.
    Brice approaches Maury.
"Are you getting ready to go?" Brice asks, meaning getting ready to leave with the foster children. She is unwinding the cord of the Eureka.
"No. Are you ready for us to leave?" Maury responds, stunned, her eyes on the vacuum.
"I'm not trying to put you out," Brice says.
"It's your decision," Maury replies.
"Well, my friend is going to take me grocery shopping," Brice says. "He doesn't know how to get here. So I'm going out to meet him."
"It's up to you," Maury says.
The social worker cannot believe that Brice wants to end the visit two hours early.
"Well, I need to go grocery shopping," Brice says, shaking Maury's hand. "I had a very good visit."
She adds, "I need to get some peace."
Within minutes, the emerald rugs are free of crumbs and children.

At a Crossroads
The curtailed visit was a turning point. Maury doubted that a mother unable to make it through an afternoon visit could handle the years of stress to come. "I think [Brice] is doing a good job, taking into consideration her limitations and the fact that she has five children with special needs," Maury said. " . . . It does not mean she is a good parent for eight kids. I think the situation right now is too fragile to add three more boys." After Maury prepared her recommendation for the family court judge, Brice was livid. She vowed to fight any decision to have her children adopted. "It is going to hurt them to the heart," she said. "I don't want them to think I didn't want them or that I abandoned them. I want them to know somebody else made the decision for adoption."
    But a month later, in December, Brice's handle on her family is still tenuous. Her 14-year-old is failing all her school subjects and staying up so late that she falls asleep in class. The other children are ignoring their chores. Homework is an afterthought. Brice wonders whether her kids are testing her. "They are wondering if I'm going to go back out in the streets," she said. The vacuum cleaner has worn out, replaced by a sleek, black model called "The Boss." Brice still struggles to claim the same title. Desperate to appear in control, she schedules appointments for the children. But one morning, the schedule places her in two locations for three meetings.
    Over the next five months, House of Ruth counselors watched Brice closely and warned her about lapses in her parental supervision. While she attended a Memorial Day picnic, her 7-year-old son was found roaming the neighborhood with a group of boys. Brice had left the child with a relative. When counselors asked Brice to deal with her son, Brice refused. Smith-Gerber decided that Brice had crossed a line. "I don't think she can handle these five children," said Smith-Gerber, citing her concerns about Brice's effect on others in the program. "It is so disruptive that it starts to affect the people who are trying to do the right thing. I think she is disorganized, very emotional and totally overwhelmed. There is only so much we can do. We cannot raise these children."
    Last month, the House of Ruth dropped her from the program. Brice disagreed with the decision but was relieved to escape what she viewed as a smothering blanket of rules and overly watchful counselors. She embraced her new independence. She found a $600 two-bedroom apartment in Southeast Washington that she thought she could afford on her monthly income,$1,029 in welfare and disability payments. Four children had moved in with her, but only the baby and her 11-year-old daughter were likely to stay, she said. Her teenage daughter and her 7-year-old son would probably be placed in residential programs to help them with their emotional and academic problems. She sent her 2-year-old son to live with a relative but said she would bring him back when the others moved out.
    For more than two years, Brice had clung to her dream of creating "one big happy family." She had defiantly dismissed social workers' doubts about whether the boys in foster care should ever come home. But little by little in recent months, Brice began to weigh the words of counselors, relatives and friends -- all suggesting that good parents make sacrifices. Sitting in her new apartment, she took a deep breath and calmly talked about the toughest decision of her new life. "I'm going to give the boys up for adoption," she said. "I see my sons with a better life with their foster mother. They are doing good. I can't raise all of these kids by myself as a single parent. If I had them all, I would be overwhelmed. I want something better for me and the kids."
    Still, Brice is reluctant to let go. She has urged the foster mother to adopt the boys and asked that she be allowed to visit and remain a part of their lives. And today, she will return to family court to face the judge who gave her a chance to pursue her dream. "I've come from nothing to something," she said. "I'm going to tell the judge I don't want to set myself up for failure. I've come too far to lose everything I've struggled for." She has custody of some of her children. She is sober -- two years, four months and counting. And when she sees the judge, she said, she will tell her she is ready to settle for pieces of the dream.

