Noteworthy News Articles on Mental Health Topics, September 1-6, 2001

HMO Restricted California Patients' Access Amid Campaign Touting Accessibility
Associated Press, 9/1/2001

LOS ANGELES -- Kaiser Permanente, California's largest health maintenance organization, restricted patients' access to doctors during an ad campaign that touted their accessibility, the Los Angeles Times reported Saturday.  The HMO's campaign used the slogan ''you're in the hands of doctors.'' But the newspaper's review of documents, including e-mails and notes of private meetings, reveals Kaiser encouraged its doctors in Northern California to make themselves as unavailable as possible to their patients in order to lower patient demand and costs.
    Dr. Robert Pearl, chief executive of Kaiser, said at a private meeting that ''we chose not to provide our patients with what they desired,'' the Times reported. Later, Pearl recommended a change in the way the company conducted business to his physician group's board of directors, saying the policy was making patients and doctors very unhappy and wasn't saving money. Pearl said cost-saving measures failed because most patients persisted in efforts to get an appointment, according to the minutes of a July 2000 meeting. He recently told the Times that the HMO had become a leader in improving patient access.
    Other internal documents show that Kaiser encouraged the use of non-doctors and this worried other employees who said it went against their 1998 ''in the hands of doctors'' campaign. Kaiser official Cecilia Runkle complained in an e-mail that ''the tag line may promise more than we can deliver.'' The internal documents were obtained from a nurses' labor union and a consumer group that sued the HMO for false advertising. The lawsuit is pending.
    There was no comment Saturday from Kaiser-Permanente. Spokeswoman Laura Marshall, at the HMO's headquarters in Oakland, did not immediately respond to telephone messages and pages. The Times said the company denied it misled anyone and cited favorable results from an independent survey of its 3 million Northern California members. When it came to patients' access to primary care physicians, Kaiser was rated above average in the late 1990s compared to other HMOs. Kaiser's Southern California services were rated about average.

Suicide: Don't Avoid the Issue, Experts Say
Gordy Holt, Seattle Post-Intelligencer- 9/1/2001

Suicide remains a fearful topic that many Americans keep in the closet. Most experts agree it's important to "demystify" suicide, alerting the public to warning signs and preventive measures, but they're divided on whether it's also beneficial to publicize suicide attempts such as the distraught Pierce County woman's 160-foot leap this week into Lake Union. Some say the news media should do more to bring attention to the issue -- even by covering suicides as they now cover murders. Others contend coverage of an event like Tuesday's jump from the Ship Canal Bridge can only glamorize suicide, prompting others to follow suit. The 26-year-old woman, who was taunted by motorists before taking the plunge, survived but remains in serious condition at Harborview Medical Center.
    One thing is clear, said Dr. David Litts, suicide prevention adviser to the U.S. surgeon general. "We need to begin a massive public education program -- something on the order of what began in the 1950s after President Eisenhower had his heart attack," he said. "People began to learn how to recognize the warning symptoms. They learned CPR. They learned about diet and exercise, and how to live a more healthy life." A similar set of helping and coping skills is needed today to slow the suicide rate, Litts said.
    The latest figures from the American Association of Suicidology show Washington ranked 23rd in the nation in 1998 with 708 suicides, down from 728 the previous year. Nationally, 30,575 committed suicide in 1998 -- one every 17 minutes. More people kill themselves than are killed by other people, the association reports. In the United States, suicides outnumber homicides 3-2. Yet, experts have few answers.
    News coverage of public suicide attempts can be a negative influence that encourages copycats, according to a report released earlier this summer and endorsed by the Surgeon General's Office and the National Institute of Mental Health. News organizations should avoid "excessive coverage" of suicides and refrain from providing detailed descriptions of the acts, according to the report.
    Those conclusions were rebutted in a recent survey of suicide survivors in Texas by the Centers for Disease Control and Prevention. Researchers determined that the survivors were not influenced to take the drastic action by earlier public exposure of suicide attempts in news reports. In fact, media coverage of suicides could well be preventive, prompting other disturbed people to realize that help is available and that others are experiencing similar woes, the researchers found.
    Although the Texas study was criticized as being too limited in scope by authors of the earlier report, its conclusions are applauded by Seattle psychologist Steve Cummings. Cummings wants more reporting on public suicides, calling it a significant mental health issue that needs to be examined and discussed fully, not hidden from view. "People ought to know what happens when it happens," he said. "They need to know that help is available, and that there is no room for shame in this. It's too important. Once you take that jump it's too late."
    Most news organizations, including the Seattle Post-Intelligencer, do not report on suicides unless the public is affected, like the thousands of morning commuters who were stalled during Tuesday's 3 1/2-hour bridge drama in Seattle. That incident was extensively covered by newspapers, radio and television, fueled by police reports that frustrated motorists were urging the woman to jump. Since then, people from across the state have flooded the hospital with expressions of sympathy and support, sending more than 500 cards, 100 flower bouquets, and stuffed toys, dolls, balloons and books. There was no coverage, however, in early May when a woman killed herself in a leap from the Aurora Bridge, largely because traffic backups were relatively light.
    Litts, the surgeon general's adviser, said news coverage or not, suicide prevention is no simple task. In a program he helped develop for the Air Force, an upfront approach is described as vital. Mental health questions must be broached as openly as the nation now addresses physical health, he said. "We try to start with families by addressing their problems openly," Litts said. "It means early childhood intervention programs; programs to prevent child abuse. It means offering parenting and anger management skills classes and education on the warning signs so that we can get people the help they need early."
    Prevention also can take a physical tack, as it has in the San Francisco Bay Area. The train tracks between San Jose and San Francisco have begun to give the Golden Gate Bridge a run for its money as a magnet for suicides. So far this year, 19 people have been killed on the tracks. A couple of years ago, Caltrain responded to the problem by placing 400 signs along the railroad right of way. "We've got them every 1,200 feet," Caltrain's Christine Dunn said. "They say help is available, and include an 800 suicide hot-line number." The Golden Gate Bridge, Highway and Transportation District also does what it can to discourage suicides. Emergency call boxes for stranded motorists provide free links to local crisis lines. Claudia Cornish, a Washington Transportation Department spokeswoman, said yesterday that suicide attempts are too rare on the Ship Canal Bridge to justify similar call boxes or signs. Tuesday's jump was the first this year. Unlike the Golden Gate Bridge, pedestrians aren't allowed on the I-5 span. Richard Miller, whose city roadway-structures division maintains the Aurora Bridge for DOT, said a suicide hot-line sign has never been suggested.

Steps Taken on Methadone Issue in Vermont
Associated Press, 9/2/2001

MONTPELIER - Health officials are making headway in their efforts to open methadone clinics in Vermont but they say any program is still months away. The state has made some concessions in its negotiations with hospitals considering hosting methadone maintenance programs. The Department of Health has agreed to cover the cost of uninsured patients who enroll in the programs, and indicated a willingness to raise considerably the rate at which hospitals are reimbursed.
    Thomas Perras, the director of the department's Office of Alcohol and Drug Abuse Programs, said the state is committed to providing this service to Vermonters addicted to opiates. ''We've got a lot of sick people out in the streets and our priority is to get them help,'' he said Friday. ''The key for us is getting them off the street and using, and begin recovering.''
    It has been more than a year since the Legislature passed a law allowing the use of methadone to treat heroin addiction. It has been a hot-button issue since then, with proponents and opponents publicly squaring off to debate the merits of the treatment. Estimates based on other programs show just under half of the patients wouldn't have insurance. Perras said a reimbursement schedule had not been agreed upon with officials from the three hospitals that had expressed interest in starting the program. However, discussions do appear to be settling on a dosage rate in the mid $20 range, a considerably higher figure than the $5.50 the state had originally proposed. That fee would cover the costs of the methadone as well as laboratory costs, training for staff, and in some cases increased security personnel, Perras said. Including both state and federal funding, there is a little more than $1.3 million to fund the programs. That figure was based largely on the $5.50 rate and was estimated to last for one year.

Psychiatric Patients Choose Remaining in Hospital over Homelessness
Associated Press, 9/2/2001

CONCORD, N.H. --About a quarter of patients at New Hampshire's state-run psychiatric hospital could be discharged, but stay there because of a lack of affordable housing and appropriate community services. It's not uncommon for patients to stay for months after they could have left, advocates of the mentally ill say. Others who do leave sometimes end up in homeless shelters or on the street. ''One of the primary challenges is affordable housing,'' said Linda Saunders, acting director of the division of behavioral services. ''Apartment availability is limited even if they can afford the rent. Many of our patients struggle with mental illness and poverty.''
    The newspaper, Union Leader, took a snapshot of the mentally ill population at New Hampshire Hospital on Aug. 23. That day, 20 of 176 patients could have gone home, but had no place to live, officials said. Another 22 patients were ready to leave but could not because there were no support programs for them.  Saunders says there is extreme pressure on the state hospital because of fewer state beds available in private psychiatric facilities and an ongoing housing crunch. ''The housing crunch is complicated by the fact that more folks are coming in the doors of the state hospital as a result of the closure (of state beds) at places like Portsmouth Pavilion,'' she said. The closure of Miller House in Concord and Strafford Commons in Dover also reduced the number of residential beds, she added.
    Dale Klatzker, president of Riverbend in Concord, one of the state's community mental health centers, said it's a complicated problem. ''It's tied into the housing stock available in communities, managed care insurance, the state budget and state dollars for Health and Human Services,'' Klatzker said. ''It's tied into the economics of living in New Hampshire. It's not solely a New Hampshire Hospital issue, it's more of a societal and statewide issue.'' He said managed care has micromanaged reimbursement rates to community mental health facilities so much they have left the business, leaving New Hampshire Hospital as the only fallback for many individuals. Klatzker said the Division of Health and Human Services is looking at the issue, but the Legislature and state insurance official need to pay more attention.
    Others, like Donna Woodfin of Concord's Disability Rights Center, are accusing the state of not meeting its obligations. Many critics say it's more financially responsible for the state to fix the problem rather than keep people at the hospital. They say the cost to serve the mentally ill in their communities ranges from $8,000 to $60,000 a year. But that's still less than the $240,000 it would cost per patient to stay at the state hospital.  ''We're always penny-wise and pound foolish,'' said state Sen. Katie Wheeler, D-Durham, chairwoman of the Senate Health and Human Services Committee. Wheeler suggests appropriating money for smaller, community facilities that could serve as temporary residential halfway houses.

Pro-Anorexia Venues Showing up on Web
Alfredo Lubrano, Houston Chronicle- 9/2/2001

PHILADELPHIA -- Emaciated young women are displaying their protruding ribs and backbones, then boasting about five-day fasts, on pro-anorexia Web sites that celebrate the sisterhood of self-induced starvation. In the last few months, forums and clubs with such names as skin 'n bones and anorexiarocks have flourished on the Web.  The self-described "anas" recast the deadly psychiatric disorder -- which affects mostly young women ages 14 to 24 -- as a lifestyle choice. The clubs also attract bulimics (who binge on food, then purge) as well as others suffering from eating disorders. "More than ANYTHING, I want my hipbones to stick out," an ana named Tracy wrote.
    Since July, horrified health professionals at eating-disorder clinics across the country have been monitoring hundreds of such sites, which they attest pose a real danger by advocating destructive behaviors. The National Association of Anorexia Nervosa and Associated Disorders wrote to Web hosts, including Yahoo, asking them to remove pro-anorexia Web sites and chat groups. Association President Vivian Hanson Meehan said Yahoo immediately complied, an action that she said "potentially benefits millions of young people." Neither anorexiarocks nor skin n'bones is now listed among Yahoo groups. But as quickly as known sites are unplugged, new ones pop up.   "It's pretty distressing," said Robert Berkowitz, medical director of the University of Pennsylvania Medical School Weight and Eating Disorders Program. "It's like alcoholics entering drinking contests. They have found a way to get better at being ill."
    Adapting the style and tone of support groups, many of the Web sites offer devastatingly unhealthy tips on staying thinner than thin, including how to lose weight by eating fewer than 500 calories a day -- a dangerously low amount, experts say -- and how to fool your parents into thinking you're eating by snatching food off your plate and stuffing it into your pockets. The sites run competitions for shedding pounds, and they explain how pro-EDs (people who are advocates of eating disorders) find comfort in the disorders. "I'm too scared to risk this ED security blanket," a young woman wrote on a pro-anorexia site. "Right now, I need it still." Typical of the sites are "thin commandments," including beliefs such as "Being thin is more important than being healthy," "What the scale says is the most important thing," and "Being thin and not eating are signs of true willpower and success."
    The Web sites have chilled the psychological community. "It's grotesque to have people celebrating a disease," said Nada Stotland, a psychiatrist and an obstetrician-gynecologist at Rush Medical College in Chicago. Only in the last month have clinicians become aware of the sites, which number 200 or more, said Daniel Le Grange, director of the University of Chicago's Eating Disorders Program. "My guess is these people are so embattled by relatives and clinicians that they feel the Web is the only retreat they have. I hope it's a small group of people, but we have no way of knowing."
    Anne Kearney-Cook, psychologist and body-image expert, said the sites have her worried. "The dangers are unbelievable," said Kearney-Cook, who works with Columbia University's Partnership for Women's Health. "The message is that being anorexic is something to be proud of, a source of achievement. Unfortunately, it's keeping everybody ill. These girls feel isolated and want to feel a part of something, and their message is, `Don't let them take anorexia away from you.' "
    The most successful anorexics die, therapists say. Anorexia is so deadly, in fact, it is considered by experts to be the most lethal psychiatric disorder. More people die from anorexia than commit suicide in the United States, Kearney-Cook said. Eight million people in America have eating disorders, 7 million of them women and girls, according to the National Association of Anorexia Nervosa and Associated Disorders in Chicago. Six percent of the most serious cases die each year; 77 percent suffer from one to 15 years, and only 50 percent are cured. Girls going through puberty with eating disorders risk shortened statures, osteoporosis, compromising their reproductive systems, and even heart attacks, the association said.
    Experts explain that anorexics are very good at starving themselves and look it, weighing 15 percent or more below the healthy norm. Bulimics resort to vomiting after they binge -- eating as much as 10,000 calories in a single sitting.  People with eating disorders often lack self-esteem, feeling they possess no laudable personal characteristics or abilities, the anorexia association reports. Sufferers try to control their weight to demonstrate mastery over something in a world of chaos, experts say. "When you weigh 85 pounds, you've shown control over eating," Stotland said. "A lot claim their disease was first triggered by someone telling them they're fat. So anorexia becomes a triumph."
    On the pro-anorexia Web sites, participants often praise overly thin celebrities as heroes and role models. Actresses and models such as Kate Moss, Jennifer Aniston, Lara Flynn Boyle, Kirsten Dunst, and the oft-mentioned Calista Flockhart are constantly discussed by anas envious of the famous women's superthin bodies. "Oh, these sites turn my stomach," said Jane Spears-Bennorth, a 35-year-old Mahwah, N.J., pharmaceutical executive who suffered from anorexia for years. "Women and girls are exposed to enough negativity about weight and looks on TV without these Web sites making anorexia seem glamorous," she said.

Slain Children Live in Yates' Memory
Lee Hancock, Dallas Morning News- 9/2/2001

HOUSTON - Rusty Yates barely pauses in the dark hallway. His voice is as flat as it was on the June morning he tried to tell the world why he thought his wife had drowned their five children in the family tub. His words fall like a slap, echoing through the empty house. ''There,'' he says. ''That's the bathroom.'' The narrow room where he may shower after an evening workout. The place his family died. One of the few lighted rooms in the house.
    Two months after Andrea Pia Yates called police to say she'd just methodically drowned her children, friends, relatives, and acquaintances say her husband is trying to pick up his shattered life. They say he goes most days now to his engineering job at nearby Johnson Space Center. He has friends over for weekly basketball games in the driveway where he and 7-year-old Noah played horse. He sees his 37-year-old wife at the Harris County Jail, trading off visiting hours with her family, and like them, taking her collect calls on the days she can't see them. Her mother and other Houston relatives and acquaintances say he has expressed hope that he and his wife can be together again if and when she is freed from jail; two empty burial sites have been set aside for the Yateses beside their children's graves.
    Rusty Yates, 36, stares sometimes at snapshots of his stair-step boys and baby girl. He has posted favorites on an Internet site he is constructing as equal parts memorial for his children, thank you to those who helped bury them, and legal fund-raiser for his wife. ''It's a work in progress,'' he said, showing the site to a visitor in his home. ''That's one reason I'm staying in the house. There are good memories, too. It's weird. Sometimes when I see the kids, I just grieve. And sometimes I'm happy.''
    He endures reporters who show up at his suburban home, and he wearily explains that a gag order in his wife's capital murder case prevents him from defending her or even publicly venting anger and grief. ''The most important thing is what will help Andrea. I can only take so much right now. I have to focus my energy.'' Said a relative, ''He can't express himself. He can't get away from the situation. And he's grieving, trying to grieve for the children. ... It's been very difficult for him.''
    Andrea Yates called police shortly after her husband left for work on June 20. She called her husband, told him to come home, and then led a Houston officer to the bodies of her five children, ages 6 months to 7 years. The former registered nurse later gave police a 90-minute statement. She said she drowned Luke, Paul, John, Mary, and Noah one at a time because she thought she was a bad mother and they were hopelessly damaged. An official familiar with her confession said that she had thought of killing them months before they died and that she had thoughts they'd be better off with God.
    Rusty Yates moved back into his home the weekend after the funerals. He briefly lined his living room with the hundreds of stuffed animals, plants, and devotional candles left in his yard by strangers after the drownings, and then gave most of them away. Some of the candles still sit on the fireplace mantle. The room's few other decorations are a large religious poster and a framed family portrait with a crooked cardboard heart glued by a child to the wall above it. The family's dining table, in the adjoining kitchen, is now a ''war room'' covered with records, papers, and files. Rusty Yates has told relatives that he threw away the bed he shared with his wife because she had laid the wet bodies of his drowned children on it, and then cleaned out a storage room so he could sleep there. The couple's former bedroom now looks like a shrine. Toys and crayon drawings - one a bright, hand-lettered Mothers' Day card - are scattered about. Andrea Yates's belongings are stacked against a wall, and five large plastic containers hold each child's favorite toys and mementos.
    Rusty Yates has said he's considering posting pictures of the keepsakes on his family Web site, as well as a transcript of his eulogy. He gave away his sons' school desks and the four-bunk bed he built for them. Their bedroom and school room are now empty, save for a few children's books and a grease board where he has scrawled a timeline of his wife's medical treatment and the names of several high-profile lawyers.
    Family and friends say Rusty Yates talks of suing the hospital and the psychiatrist who treated his wife of eight years. Andrea's brother, Andrew Kennedy, said his brother-in-law wants someone held accountable for discharging her from the hospital when she was too incoherent to speak as well as for the decision to take her off the psychiatric medication that reversed an earlier bout of depression. The children died within a few weeks after Andrea was taken off the drug. Officials at the hospital declined to comment, and a phone number given by the hospital for her former psychiatrist has been disconnected.
    Kennedy and others say Rusty Yates is furious that Harris County prosecutors are seeking the death penalty against his wife. They say he considers that cruel disregard for his wife's illness and infliction of further pain on a family that has already endured the unimaginable. The section of his Web site explaining his wife's defense fund all but spells out his anger. ''The state, who will reportedly spend one million tax dollars to prosecute Andrea, is seeking the death penalty against her,'' he writes. ''Any funds received in excess of what's required to defend Andrea will be donated to causes for women's mental health issues, particularly postpartum depression and psychosis.''