A Referee in Disputes Between Patients, HMOs
Benedict Carey, Los Angeles Times- 7/31/2001

One is a new mother whose infant son requires around-the-clock medical attention. The other is a retired police officer who needs a specialist nearby to help treat a chronic illness. Like millions of Americans across the country who have had disputes with their HMOs, these two Californians had neither the energy, the time, nor the willingness to pursue a lawsuit. They simply wanted their problems to be fixed. So Nicole Breslin, 29, of San Jose, and Gerry Goldshine, 47, of Rohnert Park, turned to the state agency whose job it is to hear their complaints and try to do something about them: the California Department of Managed Health Care. As Congress continues to debate new patient protection bills, experts say it is not the bills' most politically charged feature--the expanded rights to sue--that will directly affect most of the 175 million Americans in private health plans. Rather, the most important element in the congressional debate "is securing the right to a second opinion about your case," said Sara Rosenbaum, a professor of health law and policy at George Washington University in Washington, D.C. A little more than a year ago, the California legislature established the Department of Managed Health Care to do just that.
    While 41 other states have enacted laws providing outside review of HMO complaints, the agency serves the country's largest HMO market--23 million members. While HMO complaints are handled by a variety of regulatory agencies in other states--typically, state departments of insurance--the managed health care agency is the only stand-alone agency of its kind in the country. "I have said from the beginning that we would not be impartial, that we would be admittedly pro-patient," said director Daniel Zingale, a former AIDS activist. Many health policy experts and legislators across the country believe that the California agency offers perhaps the best glimpse of how expanded patient rights may play out for most Americans.
    Based on interviews with patient advocates, health care lobbyists and policymakers around the state, there is a broad consensus that the department is largely fulfilling Zingale's pledge to create a consumer agency that is responsive to patients and effective in addressing their concerns. Observers said the agency has responded swiftly to cases that involved medical emergencies, has cut through HMO red tape to end delays in providing care and has quickly resolved misunderstandings between plans and patients. They say the department is a vast improvement on its predecessor, the Department of Corporation, another state agency that handled HMO complaints previously.
    At the same time, advocates say there are many patients receiving substandard care whom the department cannot or does not help, either because the cases involve a thicket of disputed facts or because patients haven't presented their case effectively. "We hear the same thing from advocates around the country," said Ron Pollack, executive director of Families USA, a health consumers' rights group based in Washington, D.C., which has been active in the patients' rights debate. "These external review boards are trying to be objective, and many consumers just don't have the capacity to present their case like health plans do."
    Nicole Breslin can talk about the department at its best. Last November, Breslin and husband, Christopher, gave birth to their first child, Christopher Liam, a child whose 91/2 pounds belied creeping degenerative muscle disease. Pale and ominously passive, the boy didn't squirm; he flopped. His breathing was uneven, his bones unusually soft. After weeks of testing, and surgery to correct his lung function, the Breslins still had no diagnosis. All they knew for certain, she said, was that their son would need a team of pediatric specialists to ensure his survival.
    The new parents assumed their insurance was solid, for they were double-covered: Nicole had a Cigna HealthCare of California policy through her former job, and Christopher had recently enrolled in Kaiser Foundation Health Plan. But in fact the double coverage proved problematic; an agreement between insurers providing joint coverage prompted the child's transfer from Cigna's care to a Kaiser facility in the middle of treatment. The Breslins couldn't bear the thought of moving their son. "We'd already moved him once, and after all he'd been through, we didn't want to have him poked and prodded and reexamined yet again," she said. The stalemate put the baby's coverage, and his life, in the balance, the Breslins thought.
    Desperate, Nicole called her legislator's office and learned about the health agency's HMO Help Center, which operates a 24-hour consumer hotline. After reviewing the family's case, an agency lawyer informed the health plans that they could not deny or interrupt coverage because of problems coordinating care. The boy would be covered, as long as he stayed in the hospital. "I honestly don't know what we would have done without the department," said Nicole Breslin. The consumer hotline is the nerve center of Zingale's department, staffed by about 100 people, including customer service representatives, nurses and lawyers. If a health plan refuses to pay for care, or strings along the patient for more than 30 days, case managers can issue a formal complaint requesting that the health plan justify its position. And when doctors disagree about whether a procedure is medically necessary, by law the department must send the case to an independent panel of specialists, whose decisions are binding.
    The department also has broad powers to intervene if it concludes that there's been a major violation, and Zingale has not hesitated to use them. Among the department's significant actions in its first year:
* In May, 2000, Zingale decided to fine Kaiser Permanent $1 million for failing to provide adequate care to a 74-year-old woman who later died of complications from a ruptured aneurysm. Kaiser is appealing the fine.
* In February, the department forced PacifiCare of California to pay overdue claims it owed to doctors and others in its networks.