Open-Container Law Finally Passed in Texas
Mark Wrolstad, Dallas Morning News- 9/2/2001

DALLAS - Starting yesterday, Texas drivers had a second hand for the wheel. For the first time since buggies became horseless, it became illegal to drink and ride. The open-container law outlaws what many Texans came to view as a staple of road trips, drives to sporting events or just the ride home from work - an open can, bottle or cup of anything with alcohol in it.
    Safety advocates and law enforcement groups, who tried to get the restriction passed for more than a decade, finally have seen their efforts produce a law that they say is founded on simple common sense. ''If we really want to stop drinking and driving, we need to get the alcohol out of the cars,'' said Bill Lewis, a spokesman for Mothers Against Drunk Driving. ''The only way to do that is for the law to apply to everybody in the car. ''It's been too easy for drivers to drink and then pass it to their buddy and say, `It's not my beer. It's his.'''
    The prohibition represents a big stride away from the state's freewheeling reputation involving alcohol and the open road. ''Texas has always been different,'' said Roger Hodges, 55, who had beers with friends this week around the tailgate of a pickup at a drive-in in northeast Dallas. ''I don't like the law. I don't see nothing wrong with having an open container if you're not driving.''
    It's been illegal in Texas only since 1987 to drink while driving, and police considered the law virtually unenforceable since it required them to see a driver consume a clearly alcoholic beverage before stopping a vehicle.  About two-thirds of the states now have laws banning open or resealed drinks in passenger compartments.
    In counterpoint to the fundamental safety concerns, others view the question as a matter of individual responsibility and personal freedom. ''There's no reason to have an open-container law for passengers,'' said Lee Sammons, 45, who drank a beer while riding to Dallas from Tyler, Texas, this week. ''If there's a suspicion about the driver drinking, the police can give him a Breathalyzer test.''
    A prevailing attitude that people could make their own choices about having a beer when they're merely riding in a vehicle kept supporters of the new law frustrated for years. ''That's probably the number one reason we didn't get the law changed sooner,'' said Dallas police Lieutenant John Branton. Drinking while riding - and even driving - is part of a ''good ol' boy'' outlook that's been slow to change, he said. ''People kind of winked at it. Now people see it for more of the evil it is.''
    Opposition from the beer and liquor legislative lobbies also sidetracked proposed open-container bans during the '80s and '90s, said Lewis of MADD, a group credited for the law's eventual approval. ''I think it finally started to sink in that they don't want to be the bad guys in this,'' Lewis said of the alcohol industry. ''Well sure, we're citizens, too,'' responded Robert Sparks, a lobbyist and the head of Licensed Beverage Distributors, a trade association for liquor wholesalers. The distributors and other lobbying groups changed their strategy this year and decided to support the new limits. ''It seemed like the time had come to do it,'' Sparks said. ''Public sentiment was there.''

New Facility Los Angeles Offers Rape Victims a Quiet Space
Jean Guccione, Los Angeles Times- 9/3/2001

Kathy Adams works in a cramped part of the Northridge Hospital Medical Center emergency room where she interviews victims and collects evidence of sexual assault. Outside the examination room, police officers sit at a small desk to type reports and telephone witnesses. A few feet away are two chairs for the victim's family. That's all the space there is for the half-dozen or more people who accompany sexual assault victims to the hospital. But on Wednesday, the Children's Assault Treatment Services/Sexual Assault Response Team is set to move from the noisy emergency room into a secluded building on the hospital's Van Nuys campus, a space designed to give victims more privacy and a calmer setting. "They won't have all the sights, sounds and smells of an emergency room," said Adams, the program's clinical director and a registered nurse who conducts some of the interviews and medical exams.
    The new facility will have a private entrance so police can quietly escort victims into the building all hours of the day and night without having to walk through the emergency room, Adams said. Inside, there will be two fully equipped examination rooms--one for adults and another for children--a separate interview room and a reception area for families, Adams said. Private offices will be available for police and prosecutors, if they want them, and for a crisis intervention program.
    Northridge is one of three hospitals in the San Fernando Valley where police can bring victims for forensic exams. It is the only one open to children around the clock. Since its inception in 1997, the program has grown from about 12 cases a month to a record 95 last May, said Bonnie Bailer, its administrative director. Last fiscal year, the five-nurse staff examined 785 alleged victims--more than 550 of them minors--brought to the hospital by law enforcement or county social workers, program statistics show.
    Nurses conduct physical examinations of the alleged victims, collecting DNA samples and using a colposcope, a special microscope that photographs tiny internal injuries. "Their body actually becomes a crime scene," said Adams, who has testified as a witness in about 15 sexual assault cases since 1995. Police and prosecutors credit Adams and her staff with helping to solve crimes and win convictions by collecting critical DNA and other physical evidence.
    They say the new facility should improve the atmosphere where traumatized victims, especially children, complete the medical exam, which can take anywhere from two to seven hours. "Now we can take them to a calmer place," said Det. Corinne Malinka, head of the sexual assault unit in the Los Angeles Police Department's Foothill Division. "We don't want to give them any more trauma than has to occur" with the examination.
    Eventually, Northridge would like to be the first L.A. County hospital to videotape interviews with crime victims for law enforcement use, Adams said. Hospitals in other California counties, such as Orange and Santa Barbara, already videotape interviews, she said. In Los Angeles, a protocol is being developed. Two video cameras would be hidden in the ceiling of the interview room and hooked to a monitor in an office across the hall so police could watch as nurses ask patients to recall every detail of their sexual assault, Adams said. Interviews are now audio taped; the recordings have proved valuable in the court system.
    Once, to help them convict her father, jurors heard the hospital's tape recording of a 13-year-old victim recounting the sexual assault she endured, said Deputy Dist. Atty. Eduards R. Abele. It was played in court after the girl's mother fled to Mexico with the child, making her unavailable to testify. The tape "brought the victim to life in front of the jury," said Abele, a veteran sex crimes prosecutor in Van Nuys, crediting the expert medical staff. "A conviction would not have been possible without the audio tape and the medical evidence." The father was sentenced to 15 years to life in prison, he said.
    As part of the program, victims also are introduced to specially trained advocates from the Valley Trauma Center, who suggest counseling and guide them through the criminal justice process. Earlier this month, a counselor accompanied a 16-year-old Birmingham High School student who was gang raped by at least four teenagers to court in Van Nuys to face her attackers. The counselor also was present when the girl testified in court earlier this year. That was another case in which the nursing staff made a difference. "They provided us with the first set of clues of the likelihood that the victim [who passed out drunk] was sexually assaulted multiple times," Abele said.
    Most of the $200,000 for building renovations and new equipment for the new facility came in donations from nonprofits such as the California Endowment and UniHealth Foundation, Bailer said. Carolyn McNary, a veteran sex crimes prosecutor in San Fernando, is so impressed with the new facility that she's leading a fund-raising drive to decorate it.

Stress Has Hormonal Link to Alcohol, Drug Abuse
Steven Stocker, Washington Post- 9/3/2001

Lawrence Kudlow is an economist, contributing editor of National Review magazine and frequent guest on "The McLaughlin Group," where he often argues in favor of deep tax cuts. He is also a recovering alcoholic and cocaine addict. Kudlow attributes his bout with drug and alcohol abuse partly to the pressure he felt when he was chief economist and senior managing director of Bear, Stearns & Co., a Wall Street investment firm. In the late 1980s and early 1990s, Kudlow followed an exhausting schedule involving writing reports, traveling and giving speeches. Although he had started drinking regularly in the late 1970s, his drinking increased and he began bingeing on cocaine.
    Kudlow's story is not unusual. Research indicates that long-term stress caused by work, family or combat can lead people to use alcohol, drugs and cigarettes. A study conducted by researchers at Johns Hopkins University and the University of Maryland found that full-time nurses who work in a high-strain environment are 1 1/2 times as likely to use cocaine, marijuana and other psychoactive drugs as nurses who work in a low-strain environment. A high-strain environment was defined as one in which the psychological or physical demands of the job were high while the amount of control a nurse was allowed to have in the job was low.
    Stress also can promote drug intake by animals. Physical stressors such as mild, intermittent foot shocks or repeated tail pinches increase the rate at which animals press a bar to receive an intravenous infusion of cocaine or amphetamine. Psychological stressors, such as being the object of an aggressive attack or witnessing another animal being subjected to repeated foot shocks, have the same effect. Stress promotes the intake of addictive drugs by causing the release of hormones called glucocorticoids, according to neuroscientist Pier Vincenzo Piazza of the French National Institute for Health and Medical Research. These hormones are released from the adrenal glands, which sit like little hats on top of the kidneys. "Glucocorticoids were believed for a long time to mediate the aversive effects of stress, so they were considered 'bad' hormones," Piazza said. "However, there is no real evidence for that. All the evidence indicates that glucocorticoids are experienced by the subject more like rewarding hormones than aversive ones." Glucocorticoids stimulate the same reward pathway in the brain that is stimulated by drugs of abuse, Piazza said. This pathway consists of nerve cells that release the messenger chemical dopamine. This dopamine release often occurs in response to pleasurable events, such as eating tasty food or seeing an appealing sexual partner, but drugs of abuse and glucocorticoids can provoke this release as well.
    Just as with drugs of abuse, animals will press a bar to receive an infusion of a glucocorticoid, showing that these hormones are indeed rewarding. People also sometimes find them rewarding, as shown by the fact that patients occasionally abuse synthetic glucocorticoids, such as cortisone. The reason that glucocorticoids are rewarding is to counter the aversive effects of stress, thereby allowing an animal to react to a threat by doing something other than just running away, according to Piazza. "If the only reactions to threatening and aversive stimuli was avoidance and flight, individuals would be severely limited in how they adapt to environments," he said. By activating brain sites of reward, glucocorticoids can decrease or even totally suppress the tendency to flee and increase the tendency to try some other approach, such as fighting or putting an obstacle in the way of the aggressor.
    The problem in this day and age of psychoactive, rewarding drugs is that high levels of glucocorticoids can sensitize the brain's reward pathway to these drugs. As a result, when a person takes cocaine, amphetamine or some other drug of abuse, the drug provokes more dopamine release in the reward pathway, making the effect of the drug more pleasurable than it would be otherwise. People who produce large quantities of glucocorticoids in response to stress could be particularly prone to abusing drugs because the glucocorticoids make their reward pathways hypersensitive to any drugs of abuse they might take, Piazza said. In studies with rats, he found that rodents that secrete more corticosterone, the principal glucocorticoid in rats, also learn to stick their nose through a hole in their cage to receive intravenous infusions of amphetamine or cocaine at lower doses than rats that secrete less corticosterone. The fact that the high corticosterone producers make the mental connection between nose pokes and drug infusion at lower drug doses indicates that they find these drugs more rewarding.
    Individuals could be high glucocorticoid producers because of genes or because of chronic stress, Piazza said. This includes stress occurring in infancy or even prenatally. In one study, his group found that placing mother rats during their last week of pregnancy in narrow plastic cylinders three times a day caused their offspring to grow into adults that produced more corticosterone during stress than rats that had not been prenatally stressed. The prenatally stressed rats were also regular drug fiends, sticking their nose through the cage hole to receive amphetamine infusions about 2 1/2 times more than rats that had experienced a more relaxing time in the womb.
    In terms of promoting drug intake, the key component in stress appears to be its ability to be controlled, according to pharmacologist Nicholas Goeders of Louisiana State University. He and colleague Glenn Guerin demonstrated this in a study involving rats that received occasional foot shocks while pressing a bar to receive food pellets. The study involved three groups of rats. The first group received a food pellet if they pressed the bar 10 times but a foot shock if they pressed the bar an average of 15 times, which gave them some control over the foot shocks. The second group also received a food pellet if they pressed the bar 10 times but they had no control over their foot shocks, receiving them at the same instant their compatriots in the first group received them. And the third group pressed the bar for food pellets but received no foot shocks. When the rats were later tested to see how much they would press a bar to receive different doses of cocaine, the rats in the second group, who had no control over their foot shocks, were found to be the most sensitive to the rewarding effects of cocaine. These rats pressed the bar more often for cocaine infusions and did so at lower doses of cocaine.
    Goeders thinks that this study has important implications for people. "If certain individuals are more sensitive to stress, especially if they are in an environment where they feel that they have inadequate control over this stress, then these individuals may be more likely to use cocaine and other drugs of abuse," said Goeders. "This could occur whether the person is an executive in a high-level stress position or a teenager living in a low-income, inner-city environment with no hope of ever advancing."

NOW Rallies to Mother's Defense
Paul Duggan, Washington Post- 9/3/2001

HOUSTON -- As Andrea Pia Yates sits in the mental ward of a jail here, facing a possible death sentence for allegedly drowning her five children, the National Organization for Women has stirred controversy in the case by rallying to Yates's defense. NOW blames her "ordeal" on prosecutors' "callous refusal" to recognize that she was allegedly driven to kill by postpartum psychosis. Calling the district attorney's office "totally inhumane" for seeking the death penalty in Yates's case, NOW's Texas state president, Deborah Bell, said her group and others intend to hold a candlelight vigil outside the jail on the eve of Yates's next court appearance, scheduled for Sept. 12. At the vigil and other events being planned, Bell said, volunteers will seek donations for a fund set up by Yates's attorneys to help pay for mental health experts to examine her and testify on her behalf.
    Prosecutors should concede that Yates deserves help, not prison or a lethal injection, NOW said. "From what we know right now, [Yates's] psychosis is so obvious and her mental illness is so heart-wrenching that clearly she's entitled to treatment and not punishment," declared Terry O'Neill, a NOW vice president in Washington. She said the group's national leadership "completely supports" Bell's efforts, which have been denounced by victims' rights advocates, media pundits and others. In an interview, Bell said she was "appalled" when Harris County District Attorney Chuck Rosenthal announced Aug. 8 that his office would seek a death sentence for Yates, 37.
    Like all lawyers in the case, Rosenthal is under a court order not to discuss it publicly. But Dianne Clements, a Rosenthal supporter and head of Justice for All, Texas's biggest victims' rights organization, reacted angrily to NOW's criticism. "I don't believe they should be using their political power and prestige to help a woman who has acknowledged killing five children," Clements said. She accused NOW of "prejudging" Yates based on liberal ideals before a word of testimony has been heard. "They've decided to seek absolution for Andrea Yates," Clements said. "They've absolutely accepted that she's not responsible for what she did before they've heard any facts in court. . . . None of us can say why she killed those children, whether it was because she was psychotic or she was just plain evil."
    The declaration of support for Yates by the nation's largest women's rights group, and the furious debate it sparked among Clements, O'Neill and others last week, was another sign of the unusually strong passions and opinions generated by the case. Lawyers and mental health experts said the public's differing views on whether Yates should be held criminally culpable for her children's deaths presage a difficult trial in which jurors may have trouble reaching a unanimous verdict. "The instinct to protect our offspring is hard-wired into our makeup," said Diana Dell, a Duke University psychiatrist who specializes in postpartum depression and psychosis. "So to my way of thinking, if a woman reaches a place where she harms her child postpartum, she is by definition psychotic." Clements said, "I think the reason NOW and all these other people are feeling sorry for Andrea Yates is that they just can't conceive of someone in their right mind doing what she did."
    But for a defendant who pleads not guilty by reason of insanity, the law in Texas, as in other states, requires more than a showing of psychiatric illness. The burden will be on Yates to prove to jurors by "a preponderance of the evidence" that her mental condition prevented her from distinguishing right from wrong. For that reason, lawyers observing the case said, her call to police after the killings may prove to be troublesome evidence for the defense. Yates's lawyers contend that in her current mental state, she is unfit to stand trial, but prosecutors disagree. That issue will be addressed in a court proceeding beginning Sept. 12.
    Yates, the wife of an $80,000-a-year computer engineer at NASA's Johnson Space Center in Houston, was a stay-at-home mom with a history of postpartum depression. The condition afflicts about one in five women after they give birth, Dell said. Although most cases involve relatively mild symptoms, Yates suffered severe depression, leading to two suicide attempts, her lawyers have said in court. Postpartum psychosis is far more unusual, occurring in two or three new mothers out of 1,000, Dell said. In those cases, women often become delusional and sometimes hear voices urging them to commit suicide or harm their babies. Among those rare cases, Dell said, a tiny percentage of women end up harming their children. More often, she said, the mothers harm themselves.
    As a result, lawyers said, murder cases in which women raise postpartum depression or psychosis as an insanity defense are unusual in the United States. "Such a defense, however, is not novel," wrote Dallas lawyer Brenda Barton Neuwirt in the Southern Methodist University Law Review. In a 1998 article, she recounted successful postpartum psychosis defenses by a California mother who intentionally ran over her infant with a car and a New York woman who smothered two of her babies and tried to smother a third. She also cited the highly publicized D.C. Superior Court case of LaTrena Pixley, who pleaded guilty to second-degree murder in 1993 in the suffocation of her infant daughter. At her sentencing, after a defense lawyer submitted a psychiatrist's report attributing the crime partly to postpartum depression, the judge stunned the court by ordering Pixley, then 20, to spend weekends in jail for three years. Prosecutors had sought the maximum term of 15 years to life.
    Besides the candlelight vigil, Bell said, members of Texas NOW plan to organize an "educational forum" about postpartum mental illness at which donations will be accepted for Yates's defense fund. She said Texas NOW also is trying to book "a high-profile person" to give a fundraising speech to benefit Yates at the group's state convention in October. "We're hoping for Rosie O'Donnell," Bell said. The popular talk show host, who has publicly recounted her own battles with depression, recently expressed "overwhelming empathy" for Yates in an appearance on ABC's "Good Morning America." O'Donnell's publicist's office said she has not been approached about the convention and would "politely decline" to attend because she will be busy with her show in October.
    In an Aug. 8 statement announcing the decision to seek the death penalty, Rosenthal, a Republican elected in November, said, "The citizens of Harris County ought to be able to consider the full range of punishment in this case." If a trial jury rejects Yates's insanity defense but also rejects capital punishment for her, she would be sentenced to life in prison with parole eligibility in 40 years. "Effectively what they're saying is, let's tag this woman as a monster," O'Neill said. "If we can label her as a monster, then we can just kill her, and the whole problem [of postpartum mental illness] will go away. We won't have to deal with it."
    Other critics saw pragmatism in Rosenthal's decision. Here in the nation's leading execution state, Houston is the capital city of capital punishment. Since the restoration of the death penalty 25 years ago, 62 convicted murderers sentenced in the Harris County courthouse have been put to death, more executions than in 36 of the 38 states with capital punishment laws. "For a new D.A. with his first high-profile case, he can't not ask for the death penalty for a middle-class white woman," said David R. Dow, a University of Houston law professor and opponent of capital punishment. "It would just fuel the criticism that racial and class biases influence which defendants get the death penalty."
    But Clements, who described Rosenthal as "a very thoughtful and deliberate man," said Yates's sympathizers tend to lose sight of an important element of the tragedy. "You know what I think [Rosenthal] saw when he looked at this case?" Clements said. "I think he saw the same thing I saw: five beautiful children, dead."