* In May, the department took over daily management of Maxicare Health Plans, a statewide HMO with some 275,000 members, which is having severe financial problems.
    For all that, there are some patients who feel the department has failed them. Gerry Goldshine is one. Goldshine has Crohn's disease, a chronic affliction in which the body attacks its own intestines, causing intestinal blockages, severe stomach cramps, disabling diarrhea and other symptoms. "Some days are better than others, some months better than others," Goldshine said. "But you need to have a gastroenterologist you can see when the disease flares up."
    About the time the Breslins were haggling with their insurers, Goldshine learned that visits to his longtime gastroenterologist would no longer be covered; the doctor had terminated his relationship with Goldshine's health plan, PacifiCare of California. Goldshine called customer service and asked for a replacement. He was referred to a doctor in San Francisco--more than an hour's drive from his house. "That's just too far to go," he said. "To be honest, all I really wanted was for them to say, 'Go ahead and see your regular doctor, and we'll cover you until we find someone else."' No such luck. By mid-March, frustrated with the delay, Goldshine called the HMO Help Center. A case officer contacted the health plan a few days later, and PacifiCare assured him that it had a gastroenterologist with an office in Petaluma, near Goldshine's home. But when Goldshine called the Petaluma office, he learned that the doctor would not be seeing patients there for a couple of months. Even then, office hours were unpredictable, he said. "I was told that the doctor would be spending only two weeks a month in Sonoma County, and they couldn't tell me in advance which weeks those were," he said.
    And there the matter stands. Though the department hasn't officially closed the case, it has not taken any action either, and Goldshine is now paying out of pocket to see his original doctor. "I was a police officer for 20 years," he said, "and if I let a case drop like this, I would have been fired." Asked about the case, Zingale acknowledged that the patient is in a tough spot. "If at all possible," he said, "we should be able to get people in to see the doctors they want to see." At the same time, he said, Goldshine's situation has problematic elements: Namely, there was no medical emergency; and, in the end, there was no clear violation of state rules governing HMOs.
    In fact, patient advocates say, it's often difficult to pinpoint violations, even when it appears likely that a patient is receiving substandard care. "The department is relying at least partly on the health plans' account of what happened to patients," said John Metz, chairman of the California Consumers Health Care Council, a nonprofit advocacy group in Oakland, "but they have no way to verify the facts provided by the plan." The result, said Metz, is that some cases go in favor of the HMO because it's not clear what happened. "If the department takes no action, that's a decision in favor of the plan," he said, "and often we think that's the wrong decision."
    Barbara Reagan, chief of the HMO Help Center, acknowledged that it's not always clear from reviewing the information consumers and plans provide what exactly happened. "We cannot get involved in every 'he said/she said' case if there's no evidence of a violation" by the plan, she said. The agency is required by law to take action on complaints in 30 days. And the workload is enormous. The agency said its customer service representatives field about 6,000 calls a month and file 300 to 400 formal complaints. (An automated phone system takes an additional 9,000 to 10,000 calls a month.) The volume is so high that, during peak hours, calls sometimes bounce to an outside answering service, staffers said.
    That doesn't surprise advocates who have worked consumer hotlines. According to a study commissioned by Shelley Rouillard, who runs the Patients' Rights Hotline in Sacramento, an advocacy outfit serving four Central Valley counties, almost 60% of hotline calls take between 30 minutes and five hours to handle. The average for those calls: an hour and a half. Even quick-resolution calls--35% of the total, according to the survey--take an average of 17 minutes, she said. "The way the HMO Help Center hotline is set up, they don't have time to help every patient prepare his or her own case," said Rouillard, who advised the HMO Help Center on its hotline. "They're trained to do quick resolution, to take care of the urgent cases and advise consumers on how to be their own advocates."
    Yet when it comes to advocating for oneself, the deck is still stacked in favor of health plans, patients' rights experts agree. The plans deploy medical directors, lawyers and other paid professionals to argue their side, Pollack says. Patients, however, are often sick, confused and unfamiliar with the legal and medical fine points that pertain to their case. Some of the most time-consuming cases that Rouillard's outfit handles, for example, involve standoffs in which a patient needs a highly specialized surgery and believes that the HMO's doctors lack sufficient expertise. The plan is not technically denying care; it has board-certified specialists in place. The question is whether those doctors are among the best ones to perform the procedure. "In these cases, people need a lot of help in order to make a convincing appeal to the health plan," she said, "and the DMHC can't do that for you. They're not authorized to do that."
    Yet if departments are to make managed care actually work for American consumers, Pollack said, then they'll need not only a strong leader, like Zingale, and a clear mandate to advocate for patients, but lots of help, from patient consultants like Rouillard. In bills being debated by Congress, Families USA has sponsored amendments authorizing federal money for patient assistant programs throughout the country. "We know these patient assistance programs can make a big difference for people," he said, "and they can often get things solved before they reach external appeal."