Japan Suffers High Rate of Suicides, But Restricts Therapeutic Drugs
Jan Chorlton, ABC News- 9/4/2001

T O K Y O— Mostly it's the men who do it, quietly and almost always alone. And being Japanese, they don't allow themselves to talk about it. They'd rather die. Last year, more than 31,957 people killed themselves in Japan, one of the most affluent and advanced societies in the world. They didn't die of plague, or starvation or natural catastrophe; they died because they just couldn't stand to live any longer, and following the stern rules of their culture they didn't ask for help.
    The figures for 2000 reflect a slight decrease of 1,091 from the previous year but still, an average of almost 100 people kill themselves every day. There are higher rates in other countries, but none with such a high level of economic and industrial development. The United States has about the same number of suicides as Japan annually, but Japan has a total population of 126 million compared to the United States' 275 million. Almost three-quarters (71 percent) of the suicides last year were Japanese men.
    This doesn't surprise Dr. Tia Powell, an American psychiatrist trained at Harvard, Yale and Columbia, who now lives and works in Tokyo. She told ABC News that in her experience in Japan, suicide is almost always the result of depression, which may or may not be linked to outside events, like losing a job. Ironically, with new advances in medicine, depression is now relatively treatable. But there is a tricky aspect to getting a depressed person in Japan the help that he or she needs. In Japan, mental illness is still commonly defined not in terms of "chemical imbalance" or "illness" … but in the much more shameful terms of "weakness." And for Japan's men, admitting such a "weakness" is generally unthinkable. Rather than ask for help, they hang themselves, or jump in front of trains … this century's lonely versions of ritual suicide. Japanese women who want to die sometimes choose death by drowning, or they overdose on medication.
    Another factor is Japan's health system and its prevention of the sale of anti-depressants, which for years have been routinely prescribed in the West. Prozac, which is widely used throughout the world, has not been approved for use in Japan. Neither has the popular Zoloft. Paxil was only recently allowed. Japan's health system provides low-cost treatment to all, but local clinics used by most people are staffed by doctors lacking training in, or unwilling to diagnose, depression. Clinical psychologists are not allowed to examine patients independently of general practitioners. "Mental-health problems have not been considered as important as physical problems, so the status given to psychology professionals has accordingly been low," Yoshitaka Otsuka of Japan's Certification Board for Clinical Psychologists recently told Newsweek magazine.
    Powell says the Japanese government could do a lot more to educate the public about depression and these new and available treatments. She believes the old days of doctors telling troubled and miserable Japanese patients that they should just go home and "forget" about their problems are, if not completely over, at least coming to an end. There are several telephone "life lines" now available to help the desperate. And Powell says something new, and considered locally as almost revolutionary, is now gaining ground; Japanese companies offering counseling at work, for employees who want help. This simple step may not sound like much to Americans, who see no stigma in seeking professional help if they feel they need it. But in Japan, where "face" is everything and "losing face" is shameful, getting help is a major undertaking only a handful of Japanese are pursuing.

Study: Men, Women Have Different Issues with Problem Gambling
Diane Scarponi, Associated Press- 9/4/2001

NEW HAVEN, Conn. -- Men and women with gambling problems get hooked on different games and play for different reasons, according to a new Yale University study that may help develop treatments for women. Problem gambling, long considered to affect mostly men, is becoming more common among women, especially as women gain more financial independence and the number of casinos grows, researchers said. ''Trying to understand and distinguish characteristics between males and females with problem gambling may help figure out how to best treat people with gambling problems,'' said Dr. Marc Potenza, a psychiatry professor at Yale who heads the Problem Gambling Clinic.
    The study by Potenza and other researchers found that women were more likely than men to have problems with games that do not involve much strategy or face-to-face interaction, such as slot machines and bingo. Men were more likely than women to have problems with strategic, face-to-face games such as blackjack, poker, racing and sports betting. Also, the study found that female problem gamblers often gamble to escape family troubles or other problems. Men who have gambling problems are more likely to be thrill-seekers who are chasing the rush they get from winning. Women with gambling problems were more likely than men to have started gambling later in life. Once they started, however, they tended to get hooked on gambling more quickly than men, Potenza said.
    Many of these findings are also seen among cocaine addicts and alcoholics, Potenza said, suggesting a biological basis for gambling addiction. ''Like other addictive disorders, pathological gambling should be treated within a medical and psychiatric clinical setting,'' he said. The study of 562 callers to a gambling help line in Connecticut in 1998 and 1999 was published this month in the American Journal of Psychiatry. About 70 percent of callers were from Connecticut, and most of the rest were from neighboring states.
    Women with gambling problems often are dealing with the loss of a spouse, abuse and other problems, said Marvin Steinberg, executive director of the Connecticut Council on Problem Gambling. ''Women may need to get help for other circumstances, first, before getting help with gambling,'' said Steinberg, whose group collaborated with Yale on the study. Women also are more attracted to gambling as they become financially independent, and because gambling is more socially acceptable than in years past, he said. Some women in charge of family or small business checkbooks and even former tax collectors in Ledyard and Sprague have embezzled money to feed gambling habits.
    Other findings mirrored trends in the general adult population. Men who had gambling problems were more likely to abuse drugs or alcohol, while the women were more likely to be receiving mental health treatment. A large number of problem gamblers of both sexes also reported being in debt and feeling depressed or anxious over their gambling problems. More study needs to be done on gender differences and gambling problems, said Christine Reilly, the executive director of the Institute for Research on Pathological Gambling and Related Disorders at Harvard Medical School. The Harvard center was not involved in the Yale study.
    Studies need to be done not just on women, but on problem gambling among the elderly and racial minorities, Reilly said. ''The important thing to figure out is, do we need to approach them differently for treatment? ... Otherwise it's not relevant,'' Reilly said. Researchers stressed that problem gambling is a rare disorder among American adults. Less than 2 percent of the population is thought to be so involved in gambling that it seriously interferes with the rest of their lives.

Vermont Court Programs Help Drug Defendants Get Treatment
Associated Press, 9/4/2001

BURLINGTON, Vt. -- The Vermont court system is using drug case managers to help cope with the growing number of addicts in the criminal justice system. Rather than waiting for a court conviction, the case managers will offer treatment, often diverting the defendants away from jail. ''This is the belly of the beast,'' said Jon Coffin, one of two part-time case managers working at Vermont District Court in Burlington. He's become a fixture in court. He's convinced that many of the defendants he sees are addicts. They steal for drug money. They fight because they're drunk.
    Judges send heroin addicts and some repeat drunken drivers to the drug case managers as soon as the defendants are charged. The case managers recommend treatment that can range from outpatient counseling to intensive residential rehabilitation. Defendants who agree to treatment stay out of jail. Case managers keep tabs on defendants to make sure they are following through, and alert the court if they are not. The lapses can mean jail time.
    Before the system was created, defendants were not offered help with treatment until after sentencing. ''We have these heroin addicts that were absolutely unreliable to come back to court. Instead of just putting those people in jail, we're giving them a chance to get help before their cases progress,'' said Judge Brian Burgess, who helped organize the program. It's modeled after a drug case manager program begun in Chittenden Family Court.
    Coffin and Dana Poverman, both of the Howard Center for Human Services, are splitting the part-time position. They have seen about 25 people since starting in June. The program is paid for and coordinated by the state Office of Alcohol and Drug Abuse Prevention. The program is similar to the hundreds of formal drug courts across the country. These courts deal exclusively with drug offenders and combine extensive court supervision and treatment.  The Legislature is considering funding a pilot drug court in Vermont. It's too early to tell how effective the program has been, the case workers, judges and lawyers said, but they're hopeful.

Prison vs. Drug Program Weighed in Colorado
Julia C. Martinez, Denver Post- 9/5/2001

State lawmakers are considering legislation that would have Colorado join a national trend to keep some nonviolent drug offenders out of prison, freeing up millions of tax dollars for drug abuse treatment programs instead. The controversial proposal, unveiled Tuesday, would pertain only to offenders charged with possessing small amounts of drugs, said Sen. Ken Gordon, the Denver Democrat putting forth the plan. "I'm not trying to be soft on crime. I'm trying to be hard on crime," Gordon said. "I want to reduce the amount of crime in our society. People who have substance abuse problems don't just commit (drug crimes). They also commit forgeries, robberies, burglaries. They do things to get money for their drug abuse."
    If approved, the move would free up space in Colorado's crowded prison system for violent offenders and save millions, supporters say. Democrats say it may be tough to sell Republicans on the idea, but criminal prosecutors said they might support it as long as treatment programs are mandatory and have a proven track record.
    A meeting to hammer out the details with drug experts is planned later this month. "I think DAs want to be fiscally responsible and if there's a creative way to treat drug offenders and free up funds to more effectively prosecute violent offenders, that merits consideration," said Peter Weir, president of the Colorado District Attorneys Council. "But we don't want to be diverting money under the rubric of treatment ... without a proven treatment program."  Even Republican Rep. Lynn Hefley, who chairs the Criminal Sentencing Committee, which will make the decision about whether to draft legislation, at first rejected the idea during a subcommittee meeting, then reversed course.  "It depends on what the district attorneys decide," Hefley said. "I think there are some valid points to treatment as long as it's on the front end, before someone goes to prison. But it will be difficult to convince people of this."
    Seventy-five percent of the state's 16,764 prison inmates have substance abuse problems, according to the Department of Corrections.  Half are getting treatment at a cost of more than $4 million a year - about $318 per inmate, which the state wants to increase. The others are being turned out to the streets without treatment. Gordon's proposal would funnel the savings for all drug offenders - not just those diverted from prison - to statewide treatment programs. Of the 1,714 drug offenders serving time for drug possession, 52 are first-time offenders. Diverting just those from prison would save approximately $1.3 million a year for treatment, said Sen. Doug Linkhart, D-Denver, who favors the proposed legislation. Diverting all 1,714 would save the state more than $43 million a year, he said. It costs $26,000 a year to house one prisoner in a state prison. It is estimated it would cost far less to treat an offender, depending on the nature of the treatment, Gordon said.
    While Colorado has little data on the effectiveness of drug treatment, one short-term study showed that the rate of recidivism dropped from 38 percent to 22 percent for prisoners who underwent treatment. Nationally, many states are promoting treatment over prison and working to reform old drug laws. The Western Governors Conference last year issued a white paper calling on member states, including Colorado, to find alternatives to incarceration and increase treatment for drug abusers. The paper noted that while drug-related spending by states was increasing sharply, drug use had remained unchanged since 1992. And though promising drug treatment programs were emerging, they were available to only a small fraction of those who needed it, the paper said.
    New York's Gov. George Pataki recently proposed a plan that would give more defendants the opportunity to undergo drug treatment rather than serve long prison terms. California and Arizona have passed laws requiring nonviolent drug offenders to enter rehabilitation rather than prison. While local prosecutors and even liberal legislators say California's law is too radical for Colorado, they are in the early stages of reforming the state's sentencing laws, starting with Tuesday's proposal. "It's amazing how many people we're keeping in prison for nonviolent drug offenses," said Linkhart. "We need to find money for treatment and we're trying to be reasonable and common-sensical. But I would not be in favor of California's law here."

Drugs & Alcohol Rampant in Secondary School
ABC News, 9/5/2001

As middle and high school students return to classes this fall, drugs and alcohol will be almost as much a part of the educational experience as reading, writing and arithmetic, researchers say. More than 9.5 million high school students — about 60 percent — and nearly 5 million middle school kids — 30 percent — attend school where illegal drugs are used and sold, according to a report released by the National Center on Addiction and Substance Abuse at Columbia University.
    During this school year, more than 13 million students between the ages of 12 and 17 will try tobacco, alcohol and illicit drugs for the first time, the report said. Meanwhile, substance abuse and addiction will add at least $41 billion — 10 percent — to the costs of elementary and secondary education this year, as schools are forced to pay the costs of class disruption and violence, tutoring, truancy and teacher turnover.
    Joseph Califano, president of the National Center on Addiction, told ABCNEWS' Good Morning America the six-year study found that parents need to get much more involved in getting drugs out of the schools. "If there's asbestos in a school, parents raise hell about it and they won't send their kids to school until it's out of there," Califano said. "Yet they send their kids to schools riddled with drugs every day. I mean when parents start to feel as strongly about drugs in school as they do about asbestos in school, we'll take a major step."
    Here are some of the report's findings:
By the time students reach 12th grade and receive their high school diplomas:
* 70 percent will have smoked cigarettes
* 81 percent will have drunk alcohol
* Almost 50 percent will have used marijuana
* 24 percent will have used other illicit drugs.
    In the 110-page report, "Malignant Neglect: Substance Abuse and America's Schools," the researchers have some tough words to describe what's happening in American schools. Over the past six years, CASA surveyed 12- to 17-year-olds and their teachers, principals and parents about their attitudes toward tobacco, alcohol and illegal drugs. No one, it seemed, was taking responsibility for American kids' substance abuse problems. "The finger-pointing and denial constitute a conspiracy of silence that threatens millions of our nation's children and savages many of them for life," the report says. "Parents deny that their child or their child's friends could be using drugs. School administrators have every incentive to downplay the extent of smoking, drinking and drug use on school grounds. Teachers claim it is their job to teach math, reading or history, not to spot or police substance use by their pupils."
    And other students, especially juniors and seniors in high school, do not report classmates who are using or stealing drugs, the report says. Yet, according to those statistics, drugs aren't hard to find.  More than half of high school students between the ages of 15 and 17 and almost a quarter of middle school students aged 12 to 14 say they know someone at their school who can sell them drugs. The effects are disastrous for education, the report found. The more a student uses alcohol, marijuana and other illicit drugs, the lower his grade point average is likely to be. High school students who use alcohol or other drugs frequently are up to five times more likely than other students to drop out of school.
    Although no one takes the blame, parents, teachers and communities should share it, the report said. Parents fail to be actively engaged in their child's life, while teachers and principals fail to keep drugs off the premises. Another key problem is communities that lack out-of-school activities for children and do not enforce laws that prohibit the sale of cigarettes and alcohol to minors. To make matters worse, many communities do not provide treatment for substance-abusing teens, the report says. "The collective response is reminiscent of the three monkeys guarding the shogun's stable: see no evil, hear no evil, speak no evil," the report said. "For the most part, we close our eyes or look the other way; we choose not to speak up and demand that our schools be substance-free."

Coercive Interviews in Sex Abuse Case Didn't Violate Man's Civil Rights, Court Rules
David Kravets, Associated Press- 9/5/2001

SAN FRANCISCO -- Social workers did not violate a man's civil rights during a child sex abuse investigation, even though their interrogations may have coerced false statements from the children, an appeals court ruled Wednesday.  The 9th U.S. Circuit Court of Appeals ruled 8-3 that Robert Devereaux could not sue the city of Wenatchee, Wash., over the investigation in 1994-95 of alleged child sex rings. His lawsuit was dismissed earlier by a three-judge panel of the appeals court. Devereaux was among 43 adults charged with multiple counts of sex abuse in the investigation. All the charges against him were dropped after the alleged victims recanted, and most of the other cases have ended in dismissals, acquittals or dropped charges.
    Techniques investigators used included interviewing young children for six hours or more until they said they were sexually abused by Devereaux or by others. ''Interviewers of child witnesses of suspected sexual abuse must be given some latitude in determining when to credit witnesses' denials and when to discount them,'' Judge A. Wallace Tashima wrote in the opinion. Dissenting Judge Andrew Kleinfeld wrote that Devereaux's case should be reinstated because investigators knew or should have known he was innocent and that their techniques would have yielded false information.