Study Says One in Five Girls Is Abused by Boyfriend
Rose Palazzolo, ABC News- 7/31/2001

One in five girls has experienced physical or sexual violence from a dating partner, according to a new study. The study, which appears in the Aug. 1 issue of the Journal of the American Medical Association, also says that abused girls are significantly more likely to engage in risky behavior. "Girls who reported being victims of dating violence were four to six times more likely to get pregnant and eight to nine times more likely to have made a serious suicide attempt," said lead author Jay Silverman, assistant professor of health and social behavior at the Harvard School of Public Health. The study did not conclude whether dating violence causes teens to engage in unhealthy behaviors, or whether already troubled girls are more likely to date violent partners.
    Researchers looked at data from the 1997 and 1999 Massachusetts Youth Risk Behavior Surveys. They analyzed responses on a question and answer form filled out by 1,977 adolescent girls in grades 9 through 12 from 1997 and survey of 2,186 girls from a 1999 survey. Girls were asked if they had ever been hit, slapped, shoved or forced into sexual activity. The results cut across all socioeconomic and racial and ethnic categories. Previous studies report the problem to be even worse. Other studies have said that as many as one in three girls will have been in an abusive relationship by the time she gets to college. Last year, Justice Department statistics revealed that the highest rates of violence were among people under 25.
    "This study breaks the myth that domestic violence occurs only in the adult population," said Juley Fulcher, public policy director of the National Coalition Against Domestic Violence. "We really need to take a good hard look at what we need to do to curb this trend." Fulcher said that some much of the abuse adolescents encounter is similar to the physical and emotional abuse adults encounter. Since girls who are abused tend to be embarrassed and fearful, a lot of abuse goes unnoticed or unrecognized, said Silverman, who is also the director of a violence protection program at Harvard. Then when they do come forward, there are few social programs for them to turn to. "The legal remedies and services available to adult victims are also not always there for adolescents," Fulcher said.  "The finding of such a high prevalence of dating violence against adolescent girls throws a spotlight on the need for all of us to do more to prevent and intervene in this violence to reduce both the immediate risks of injury to young women and the very serious risks to their health that may follow," said Silverman.
    Part of the problem is also that more often than not the abuse problem is not taken seriously, according to Irene Frieze, professor of psychology and women's studies at the University of Pittsburgh. Frieze adds that she sees many young women also abusing boys in relationships. The definition of abuse is often in question for young people, she said. "If a woman slaps her boyfriend it isn't always considered abuse," she said. "Although this study and many other studies focus on adolescent girls, this behavior is not something that is under their control," Silverman said. "We cannot hold them responsible for preventing this from happening. We need to be working with young men at preventing this behavior and understanding it."