Anne Heche Talks About Her Childhood Abuse and Mental Illness
Rebecca Raphael, ABC News- 9/5/2001

Anne Heche says the sexual molestation she suffered at the hands of her father caused her to escape into a "fourth dimension" fantasy world in which she believed she was from another planet. "I'm not crazy," Heche tells 20/20 on Wednesday in an exclusive interview with Barbara Walters. "But it's a crazy life. I was raised in a crazy family and it took 31 years to get the crazy out of me." In the wide-ranging interview, Heche, 32, talks about her childhood, her career, her relationship with Ellen DeGeneres — she says her first night with the comedian was "the best sex I'd ever had" — and new love Coleman "Coley" Laffoon, a 27-year-old cameraman whom she married on Saturday.
    Heche told Walters she was not pregnant at the time of the interview. She has since called Walters to say she is three months' pregnant, and Walters was the first to disclose this news on 20/20. Heche, promoting her new book, Call Me Crazy (Simon & Schuster), says she's had a lifelong battle with mental illness. "I had a fantasy world that I escaped to. I called my other personality Celestia," she explains. "I believed I was from that world. I believed I was from another planet. I think I was insane."
    Heche traces her problems back to her father. Donald Heche, a choir director in a Baptist church, began sexually abusing his daughter when she was still a toddler, she says. "He raped me … he fondled me, he put me on all fours, and had sex with me," says Heche, qualifying that the abuse is only "in my memory." "I think it's always hard for children to talk about abuse because it is only memory. I didn't carry around a tape recorder … I didn't chisel anything in stone … Anybody can look and say, 'Well how do you know for sure?' And that's one of the most painful things about it. You don't." She says she contracted herpes from him. "I had a rash, I had sores, I had welts on my nose and on my lips," she says. Heche did not learn that her father also had homosexual encounters until 1983, when he was dying of AIDS. When she learned he had the disease, she feared for her own life, she says.  To get away, Heche says, "I drank. I smoked. I did drugs. I had sex with people. I did anything I could to get the shame out of my life."
    Heche also began acting, playing twins on the soap opera Another World from 1988 to 1992. By the time she was 25, Heche says her personality had begun to fragment, shattering into moments of madness. Celestia, her other personality whom she believed was a reincarnation of God, spoke a different language and had special powers.   "You name it, I could do it. I could see into the future. I could heal people," Heche says. "I don't know where it came from. I was, in my mind, learning it from God."
    Having been abused as a child affected her adult relationships, she says. For two years, she dated actor/comedian Steve Martin, 24 years her senior. Heche says she thought she had found love with him. "I wanted the love of an older man. I wanted comfort. I wanted humor. I wanted all of the things that he offered," she says. "Why did we break up? There's wasn't anything wrong with Steve. It was just that it was not what I wanted to commit my life to."
    Then, in 1997 on Oscar night, she says, "I saw the most ravishing woman I had ever seen in my life standing across the room. Her name was Ellen DeGeneres. She was radiating. I think at certain times in people's lives you just radiate an energy and a glow of fabulousness. And that was her. I had never seen anybody so lit up." They slept together that night. "Up until that point, that was the best sex I'd ever had," says Heche, who says she had never before had sex with a woman. "I felt cared for … I felt free to express a part of me that I had not been able to express with a man. I felt sensuous and sexual in a way I hadn't before."
    DeGeneres' sitcom character was about to announce her homosexuality, and soon Heche and DeGeneres would become America's most prominent lesbian couple. But behind the united front they presented to the world, there were difficulties. "Ellen knew everything," Heche says, including her identity as Celestia, and her belief that she could speak to the dead. Their three-year relationship ended in August 2000. The day after the breakup, Heche was found wandering door-to-door in Fresno, Calif. She ended up in a stranger's back yard, deeply confused. "I was told to go to a place where I would meet a spaceship. I was told in order to get on the spaceship that I would have to take a hit of Ecstasy," says Heche, who adds that she is not a consistent drug user. "Fresno was the culmination of a journey and a world that I thought I needed to escape to in order to find love." That day, Heche says, she regained her sanity and began to put the fragmented pieces of her life in place. "I'm here … I could not be more elated with my life," says Heche.
    Heche met her new husband while working on a documentary about DeGeneres. She denies that the new relationship hastened the demise of the old one. "How do you put into a sentence why you break up with somebody?" asks Heche. "We had gotten to the point where we were not happy together anymore. We had become isolated from the world, together." Heche says she does not label herself straight, gay or bisexual — and that Laffoon understands her. "He's an extraordinary guy," says Heche. "He's one of the few people I've ever met who actually embraces the same notion about sexuality that I do … which is that you love who you love. You fall in love with a person, not a sex." She adds: "I would never limit myself to saying I would be with a man or a woman."
    Heche sees herself as a survivor. She's starred in such movies as the remake of Psycho and Six Days, Seven Nights, with Harrison Ford. She now says she has a TV comedy in the works. "I think everything I've done in all my insanity was to try to get my parents to love me," she says. "My father loved movie stars. I decided I needed to become famous to get his love. My mother loved Jesus. That was her thing. So I wanted to become Jesus Christ."
    As an adult, Heche says she confronted her mother about her father's sexual abuse. "She hung up the phone on me," Heche recalls. "To have gone through so much work to heal myself and have my mother not acknowledge in any way that she was sorry for what had happened to me broke my heart."  20/20 tried to contact Heche's family for comment. Susan Bergman, the actress's older sister, said the family had not yet read Heche's book or seen the interview. Bergman said they plan to issue a statement that will be posted on the Internet after they watch the interview Wednesday night. Heche says she wrote Call Me Crazy to say goodbye "once and for all, to my story of shame and embrace my life choice of love." "The fact that there are people hearing my story is the icing on the most beautiful cake in the world, that I imagine says, 'Happy freedom, Anne. You have made it to the other side.'"

California Set for Controversial Release of Repeat Rapist
Oliver Libaw, ABC News- 9/6/2001

Convicted eight-time rapist Patrick Henry Ghilotti will soon have his freedom back — in a very unusual and controversial way. Ghilotti is set to become the first person released under California's 1996 violent sexual predator law, which lets authorities keep individuals locked up even after they have finished serving their prison sentences.   The controversial legislation, which the Supreme Court has reviewed and found constitutional, allows authorities to classify criminals as "sexually violent predators" if they have committed at least two sex crimes and are deemed to pose an ongoing, serious risk to society. Once labeled an SVP, individuals can be held in a psychiatric hospital after they have completed their jail time. Though their progress is reviewed regularly, they can be kept indefinitely if officials continue to label them a serious threat. California has one female and 325 male SVPs, none of whom has been approved for release.
    As of last year, 35 SVPs had been released nationwide in the 16 states with sexually violent predator laws, according to the Center for Sex Offender Management, a nonprofit research center funded by the Justice Department.  Too few have been released to draw conclusions about the programs' effectiveness, however, says Scott Matson a researcher at the center. Matson also stresses the fact that while the circumstances of Ghilotti's release may be groundbreaking, he is by no means the first repeat sexual offender to be freed, or to be carefully monitored once released.
    Some experts, like Fred Cohen, a professor at the State University of New York at Albany's School of Criminal Justice, believe that the combination of testosterone-lowering drugs, therapy and careful monitoring is generally effective. "Treatment does seem to be working," he says. In Ghilotti's case, he began receiving counseling and other treatment at Atascadero State Hospital in central California in 1998 after serving 12 years in prison for a 1985 rape. He committed that attack less than a year after serving a sentence for raping three women in 1977.
    Once the arrangements of his supervision and monitoring have been finalized and then approved by the court, Ghilotti will be a free man. But he will face unprecedented restrictions on that freedom. If he violates any of the many conditions, he could be returned to Atascadero. Ghilotti will be the first person required by the state to wear a satellite-linked tracking device attached to his body. The GPS system will track his movements constantly and have an unlimited range, officials say. Similar units have been used to monitor parolees in Florida and other states. Ghilotti will have his testosterone chemically lowered with the drug Lupron, subject himself to drug and alcohol testing, as well as polygraphs and random searches of his home. He will not be allowed to have contact with children, and he will have to obtain written permission to purchase a camera or use the Internet. He will have a curfew and will not be allowed to drink alcohol or have pornography, and will be required to attend frequent counseling sessions. He and his wife will not be allowed to see each other, at least at first. Authorities fear that any disagreement with her might put more stress on Ghilotti as he readjusts to society.   Several key elements of Ghilotti's release have yet to be determined, including where he will live, and officials hope to find suitable work for him, but admit it will be difficult to find a willing employer. These extraordinary measures appear to have satisfied no one involved with the case, and they're expensive. Estimates put the cost of monitoring Ghilotti at well over $100,000 a year.