N.J. Allows Residents to Sue HMOs as Congress Debates Next Step
Ralph Siegel, Associated Press-7/31/2001

TRENTON, N.J. -- New Jersey residents can sue commercial health-insurance companies for medical malpractice under a new law signed by acting Gov. Donald DiFrancesco. Advocates of the law, signed Monday, praised it as the nation's toughest because it allows people to go straight to court if they claim to be at serious risk from an HMO decision. Typically, complaints must first be heard by a medical panel.
    Now Congress must determine if the law will be allowed to survive and if it will be extended to the half of state residents whose insurance plans are controlled exclusively by federal regulations. The law does not apply to millions of residents who receive insurance from unions or from companies that pay insurance claims themselves. Only a change in federal law could allow those people to sue.
    New Jersey is the tenth state to allow patients to sue health maintenance organizations; several dozen more are considering it. Advocates for the law, including doctors' associations and citizen watchdog groups, say allowing patients to sue provides essential recourse if patients are denied necessary care. ''Physicians have been pounding their heads against the wall for years, fighting for patients and appeals and using up a tremendous amount of resources,'' said Angelo S. Agro, president of the Medical Society of New Jersey.
    Michelle Guhl, a lobbyist for insurers, said New Jersey's law will create a flood of litigation. Critics say lawsuits would drive up insurance prices and cause some people to lose coverage. ''It's Christmas in July for trial lawyers,'' Guhl said. ''I think it is frightening.''
    The White House and key lawmakers were hashing out their differences on federal patients' rights legislation Tuesday. Most Democrats in Congress favor a bill that would allow patients to sue in state courts, where trial lawyers feel such cases are more likely to prevail. President Bush and most Republicans prefer to limit damages and send most suits to federal courts. Some versions being debated in Washington would bar direct action in state courts and therefore nullify a key ingredient of New Jersey's new law. U.S. Rep. James Saxton, R-N.J., met with White House officials Monday seeking to ensure any new federal law does not reverse New Jersey's measure.
    Under New Jersey's law, most people will still go through a state-appointed medical panel before going to court. But patients can skip the panel if they say the HMO's decision has placed them at risk of death or serious injury or illness. Plaintiffs will still have to show they tried to arbitrate the complaint out of court, and will have to prove to a jury that the HMO was given all the facts yet negligently refused to act, said Gary Levin, an expert in malpractice law.

Beginning Wednesday, DUI Suspects' Cars Subject to Seizure
John Curran, Associated Press- 7/31/2001

Beginning Wednesday, police in New Jersey have the power to seize the vehicles of drunken driving suspects and keep them for 12 hours after the arrest. ''John's Law,'' named for a U.S. Navy ensign killed in a drunken driving accident last summer, also requires anyone who takes custody of a suspect after his arrest to receive a written warning about their liability should the drunk person get back behind the wheel.
    Last July, U.S. Navy Ensign John R. Elliott, 22, of Egg Harbor Township, was killed in a head-on collision with a driver who had been charged with DUI earlier that night. According to police, the man Michael Pangle, 37, of Woodstown got back into his SUV after a friend picked him up at a state police barracks after his July 22, 2000, arrest. Pangle's blood-alcohol content was .21, more than twice the legal limit for drivers. He was still drunk three hours later when his 1987 Chevy Blazer crossed a center line on U.S. 40 in Pittsgrove Township and struck Elliott's 1994 Nissan Ultima, killing both men at the scene, according to police. The friend, Kenneth Powell, 39, is awaiting trial on charges he was an accomplice to the accident, even though he wasn't involved in it directly. He is charged with manslaughter, vehicular homicide and aggravated assault.
    Elliott's father, William Elliott, used his son's death to persuade lawmakers to make New Jersey's DUI laws tougher.  ''The law goes a long way toward ensuring that anyone who is arrested for driving while under the influence will simply not have access to their vehicle for half a day following their arrest,'' said Attorney General John J. Farmer Jr. The state Division of Criminal Justice has notified all state law enforcement agencies about how to implement it.  The vehicle can be released in less than 12 hours if the person taking custody of the suspect agrees to sign the written warning about liability, according to Farmer. If the person refuses to sign, the vehicle would remain impounded for 12 hours after the arrest. After that, it could be released to the suspect himself, Farmer said.  Elliott's father said the law would have saved his son's life if it had been in effect last year. ''It represents John's final gift of life to all of us,'' said William Elliott. ''We hope that, in his name, it will save lives. It would have saved his.''