The state agency overseeing his release and monitoring would prefer to keep him locked up. "We believe he still needs the secure treatment of the state hospital," says Nora Romero, a spokeswoman for the Department of Mental Health, which will oversee Ghilotti through its Forensic Conditional Release Program, called CONREP. Marin County Deputy District Attorney Al Charmatz said his office, which prosecuted Ghilotti, also opposed his release.  "We felt Mr. Ghilotti was dangerous and likely to reoffend," he explained. "He was only out for seven months [in 1985] before he reoffended. Because of his history, we have serious concerns." Several doctors who have treated Ghilotti at Atascadero have spoken out publicly against letting him out, but the hospital officially recommended his release and said he responded well to treatment.
    Ghilotti himself is angry about the restrictions he faces in the outside world. "The conditions are totally unreasonable and unacceptable," Ghilotti told the San Francisco Chronicle earlier this month. "I'm not going to sign conditions that I cannot talk to or see my wife. I would rather just wait out my time." As the conditions stand, Ghilotti will only be able to talk to his wife on the phone initially, but that restriction will be reviewed as time passes.
    Ghilotti also insisted therapy had "changed his life" and he would not rape again. Though Ghilotti is the first person classified as a sexually violent predator in California to be released, CONREP reports considerable success with previous participants. CONREP participants — generally people found by courts to be not guilty by reason of insanity, mentally disordered offenders, and people judged unfit to stand trial — have a 6 percent recidivism rate, compared with 27 percent for people released from state hospitals without monitoring by CONREP.
    The biggest hurdle remaining for those overseeing Ghilotti's release is finding suitable housing, officials say. If officials cannot finalize his supervision conditions by December, it is possible Ghilotti will simply be released with no monitoring, Charmatz said. His civil commitment expires before the end of the year, and unless a judge has approved a supervision plan or officials petition a judge to extend his commitment, he may be free to do as he pleases. "Either they are going to find a place for him, or judge will release him, or he'll just walk out," says Charmatz.

Health-Care Plans Fined $1.4 Million By Maryland
Bill Brubaker, Washington Post- 9/6/2001

Maryland insurance regulators yesterday announced $1.4 million in fines against five health-care plans, including a state-record $850,000 against Aetna U.S. Healthcare, a repeat offender. The violations included failing to process provider claims within the required 30 days, failing to pay interest on late claims and failing to monitor subcontractors. The five plans agreed not to contest the penalties. The other insurers penalized were United Health Care of the Mid-Atlantic Inc. ($300,000), Magellan Behavioral Health Inc. ($150,000), Dental Benefit Providers of Maryland Inc. ($75,000) and Cigna Dental Health of Maryland ($25,000). Most states have prompt-payment laws, and Maryland -- with Texas, Massachusetts and New York -- is one of the most vigilant in enforcing them, executives in the health-care industry say. Last month 17 health insurers in Texas agreed to pay $9.25 million in fines and restitution.
    The fines in Maryland come as Aetna struggles to repair its image nationally. "We have acknowledged that we have service issues that need to be addressed," Aetna spokesman Walt Cherniak said. "We've had a nationwide effort for more than a year to resolve these issues. We feel we're making significant progress." Maryland Insurance Commissioner Steven B. Larsen called Aetna the most "egregious" offender. Aetna's Maryland-based health plan paid a $400,000 fine last year for making late payments to providers, such as doctors and hospitals. "We've gone through this twice with them and ratcheted up the penalties significantly," Larsen said in an interview. "If this doesn't get their attention, then clearly we'll have to go to the next level." He said another violation by Aetna could result in a harsher penalty, such as forbidding the insurer to sign up new members for several months. "I would not under these circumstances go so far as to say they have to leave the state," Larsen said. "That would be Draconian. But nonetheless you do reach a point where it seems that simply fining them does not have the desired effect." Cherniak said: "We are committed to complying with Maryland's insurance laws and regulations. We understand the importance of accurate and efficient claims processing and we're committed to continuing to take whatever steps we need to improve areas that are in need of improvement."
    Aetna was fined $600,000 for violations involving a subcontractor, the American Physical Therapy Network (APTNet) and $250,000 for failing to comply with an agreement Aetna made with the state to pay podiatrists what they are owed. Aetna had been underpaying some podiatrists, the state alleged. By itself, the $600,000 fine is the largest ever levied in Maryland against a health insurer, Larsen said. Aetna employs APTNet to service and manage physical-therapy benefits for Aetna members. In a review of 498 claims, state investigators found that APTNet failed to process 447 within 30 days and did not pay interest on late claims. The average claim was 55 days old and the oldest almost two years, Larsen said. Aetna also did not publish a list of physical therapists hired by APTNet. And when Aetna increased its reimbursement rates to APTNet, the subcontractor did not pass on that increase to providers, the state found. Cherniak said Aetna decided after an internal review to terminate its contract with APTNet, effective Oct. 30. He said the decision is unrelated to Maryland's action.
    Among the other violators, United did not pay many claims within the 30-day limit, the commission reported. United also was ordered to pay $202,000 in back interest. Magellan was fined after reporting to Larsen's office that it had not complied with an agreement it made with the state last year to process unpaid claims. Yesterday, Larsen praised Magellan for taking substantial corrective action. Dental Benefit Providers failed to pay interest on late claims, and Cigna failed to comply with several state insurance laws.

Father of Alleged Santana Shooter Says Bullied Son Snapped
ABC News, 9/6/2001

When Jeff Williams heard there was a shooting at his son's high school in Santee, Calif., he rushed to the scene to make sure his boy was safe. The last thing he expected to find was that his son, 15-year-old Andy, was the suspected shooter. Andy had allegedly taken his father's 22-caliber rifle and opened fire on his classmates, killing two and wounding 13 others. The teenager has been charged as an adult and could face life in prison if convicted. His lawyers are seeking to have him charged as a juvenile. "I think I would have been less hurt if he were one of the ones that got shot than to find out that he was the one that did this," Williams told ABCNEWS' Diane Sawyer in an exclusive interview, his first since the March 5 shooting.
    Six months after the San Diego-area shooting, the criminal case has been delayed while defense attorneys attack the constitutionality of a voter-approved law mandating adult trials for some youths charged with violent crimes. Williams said he has asked his son why he did it. "He doesn't know why," said Williams. "He didn't give an answer. He just looked down and shook his head." Friends describe Andy as the scrawny kid who made people laugh. He was also an honor roll student who was once voted by his football teammates as having the most heart. "Something happened to make him snap for those 10 minutes," Williams said. "I can tell you that's not my boy at 9:30 a.m. on March 5. That was not my Andy."
    Williams said he was a caring and attentive father who thought his son to be a warm and sensitive boy. But he would learn too late about Andy's secret world of trouble and torment. Andy grew up in rural Brunswick, Md. His parents divorced when he was a young child, and he later moved to Santee when his father got a new job. After his first day at Santana High School, where his class had 1,900 students, Andy e-mailed a friend saying his slight build and different clothes made him a target. "They've started already. They're calling me gay, country boy," he wrote.
    "He'd be walking down the hallway and people would just come up and punch him in the back of the head," Kathleen Seek, Andy's best friend back in Maryland, said he told her. "He kept saying, 'I can't take it anymore, I can't take being treated like this.'" Seek said Andy did not tell his father about the bullying. "He always tried to be happy … He always tried to be upbeat, act like nothing was wrong, when he was just like falling apart."
    Even Andy's own friends at Santana chased him, knocked him down, shoved him and humiliated him, classmates said. And 20 sources confirm with ABCNEWS that neighborhood bullies mistreated him week after week. But San Diego County prosecutors say they don't believe he was bullied. They say that he was using drugs like some of the kids he was starting to hang out with at a skateboarding park, and that he was the class clown. "Maybe their definition of being bullied is different, I guess," said Williams. "When you're getting cigarette burns on your neck, that's not bullying to them."
    On the morning of March 5, Andy took one of the guns that his father kept in a locked cabinet, and wrote out the lyrics from a song by Linkin Park, an alternative rock band: "I tried so hard and got so far, but in the end it doesn't even matter. I had to fall to lose it all." He signed the note, "Sorry Dad, I love you," and pinned it to the speakers in his room. The shots he fired killed 15-year-old Randy Weber and 14-year-old Brian Zuckor. Williams said he never felt the need to hide any guns from Andy "because he always asked permission."
    Relatives of the victims say that Andy's alleged actions were deliberate and he should be punished as an adult. If Andy is tried and convicted as an adult, he could get be sentenced to 400 years in prison. As a juvenile, he could be out by the time he is 25. Williams said he feels sorry for the victims and their families, but does not believe his son should be imprisoned for the rest of his life. "There is a difference between justice and vengeance … I would like to see justice in this case," he said. "He's gotten really tall the last three months," Williams said. "He wants to be a helicopter pilot. He wants to be a probation officer. He'd like to be a cop. You give him that chance and he might be able to make up for what he's done."